A nurse is caring for a client who is in skeletal traction. Which of the following actions should the nurse take?

Unscrew the pins to cleanse the pin sites.

Remove the weights while turning the client in bed.

Loosen the rope knots holding the weights for 30 min if the client reports pain.

Ensure that there is at least 4.5 kg (10 lb) of weight applied to the client's traction.

Answer and Explanation

The Correct Answer is D

A. Unscrew the pins to cleanse the pin sites: Unscrewing the pins is incorrect as it can compromise the stability of the traction and increase the risk of infection. Pin site care should be performed according to the facility's protocol without disturbing the pins.
B. Remove the weights while turning the client in bed: Removing weights is incorrect as it can disrupt the alignment and effectiveness of the traction. Weights should be left in place to maintain proper traction and alignment.
C. Loosen the rope knots holding the weights for 30 min if the client reports pain: Loosening the rope knots is inappropriate and can interfere with the traction's effectiveness. Pain management should involve assessing the client's comfort and reviewing the traction setup, but not altering the traction itself.
D. Ensure that there is at least 4.5 kg (10 lb) of weight applied to the client's traction: This is correct as maintaining the appropriate amount of weight is crucial for proper skeletal traction. Ensuring that the prescribed weight is applied helps in achieving the desired therapeutic effect.

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Correct Answer is D

Explanation

A. "I should consume fish once per week": While consuming fish is beneficial, particularly fatty fish high in omega-3 fatty acids, this alone is not a comprehensive strategy for preventing hypertension.
B. "With a BMI of 30, I should focus on maintaining my current weight": With a BMI of 30, which is classified as obese, the focus should be on reducing weight rather than maintaining it to help prevent hypertension.
C. "I should exercise for 30 minutes three times per week": The recommended amount of exercise for cardiovascular health is at least 150 minutes of moderate-intensity exercise per week, which is more frequent than three times per week.
D. "I should consume no more than 2,000 milligrams of sodium per day": This is correct as reducing sodium intake to no more than 2,000 milligrams per day is a key strategy for preventing and managing hypertension.

A. "My provider might prescribe a glucocorticoid regimen to decrease my risk for a stroke." B. "Having a total cholesterol level below 200 mg/dL increases my risk for a stroke." C. "My risk for a stroke increases if my HbA1c level is 6 percent or less." D. "I can decrease my risk for a stroke by losing excess weight."

Correct Answer is D

Explanation

A. "My provider might prescribe a glucocorticoid regimen to decrease my risk for a stroke": This is incorrect as glucocorticoids are not typically used to reduce stroke risk; they are more commonly used to manage inflammation and other conditions.
B. "Having a total cholesterol level below 200 mg/dL increases my risk for a stroke": This is incorrect because having a total cholesterol level below 200 mg/dL is generally considered desirable and lowers the risk of stroke.
C. "My risk for a stroke increases if my HbA1c level is 6 percent or less": This is incorrect because an HbA1c level of 6 percent or less is generally considered well-managed for diabetes and does not increase stroke risk; higher levels are more concerning.
D. "I can decrease my risk for a stroke by losing excess weight": This is correct as losing excess weight can reduce the risk of stroke by improving overall cardiovascular health and managing diabetes.

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A nurse is caring for a client who is in skeletal traction. Which of the following actions should the nurse take?

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Naxlex Comprehensive Predictor Exams

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