CNA Certification (Written Exam)Basic Nursing SkillsEasy
While bathing an elderly resident, a nurse aide notices the skin on the back of the resident's hand remains 'tented' for several seconds after being gently pinched. What should the nurse aide do?
- AConsider this a normal finding in elderly residents and continue care as usual
- BReport this finding to the nurse, as it may indicate dehydration
- CApply lotion to the area and document that the skin appeared dry
- DEncourage the resident to limit fluid intake to reduce skin tenting
Show answer & explanationAnswer & explanation
Correct answer: B. Report this finding to the nurse, as it may indicate dehydration
Poor skin turgor, indicated by skin remaining 'tented' after being pinched, is a sign of dehydration. This finding should be reported to the nurse so the resident's fluid status can be further assessed.
Why the other options are wrong
- A. While skin elasticity can decrease with age, tenting is still a sign that warrants reporting, not dismissal.
- C. Applying lotion does not address the underlying concern and skips reporting an important sign.
- D. Limiting fluids would worsen, not improve, a possible dehydration issue.
Skin Turgor and Dehydration
Skin turgor is tested by gently pinching the skin; if it remains 'tented' rather than snapping back quickly, it may indicate dehydration.
- Poor turgor = skin stays tented after pinching
- A sign of dehydration, especially in elderly residents
- Should be reported to the nurse for further assessment
Memory trick: 'Tent stays up? Fluids are low — report it now!'