The nurse is evaluating the patient's pain level after applying skin traction. Which finding indicates the need for further intervention?
The patient rates pain as a 3 on a scale of 0 to 10.
The patient's pain is well-controlled with prescribed analgesics.
The patient reports occasional sharp pain during movement.
The patient states that the pain is worse with the traction off.
The Correct Answer is D
The patient stating that the pain is worse with the traction off requires further intervention. Skin traction should relieve pain and discomfort; an increase in pain when the traction is off may indicate inadequate traction or an underlying issue.
a. The patient rating pain as a 3 on a scale of 0 to 10 suggests mild pain and may be expected with some level of discomfort related to the fracture and traction.
b. The patient's pain being well-controlled with prescribed analgesics is a positive finding and indicates that the current pain management plan is effective.
c. The patient reporting occasional sharp pain during movement may be expected with skin traction, but the nurse should assess for any signs of worsening or intolerable pain.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Swelling and discoloration of the affected limb can indicate neurovascular compromise and require immediate intervention. The nurse should assess circulation, sensation, and motion of the affected limb and notify the healthcare provider promptly.
a. Mild discomfort at the traction site is common and expected. The nurse can provide pain relief measures as prescribed.
c. Traction weights hanging freely off the edge of the bed is the correct way to set up skin traction. This finding does not raise concern.
d. Traction cords secured with tape to the bedrails is the appropriate way to secure the traction. This finding does not raise concern.
Correct Answer is B
Explanation
Skin traction and skeletal traction are both used to stabilize and immobilize fractured bones, but they differ in the method of application. Skin traction uses weights attached to adhesive straps on the skin near the fractured area, while skeletal traction involves weights connected to metal pins inserted directly into the bone.
a. Skin traction is less invasive than skeletal traction because it does not require surgical insertion of metal pins.
c. Skin traction is not only used for chronic orthopedic conditions; it is commonly used for acute fractures as well.
d. Skin traction is not used to replace surgical interventions; it is an adjunctive intervention used in conjunction with other treatments for fractures.
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