A nurse is teaching a client who has chronic tophaceous gout about his new prescription for allopurinol. The nurse should explain that the purpose of this medication is to reduce blood levels of which of the following substances?

Choice A reason: Using a blow dryer to dry a fiberglass cast is inappropriate, as casts should be kept dry to prevent skin maceration or infection. Fiberglass is water-resistant but not waterproof, and heat can damage the cast or skin. This instruction risks complications, misguiding patients on proper cast care and hygiene.

Choice B reason: Using a cotton swab under the cast to relieve itching is unsafe, as it may introduce debris or cause skin injury, increasing infection risk. Itching should be managed with elevation or antihistamines. This advice misaligns with cast care, potentially leading to complications like dermatitis or bacterial infection under the cast.

Choice C reason: Avoiding all movement of the affected leg is impractical and harmful. Controlled movement, as advised, prevents stiffness and muscle atrophy while maintaining circulation. Complete immobilization risks complications like contractures. This instruction misguides recovery, delaying rehabilitation and functional restoration in patients with a tibial fracture.

Choice D reason: Reporting worsening or unrelieved pain is critical, as it may indicate complications like compartment syndrome, infection, or cast pressure. Pain assessment ensures timely intervention, preventing serious outcomes like tissue necrosis or delayed healing. This instruction aligns with safe cast care, promoting patient safety and effective fracture management.

Choice A reason: Equal weights on each side are appropriate in skeletal traction, ensuring balanced force to maintain bone alignment. This finding supports the traction’s purpose of stabilizing the fracture without causing uneven stress on the bone or soft tissues. No correction is needed, as this is a correct setup.

Choice B reason: Securely attached ropes to pins are essential in skeletal traction to transmit consistent force to the bone. Loose attachments could disrupt alignment or cause pin site complications like infection. This finding is correct and does not require correction, as it ensures effective traction and patient safety.

Choice C reason: Weights resting against the bed negate the traction’s pulling force, failing to maintain bone alignment. Weights must hang freely to apply continuous tension, counteracting muscle spasms and stabilizing the fracture. This finding requires correction to restore effective traction and prevent malunion or delayed healing.

Choice D reason: Ropes centered in wheel grooves ensure smooth movement and consistent traction force without fraying or misalignment. This is a correct setup, as misaligned ropes could reduce traction effectiveness or cause mechanical issues. No correction is needed, as this supports proper traction mechanics.