Which body area is at highest risk for a pressure injury in a client who lies on their back?

The tailbone (sacrum) and heels

The stomach, especially just below the ribs on either side

Which group of signs around a client's skin tear suggests infection?

Redness, warmth, swelling and pus

A thin scab with healthy pink skin around it that keeps shrinking

Cool, dry skin with no drainage

How often should a client who cannot move independently be repositioned in bed, unless the care plan says otherwise?

Only when the client complains of discomfort

Every 8 hours, at each shift change

During a back rub, the aide sees a reddened area over the tailbone that does not fade. What should the aide do?

Not massage it, and report it to the nurse

Massage it firmly to bring back circulation

Cover it with a heating pad for twenty minutes

Rub alcohol on it to toughen the skin

What is the earliest sign of a pressure injury on light skin?

Redness that does not fade when gently pressed

A deep open crater with yellow tissue at the bottom

Dry, flaky skin all over the legs

A client lies on his back in bed. What helps keep his heels off the mattress?

A pillow placed lengthwise under the calves

A rolled towel placed directly under each heel

Tucking the top sheet tightly over the feet

Raising the head of the bed to 90 degrees

Which practice helps prevent skin tears in an older client?

Lifting with a sheet and padding bed rails and wheelchair parts

Pulling the client up in bed by the arms

Using adhesive tape directly on fragile skin

Keeping the aide's nails long but well filed

The care plan assigns the aide a simple, clean dressing change on a healing skin tear. Under the dressing, the aide sees new yellow drainage and a bad smell. What should the aide do?

Apply a fresh dressing as assigned and report the change to the nurse

Scrub the wound with soap until the drainage is gone

Leave it open to air out the smell

Apply an antibiotic ointment from the client's cabinet, then check it again tomorrow

Pressure injuries and skin tears: what HHAs check and report

Recognizing and reporting changes in skin condition is its own line in the federal training rule. An aide sees a client's skin more often than anyone else on the team, so the questions focus on spotting the first stage early, knowing where injuries form, and the handful of well-meant habits that make them worse, such as massaging a red spot or rubbing fragile skin dry.

Stage 1	Intact skin with redness that does not fade when gently pressed. On darker skin it may look purple, bluish or shiny, or feel warm or firm
Lying on the back	Tailbone (sacrum), heels, shoulder blades, elbows, back of the head
Lying on the side	Hips, knees, ankles, ears
Repositioning in bed	At least every 2 hours unless the care plan says otherwise; more often for weight shifts in a chair
Heels	A pillow lengthwise under the calves floats the heels off the mattress. A towel under the heel still presses on it
Red area that does not fade	Do not massage it. Relieve the pressure and report it
Moving a client	Lift with a draw sheet; dragging skin across sheets causes friction and shear injuries
Sheets	Smooth, dry and free of crumbs and wrinkles
Fragile skin	Pat dry, moisturize as the care plan allows, avoid tape, keep nails short, pad rails and wheelchair parts
Incontinence	Clean and dry promptly; urine and stool break skin down fast
Braces and splints	Check the skin underneath every time the device comes off
Wound changes to report	Redness, warmth, swelling, pus, new drainage or odor

Where the point is lost: The trap answers here are kind but harmful: massage the red spot to bring back circulation, rub the skin briskly with a towel, prop the heel on a rolled towel, put a heating pad on it. Each one adds pressure, friction or heat to tissue that is already starved of blood. The correct answer is almost always to take the pressure off and report what you saw.