Nur2790 Actual Final Exam Question And Latest Answers As Per Marking Scheme.

NUR2790 ACTUAL FINAL EXAM QUESTION AND LATEST ANSWERS AS PER MARKING SCHEME. CHAPTER 51: CARE OF PATIENTS WITH MUSCULOSKELETAL TRAUMA ( MULTIPLE CHOICE 1. A nurse assesses a client with a fracture who is being treated with skeletal traction. Which assessment should alert the nurse to urgently contact the health provider? a. Blood pressure increases to 130/86 mm Hg b. Traction weights are resting on the floor c. Oozing of clear fluid is noted at the pin site d. Capillary refill is less than 3 seconds ANS: B The immediate action of the nurse should be to reapply the weights to give traction to the fracture. The health care provider must be notified that the weights were lying on the floor, and the client should be realigned in bed. The clients blood pressure is slightly elevated; this could be related to pain and muscle spasms resulting from lack of pressure to reduce the fracture. Oozing of clear fluid is normal, as is the capillary refill time. Weights should not be removed without a prescription. They should not be lifted manually or allowed to rest on the floor. Weights should be freely hanging at all times. Inspect the skin Q8H for