ATI Basic Care and Comfort Practice Test Prep - Practice Exam & Study Guide

The client identified as being at the greatest risk for skin breakdown is the older adult who has a hip fracture and is in Buck's traction. This situation poses several factors that increase the risk of skin integrity issues.

Firstly, older adults often have thinner, more fragile skin, which can be more susceptible to pressure injuries. The application of Buck's traction, which is used to immobilize the hip and promote healing, places the patient in a position that can create pressure points, especially on bony prominences, such as the sacrum and heels. This pressure, combined with the immobility associated with traction, limits blood flow to the skin, further increasing the likelihood of developing skin breakdown or pressure ulcers.

In contrast, the other clients—such as the young adult with a sprained ankle, the middle-aged client with a broken wrist, and the older adult recovering from a knee replacement—are less likely to experience significant immobility or pressure-related injuries. These clients typically have more mobility due to either their condition or post-surgical recovery protocols, which helps promote circulation and skin integrity. Therefore, the orthopedic unit nurse must prioritize the care of the client in Buck's traction to prevent complications related to skin breakdown.