Study with Quizlet and memorize flashcards containing terms like The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse should plan to perform which action?, The nurse witnesses a client sustain a fall and suspects that the client's leg may be ...A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should be included in the plan of care? Ans: Assess the pin insertion site every 8 hours. The nurse is developing a plan of care for a client with a fractured femur, is in traction, and will be restricted to bed for some time. Which domain should the nurse look to for developing a nursing diagnosis based on this client's musculoskeletal health problems? A. Nutrition B. Activity/Rest C. Health Promotion D. Self-perceptionA nurse is caring for a client whose cultural background is different from her own. Which actions are appropriate? Select all that apply. A. Consider that nonverbal cues, such as eye contact, may have different meanings in different cultures B. Respect the client's cultural beliefs C. Ask the client if he has cultural or religious requirements that should be considered in his care D. Explain ...A client has just been admitted to the hospital with a fractured femur and pelvic fractures. The nurse should plan to carefully monitor the client for which signs/symptoms? 1.Fever and bradycardia 2.Fever and hypertension 3.Tachycardia and hypotension 4.Bradycardia and hypertensionA nurse is caring for a client whose cultural background is different from her own. Which actions are appropriate? Select all that apply. A. Consider that nonverbal cues, such as eye contact, may have different meanings in different cultures B. Respect the client's cultural beliefs C. Ask the client if he has cultural or religious requirements that should be considered in his care D. Explain ...Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient? A) The cast will feel cool to touch for the first 30 minutes. B) The cast should be wrapped snuggly with a towel until the patient gets home. C) The cast should be supported ...The nurse is planning care for a client with a femoral fracture who is in balanced suspension traction. Which nursing care can be included in the plan of care? A) Using a fracture bedpan when the client is in the trapeze to raise hips B) turning the client side decide to give back care C) raising the head of the bed to 90° to set the client up ...The office nurse for an orthopedic health care provider receives 4 telephone messages. Which client does the nurse call back first? 1. Client who had a left total knee replacement 7 days ago and reports cramping pain in the left calf 2. Client with a fractured wrist who reports severe itching under a cast that was applied 3 days ago 3.Study with Quizlet and memorize flashcards containing terms like A client with a fractured femur is placed in skeletal traction. The nurse should do which to monitor for nerve injury?, A primary health care provider has given a prescription for dietary iron supplements to the client with osteoporosis who has an iron deficiency anemia. A nurse is caring for an adolescent client who has a newly fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take? A. Perform a neurovascular assessment. B. Explain the discharge instructions to the client and parents. C. Provide reassurance to the client and parents.Have client advance the right leg. Explanation: First, perform hand hygiene. Next, secure a gait belt around client's waist. Then, place the cane in the client's right hand, because the right side is the unaffected side. Have the client advance the cane and the left leg about 4 to 8 inches (10 to 20 cm).Study with Quizlet and memorize flashcards containing terms like Which statement made by a client diagnosed with Addison's disease indicates to the nurse that the client needs further teaching about fludrocortisone therapy? 1. "Taking my medicine at night will help me sleep." 2. "It is important to wear a medical alert bracelet all of the time." 3. "My medication dose may change based on my ... 2.The patient must prove injury, damage, or loss occurred. 3.The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. 4.The patient must prove that a breach in the prevailing standard of care caused an injury. 5.The burden of proof is always the responsibility of the nurse. 1., 2., 3.Which action should the nurse take?, A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? and more. Study with Quizlet and memorize flashcards containing terms like A child with cerebral palsy is in a management program to achieve maximum potential for ...The nurse is planning care for a client with a femoral fracture who is in balanced suspension traction. Which nursing care can be included in the plan of care? A) Using a fracture bedpan when the client is in the trapeze to raise hips B) turning the client side decide to give back care C) raising the head of the bed to 90° to set the client up ...Requires frequent pin care A child with a fractured femur is placed in Buck's skin traction, and the nurse is planning care for the client. Which information about this type of traction is correct? Which information about this type of traction is correct?Study with Quizlet and memorize flashcards containing terms like The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse should plan to perform which action?, The nurse witnesses a client sustain a fall and suspects that the client's leg may be ... The nurse is planning care to prevent complications for a client with multiple myeloma. Which intervention is most important for the nurse to include? A. Safety precautions during activity. B. Assess for changes in size of lymph nodes. C. Maintain a fluid intake of 3 to 4 L per day. D. Administer narcotic analgesic around the clock.1 Taking supplemental calcium and vitamin D. 2 Increasing the consumption of eggs and cheese. 3 Taking supplemental magnesium and vitamin E. 4 Increasing the consumption of milk and milk products. 1. A client with a fractured head of the right femur and osteoporosis is placed in Buck extension before surgical repair. A nurse who is accompanying the group suspects a fracture of the tibia. To immobilize the suspected fracture, where is the best location to apply the splint?, The nurse is checking on a client with a fractured femur who is in skeletal traction. Which of the following actions is necessary to determine a client's neurovascular status?Study with Quizlet and memorize flashcards containing terms like A client is confined to bed with a fracture of the left femur. He begins receiving subcutaneous heparin injections. What is the purpose of this medication? 1. To prevent thrombophlebitis and pulmonary emboli associated with immobility 2.To promote vascular perfusion by preventing formation of microemboli in the left leg 3.To ...A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider? A. Ecchymosis of the thigh B. Serous drainage at the pin site C. Chest petechiae D. Muscle spasms in the left leg. A nurse is preparing a client for an electromyogram (EMG).A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The client’s vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%.The nurse is developing a plan of care for a client with a fractured femur, is in traction, and will be restricted to bed for some time. Which domain should the nurse look to for developing a nursing diagnosis based on this client's musculoskeletal health problems? A. Nutrition B. Activity/Rest C. Health Promotion D. Self-perceptionStudy with Quizlet and memorize flashcards containing terms like A client experiences a muscle sprain of the ankle. When assessing the injury, the nurse discovers that a hematoma is developing, edema is present and that the client reports tenderness when the ankle is palpated. The nurse anticipates that the plan of care will include the applying of a/an: 1. Binder 2. Ice bag 3. Elastic bandage ... A nurse is caring for a toddler who has a fractured right femur and is in Bryant's traction. When monitoring to determine if the traction is appropriately assembled, the nurse expects to observe which of the following? a. Skin straps maintaining the leg in an extended position b. Weights attached to a pin that is inserted in the femur c.Study with Quizlet and memorize flashcards containing terms like A client has an intracapsular hip fracture. the nurse should conduct a focused assessment to detect: 1. internal rotation 2. muscle flaccidity 3. shortening of the affected leg 4. absence of pain the fracture area, the nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit during the ...The nurse is planning care for a client with a femoral fracture who is in balanced suspension traction. Which nursing care can be included in the plan of care? A) Using a fracture bedpan when the client is in the trapeze to raise hips B) turning the client side decide to give back care C) raising the head of the bed to 90° to set the client up ...Study with Quizlet and memorize flashcards containing terms like A school nurse suspects that a 13-year-old has structural scoliosis. Asking the adolescent to perform which maneuver would be the nurse's priority when gathering data for this condition?, The nurse is caring for a 15-year-old client admitted with suspected bacterial pneumonia. Which nursing action takes priority?, The nurse is ...c. "Use a cloth-covered pillow to elevate the client's leg." d. "Handle the cast with your fingertips to prevent indentations.", A nurse obtains the health history of a client with a fractured femur. Which factor identified in the client's history should the nurse recognize as an aspect that may impede healing of the fracture? a. Sedentary ...Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who has balanced skeletal traction with a Thomas splint for the treatment of a fracture of the femur. Which of the following actions should the nurse take to prevent skin breakdown?, A nurse is collecting data from an older adult client who is preoperative for a total hip arthroplasty. For which of ...The nurse is planning care for a 14-year-old client whose x-ray shows a comminuted fracture with the need for external appliance stabilization. Which nursing action is most important? assessing the color and movement of the hand and fingers. An infant was born with a severely deformed hand. He is now 6 months old. Which action should the nurse take?, A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? and more. Study with Quizlet and memorize flashcards containing terms like A child with cerebral palsy is in a management program to achieve maximum potential for ...Study with Quizlet and memorize flashcards containing terms like The nurse is reinforcing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates the need for further teaching?, The mother of a child with juvenile idiopathic arthritis calls the nurse because the child is experiencing a painful exacerbation of the disease. The ...3. "I will assess the skin using the Braden scale." 4. "A pillow will be placed between the knees when client is side lying." 5. "The incontinent client will be kept clean and dry." 1,3,4,5. The nurse is caring for a client in an outpatient clinic. The client is being treated with warfarin for prevention of a stroke due to atrial fibrillation.Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient? A) The cast will feel cool to touch for the first 30 minutes. B) The cast should be wrapped snuggly with a towel until the patient gets home. C) The cast should be supported ... ati practice mental health test 1. a nurse is planning care for a client who has thoughts of suicide which of the following goals should the nurse include in the clients plan of care. Click the card to flip 👆. the client agrees to notify a staff member of thought of self harm. Click the card to flip 👆. Discuss the complications that the client's may experience if they don't cooperate with the care plan. The nurse should discuss the care plan and its rationale with the client. Calling the physician to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Study with Quizlet and memorize flashcards containing terms like A school nurse suspects that a 13-year-old has structural scoliosis. Asking the adolescent to perform which maneuver would be the nurse's priority when gathering data for this condition?, The nurse is caring for a 15-year-old client admitted with suspected bacterial pneumonia. Which nursing action takes priority?, The nurse is ... The office nurse for an orthopedic health care provider receives 4 telephone messages. Which client does the nurse call back first? 1. Client who had a left total knee replacement 7 days ago and reports cramping pain in the left calf 2. Client with a fractured wrist who reports severe itching under a cast that was applied 3 days ago 3.Make sure the head of the bed is kept at a 45- to 90-degree angle. Monitor the weights to be sure that they are resting on a firm surface. Inspect the skin under the boot. The nurse prepares to care for a client with acute cellulitis of the lower leg. Study with Quizlet and memorize flashcards containing terms like To assess the joints, a nurse asks a client to perform various movements. As the client moves his arm away from the midline, the nurse evaluates his ability to perform:, Passive range-of-motion (ROM) exercises for the legs and assisted ROM exercises for the arms are part of the care regimen for a client with a spinal cord injury ...Study with Quizlet and memorize flashcards containing terms like A school nurse suspects that a 13-year-old has structural scoliosis. Asking the adolescent to perform which maneuver would be the nurse's priority when gathering data for this condition?, The nurse is caring for a 15-year-old client admitted with suspected bacterial pneumonia. Which nursing action takes priority?, The nurse is ... Select all that apply. - Apply occlusive dressings after rewarming - Elevate affected extremities after rewarming - Massage the areas to increase circulation - Provide adequate analgesia - Provide continuous warm water soaks., The nurse is planning care for an 11-year-old admitted for surgical treatment of a fractured femur.A nurse is caring for a client whose cultural background is different from her own. Which actions are appropriate? Select all that apply. A. Consider that nonverbal cues, such as eye contact, may have different meanings in different cultures B. Respect the client's cultural beliefs C. Ask the client if he has cultural or religious requirements that should be considered in his care D. Explain ... The nurse is assigned to care for a client in traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan? 1. Ensure that the knots are at the pulleys. 2. Check the weights to ensure that they are off of the floor. 3. Ensure that the head of the bed is kept at a 45- to 90-degree angle. 4.Study with Quizlet and memorize flashcards containing terms like The nurse witnesses an accident on a highway and stops to provide assistance to the victim. The nurse notes that the client sustained a head injury and a compound fracture to the left leg. The nurse provides the appropriate care before transport of the victim to the hospital by ambulance. The client develops a severe bone ... Make sure the head of the bed is kept at a 45- to 90-degree angle. Monitor the weights to be sure that they are resting on a firm surface. Inspect the skin under the boot. The nurse prepares to care for a client with acute cellulitis of the lower leg. Study with Quizlet and memorize flashcards containing terms like The nurse witnesses an accident on a highway and stops to provide assistance to the victim. The nurse notes that the client sustained a head injury and a compound fracture to the left leg. The nurse provides the appropriate care before transport of the victim to the hospital by ambulance. The client develops a severe bone ... Which of the following responses by the nurse is an example of therapeutic communication?, A nurse is planning reminiscence therapy for an older adult client. The nurse should identify which of the following goals for the client's therapy?, A nurse is an emergency department is caring for an 18-month-old toddler who has a fractured left femur. Study with Quizlet and memorize flashcards containing terms like An overweight adolescent client has lost 12 lb (5.4 kg) in 8 weeks using diet strategies. The client reaches a weight loss plateau and is discouraged. The nurse instructs the client to keep a food diary for what purpose?, An adolescent is on the football team and practices in the morning and afternoon before school starts for the ...A femur fracture is a condition that involves a broken thigh bone and usually happens due to a strong force or a major accident. The femur consists of two femora connected to the pelvis via the hip joint and to the tibia via the knee joint.A client has just been admitted to the hospital with a fractured femur and pelvic fractures. The nurse should plan to carefully monitor the client for which signs/symptoms? 1.Fever and bradycardia 2.Fever and hypertension 3.Tachycardia and hypotension 4.Bradycardia and hypertensionA nurse is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation which of the following intervention should the nurse include in the plan of care? A) Keep the head of the bed at a 30° angle. B) Reposition the client by logrolling every four hours. Study with Quizlet and memorize flashcards containing terms like When inspecting a client's skin, a nurse finds a circumscribed elevated area filled with serous fluid. What term should the nurse use to document this finding?, An adolescent has skeletal traction for a fractured femur. Which is the most appropriate nursing intervention for this client?, A female client reports to a nurse that ...b. Right hand and placing the cane in front of the right foot. c. Left hand and 6 inches lateral to the left foot. d. Right hand and 6 inches lateral to the left foot. C. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a: a.Apr 20, 2014 · The nurse is assigned to care for a client in traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan? 1. Ensure that the knots are at the pulleys. 2. Check the weights to ensure that they are off of the floor. 3. Ensure that the head of the bed is kept at a 45- to 90-degree angle. 4. nclex practice test. 5.0 (6 reviews) after listening to the parents reports and seeing the following pediatric clients, the nurse knows that which clent demonstrates signs of abuse that may need reporting. 1. 1 year old with dyspnea, drooling, and a swollen tongue after eating part of houseplant. 2. 2 year old who is crying and has large ...c. "Use a cloth-covered pillow to elevate the client's leg." d. "Handle the cast with your fingertips to prevent indentations.", A nurse obtains the health history of a client with a fractured femur. Which factor identified in the client's history should the nurse recognize as an aspect that may impede healing of the fracture? a. Sedentary ...Discuss the complications that the client's may experience if they don't cooperate with the care plan. The nurse should discuss the care plan and its rationale with the client. Calling the physician to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. a. loosen the traction and help the patient turn onto the unaffected side. b. place a pillow between the patient's legs and turn gently to each side. c. have the patient lift the buttocks slightly by using a trapeze over the bed. d. turn the patient partially to each side with the assistance of another nurse. ANS: C.Study with Quizlet and memorize flashcards containing terms like The nurse is preparing to administer a medication through a nasogastric (NG) tube that is connected to suction. Which interventions should be included to accurately administer the medication? Select all that apply., The nurse working in a prenatal clinic reviews a client's chart and notes that the primary health care provider ...Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient? A) The cast will feel cool to touch for the first 30 minutes. B) The cast should be wrapped snuggly with a towel until the patient gets home. C) The cast should be supported ...Which action should the nurse take?, A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include which intervention? and more. Study with Quizlet and memorize flashcards containing terms like A child with cerebral palsy is in a management program to achieve maximum potential for ...3. "I will assess the skin using the Braden scale." 4. "A pillow will be placed between the knees when client is side lying." 5. "The incontinent client will be kept clean and dry." 1,3,4,5. The nurse is caring for a client in an outpatient clinic. The client is being treated with warfarin for prevention of a stroke due to atrial fibrillation.Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient?, A patient broke his arm in a sports accident and required the application of a cast. Shortly following application, the patient complained of an inability to straighten his ...A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The client’s vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. A. Log rolling every 2 hours. B. Isometric exercises of both legs. C. Active range-of-motion exercises of the left leg. D. Passive range of motion to the right leg. C. Active range-of-motion exercises of the left leg. A nurse is planning care for a newly admitted client who has skeletal traction for a fractured femur.Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient? A) The cast will feel cool to touch for the first 30 minutes. B) The cast should be wrapped snuggly with a towel until the patient gets home. C) The cast should be supported ...The nurse is planning care for a group of clients who have had total hip replacement. Of the clients listed below, which is at highest risk for infection and should be assessed first? 1. A 55-year-old client who is 6 feet tall and weighs 180 lb. 2. A 90-year-old who lives alone. 3. A 74-year-old who has periodontal disease with periodontitis. 4.Have client advance the right leg. Explanation: First, perform hand hygiene. Next, secure a gait belt around client's waist. Then, place the cane in the client's right hand, because the right side is the unaffected side. Have the client advance the cane and the left leg about 4 to 8 inches (10 to 20 cm).Study with Quizlet and memorize flashcards containing terms like Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply., plaster cast teaching, A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast? and ...Study with Quizlet and memorize flashcards containing terms like The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse should plan to perform which action?, The nurse witnesses a client sustain a fall and suspects that the client's leg may be ... A nurse is caring for a client whose cultural background is different from her own. Which actions are appropriate? Select all that apply. A. Consider that nonverbal cues, such as eye contact, may have different meanings in different cultures B. Respect the client's cultural beliefs C. Ask the client if he has cultural or religious requirements that should be considered in his care D. Explain ...Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client diagnosed with diabetes. The nurse notes that the client has a mild tremor, slight diaphoresis and is fully oriented. Which of the following nursing actions should have the highest priority?, A client is admitted to the surgical unit after sustaining a compound fracture of the left femur. The client ... Study with Quizlet and memorize flashcards containing terms like The nurse is preparing discharge instructions for a client with a history of alcohol abuse on the third day after an emergency appendectomy. The nurse suspects delirium tremens based on which assessment data?, See google docs for chart on DT and alcohol withdrawal syndrome s/s, A client with a diagnosis of antisocial personality ...1 Taking supplemental calcium and vitamin D. 2 Increasing the consumption of eggs and cheese. 3 Taking supplemental magnesium and vitamin E. 4 Increasing the consumption of milk and milk products. 1. A client with a fractured head of the right femur and osteoporosis is placed in Buck extension before surgical repair.The nurse knows that chlorzoxazone, a centrally acting skeletal muscle relaxant, is commonly used to treat: muscle spasm caused by cerebral palsy. chronic musculoskeletal disorder. lower extremity spasticity. (x) severe muscle spasm. The client sustained an open fracture of the femur from an automobile accident.
c. Use a cloth-covered pillow to elevate the clients leg. d. Handle the cast with your fingertips to prevent indentations., 3. A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients history should the nurse recognize as an aspect that may impede healing of the fracture? a. Sedentary ... . Homes for sale cambridge
Study with Quizlet and memorize flashcards containing terms like A client has an intracapsular hip fracture. the nurse should conduct a focused assessment to detect: 1. internal rotation 2. muscle flaccidity 3. shortening of the affected leg 4. absence of pain the fracture area, the nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit during the ...Study with Quizlet and memorize flashcards containing terms like The nurse is preparing discharge instructions for a client with a history of alcohol abuse on the third day after an emergency appendectomy. The nurse suspects delirium tremens based on which assessment data?, See google docs for chart on DT and alcohol withdrawal syndrome s/s, A client with a diagnosis of antisocial personality ...Study with Quizlet and memorize flashcards containing terms like A 65-year-old Asian American female has been brought to the emergency department accompanied by her spouse with a fractured femur. The health care provider has prescribed a Foley catheter be inserted. Which action(s) should the male nurse, who has been assigned to the provide care to this client, prioritize to best care for this ...b. Right hand and placing the cane in front of the right foot. c. Left hand and 6 inches lateral to the left foot. d. Right hand and 6 inches lateral to the left foot. C. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a: a. Nursing Prep U The nurse is developing a plan of care for a client with a fractured femur who is in traction and will be restricted to bed for some time. Which domain should the nurse consider when developing a nursing diagnosis based on this client's musculoskeletal health problems? Click the card to flip 👆 Activity and rest A nurse is caring for an adolescent client who has a newly fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take? A. Perform a neurovascular assessment. B. Explain the discharge instructions to the client and parents. C. Provide reassurance to the client and parents. Make sure the head of the bed is kept at a 45- to 90-degree angle. Monitor the weights to be sure that they are resting on a firm surface. Inspect the skin under the boot. The nurse prepares to care for a client with acute cellulitis of the lower leg.Study with Quizlet and memorize flashcards containing terms like An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain?, The surgical nurse is admitting a client from postanesthetic ... A nurse is caring for a toddler who has a fractured right femur and is in Bryant's traction. When monitoring to determine if the traction is appropriately assembled, the nurse expects to observe which of the following? a. Skin straps maintaining the leg in an extended position b. Weights attached to a pin that is inserted in the femur c.a. loosen the traction and help the patient turn onto the unaffected side. b. place a pillow between the patient's legs and turn gently to each side. c. have the patient lift the buttocks slightly by using a trapeze over the bed. d. turn the patient partially to each side with the assistance of another nurse. ANS: C.A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should be included in the plan of care? Ans: Assess the pin insertion site every 8 hours. A nurse is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation which of the following intervention should the nurse include in the plan of care? A) Keep the head of the bed at a 30° angle. B) Reposition the client by logrolling every four hours. Study with Quizlet and memorize flashcards containing terms like A nurse is preparing a client for ambulation. Which of the following actions should the nurse take to determine the clients level of strength?, A nurse is planning care for a client who has depression. The nurse notes that the client has weight loss, inability to concentrate, and inability to complete every day tasks, and a ... .