The nurse is caring for a patient with a fractured femur in skin traction. Which action by the nurse is appropriate?

Assessing the skin under the traction tape every 8 hours.

Tightening the traction ropes to increase the traction force.

Placing the traction weights on the bed rather than suspending them.

Removing the traction periodically to allow the skin to breathe.

Answer and Explanation

The Correct Answer is A

Option A is appropriate because assessing the skin under the traction tape helps monitor for any signs of skin breakdown, irritation, or pressure ulcers. Regular skin assessments are essential to prevent complications related to skin traction.

b. Tightening the traction ropes to increase the traction force is incorrect. The traction force should be set by the healthcare provider, and altering it without proper authorization may lead to adverse effects or further injury.

c. Placing the traction weights on the bed instead of suspending them is incorrect. Traction weights should be suspended freely to provide the appropriate traction force and maintain proper alignment of the fractured bone.

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Correct Answer is B

Explanation

: Engaging in open communication and active listening demonstrates effective nursing collaboration. Collaboration involves actively participating in discussions, sharing information, and valuing the input of all team members.

a. Refusing to seek input from other team members is not conducive to collaboration and can hinder the effectiveness of patient care.

c. Failing to communicate changes in the patient's condition can lead to errors and compromises patient safety, which is contrary to effective collaboration.

d. Limiting collaboration to only certain team members can create barriers and may result in missed opportunities for valuable input from different perspectives.

A. Capillary refill of less than 3 seconds in the affected limb. B. Warm and pink skin color in the affected limb. C. Absent pedal pulses in the affected foot. D. Mild tingling sensation in the affected limb.

Correct Answer is C

Explanation

Absent pedal pulses in the affected foot could indicate compromised circulation and require immediate action. The nurse should notify the healthcare provider promptly to assess and address the issue.

a. Capillary refill of less than 3 seconds in the affected limb is a normal finding and indicates adequate peripheral circulation.

b. Warm and pink skin color in the affected limb is a normal finding and indicates good blood flow.

d. Mild tingling sensation in the affected limb can be a common sensation due to traction, and it does not indicate neurovascular compromise.

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The nurse is caring for a patient with a fractured femur in skin traction. Which action by the nurse is appropriate?

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Naxlex Comprehensive Predictor Exams

The nurse is collaborating with the healthcare team to provide care for a patient in skin traction. Which action demonstrates effective nursing collaboration?

Correct Answer is B

Explanation

The nurse is performing neurovascular checks on a patient with skin traction. Which assessment finding would be of concern and require immediate action?

Correct Answer is C

Explanation

The nurse is providing discharge teaching to a patient with skin traction. What instruction should the nurse include to promote skin integrity?

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The nurse is caring for a patient with a fractured femur who has been placed in skin traction. Which action should the nurse take to prevent skin breakdown?