A nurse is caring for a patient with limited mobility and is planning interventions to prevent pressure injuries. What action by the nurse demonstrates evidence-based practice in pressure injury prevention?

Correct Answer: C

Rationale: Placing the patient on an alternating pressure mattress demonstrates evidence-based practice in pressure injury prevention. Alternating pressure mattresses are designed to change pressure points by alternating pressure across different parts of the body, reducing the risk of pressure injuries. Regularly turning and repositioning the patient (Choice B) is also important in preventing pressure injuries, but an alternating pressure mattress provides additional support and prevention measures. Applying moisturizing lotion (Choice A) and massaging bony prominences (Choice D) may be beneficial for skin care, but they are not proven strategies for pressure injury prevention.

Correct Answer: C

Rationale: Collaborating with interdisciplinary team members to develop a comprehensive care plan demonstrates effective care coordination. In complex healthcare situations, involving various healthcare providers such as physicians, specialists, therapists, social workers, and others is crucial to ensure that all aspects of the patient's care are addressed holistically. By working together, healthcare professionals can share information, expertise, and insights to develop a well-rounded care plan that considers all aspects of the patient's needs. This collaborative approach helps promote better outcomes for the patient and enhances overall care coordination. It also helps to ensure that the patient's preferences and values are taken into account when developing the care plan.

Correct Answer: D

Rationale: The correct action to prioritize during the initial assessment when preparing to assist with a cardiopulmonary resuscitation (CPR) procedure for a patient in cardiac arrest is to assess the patient's airway, breathing, and circulation (ABCs). This involves quickly checking the patient's airway for any obstructions, assessing their breathing for signs of breathing difficulties or absence of breathing, and evaluating their circulation by checking for a pulse. This step is crucial in determining the need for immediate intervention, such as clearing the airway, providing rescue breaths, or initiating chest compressions. By prioritizing the assessment of the ABCs, the nurse can promptly identify and address life-threatening issues to improve the patient's chances of survival during a cardiac arrest situation.

Correct Answer: A

Rationale: The nurse should prioritize adjusting the irrigation flow rate based on the patient's urine output to prevent complications during continuous bladder irrigation (CBI). Proper adjustment of the irrigation flow rate helps maintain adequate bladder drainage while preventing bladder distention, clot formation, and potential irrigation fluid overload. Monitoring the patient's urine output and adjusting the flow rate accordingly ensures optimal functioning of the CBI system and enhances patient safety. This proactive approach minimizes the risk of complications and promotes effective postoperative care following urological surgery.

Correct Answer: C

Rationale: Scabies is a contagious skin infestation caused by the Sarcoptes scabiei mite. The classic presentation of scabies includes a rash characterized by erythematous papules and vesicles that are arranged in a linear or burrow-like distribution. These linear tracks are often seen in areas such as the interdigital spaces, wrists, elbows, axillae, belt line, and genitalia. It is commonly associated with intense itching, especially at night. Unlike psoriasis, which presents with silvery scales and well-defined borders, or contact dermatitis, which results from exposure to a specific allergen or irritant, scabies is caused by a parasitic mite infestation. Atopic dermatitis, on the other hand, is a chronic inflammatory skin condition characterized by pruritic eczematous lesions, but it typically does not manifest with a linear distribution of lesions like scabies.