The nurse is assessing a patient with skin traction for any potential complications. Which finding requires immediate intervention?
Mild redness around the traction tape.
Slight discomfort at the traction site.
Skin irritation from the adhesive strips.
Purplish discoloration below the traction site.
The Correct Answer is D
Purplish discoloration below the traction site may indicate impaired circulation, and it requires immediate intervention to prevent further complications like pressure ulcers or nerve damage.
a. Mild redness around the traction tape is common and may be expected, but it does not require immediate intervention unless it worsens or is accompanied by other signs of infection.
b. Slight discomfort at the traction site is expected as a result of the applied tension, and it can be managed with appropriate pain management techniques.
c. Skin irritation from the adhesive strips can be addressed by repositioning the strips or using appropriate skin protection measures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The primary indication for skin traction is to provide short-term stabilization and pain relief for a fractured bone. It is a non-invasive method used to align and stabilize fractures before definitive treatment, such as casting or surgery.
a. Skin traction is not used to treat chronic orthopedic conditions; it is primarily used for acute fractures.
b. Skin traction is not typically used to immobilize a fractured bone during surgery; other surgical interventions are used for that purpose.
d. Skin traction does not replace the need for surgical interventions for joint dislocations; it is specifically used for fractures.
Correct Answer is C
Explanation
Using a clear and concise verbal report is an effective approach to nursing communication. It allows for the efficient transfer of essential patient information to the healthcare provider.
a. Sending a text message to the healthcare provider may not be appropriate for discussing patient information as it may not be secure and may lack important details.
b. Speaking in medical jargon during the conversation can lead to miscommunication and misunderstandings between the nurse and the healthcare provider.
d. Providing the healthcare provider with outdated patient data is not effective in patient care and may lead to incorrect decision-making.
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