Which older adult on bed rest is most at risk to develop skin breakdown? A client who:.

Applies powder after drying the skin.

Has been NPO for four days.

Bathes twice a week.

Has hypertension.

Answer and Explanation

The Correct Answer is B

A client who has been NPO for four days is most at risk to develop skin breakdown. This is because being NPO (nothing by mouth) can lead

to malnutrition and dehydration, which are both risk factors for bedsores. Malnutrition can impair the skin’s ability to heal and resist infection, while dehydration can make the skin dry and fragile.

Choice A is wrong because applying powder after drying the skin can help prevent moisture and friction, which are also risk factors for bedsores.

Choice C is wrong because bathing twice a week may not be frequent enough to keep the skin clean and free of irritants, which can also contribute to bedsores.

Choice D is wrong because hypertension (high blood pressure) does not directly cause bedsores, although it may be associated with other conditions that affect blood circulation and tissue oxygenation.

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Correct Answer is B

Explanation

Decreased sensory acuity. This is a physiological change that occurs in elderly people due to the reduced function of the sensory organs, such as the eyes, ears, nose, tongue, and skin. Elderly people may experience impaired vision, hearing loss, reduced smell and taste, and decreased touch sensitivity.

Choice A is wrong because diminished attention span is not a normal physiological change in elderly people. It may be a sign of cognitive impairment or dementia.

Choice C is wrong because the increased need for rest is not a normal physiological change in elderly people. It may be a sign of fatigue, depression, or medical conditions.

Choice D is wrong because enhanced intestinal motility is not a normal physiological change in elderly people. It may be a sign of gastrointestinal disorders or infections.

A. Formed stool two times per day, every day, for one week. B. Use of soap sud enemas weekly to promote elimination. C. Continued use of laxatives at half of the prescribed dose. D. A formed, soft stool at regular intervals without the use of a laxative.

Correct Answer is A

Explanation

Formed stool two times per day, every day, for one week. This indicates that bowel training is attaining the desired outcome because it shows regularity and consistency of bowel movements without the use of laxatives or enemas.

Choice B is wrong because soap sud enemas are not recommended for bowel training as they can irritate the bowel and cause fluid and electrolyte imbalance.

Choice C is wrong because continued use of laxatives can inhibit the natural defecation reflexes and cause dependency.

Choice D is wrong because a formed, soft stool at regular intervals without the use of a laxative is a normal defecation pattern, not an indication of fecal incontinence.

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Which older adult on bed rest is most at risk to develop skin breakdown? A client who:.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which physiological change should a nurse expect to observe when assessing an elderly client?

Correct Answer is B

Explanation

Which finding, if identified in a client who is being treated for fecal incontinence would indicate that the bowel training is attaining the desired outcome?

Correct Answer is A

Explanation

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