ATI Fundamentals 100 Exam 4 | Nurselytic

Questions 61

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ATI Fundamentals 100 Exam 4 Questions

Extract:


Question 1 of 5

The nurse is caring for a client who is able to move Independently, but has been placed on bedrest with bathroom priviledges only due to their current treatment. The client has experienced two episodes of functional urinary incontinence. Which intervention(s) should the nurse include in the care plan? (SELECT ALL THAT APPLY)

Correct Answer: A,B,C

Rationale:
Correct
Answer: A, B, C


Rationale:
A: Applying moisture barrier cream to perineal skin helps protect the skin from breakdown due to prolonged exposure to urine, reducing the risk of skin irritation and infection.
B: Consulting with the wound care nurse about the use of a specialty mattress can help prevent pressure ulcers from developing due to prolonged bedrest.
C: Instructing the client to shift their weight at least every 15 minutes helps prevent pressure injuries and promotes circulation, reducing the risk of skin breakdown.

Incorrect

Choices:
D: Keeping the head of the bed raised at 45 degrees at all times may not be necessary and could lead to discomfort for the client.
E: Massaging over bony prominences every hour while awake may increase the risk of skin breakdown and pressure injuries rather than prevent them.

Question 2 of 5

Correct Answer:

Rationale:

Question 3 of 5

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Rationale:

Question 4 of 5

Correct Answer:

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Question 5 of 5

Correct Answer:

Rationale:

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