A nurse is caring for a child in the PICU. To prevent pressure ulcers, which intervention should the nurse include in the child's plan of care?
Avoid the use of a draw sheet when turning
Post a turning schedule at the client's bedside
Vigorously massage lotion into bony prominences
Turn and reposition the client at least every 4 hours
The Correct Answer is B
Turning and repositioning the client at regular intervals is essential for preventing pressure ulcers in pediatric clients, especially those in the PICU who may be immobilized or have limited mobility due to their condition or treatment. Repositioning helps relieve pressure on bony prominences and redistributes pressure on the skin, reducing the risk of pressure ulcers. Turning schedules should be individualized based on the child's condition, mobility, and risk factors for pressure ulcers.
A. Avoid the use of a draw sheet when turning: Using a draw sheet can facilitate safe and smooth turning of the client without causing shear or friction forces. It helps distribute the weight evenly and reduces the risk of injury to the client or caregiver during the turning process. Therefore, avoiding the use of a draw sheet may increase the risk of pressure ulcers rather than prevent them.
B. Post a turning schedule at the client's bedside: While posting a turning schedule may serve as a reminder for staff, it alone does not provide direct intervention to prevent pressure ulcers. The crucial aspect is implementing the turning schedule consistently and ensuring that the client is repositioned at appropriate intervals.
C. Vigorously massage lotion into bony prominences: Massaging lotion into bony prominences can increase friction and shear forces on the skin, potentially causing tissue damage rather than preventing pressure ulcers. Additionally, vigorous massage may be uncomfortable or painful for the client, especially if they have fragile skin or existing pressure ulcers.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is A
Explanation
Excessive milk consumption can lead to iron deficiency anemia in toddlers due to its low iron content and its interference with the absorption of iron from other foods.
B. Excessive milk consumption alone is not a direct risk factor for diabetes mellitus in toddlers. Diabetes mellitus is a metabolic disorder characterized by high blood sugar levels due to insufficient insulin production or insulin resistance.
D. Excessive milk consumption can contribute to excess calorie intake, but it does not necessarily lead to obesity in all cases. Obesity is a multifactorial condition influenced by various factors such as diet, physical activity, genetics, and environmental factors.
Correct Answer is C
Explanation
A. Psoriasis can be associated with discomfort, but it is not typically characterized by intense pain. The primary symptoms are related to skin changes rather than pain.
B. Psoriasis usually presents with bilateral lesions that are symmetrical in distribution. Unilateral lesions are less common in psoriasis.
C. Silvery, white scales. This is a hallmark sign of psoriasis. Clients often have patches of thick, red skin with these distinctive silvery scales.
D. Psoriasis does not typically cause serous drainage. It is a dry skin condition that leads to scaling and flaking rather than wet or serous discharge
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