A nurse is collecting data from a client who has pernicious anemia.
The nurse should identify that which of the following findings increases the client's risk for injury?

The correct answer is choiced. “I try not to look at the scales on my body.”

Choice A rationale:Limiting time spent in sunlight is generally a good practice for individuals with psoriasis, as excessive sun exposure can trigger flare-ups or worsen symptoms.

Choice B rationale:Removing old medication before applying a new dose is a proper practice to ensure the effectiveness of the treatment and prevent skin irritation.

Choice C rationale:Avoiding fabric softener is advisable for individuals with psoriasis, as fabric softeners can contain chemicals that may irritate sensitive skin.

Choice D rationale:This statement indicates a potential psychological impact of psoriasis on the client. It suggests that the client might be experiencing distress or avoidance behavior due to the appearance of their skin, which should be reported to the provider for further assessment and support.

The correct answers are C and D.

Choice A reason: Preferred bath time is a personal preference and comfort-related aspect of patient care. While it is important for overall patient satisfaction and care planning, it is not critical information for a change-of-shift report following a total knee arthroscopy. The focus in such reports is typically on clinical status, immediate care needs, and potential complications.

Choice B reason: Admission vital signs are the initial measurements taken upon the patient’s admission to the healthcare facility. These are baseline values that can be referenced later to note any significant changes. However, for a change-of-shift report, especially 2 days postoperative, the most current vital signs and any changes since surgery are more pertinent than the admission values.

Choice C reason: The time of the last pain medication is crucial information for a change-of-shift report. Pain management is a key aspect of postoperative care, particularly after procedures like total knee arthroscopy. Knowing when the last dose was administered helps the incoming nurse manage the patient’s pain effectively and anticipate when the next dose is due.

Choice D reason: The steps required for dressing change are essential to include in the change-of-shift report. Proper wound care and dressing changes are vital to prevent infection and ensure proper healing after surgery. Detailed instructions on the dressing change process help maintain consistency in care between different caregivers.