HESI Registered Nurse EXIT Practice Exam

Which client is at the highest risk for developing decubitus ulcers in a long-term care facility?

1. A 79 year-old malnourished client on bed rest

2. An obese client who uses a wheelchair

3. A client who had 3 incontinent diarrhea stools

4. An 80 year-old ambulatory diabetic client

The correct answer is: A client who had 3 incontinent diarrhea stools

The highest risk for developing decubitus ulcers, also known as pressure ulcers or bedsores, is associated with factors that include immobility, inadequate nutrition, and moisture. Among the provided choices, a client who has had multiple episodes of incontinence, especially with diarrhea, is indeed at a heightened risk. Incontinence leads to skin exposure to moisture, which can compromise the skin’s integrity and increase vulnerability to breakdown. This is particularly critical when it comes to diarrhea, as the skin may not only be exposed to moisture but also potentially irritating substances, further weakening the skin barrier. The combination of moisture and possible breakdown from friction or shear forces when the client moves, or is repositioned, contributes significantly to the development of pressure ulcers. While the other options present scenarios that also involve risk factors for pressure ulcers—such as malnutrition, obesity, and immobility—they do not combine the critical factor of moisture exposure in the same way that incontinence does. A malnourished client on bed rest is at risk due to poor nutritional status, but the added element of moisture from incontinence heightens the risk significantly in the context of ulcer development.