A nurse is teaching a group of newly licensed nurses about the Braden scale. Which of the following responses by a newly licensed nurse indicates an understanding of the teaching?
"The scale measures six elements."
"The client's age is part of the measurement."
"The higher the score, the higher the pressure injury risk."
"Each element has a range from one to five points."
The Correct Answer is A
A. The Braden scale does evaluate six elements: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
B. The client's age isn't directly part of the Braden scale; it assesses various risk factors, but age isn't one of them.
C. In contrast, the lower the Braden scale score, the higher the risk of pressure injuries.
D. Each element in the Braden scale is rated on a scale from one to four or one to three, depending on the element, not from one to five points.
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Related Questions
Correct Answer is C
Explanation
A. Moving joints to the point of mild pain can cause discomfort or injury and isn't advisable during passive range-of-motion exercises.
B. Moving joints quickly might increase the risk of injury or discomfort and isn't typically recommended for passive range-of-motion exercises.
C. Repeating movements 3 to 5 times is a standard recommendation for passive range-of-motion exercises to improve joint flexibility and prevent stiffness.
D. Performing these movements once a day might not yield optimal benefits for joint mobility in clients with decreased mobility.
Correct Answer is C
Explanation
A. Weighing oneself once weekly may not be frequent enough to monitor changes related to heart failure or medication effects.
B. Taking hydrochlorothiazide in the evening is not usually a crucial safety consideration; it is typically taken in the morning due to its diuretic effects.
C. Leaving a light on in the bathroom at night can prevent falls, which are a significant concern in older adults with heart failure.
D. Taking a hot bath before bedtime might not be a safety consideration related to heart failure or medication use and could potentially cause issues with temperature regulation or dehydration.
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