The nurse is providing discharge instructions to a patient with skin traction. Which statement by the patient indicates a need for further teaching?
"I will clean the skin under the traction tape with mild soap and water daily."
"I will report any signs of skin redness or irritation to the nurse."
"I can remove the traction device if it becomes uncomfortable."
"I will use the trapeze bar to reposition myself in bed."
The Correct Answer is C
The patient should not remove the traction device independently. Removing the traction can compromise the effectiveness of fracture reduction and delay healing. Only healthcare professionals should adjust or remove the traction as needed.
a. Cleaning the skin under the traction tape with mild soap and water daily helps to maintain skin integrity and reduce the risk of infection.
b. Reporting any signs of skin redness or irritation to the nurse is essential to monitor for potential skin breakdown and prevent complications.
d. Using the trapeze bar to reposition in bed is an appropriate method for the patient to move independently without compromising the traction's stability.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The patient being unable to move the affected limb in skin traction requires further assessment. Traction should allow some degree of movement, and the nurse should investigate the cause of the restricted motion and take appropriate action.
a. The patient being able to perform active range of motion exercises indicates that some mobility is possible with the traction, which is a positive finding.
b. The patient experiencing some discomfort during range of motion exercises is not unexpected, as traction may cause some discomfort due to realignment of the bone.
d. The patient having difficulty moving the affected limb may be expected with skin traction, and the nurse should continue to monitor the patient's progress.
Correct Answer is D
Explanation
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.
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