The nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse monitors for the most serious complication associated with this type of traction by checking for which?
An increase in the blood pressure
An elevated temperature
A decrease in urine output
A lack of appetite
The Correct Answer is B
B. The most serious complication associated with skeletal traction is osteomyelitis, an infection that involves the bone. This condition can occur when organisms gain access to the bone either systemically or through the openings created by the metal pins or wires used in the traction.
A. Increased blood pressure can occur for various reasons but it is not the most serious complication associated with skeletal traction.
C. A decrease in urine output could indicate systemic infection which is a late feature of osteomyelitis and therefore, not the earliest to monitor.
D. Changes in appetite can occur in response to pain or stress but they are not typically the most serious complication associated with skeletal traction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
A. Observation for increasing intracranial pressure is a critical intervention in the care of a child with infectious meningitis. Meningitis can lead to inflammation of the meninges, which may result in increased pressure within the skull.
B. Isolation precautions may be necessary depending on the causative organism and mode of transmission of the infectious meningitis. Bacterial meningitis, for example, may require droplet precautions to prevent the spread of infection to others.
D. Lumbar puncture (also known as a spinal tap) is a diagnostic procedure often performed to collect cerebrospinal fluid (CSF) for analysis in cases of suspected meningitis. It is an essential intervention in the diagnostic workup of infectious meningitis as it helps identify the causative organism and guide appropriate treatment.
C. Seizure precautions are important for children with infectious meningitis, as meningitis can increase the risk of seizures due to inflammation and irritation of the brain.
C. Bright lights can exacerbate symptoms such as headache and photophobia (sensitivity to light) in patients with meningitis, especially during the acute phase of illness. Therefore, it is not advisable to turn lights on to brighten the room for a child with infectious meningitis.
Correct Answer is D
Explanation
D. Place resuscitation equipment at the child's bedside. This is because epiglottitis can lead to a life- threatening emergency requiring immediate intervention, and having resuscitation equipment readily available is essential for rapid response.
A. Establishing intravenous access may be necessary for administering fluids and medications but it is not the nurse's priority action when caring for a child with suspected epiglottitis.
B. Droplet precautions help reduce the risk of transmission of respiratory pathogens to others. However, the priority is to address the child's respiratory distress and potential airway compromise.
C. Providing blow-by humidified oxygen can be beneficial in managing the child's respiratory status. However, securing the airway takes precedence over other interventions, as indicated by the guidelines for managing epiglottitis.
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