A nurse is reviewing a client's electronic medical record (EMR). Which of the findings should the nurse identify as a risk factor for a potential accident or injury?
History of dementia
Steady gait
History of gastric reflux
Age of 45
The Correct Answer is A
A. History of dementia- Dementia can impair cognitive function and increase the risk of accidents or injuries, such as falls or wandering.
B. Steady gait- A steady gait indicates good balance and is not typically considered a risk factor for accidents or injuries.
C. History of gastric reflux- Gastric reflux may cause discomfort but is not directly related to an increased risk of accidents or injuries.
D. Age of 45- While age can be a risk factor for certain conditions, such as falls in older adults, being 45 years old alone does not necessarily indicate an increased risk of accidents or injuries.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A) Place a pillow between the client's legs prior to logrolling. - Placing a pillow between the client's legs helps maintain proper alignment of the spine and prevents excessive twisting or stress on the surgical site during logrolling.
B) Place the client in semi-Fowler's position prior to logrolling. - Semi-Fowler's position may not be necessary or appropriate for logrolling a postoperative laminectomy client.
C) Place the client's arms above her head prior to logrolling. - This position may cause discomfort or strain on the client's shoulders and is not recommended for logrolling.
D) Place the bed in the lowest position before logrolling the client. - Lowering the bed is not necessary for logrolling and may not be relevant to the client's comfort or safety during repositioning.

Correct Answer is A
Explanation
A) Cotton-tipped applicator - A cotton-tipped applicator can be used for wound cleaning and dressing application for a stage 4 pressure injury. It allows for gentle cleaning of the wound and application of topical treatments while minimizing trauma to the wound area.
B) Tongue depressor – A tongue depressor is typically used for oral examinations or to apply topical treatments to the mouth. It's not a standard supply for managing a stage 4 pressure injury, which requires specific wound care supplies designed for wound cleaning and dressing application.
C) Adhesive tape - Adhesive tape is commonly used for securing dressings or medical devices, but it may not be the primary supply needed for managing a stage 4 pressure injury. Wound care for a stage 4 pressure injury often involves specialized dressings, cleansing solutions, and applicators rather than adhesive tape alone.
D) Syringe - While syringes are versatile tools used in various medical procedures, in the context of managing a stage 4 pressure injury, their primary use might be for administering medications or irrigation solutions rather than being the essential supply for wound care in this specific instance.
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