# Place the nursing actions in the correct order for an incontinent client with dementia who has a large episode of loose stool and is attempting to get out of bed. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=568362&lang=en > language: en > subject: Personal Hygiene > category: BCC ## Question Place the nursing actions in the correct order for an incontinent client with dementia who has a large episode of loose stool and is attempting to get out of bed. Apply zinc oxide barrier, reposition the client on the low-air-loss mattress, and document skin condition and care. Perform hand hygiene and don clean gloves. Provide privacy and explain the procedure in a calm, simple manner. Remove soiled linen and gently cleanse the skin with a pH-balanced cleanser, patting dry. Ensure the bed is in the lowest position and call for assistance. ## Explanation The client is at immediate risk for falling while attempting to get out of bed, so safety takes priority. The nurse must first ensure the bed is in the lowest position and call for assistance to prevent injury. Then, to reduce agitation and allow care, the nurse should provide privacy and explain the procedure in a calm, simple manner. Hand hygiene and glove application precede any contact with stool. The nurse then removes the soiled linen and gently cleanses the skin, using a pH-balanced cleanser and patting dry to avoid further damage to denuded areas. Finally, the nurse applies the zinc oxide barrier to protect the skin, repositions the client on the low-air-loss mattress, and documents the skin condition and care provided. ## In-depth explanation Quick answer The correct order is: ensure bed is in lowest position and call for assistance; provide privacy and explain the procedure calmly; perform hand hygiene and don gloves; remove soiled linen and gently cleanse the skin; apply zinc oxide barrier, reposition, and document. Why this is correct The client is actively attempting to get out of bed, so fall prevention is the first priority. Agitation and dementia require a calm approach before any physical care. Infection control and skin protection follow standard precautions and the provider's order. Clinical picture In clients with dementia and agitation, safety and de-escalation precede task completion. Denuded skin requires gentle cleansing and a barrier to prevent further breakdown. A low-air-loss mattress reduces pressure and moisture. Memory hook Safety first, then communication, then clean technique, then skin care, then documentation. NCLEX decision rule Prioritize immediate threats to safety (falls) before infection control or skin integrity interventions. Why the alternatives are wrong Performing hand hygiene first would delay fall prevention. Applying the barrier before cleansing would trap stool and bacteria. Documenting before care would be premature and unsafe. Sources 1NCSBN 2026 NCLEX-RN Test Plan 2AHRQ skin care in the incontinent patient 3NCSBN 2026 NCLEX-RN Test Plan ## Clinical scenario An 82-year-old client with moderate dementia is in bed after a large incontinent episode of loose stool. The client is restless, attempting to climb over the side rails, and has a history of falls. Perineal skin is intact but has areas of denuded, weeping skin from previous moisture exposure. The provider has ordered a zinc oxide barrier and a low-air-loss mattress. The client becomes agitated when approached and resists care. ## Key concepts - **Moisture-associated skin damage** — Skin injury caused by prolonged exposure to urine, stool, or other moisture, leading to inflammation, erosion, and increased risk of infection. - **Low-air-loss mattress** — A specialized support surface that circulates air to reduce pressure and manage moisture, used for clients at risk for pressure injuries. - **Zinc oxide barrier** — A topical paste that forms a protective layer on the skin to prevent irritation from moisture and stool, commonly used in incontinence care. ## Related questions - [A hospice nurse is planning pain management for a client with metastatic cancer who can ta…](https://mymerci.kr/pages/nclex_q.php?qn_id=363998&lang=en) - [A nurse is creating a pressure injury prevention plan for an immobile older adult admitted…](https://mymerci.kr/pages/nclex_q.php?qn_id=366392&lang=en) - [A dying client's family asks to perform meaningful spiritual and cultural rituals at the b…](https://mymerci.kr/pages/nclex_q.php?qn_id=368302&lang=en) - [A nurse cares for family members after a loved one is told that an illness is terminal. 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