During the admission assessment to the hospital, a male client reports that he is allergic to latex, penicillin, and bananas. Which intervention should the nurse implement first?

Send a list of medication allergies to the pharmacy.

Secure an allergy bracelet around the client's wrist.

Notify the dietary department of the client's fruit allergy.

Place a latex-free supply cart outside the client's room.

Answer and Explanation

The Correct Answer is B

A. Sending a list of medication allergies to the pharmacy is important for preventing adverse drug reactions but is not the immediate priority upon admission.
B. Securing an allergy bracelet around the client's wrist is the first action to ensure that all healthcare providers are immediately aware of the client's allergies, which is crucial for preventing accidental exposure to allergens.
C. Notifying the dietary department is important to prevent allergic reactions from food, but addressing the most immediate concern ensuring the client’s allergies are known to all involved in their care is a higher priority.
D. Placing a latex-free supply cart outside the room is important for preventing latex exposure but is secondary to ensuring that the client’s allergies are clearly communicated through an allergy bracelet.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Applying a lubricating lotion helps to combat dryness and maintain skin moisture, which is particularly beneficial as skin turgor decreases with age. This is a direct way to address common skin issues in older adults.
B. Padding bony prominences helps to prevent pressure ulcers but does not address the issue of decreased skin turgor directly.
C. Encouraging a high-protein diet is beneficial for overall skin health and repair but is not specifically aimed at addressing the immediate changes in skin turgor due to aging.
D. Bathing with mild soap is gentle on the skin but does not specifically address the loss of skin turgor. Using a lotion or moisturizer directly addresses the dryness and potential discomfort associated with aging skin.

A. Apply a warm compress to the sacral area. B. Wash the area with soap and water. C. Reassess and turn the client in 30 minutes. D. Massage the reddened area with lotion.

Correct Answer is C

Explanation

A. Applying a warm compress does not address the prevention of pressure ulcers and could potentially exacerbate skin issues. The primary focus should be on preventing further pressure.
B. Washing the area with soap and water does not effectively address the issue of pressure ulcer risk or the need for repositioning to alleviate pressure.
C. Reassessing and turning the client every 30 minutes helps prevent the development of pressure ulcers by relieving pressure on vulnerable areas, which is crucial for maintaining skin integrity.
D. Massaging the reddened area can cause further damage and is not recommended. Proper repositioning and pressure relief are the appropriate interventions.

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During the admission assessment to the hospital, a male client reports that he is allergic to latex, penicillin, and bananas. Which intervention should the nurse implement first?

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Naxlex Comprehensive Predictor Exams

The nurse knows that skin turgor changes with age. Which intervention is most helpful in dealing with normal aging changes of the skin?

Correct Answer is A

Explanation

When turning a male client who has been lying on his back for 2 hours, the nurse notes that the skin over his sacrum is very white. The client is repositioned and when the nurse reassesses the sacrum 2 hours later, the area is bright red. Which intervention should the nurse implement?

Correct Answer is C

Explanation

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