RML MAINS 2025
Medical Surgical Nursing
Easy
Which one of the following measures are not recommended to prevent pressure ulcer?
Appeared in: RML MAINS 2025
Explanation
- Massaging over bony prominences is an outdated practice that is now known to be harmful.
- The friction and pressure from massage can damage fragile capillaries and underlying tissues that are already at risk due to poor circulation.
- This action can lead to the development of deep tissue injury, accelerating the formation of a pressure ulcer rather than preventing it.
- International guidelines, including those from the National Pressure Ulcer Advisory Panel (NPUAP), explicitly advise against massaging reddened or at-risk bony areas.
Why Other Options Were Wrong
- Option A: This is a recommended and effective measure. Using pressure-redistributing surfaces like water or air mattresses is a standard of care for pressure ulcer prevention.
- Option B: This is a cornerstone of pressure ulcer prevention. A consistent schedule for turning and repositioning (e.g., every 2 hours) is crucial to relieve pressure.
- Option D: This is a fundamental component of pressure ulcer prevention. Meticulous skin care, including keeping the skin clean, dry, and moisturized, helps maintain skin integrity.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pressure Ulcer Prevention as background academic context rather than a clinical decision trigger.
- A nurse's primary role in pressure ulcer prevention is risk assessment (using tools like the Braden Scale) and implementing a comprehensive prevention plan for at-risk patients.
- This includes patient and family education on the importance of repositioning, proper skin care, and nutrition, and explaining why certain practices like massaging bony prominences are harmful.
- What if? If a patient has a non-blanchable red area (Stage 1 pressure injury), the correct action is to relieve all pressure from that area, apply a protective dressing if needed, and continue all other prevention strategies. Massaging the area would be strictly contraindicated and would cause further harm.
How to Approach the Question
- First, identify the negative framing of the question: it asks for what is 'not recommended'. This means three of the options are correct actions, and one is an incorrect or harmful action.
- Second, recall the standard, evidence-based interventions for pressure ulcer prevention. These are often remembered by the acronym SKIN (Surface, Keep moving, Incontinence management, Nutrition).
- Third, evaluate each option against these standards. Using special mattresses, turning schedules, and skin care are all well-established preventive measures.
- Fourth, critically assess the option of 'massaging'. While massage is generally therapeutic, consider its effect on tissue that is already under pressure and has compromised blood flow. This leads to the conclusion that it could cause harm.
- Finally, select the option that represents a contraindicated action, which is massaging over bony prominences.
Concept Tested & Keywords
- Concept Tested: Pressure Ulcer Prevention
- Stem keywords: pressure ulcer, prevent, measures
- Lead-in keywords: not recommended
- Negative lead-in flag: The question asks for a measure that is NOT recommended, requiring you to identify the incorrect or harmful action among the given choices.
Question ID
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Reference Book
E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 111-113
Practise the full RML MAINS 2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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