A nurse is planning care to prevent skin breakdown for a client who is immobile and has urinary incontinence. Which of the following actions should the nurse include in the plan of care?

Request a prescription for an indwelling urinary catheter.

Arrange for an alternating pressure mattress.

Apply cornstarch to the client's skin.

Reposition the client every 4 hours.

Answer and Explanation

The Correct Answer is B

An alternating pressure mattress can help prevent skin breakdown in a client who is immobile by redistributing pressure and reducing the risk of pressure ulcers. This is an appropriate action for the nurse to include in the plan of care for a client who is immobile and has urinary incontinence.

a. An indwelling urinary catheter can increase the risk of infection and should only be used when other methods of managing urinary incontinence are not eﬀective.

c. Cornstarch can absorb moisture and help keep the skin dry, but it is not recommended for use on broken skin or in areas where there is a risk of fungal infection.

d. Repositioning the client every 4 hours may not be frequent enough to prevent skin breakdown. The client should be repositioned at least every 2 hours to reduce the risk of pressure ulcers.

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Correct Answer is C

Explanation

The nurse should arrange for a video conference with an interpreter who speaks the client's language to provide discharge instructions. This ensures that the client receives accurate and complete information in a language they understand. The other

a. Assistive personnel may not be trained or qualified to provide medical interpretation.

b. Family members may not have the necessary medical knowledge to accurately translate medical information.

d. Simply indicating printed instructions in the client's language may not be sufficient to ensure the client understands the information.

A. Administer 240 mL (8 oz) of oral contrast before the procedure. B. Monitor the client for pain in the suprapubic region. C. Assist the client with a bowel cleansing. D. Ensure the client is free of metal objects.

Correct Answer is C

Explanation

The nurse should assist the client with a bowel cleansing before an intravenous pyelogram. This helps to ensure that the bowel is empty and that the images obtained during the procedure are clear. The other

a. Oral contrast is not typically used for an intravenous pyelogram.

b. Pain in the suprapubic region is not a common side eﬀect of an intravenous pyelogram.

d. Removing metal objects is important for procedures that use magnetic resonance imaging (MRI), but it is not necessary for an intravenous pyelogram.

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A nurse is planning care to prevent skin breakdown for a client who is immobile and has urinary incontinence. Which of the following actions should the nurse include in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning to provide discharge instructions to a client who does not speak the same language as the nurse. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse is planning care for a client who is scheduled for an intravenous pyelogram. Which of the following actions is appropriate for the nurse to include?

Correct Answer is C

Explanation

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