what nursing interventions increase the risk the pressure injuries

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. What nursing interventions increase the risk the pressure injuries?

A. Padding hard surfaces
B. Have client sit in wheelchair as much as possible
C. Place pillows between bony surfaces
D. Keep head of bed (HOB) at or less than 3

Correct answer: B

Rationale:

2. Which client is at highest risk of compromised immunity?

A. A client who just had surgery
B. A client who just delivered a baby
C. A client with extreme anxiety
D. A client who is awaiting surgery

Correct answer: A

Rationale:

3. During a skin inspection at the outpatient clinic, the nurse notices patches of thick, red skin with silvery scales on the client's elbows and knees. What skin abnormality does the nurse suspect?

A. Scabies
B. Rosacea
C. Psoriasis
D. Statis dermatitis

Correct answer: C

Rationale:

4. What evaluation indicates successful progress on the client goal of increasing daily physical activity?

A. The client reports decreased social interaction
B. The client reports more nonsteroidal anti-inflammatory drug (NSAID) use
C. The client reports a fall
D. The client reports less fatigue walking up stairs

Correct answer: D

Rationale: The correct answer is D because reporting less fatigue when walking up stairs indicates improved physical endurance, showing progress in increasing daily activity. Choices A, B, and C are incorrect because decreased social interaction, increased NSAID use, and experiencing a fall are not indicators of successful progress in increasing daily physical activity.