A nurse is caring for an older adult patient with chronic obstructive pulmonary disease. The patient always remains in a sitting position to help them breathe more easily. Based on this information, what area on the patient's body should be frequently assessed for skin breakdown?
Elbows and behind the ears
Coccyx and back of the skull
Heels and trochanter
Sacrum and ischium
The Correct Answer is D
A. Elbows and behind the ears: These areas are not primary pressure points in a seated position.
B. Coccyx and back of the skull: The coccyx is a pressure point when lying down, but this patient is sitting most of the time.
C. Heels and trochanter: Heels are at risk in supine patients, but this patient is primarily sitting.
D. Sacrum and ischium: The sacrum and ischium (sit bones) bear the most pressure in a seated position, making them highly vulnerable to skin breakdown.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "Everyone knows there are others who can chair this committee better than me." This statement is self-deprecating and does not reflect assertive communication. It shifts responsibility to others instead of setting a clear boundary.
B. "It's just not the right time for me to do this." While this statement declines the opportunity, it leaves room for misinterpretation and follow-up pressure to accept later.
C. "I decline the opportunity at this time." This is a clear, direct, and assertive way to decline without over-explaining or inviting negotiation.
D. "Can you tell me why you chose me?" This response does not decline the role; instead, it invites discussion and may make it harder to say no later.
Correct Answer is C
Explanation
A. Avoid bathing this patient until they are stable: Hygiene is essential for preventing infection and promoting comfort. Bathing should not be entirely avoided unless the patient is critically unstable.
B. Only bathe the perineal area: While perineal care is important, other areas also require cleaning, and modifications can be made to prevent excessive exertion.
C. Perform the bath in a semi-Fowler's position: Semi-Fowler's position (30–45°) promotes lung expansion and reduces dyspnea, making it the best position for bathing a patient with breathing difficulty.
D. Delegate the task to the assistive personnel: While an assistive personnel (AP) can assist, the nurse should assess the patient first and be involved in care for clients with respiratory distress.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.