College

A nurse is caring for a client who is in Buck's traction. Which of the following actions should the nurse take? (Select all that apply)

A. Monitor peripheral pulses in the affected extremity
B. Position weights against the foot of the bed
C. Adjust the prescribed weights every 24 hours
D. Examine the skin under the traction boot
E. Assess the temperature of the affected extremity

Answer :

Final answer:

The nurse should monitor the peripheral pulses, examine the skin under the traction boot, and assess the temperature of the affected extremity. It is essential not to reposition the weights or adjust them without a provider's order.

Explanation:

A nurse caring for a client who is in Buck's traction should take the following actions:

  • Monitor peripheral pulses in the affected extremity to assess circulation.
  • Examine the skin under the traction boot for any signs of pressure sores, irritation, or skin breakdown.
  • Assess the temperature of the affected extremity for signs of infection or compromised circulation.

However, the nurse should not position weights against the foot of the bed as they need to hang freely to be effective, and they also should not adjust the prescribed weights without an order from a healthcare provider, as this could alter the therapeutic effect of the traction.