A nurse is providing care for clients on a medical-surgical unit.
Which of the following clients should the nurse identify as being at risk for the development of pressure ulcers? (Select all that apply.)

Choice A rationale

Decreased range of motion in a single joint, such as the right knee in a 77-year-old patient, can be attributed to various age-related changes like osteoarthritis or previous injury. While it warrants assessment, a recent loss of balance and fall is a more acute and potentially serious finding that requires immediate attention due to the increased risk of injury.

Choice B rationale

A history of recent loss of balance and a fall in an elderly patient is a significant finding that requires immediate further nursing assessment and intervention. Falls can lead to serious injuries, such as fractures, and may indicate underlying medical conditions, medication side effects, or environmental hazards that need to be addressed to prevent future falls.

Choice C rationale

Symmetric joint swelling of the fingers in a 77-year-old patient could be indicative of rheumatoid arthritis, an autoimmune condition more common in older adults. While it requires further assessment and diagnosis, it is generally a chronic condition and less immediately life-threatening than a recent fall.

Choice D rationale

A report of left hip aching when jogging in a 77-year-old patient could be related to musculoskeletal issues like arthritis or muscle strain. While it warrants assessment and management to improve comfort and mobility, it is less concerning in the immediate term compared to a recent loss of balance and fall, which poses a higher risk of acute injury. .

Choice A rationale

Pantothenic acid (vitamin B5) is involved in fatty acid metabolism and coenzyme A synthesis, while vitamin B6 (pyridoxine) is crucial for amino acid metabolism and neurotransmitter synthesis. Prednisone does not typically lead to deficiencies in these vitamins.

Choice B rationale

Biotin (vitamin B7) plays a role in carbohydrate, fat, and protein metabolism, and vitamin B2 (riboflavin) is essential for cellular respiration and energy production. Prednisone therapy is not directly linked to a need for these supplements.

Choice C rationale

Folic acid (vitamin B9) is necessary for DNA synthesis and cell division, and vitamin C (ascorbic acid) is an antioxidant involved in collagen synthesis and immune function. Prednisone's effects do not primarily target these metabolic pathways to cause deficiencies.

Choice D rationale

Long-term prednisone therapy can lead to bone demineralization by increasing osteoclast activity and decreasing calcium absorption in the gut, thus increasing the risk of osteoporosis. Vitamin D is essential for calcium absorption and bone health. Supplementation with calcium and vitamin D helps to mitigate these adverse effects of prednisone. Normal serum calcium levels range from 8.5 to 10.5 mg/dL, and normal vitamin D levels are generally considered to be between 20 to 50 ng/mL, although optimal levels may vary.