An older adult male client is participating in a bladder retraining program as part of the treatment for urinary incontinence. The nurse advises him to wear barrier garments, such as liners and protective pants. Which suggestion would be most appropriate to help the client maintain skin integrity?
Exposing the affected area to air.
Avoiding the application of moisture sealant.
Avoiding using an electric room deodorizer.
The Correct Answer is A
Exposing the affected area to air. To maintain skin integrity, the nurse should advise the client to expose the affected area to air.
Barrier garments, such as liners and protective pants, can trap moisture and irritate the skin, which can lead to skin breakdown. Exposing the affected area to air can help keep the skin dry and prevent skin breakdown.
B is not the correct answer because the application of moisture sealant can help protect the skin and prevent skin breakdown.
C is not the correct answer because using an electric room deodorizer is not related to maintaining skin integrity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Inspection, followed by Auscultation, Percussion, and Palpation. Inspection assesses for abdominal contour, symmetry, any visible masses, scars or other abnormalities. Auscultation assesses bowel sounds, and Percussion assesses for any areas of tenderness, and to determine the presence of fluid, gas or masses. Palpation assesses for any masses, areas of tenderness, organ size or other abnormalities. This is the order that allows the nurse to assess the abdomen systematically and accurately.
A: Palpation comes last because it can stimulate bowel sounds, which can make the nurse miss some of the sounds while auscultating.
C: Auscultation must be done before percussion and palpation to prevent altering bowel sounds.
D: Percussion comes before palpation to avoid altering the underlying structures of the abdomen.
Correct Answer is D
Explanation
Necrosis. Necrosis is the death of cells or tissue due to disease, injury, or lack of blood supply. In the process of tissue injury, necrosis occurs in the deepest and most severe area of injury.
Choice A, Hyperemia is an increase in blood flow to an area, causing redness and warmth.
Choice B, Coagulation is the process of blood clotting.
Choice C, Stasis is a reduction in blood flow to an area, causing blood to pool and resulting in tissue hypoxia.
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