After educating a caregiver of a home care client, a nurse assesses the caregiver's understanding. Which statement indicates that the caregiver needs additional education?
a. I can help him shift his position every hour when he sits in the chair.
b. If his tailbone is red and tender in the morning, I will massage it with baby oil.
c. Applying lotion to his arms and legs every evening will decrease dryness.
d. Drinking a nutritional supplement between meals will help maintain his weight.
Question 2A nurse is caring for a client who has a pressure ulcer on the right ankle. Which action should the nurse take first?
a. Draw blood for albumin, prealbumin, and total protein.
b. Prepare for and assist with obtaining a wound culture.
c. Place the client in bed and instruct the client to elevate the foot.
d. Assess the right leg for pulses, skin color, and temperature.
Question 3A nurse cares for a client who has a deep wound that is being treated with a wet-to-damp dressing. Which intervention should the nurse include in this client's plan of care?
a. Change the dressing every 6 hours.
b. Assess the wound bed once a day.
c. Change the dressing when it is saturated.
d. Contact the provider when the dressing leaks.
Question 4When transferring a client into a chair, a nurse notices that the pressure-relieving mattress overlay has deep imprints of the client's buttocks, heels, and scapulae. Which action should the nurse take next?
a. Turn the mattress overlay to the opposite side.
b. Do nothing because this is an expected occurrence.
c. Apply a different pressure-relieving device.
d. Reinforce the overlay with extra cushions.
Question 5A nurse assesses clients on a medical-surgical unit. Which client is at greatest risk for pressure ulcer development?
a. A 44-year-old prescribed IV antibiotics for pneumonia
b. A 26-year-old who is bedridden with a fractured leg
c. A 65-year-old with hemi-paralysis and incontinence
d. A 78-year-old requiring assistance to ambulate with a walker
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