The nurse is educating a patient with skin traction about self-care measures. Which instruction should the nurse provide to the patient?

"You can remove the traction weights if you feel uncomfortable."

"Avoid any movements that cause tension on the traction."

"Reapply the traction tape daily to ensure a tight fit."

"Check for any signs of skin breakdown or pressure sores."

Answer and Explanation

The Correct Answer is D

Checking for signs of skin breakdown or pressure sores is essential to prevent complications associated with skin traction. The patient should inspect the skin around the traction site regularly and report any abnormalities to the healthcare provider.

a. Removing the traction weights without healthcare provider approval can lead to inadequate traction and compromise its effectiveness.

b. Avoiding movements that cause tension on the traction is essential to maintain proper alignment and prevent further injury.

c. Reapplying the traction tape daily is not necessary and may lead to skin irritation. Proper application by healthcare professionals is essential to maintain the appropriate tension.

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Correct Answer is C

Explanation

To ensure proper alignment and prevent shearing forces on the skin, the nurse should use a lift sheet to slide the patient to the desired position. This reduces friction and minimizes the risk of skin breakdown.

a. Raising the head of the bed to a 30-degree angle does not address proper alignment for repositioning with skin traction.

b. Having the patient assist in turning to the side can place strain on the affected limb and is not recommended for patients with skin traction.

d. Applying a trochanter roll under the affected hip is not necessary for repositioning with skin traction.

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 educating a patient with skin traction about self-care measures. Which instruction should the nurse provide to the patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing to reposition a patient with skin traction. What action should the nurse take to ensure proper alignment?

Correct Answer is C

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

Which patient would benefit most from the use of skin traction?

The nurse is preparing to apply skin traction to a patient's lower leg. What is the primary purpose of applying skin traction in this situation?

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

Which of the following fractures would benefit from the use of skin traction?

Which statement is true regarding the use of skin traction?

The nurse is evaluating the patient's pain level after applying skin traction. Which finding indicates the need for further intervention?

The nurse is assessing a patient with skin traction for any potential complications. Which finding requires immediate intervention?

Which type of skin traction is often used for patients with lower leg fractures?