A nurse is assessing a female client who has pneumonia. The nurse should identify which of the following findings increases the client's risk of skin breakdown?
Receiving bronchodilator medication
Weight loss of 2.8 kg (6.2 b)
Hemoglobin 17 g/dl (12 to 16 g/dL)
Wearing an oxygen device
The Correct Answer is B
Indicates an increased risk of skin breakdown. This is because significant weight loss can lead to muscle wasting and reduced subcutaneous tissue, making the skin more vulnerable.
Bronchodilators, hemoglobin level and oxygen device do not relate directly to skin breakdown
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
D. Diet plays a crucial role in managing ulcerative colitis symptoms. Certain foods may trigger flare-ups, while others may be better tolerated. A dietitian can provide personalized dietary advice to help manage symptoms, ensure adequate nutrition, and optimize overall health.
A. Ulcerative colitis is a chronic inflammatory bowel disease that primarily affects the colon and rectum. While pain management is crucial, it is not a priority at this point.
B. Hospice services are generally provided to individuals who have a terminal illness and are nearing the end of life. While ulcerative colitis can be a serious condition, it is not typically considered a terminal illness in itself.
C. A wound, ostomy, and continence nurse (WOCN) specializes in the care of patients with ostomies (such as those resulting from surgery for ulcerative colitis), wounds, and continence issues. The client does not require the services at this point as the decision for the surgery has not been made.
Correct Answer is D
Explanation
D. Hanging a monthly calendar in the client's bedroom provides a visual aid for tracking important dates and events, which can help maintain their sense of routine and structure.
A. Keeping the client's bedroom dark at night may increase confusion and disorientation, especially if the client wakes up during the night.
B. Placing a large-face clock in the client's bedroom allows them to easily see and understand the time, which can help orient them to the day and reduce confusion. However, it may become monotonous for the client.
C. While it's essential to childproof the home to prevent accidents, covering electrical outlets with tape may not effectively prevent access to them and can pose a fire hazard.
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