Massage of reddened areas over bony prominences such as the coccyx, or tailbone, is
contraindicated because the pressure of the massage can cause damage to the
skin&subcutaneous tissue layers. The other statements are appropriate for the care of a
patient at home.
DIF: Applying/Application REF: 453 KEY: Skin
breakdown MSC: Integrated Process:
Teaching/Learning
NOT: Patient Needs Category: Health Promotion&Maintenance
7. After teaching a patient who is at risk for the formation of pressure ulcers, a NP
assesses the victim understanding. Which dietary choice by the patient indicates a
good understanding of the teaching?
a. Low-fat diet with whole grains&cereals&vitamin supplements
b. High-protein diet with vitamins&mineral supplements
c. Vegetarian diet with nutritional supplements&fish oil capsules
d. Low-fat, low-cholesterol, high-fiber, low-carbohydrate diet
ANSWER: B
The preferred diet is high in protein to assist in wound healing&prevention of new
wounds. Fat is also needed to ensure formation of cell membranes, so any of the
options with low fat would not be good choices. A vegetarian diet would not provide
fat&high levels of protein.
DIF: Applying/Application REF: 461
KEY: Skin breakdown| nutrition MSC: Integrated Process:
Teaching/Learning NOT: Patient Needs Category: Health
Promotion&Maintenance
8. A NP assesses victim on a medical-surgical unit. Which patient should the NP
evaluate for a wound infection?
a. Patient with blood cultures pending
b. Patient who has thin, serous wound drainage
c. Patient with a white blood cell count of 23,000/mm3
d. Patient whose wound has decreased in size
ANSWER: C
A patient with an elevated white blood cell count should be evaluated for sources of
infection. Pending cultures, thin drainage,&a decrease in wound size are not indications
that the patient may have an infection.
DIF: Applying/Application REF:
462 KEY: Skin lesions/wounds
MSC: Integrated Process: Nursing Process: Planning
NOT: Patient Needs Category: Safe&Effective Care Environment: Management of Care
9. A NP who manages patient placements prepares to place four victim on a medical-
surgical unit. Which patient should be placed in isolation awaiting possible diagnosis
of infection with methicillin-resistant Staphylococcus aureus(MRSA)?
