A nurse is assessing a client who has skeletal traction for a femoral fracture. The nurse notes that the weights are resting on the floor. Which of the following actions should the nurse take?

Remove one of the weights.

Pull the client up in bed.

Increase the elevation of the affected extremity.

Tie knots in the ropes near the pulleys to shorten them.

Answer and Explanation

The Correct Answer is A

A) Remove one of the weights: This is the appropriate action. If the weights are resting on the floor, it indicates that the traction is ineffective, and removing one weight may be necessary to restore proper traction. However, the nurse should first verify the prescribed amount of weight with the healthcare provider before making adjustments.

B) Pull the client up in bed: While it may be necessary to reposition the client, pulling them up in bed does not address the issue of the weights resting on the floor and could potentially cause discomfort or injury.

C) Increase the elevation of the affected extremity: While elevating the extremity may be beneficial for swelling or comfort, it does not resolve the issue of ineffective traction caused by the weights on the floor.

D) Tie knots in the ropes near the pulleys to shorten them: This action is inappropriate. Tying knots in the ropes could interfere with the proper function of the traction system and is not a safe or effective solution to the problem.

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Correct Answer is D

Explanation

A) Acute loss of alveolar elasticity: While loss of alveolar elasticity can impact overall lung function, it is more associated with chronic conditions like emphysema rather than acute asthma attacks. In asthma, the primary issue is related to airway obstruction and inflammation rather than alveolar elasticity.

B) Decreased responsiveness of airways to allergens: During an acute asthma attack, the airways typically exhibit increased sensitivity and responsiveness to allergens and irritants, not decreased responsiveness. This heightened response contributes to the bronchoconstriction and inflammation seen in asthma.

C) Suppressed bronchiolar inflammatory response: In an asthma attack, there is actually an exaggerated inflammatory response in the bronchioles. This inflammation leads to swelling, mucus production, and bronchoconstriction, which contribute to the difficulty in breathing.

D) Inability to exhale retained carbon dioxide: This is a significant factor during an acute asthma attack. The bronchoconstriction and airway obstruction make it difficult for the client to exhale fully, leading to the retention of carbon dioxide. This can cause respiratory acidosis and worsen the client's condition, highlighting the urgency of treatment.

A. Chronic infections of the middle ear B. Use of a loop diuretic C. Perforation of the eardrum D. Born with a high birth weight E. Frequent exposure to low-volume noise

Correct Answer is ["A","B","C"]

Explanation

A) Chronic infections of the middle ear: Chronic middle ear infections can lead to damage of the structures within the ear, resulting in conductive hearing loss. This is a significant risk factor for hearing loss, particularly in children and young adults.

B) Use of a loop diuretic: Loop diuretics, such as furosemide, can be ototoxic, especially at high doses or when used in conjunction with other ototoxic medications. This can result in hearing loss, making this a relevant risk factor to discuss.

C) Perforation of the eardrum: A perforated eardrum can lead to conductive hearing loss and increase the risk of infections, which may further compromise hearing. It is essential to include this in the discussion of risk factors for hearing loss.

D) Born with a high birth weight: High birth weight alone is not a recognized risk factor for hearing loss. While certain conditions associated with high birth weight may impact hearing, it is not a direct factor.

E) Frequent exposure to low-volume noise: Low-volume noise exposure is typically not a risk factor for hearing loss. It is the exposure to loud noise over time that poses a greater risk. Therefore, this factor should not be included in the teaching.

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A nurse is assessing a client who has skeletal traction for a femoral fracture. The nurse notes that the weights are resting on the floor. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is ["A","B","C"]

Explanation

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