A nurse is caring for a client with acute renal failure who is at risk for impaired skin integrity. What intervention should the nurse implement to prevent skin breakdown?
Encourage the client to sit up in a chair for extended periods.
Apply a heating pad to areas at risk for skin breakdown.
Perform regular repositioning and skin assessments.
Use adhesive tape for securing dressings to the skin.
The Correct Answer is C
A. Incorrect. Encouraging the client to sit up in a chair for extended periods can increase pressure on certain areas and contribute to skin breakdown.
B. Incorrect. Applying a heating pad to areas at risk for skin breakdown can lead to thermal injury and exacerbate skin issues.
C. Correct. Regular repositioning and skin assessments are essential in preventing pressure ulcers and maintaining skin integrity in clients with acute renal failure who may be bedridden or have limited mobility.
D. Incorrect. Adhesive tape can cause skin irritation and damage when removed, especially in clients at risk for impaired skin integrity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Incorrect. Hypovolemia is associated with prerenal acute renal failure, not intrinsic acute renal failure.
B. Correct. Glomerulonephritis is one of the common causes of intrinsic acute renal failure. It is characterized by inflammation of the glomeruli in the kidneys, which can lead to kidney damage and impaired function.
C. Incorrect. Prostate enlargement is associated with postrenal acute renal failure due to urinary tract obstruction, not intrinsic causes.
D. Incorrect. Urinary tract obstruction is also associated with postrenal acute renal failure, not intrinsic causes.
Correct Answer is D
Explanation
:
A. Incorrect. Cheese and yogurt are high in phosphate and should be avoided in a low-phosphate diet.
B. Incorrect. Beans and lentils are also high in phosphate and are not suitable for a low-phosphate diet.
C. Incorrect. Eggs and poultry are significant sources of phosphate and are not recommended in a low-phosphate diet.
D. Correct. Fresh fruits and vegetables are generally low in phosphate and are suitable for a low-phosphate diet. These foods can help meet the client's nutritional needs while adhering to the dietary restriction.
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