A nurse is caring for a client who has herpes zoster.
Which of the following findings should the nurse expect?

Choice A rationale

A client who is ambulatory following a cardiac catheterization 4 hours ago has increased mobility, which reduces the risk of prolonged pressure on bony prominences. The short duration post-procedure and ability to ambulate make this client less susceptible to pressure ulcer development.

Choice B rationale

Postoperative delirium can lead to decreased mobility, increased agitation and friction against surfaces, and impaired ability to communicate discomfort or reposition themselves. These factors significantly increase the risk of prolonged pressure and subsequent pressure ulcer formation.

Choice C rationale

Protein-calorie malnutrition results in decreased subcutaneous tissue and muscle mass, which normally provide cushioning over bony prominences. Poor nutritional status also impairs tissue repair and increases skin fragility, making the client highly susceptible to pressure ulcer development.

Choice D rationale

Right-sided heart failure can cause fluid overload and peripheral edema, particularly in the lower extremities. This edema increases tissue fragility and reduces blood flow to the skin, making it more susceptible to breakdown and pressure ulcer formation, especially in areas with bony prominences like heels and ankles.

Choice E rationale

While hyperglycemia in type 1 diabetes mellitus can impair wound healing and increase the risk of infection if a pressure ulcer develops, it is not a direct primary risk factor for the initial development of pressure ulcers. Immobility, malnutrition, and edema are more direct contributors to skin breakdown due to pressure.

Choice A rationale

Checking blood glucose levels for hypoglycemia once yearly is insufficient for a patient taking high doses of oral glucocorticoids for an extended period. Glucocorticoids can cause hyperglycemia by increasing gluconeogenesis and insulin resistance. Therefore, blood glucose monitoring should be more frequent, especially when initiating or adjusting the dosage. Normal fasting blood glucose levels are typically 70-99 mg/dL.

Choice B rationale

Limiting the intake of calcium-rich foods is incorrect advice for a patient on long-term glucocorticoid therapy. Glucocorticoids can decrease calcium absorption from the gut and increase bone resorption, leading to osteoporosis. Therefore, patients on these medications should be encouraged to maintain an adequate intake of calcium and vitamin D to help preserve bone density. Normal total serum calcium levels range from 8.6 to 10.2 mg/dL.

Choice C rationale

Monitoring for fractures over the next several months is an important instruction for a patient taking high doses of oral glucocorticoids long-term. Glucocorticoids increase the risk of osteoporosis and subsequent fractures, particularly vertebral compression fractures and hip fractures, due to their effects on bone metabolism. Regular monitoring and preventive measures are crucial.

Choice D rationale

Glucocorticoids do not boost immunity; instead, they suppress the immune system by inhibiting the production and function of various immune cells and inflammatory mediators. This immunosuppressive effect is why they are used to treat autoimmune diseases like rheumatoid arthritis, but it also increases the risk of infections.