Mrs. Moore, a 69-year-old client, is emaciated. The nurse aide takes precautionary measures in order to prevent which of the following problems in skin integrity?
  1. Blisters
  2. Pressure sores
  3. Reddening of the skin
  4. Pustules
Explanation
Answer: B - Pressure sores are a concern with emaciated clients. Factors that contribute to the formation of pressure ulcers include the following: immobility, prolonged inadequate nutrition that causes weight loss, muscle atrophy, and loss of subcutaneous tissue; fecal and urinary incontinence; decreased mental status; diminished sensation; excessive body heat; and advanced age.
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