The patient has a risk for skin impairment and has a 15 on the Braden Scale upon admission. The nurse has implemented interventions. Upon reassessment, which Braden score will be the best sign that the risk for skin breakdown is removed?
a. 12
b. 13
c. 20
d. 23
ANS: D
The best sign is a perfect score of 23. The Braden Scale is composed of six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. The total score ranges from 6 to 23, and a lower total score indicates a higher risk for pressure ulcer development. The cutoff score for onset of pressure ulcer risk with the Braden Scale in the general adult population is 18.
You might also like to view...
Which of the following patients is most likely to benefit from the administration of epoetin alfa?
A) A toddler who has just been diagnosed with hemophilia A B) A 44-year-old man who suffered a workplace accident resulting in musculoskeletal trauma and massive blood loss C) An 80-year-old woman who experienced an ischemic stroke that was attributable to atrial fibrillation D) A 66-year-old woman with type 1 diabetes who is experiencing the effects of diabetic nephropathy
The nurse assessing a newborn notes an enlarged head with visible prominent scalp veins. Which should the nurse suspect the newborn is experiencing?
A. Acromegaly. B. Craniosynostosis. C. Fetal alcohol syndrome. D. Hydrocephalus.
A nurse is providing teaching for a nondiabetic adult who develops growth hormone deficiency and who will begin treatment with somatropin (Humatrope). Which statement by the patient indicates understanding of the teaching?
a. "Intramuscular dosing is more effective than subcutaneous dosing." b. "I will have increased muscle mass and strength as well as increased height." c. "I will need to monitor my blood pressure frequently while taking this drug." d. "I will need to take insulin while using this, because it causes hyperglycemia."
Which statement accurately describes how water can be rendered safe for drinking in the event of a disruption of service? (Select all that apply.)
a. Allow water to sit for 24 hours before us-ing. b. Boil water for 3 to 5 minutes. c. Add 1 mL (16 drops) of household bleach to a gallon of water and let it stand for 30 minutes. d. Drain water from hot water heaters. e. Pour water through several layers of cot-ton towels.