A nurse is caring for a female client who had a stroke. Which of the following findings should indicate to the nurse that the client has an increased risk of developing skin breakdown?

Hgb 18 g/dL (12 to 16 g/dl)

WBC 12.000/mm3 (5,000 to 10,000/mm3)

25-Hydroxyvitamin D 92 ng/ml. (25 to 80 ng/mL)

Albumin 3.1 g/dL (3.5 to 5 g/dL)

Answer and Explanation

The Correct Answer is D

Albumin is a protein that plays a crucial role in maintaining skin health. Low albumin levels (hypoalbuminemia) can lead to poor wound healing and skin vulnerability.

Hemoglobin level, white cell count and 25-hydroxyvitamin have no direct role in skin breakdown.

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Correct Answer is A

Explanation

A. Malnutrition can lead to inadequate intake of essential nutrients, such as vitamins and minerals, which are necessary for maintaining healthy hair growth.
B. Double vision, or diplopia, is more commonly associated with neurological or ocular conditions rather than malnutrition.
C. Malnutrition may result in dry, flaky skin due to deficiencies in essential fatty acids and other nutrients.
D. While malnutrition can affect various physiological processes, increased salivation is not a common manifestation of mal

A. Use an elevated toilet seat. B. Log roll the client onto the operative side. C. Keep client's affected heel on the bed. D. Perform internal and external rotation exercises of hip.

Correct Answer is A

Explanation

A. Use an elevated toilet seat: Using an elevated toilet seat can help prevent excessive bending of the hip joint, reducing strain and potential dislocation risk after total hip replacement surgery.
B. Log rolling onto the operative side is contraindicated after total hip replacement surgery. This movement could place excessive stress on the newly replaced hip joint, increasing the risk of dislocation and complications.
C. Keeping the affected heel on the bed helps maintain proper alignment and precautions after total hip replacement surgery. It supports the hip joint and reduces the risk of dislocation by preventing excessive rotation or movement.
D. While some hip exercises are beneficial, internal and external rotation exercises are typically avoided immediately after total hip replacement surgery to prevent strain on the new joint.

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A nurse is caring for a female client who had a stroke. Which of the following findings should indicate to the nurse that the client has an increased risk of developing skin breakdown?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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