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?

Increase the elevation of the affected extremity.

Remove one of the weights.

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

Pull the client up in bed.

Answer and Explanation

The Correct Answer is A

A. Increasing the elevation of the affected extremity helps to relieve pressure and maintain proper alignment of the fracture. This action ensures that the traction remains effective and that the weights are properly suspended.

B. Removing weights can compromise the effectiveness of the traction and should only be done under specific orders from a healthcare provider.

C. Tying knots in the ropes can alter the alignment and effectiveness of the traction. Proper adjustment should be made by healthcare professionals according to protocol.

D. Pulling the client up in bed does not address the issue of the weights resting on the floor and may cause further complications.

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Correct Answer is B

Explanation

A. Intrinsic factor is related to vitamin B12 absorption and is not directly affected by gout.

B. Elevated uric acid levels are characteristic of acute gout, as gout is caused by the accumulation of uric acid crystals in the joints.

C. Chloride levels are not specifically related to gout and are not typically elevated in this condition.

D. Creatinine kinase is an enzyme associated with muscle damage, not specifically related to gout.

A. Blood glucose level B. Bowel sounds C. Blood pressure D. Pain level E. Electrocardiogram findings F. Lung sounds G. Troponin T level

Correct Answer is ["C","D","E","G"]

Explanation

A. The client’s blood glucose in this scenario is within the normal range.
B. The bowel sounds in this scenario are present in all the 4 quadrants which is normal.
C. The client's blood pressure is elevated at 164/80 mm Hg. Hypertension can exacerbate cardiac ischemia and increase the risk of complications. Therefore, monitoring and potential management of blood pressure are warranted.
D. The client's blood pressure is elevated at 164/80 mm Hg. Hypertension can exacerbate cardiac ischemia and increase the risk of complications. Therefore, monitoring and potential management of blood pressure are warranted.
E. The client's blood pressure is elevated at 164/80 mm Hg. Hypertension can exacerbate cardiac ischemia and increase the risk of complications. Therefore, monitoring and potential management of blood pressure are warranted.
F. The lungs are clear on auscultation of all the lobes which is normal.
G. The client's blood pressure is elevated at 164/80 mm Hg. Hypertension can exacerbate cardiac ischemia and increase the risk of complications. Therefore, monitoring and potential management of blood pressure are warranted.

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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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