The nurse is assessing the patient's output for the shift. What finding is most concerning?

A. A patient who is lying on wrinkled sheets: Wrinkled sheets can cause pressure injuries, but they do not directly lead to shearing.

B. A patient who is pulled up in the bed by the nurse: Shearing occurs when the skin remains in place while underlying tissues move, often when a patient is dragged up in bed instead of lifted. This can damage skin layers and underlying tissues.

C. A patient who is frequently incontinent: Incontinence increases the risk of moisture-associated skin damage and pressure injuries but is not directly related to shearing.

D. A patient who is noted to have slough tissue: The presence of slough (dead tissue in a wound) indicates existing tissue damage but does not suggest an increased risk of shearing.

A. "It is okay to take laxatives every day to help you have a bowel movement." Frequent laxative use can lead to dependence and decreased bowel function over time. Instead, non-pharmacologic measures such as fiber intake, hydration, and physical activity should be encouraged first.

B."Do not ignore the urge to have a bowel movement even if you feel it is inconvenient." Ignoring the urge can lead to constipation as stool remains in the colon longer, resulting in increased water absorption and harder stools. Encouraging regular bowel habits helps maintain normal function.

C. "Do not take opiate medications as those can cause constipation." While opiates can cause constipation, this statement is too broad. Some individuals may require opioid therapy for pain management. Instead, the focus should be on preventing and managing opioid-induced constipation rather than avoiding these medications altogether.

D. "Be sure to eat at least 20 grams of fiber and drink at least 1,000mL per day." While increasing fiber intake is important, 20 grams may not be sufficient (the recommended daily fiber intake for older adults is about 25–30 grams). Additionally, 1,000 mL (1 liter) of fluid may be inadequate, as older adults should aim for at least 1,500–2,000 mL per day unless contraindicated.