The nurse is evaluating the patient's pain level after applying skin traction. Which finding indicates the need for further intervention?
The patient rates pain as a 3 on a scale of 0 to 10.
The patient's pain is well-controlled with prescribed analgesics.
The patient reports occasional sharp pain during movement.
The patient states that the pain is worse with the traction off.
The Correct Answer is D
The patient stating that the pain is worse with the traction off requires further intervention. Skin traction should relieve pain and discomfort; an increase in pain when the traction is off may indicate inadequate traction or an underlying issue.
a. The patient rating pain as a 3 on a scale of 0 to 10 suggests mild pain and may be expected with some level of discomfort related to the fracture and traction.
b. The patient's pain being well-controlled with prescribed analgesics is a positive finding and indicates that the current pain management plan is effective.
c. The patient reporting occasional sharp pain during movement may be expected with skin traction, but the nurse should assess for any signs of worsening or intolerable pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Visible signs of skin breakdown under the traction tape require immediate intervention. It indicates that the skin is compromised, and the patient is at risk of developing pressure ulcers or skin breakdown. Prompt action is necessary to prevent further damage and ensure patient safety.
a. Slight redness at the site of the traction tape may be expected, and the nurse should monitor for any signs of worsening or discomfort. It does not require immediate intervention unless it progresses.
b. Mild discomfort during movement of the affected limb is common with skin traction, and the nurse should assess for any signs of worsening or intolerable pain.
c. Pain rated as 6 out of 10 on the pain scale should be addressed, but it does not require immediate intervention unless it is associated with other concerning signs or symptoms
Correct Answer is C
Explanation
Skin traction is a type of traction that involves applying force to the skin to reduce swelling and edema around the fractured bone. It helps to alleviate pain and promote proper alignment of the bone fragments.
a. Skin traction does not immobilize the fractured bone; rather, it provides continuous but controlled tension to reduce swelling and discomfort.
b. Skin traction is not applied directly to the fractured bone. Instead, it involves applying adhesive strips or bandages to the skin, followed by connecting weights to provide the desired tension.
d. While skin traction may promote some mobility, its primary purpose is to reduce swelling and discomfort rather than facilitating early ambulation.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.