A nurse is completing an assessment of an older adult client and notes reddened areas over the bony prominences, but the client's skin is intact.

Which of the following interventions should the nurse include in the plan of care?

Apply an occlusive dressing.

Turn and reposition the client every 4 hr.

Support bony prominences with pillows.

Massage the reddened areas three times daily.

Answer and Explanation

The Correct Answer is C

The nurse should include this intervention in the plan of care because it can help relieve pressure on the reddened areas over the client’s bony prominences and prevent the development of pressure injuries.
Choice A is incorrect because applying an occlusive dressing to intact skin over bony prominences is not an appropriate intervention for preventing pressure injuries.
Choice B is incorrect because turning and repositioning the client every 4 hours may not be frequent enough to prevent the development of pressure injuries.
The client should be turned and repositioned more frequently, at least every 2 hours.
Choice D is incorrect because massaging reddened areas over bony prominences is not recommended as it can cause further damage to the skin and underlying tissues.

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Correct Answer is D

Explanation

One of the lifestyle changes that doctors recommend for managing symptoms of gastroesophageal reflux disease (GERD) is elevating the head during sleep by placing a foam wedge or extra pillows under the head and upper back to incline the body and raising the head off the bed 6 to 8 inches.
Choice A: “Increase your caloric intake by 250 calories per day” is not an answer because it is not mentioned as a self-management strategy for GERD in my sources.
Choice B: “Lie down for 30 minutes after each meal” is not an answer because it is not mentioned as a self-management strategy for GERD in my sources.
Choice C: “Eat a light meal 1 hour before bedtime” is not an answer because it is not mentioned

A. "You will receive a general anesthetic during the procedure.". B. "You should plan to remain in bed for 18 hours after the procedure.". C. "You should expect a warm sensation after the injection of the contrast dye during the procedure.". D. "You will have blood pressure measurements every 5 minutes for the first 2 hours after the procedure.".

Correct Answer is C

Explanation

“You should expect a warm sensation after the injection of the contrast dye during the procedure.” During cardiac catheterization, a contrast dye is injected into the body to highlight blood flow through the arteries and show blockages in the blood vessels that lead to the heart.
This can cause a warm sensation.
Choice A is incorrect because usually, patients are awake during cardiac catheterization but are given medications to help them relax.
Choice B is incorrect because recovery time for a cardiac catheterization is quick.
Choice D is incorrect because there is no information found to support this statement.

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A nurse is completing an assessment of an older adult client and notes reddened areas over the bony prominences, but the client's skin is intact. Which of the following interventions should the nurse include in the plan of care?

Nursing Test Bank

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A nurse is completing an assessment of an older adult client and notes reddened areas over the bony prominences, but the client's skin is intact.

Which of the following interventions should the nurse include in the plan of care?