A nurse is caring for a client who is malnourished with poor skin integrity. The nurse should utilize which type of dressing to protect the client's bony prominences?
Foam
Non-adherent
Ace bandage
Hydrocolloid
The Correct Answer is B
A. Foam:
Explanation: Foam dressings are highly absorbent and provide cushioning and protection to wounds. They are suitable for wounds with moderate to heavy drainage. While foam dressings are excellent for wound exudate management, they are not specifically designed for protecting bony prominences or areas with poor skin integrity.
B. Non-adherent:
Explanation: Non-adherent dressings are made from materials that do not stick to the wound bed. They are ideal for fragile skin, bony prominences, or superficial wounds where minimizing trauma during dressing changes is important. Non-adherent dressings are often used for preventing further skin damage in malnourished clients with poor skin integrity.
C. Ace bandage:
Explanation: Ace bandages, or elastic bandages, are primarily used for providing compression and support to injured joints or muscles. They are not designed for protecting bony prominences or fragile skin areas. Using an Ace bandage on a bony prominence could lead to pressure points and skin damage.
D. Hydrocolloid:
Explanation: Hydrocolloid dressings are absorbent and form a gel-like barrier when they come into contact with wound exudate. They provide a moist environment that supports healing and autolytic debridement. Hydrocolloid dressings are suitable for wounds with light to moderate drainage. While they are beneficial for certain wounds, they are not specifically indicated for protecting bony prominences in malnourished clients.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The findings of pale and cool skin on the lower legs, along with small circular ulcers on the soles of the feet, are indicative of arterial insufficiency. Arterial insufficiency occurs when there is a decreased blood flow to the extremities, often due to conditions such as atherosclerosis or peripheral arterial disease. This reduced blood flow can result in pale and cool skin, as well as the development of ulcers, which are typically round and have well-defined borders. It is essential to assess and manage arterial insufficiency promptly to prevent complications like tissue necrosis and gangrene.
Correct Answer is A
Explanation
A. "I will reduce my intake of vitamin K-rich foods."
Vitamin K is essential for bone health as it helps in the regulation of calcium within bones and blood vessels. Therefore, reducing the intake of vitamin K-rich foods would not be beneficial for preventing osteoporosis. In fact, adequate intake of vitamin K is important for bone health.
B. "I will limit my intake of soft drinks." - Soft drinks, especially cola beverages, contain phosphoric acid, which can leach calcium from bones, making them weaker and more susceptible to fractures.
C. "I will reduce my intake of sodium." - High sodium intake can lead to increased calcium excretion in the urine, potentially weakening bones over time. Reducing sodium intake can help in preventing bone loss.
D. "I will decrease my intake of caffeine." - Excessive caffeine consumption can interfere with calcium absorption, contributing to bone loss. Decreasing caffeine intake is advisable for maintaining bone health.
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