When performing a skin assessment, which areas of the skin are at the highest risk for skin breakdown? Select all that apply.

Groin

Соссух

Heels

Scapula

Under the breasts

Answer and Explanation

Correct Answer : A,B,C,E

A.   The groin area is prone to skin breakdown due to friction, moisture, and pressure, especially in immobile patients.
B.   The coccyx (tailbone) is a high-risk area for pressure ulcers due to constant pressure when sitting, particularly in bedridden patients.
C.   The heels are vulnerable to pressure ulcers because they are under constant pressure when lying down or when standing for prolonged periods.
D.   While the scapula may be at risk in certain conditions (e.g., if the patient is immobile and lying on their back), it is generally not as high-risk as other areas like the coccyx or heels.
E.   This area is at risk due to moisture, friction, and pressure from the breast tissue, especially in obese or immobile patients.

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Correct Answer is B

Explanation

A. Scale refers to flakes of dead skin cells and is not typically used to describe acne lesions.
B. Pustules are small, inflamed, pus-filled lesions, which are characteristic of acne.

C. A macule is a flat, discolored spot on the skin and does not apply to the raised, pus-filled lesions seen in acne.
D. A papule is a small, solid, raised lesion, but it is not filled with pus like a pustule. Acne lesions are often described as pustules when they contain pus.

A. Electrical cords are placed along the walls. B. Scatter rugs are present in the kitchen. C. Handrails are present in the bathroom. D. Uses a microwave for cooking.

Correct Answer is B

Explanation

A. Electrical cords along the walls are not a major safety hazard for individuals with visual impairments as long as they are properly secured and out of the way.
B. Scatter rugs in the kitchen can be a significant risk for falls, especially for individuals with decreased vision. Rugs can cause tripping, and if not secured properly, they can be dangerous in areas with high foot traffic like the kitchen.
C. Handrails in the bathroom are actually a safety feature and would help prevent falls in an area with higher risk of slips.
D. Using a microwave for cooking is a safe alternative to using a stove or oven, especially for someone with visual impairment. It is less hazardous since there is no open flame.

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When performing a skin assessment, which areas of the skin are at the highest risk for skin breakdown? Select all that apply.

Nursing Test Bank

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When assessing a client's skin, the nurse finds acne. How would the nurse document the lesions?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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