How often should a nurse reposition an immobile patient to prevent pressure ulcers?

Correct Answer: B

Rationale: Repositioning an immobile patient every 2-4 hours prevents pressure ulcers by relieving sustained pressure on bony prominences, allowing blood flow to replenish oxygen and nutrients to tissues. Once a day is insufficient ulcers can form within hours under constant pressure. Weekly repositioning neglects basic care standards, risking severe skin breakdown. Waiting for patient requests is unreliable, as many can't sense discomfort or communicate needs. Evidence-based practice supports this frequency, adjusted to individual risk factors like skin condition or mattress type, making it a cornerstone of preventive nursing care for immobile patients.

Correct Answer: C

Rationale: Using pressure-reducing devices and repositioning promotes skin integrity in bedridden patients by alleviating pressure on vulnerable areas, enhancing circulation, and preventing ulcers. Vigorous massage over bony prominences risks tissue damage, not protection. Prolonged same-positioning causes pressure sores exactly what's to be avoided. Heat packs directly applied can burn or dry skin, worsening integrity. Nurses combine mattresses or cushions with regular turns (e.g., every 2 hours) to distribute weight, a proven strategy for maintaining healthy skin in immobile patients.

Correct Answer: D

Rationale: A warm, moist compress promotes wound healing by increasing blood flow, delivering oxygen and nutrients to the site, and keeping it moist to aid tissue repair and reduce scabbing. Encouraging infection is the opposite moisture must be clean to avoid this. Preventing blood flow contradicts warmth's vasodilating effect. Constricting vessels is cold's role, not warm's. Nurses apply this to enhance circulation and comfort, often for chronic or slow-healing wounds, supporting the body's natural recovery process with controlled application.

Correct Answer: C

Rationale: Explaining meal choices and allowing the patient to decide respects autonomy, boosts morale, and ensures dietary needs align with preferences, enhancing satisfaction. Skipping hygiene risks infection hand washing is non-negotiable. Choosing without input dismisses patient voice, reducing dignity. Serving all at once overwhelms and ignores timing needs. Nurses present options within medical limits, fostering control and comfort, a small but impactful step in holistic care before feeding assistance.

Correct Answer: B

Rationale: Emptying the drainage container frequently prevents overflow, promoting comfort by avoiding leaks or pressure buildup that could irritate the wound site or distress the patient. Waiting until full risks mess and infection, reducing comfort. Discouraging observation might ease anxiety but doesn't address physical needs education can help instead. Limiting fluids alters drainage minimally and risks dehydration, not comfort. Nurses monitor and empty as needed, ensuring the system works smoothly, enhancing patient ease and trust in care.