A nurse assesses clients on a medical-surgical unit.
Which client is at greatest risk for pressure injury development?

Choice A rationale

Abrasive pumice stones should be avoided in peripheral vascular disease. The reduced blood flow and neuropathy in this condition make the skin more fragile and susceptible to injury. Abrasions or small cuts from a pumice stone can lead to non-healing ulcers and serious infections due to poor circulation.

Choice B rationale

Wearing cheap flip-flops is not a good practice. They offer inadequate support and protection. Clients with peripheral vascular disease often have reduced sensation (neuropathy), making them unaware of foot injuries from ill-fitting or unprotected footwear. Properly fitting, supportive shoes are essential for foot protection.

Choice C rationale

Keeping feet dry, especially between the toes, prevents maceration and fungal infections like athlete's foot. In peripheral vascular disease, even minor skin breaks can become entry points for pathogens, leading to severe infections and ulcers that are difficult to heal due to compromised circulation.

Choice D rationale

Applying lotion is beneficial for dry skin but it should not be applied between the toes. Applying lotion between the toes can create a moist environment that promotes fungal growth. Fungal infections can lead to skin breakdown, which is a significant risk for ulceration and infection in clients with poor circulation.

Choice E rationale

Washing feet in room-temperature water is critical for client safety. Clients with peripheral vascular disease often have sensory deficits (neuropathy) and may not be able to accurately perceive temperature. Using hot water could easily cause burns, which in a client with poor circulation can lead to severe, non-healing wounds.

Choice F rationale

Daily inspection of the feet is a cornerstone of self-care for peripheral vascular disease. Clients should be taught to look for any cuts, sores, blisters, or redness. Early detection of these issues allows for prompt intervention before they can progress into serious, difficult-to-treat infections or ulcers.

Choice A rationale

Certain broad-spectrum antibiotics, such as tetracyclines, can alter the gut flora responsible for enterohepatic circulation of estrogens. This disruption can reduce the reabsorption of ethinyl estradiol, the synthetic estrogen in oral contraceptives, from the gut. The decreased serum levels of the hormone may lead to a reduction in the contraceptive's effectiveness, increasing the risk of unintended pregnancy. A backup birth control method should be used.

Choice B rationale

Urinary burning and frequency are more commonly associated with urinary tract infections (UTIs) or some sexually transmitted infections, and not a typical side effect of antibiotics used for acne like tetracyclines or minocycline. These symptoms would indicate an inflammatory process in the urinary tract, which is distinct from the mechanism of action and side effect profile of these specific antibiotics.

Choice C rationale

Breast engorgement is a physiological condition often associated with hormonal fluctuations during the postpartum period or premenstrually. It is not a recognized side effect of systemic antibiotics used to treat acne. The mechanism of action of these medications does not involve hormonal pathways that would lead to breast tissue swelling and tenderness.

Choice D rationale

While some antibiotics can predispose to vaginal yeast infections (vaginitis) by disrupting the normal vaginal flora, this is not a side effect of all antibiotics used for acne. The reduction of beneficial lactobacilli can allow for an overgrowth of Candida albicans, leading to symptoms like itching and discharge, which is a known risk with some antibiotic classes but not a universal side effect across all.