Exhibits
Complete the following sentence by using the list of options.
Mrs. Thompson is at high risk for developing
The Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"C"}
Mrs. Thompson is at high risk for developing pressure sores evidenced by the client's end-of-life stage and deteriorating condition.
Emotional distress. While emotional distress is common in end-of-life patients, Mrs. Thompson has already expressed her wishes for a peaceful, pain-free death and has family support for decision-making. Emotional distress is not the primary risk factor for physical complications such as pressure sores.
Dehydration. Decreased oral intake is expected in the end-of-life stage, but dehydration does not directly cause pressure sores. While maintaining comfort is important, forced hydration is often avoided as it may not improve the patient’s quality of life.
Pressure sores. Mrs. Thompson’s declining condition and decreased mobility put her at high risk for developing pressure sores. Limited movement reduces circulation to pressure points such as the heels and sacrum, leading to tissue breakdown. Preventive measures such as repositioning and skin care should be prioritized.
Frequent movement and activity. This is incorrect because frequent movement reduces the risk of pressure sores by promoting circulation and relieving pressure on bony areas. Mrs. Thompson's deteriorating condition likely limits her mobility, making this choice inappropriate.
Ability to communicate their needs. This is incorrect because even if a patient can verbalize discomfort, they may still be unable to move independently. Pressure sores develop primarily due to immobility rather than communication barriers.
End-of-life stage and deteriorating condition. This is correct because patients nearing the end of life experience profound weakness, reduced circulation, and prolonged immobility, all of which increase the risk of pressure sores. These factors make skin breakdown prevention a key nursing priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Supporting the client's wish to refuse prescribed medications. Autonomy refers to the right of individuals to make their own decisions regarding their healthcare. If a client chooses to refuse medication, the nurse must respect this decision, as long as the client is deemed competent to make informed choices.
B. Explaining unit rules and policies regarding unacceptable behaviors. This action supports a structured therapeutic environment but does not specifically relate to autonomy. It aligns more with beneficence (acting in the client’s best interest) and justice (ensuring fairness in care).
C. Making sure the client understands expectations for client participation. Ensuring understanding of treatment expectations promotes informed participation but does not directly uphold the ethical principle of autonomy, which emphasizes the right to make personal choices.
D. Encouraging client feedback about satisfaction with the facility experience. Seeking client feedback supports patient-centered care but does not specifically demonstrate autonomy, which involves the right to accept or refuse medical interventions.
Correct Answer is C
Explanation
A. Take the medication with an aspirin to increase effectiveness. Ibuprofen and aspirin are both NSAIDs, and taking them together increases the risk of gastrointestinal bleeding and ulcers. Ibuprofen can also reduce the antiplatelet effects of aspirin, potentially decreasing its cardiovascular benefits.
B. Sustained-release forms may be crushed for easier administration. Sustained-release formulations are designed to release the drug gradually over time. Crushing them can lead to rapid drug absorption, increasing the risk of toxicity and side effects.
C. Take the medication with food. Ibuprofen can cause gastrointestinal irritation, ulcers, and bleeding, especially with prolonged use. Taking it with food helps protect the stomach lining and reduces the risk of gastrointestinal side effects.
D. Taking the maximum dose will offer stroke prevention. Ibuprofen is not used for stroke prevention. High doses of NSAIDs may increase the risk of cardiovascular events, including heart attacks and strokes, rather than preventing them.
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