Choice A rationale

The 44-year-old client with pneumonia receiving intravenous antibiotics is at some risk due to potential immobility and fever, which can lead to diaphoresis and skin maceration. However, this client is likely mobile enough to shift positions independently or with minimal assistance, reducing the risk of sustained pressure. The client's age and general health status, aside from the acute infection, suggest good tissue perfusion and skin integrity.

Choice B rationale

A 26-year-old who is bedridden with a fractured leg is at significant risk due to immobility. The inability to shift weight and relieve pressure on bony prominences can lead to ischemia and tissue damage. However, younger individuals generally have better vascular supply, skin turgor, and faster cellular regeneration compared to older adults, which provides some protective physiological advantage against pressure injury development.

Choice C rationale

This 65-year-old client is at the greatest risk due to a combination of multiple risk factors. Hemiparesis leads to immobility and the inability to reposition, causing prolonged pressure on one side of the body. Incontinence exposes the skin to moisture and chemical irritants from urine and feces, leading to maceration and a breakdown of the skin's protective barrier, making it more susceptible to injury.

Choice D rationale

A 78-year-old requiring a walker for ambulation is at a lower risk for pressure injuries compared to a bedridden individual. Although advanced age and the need for assistive devices suggest some mobility limitations, the ability to ambulate, even with assistance, indicates the capacity to shift weight and relieve pressure on a regular basis. This regular movement promotes circulation and prevents prolonged periods of immobility.

Choice A rationale

Wet-to-damp saline moistened gauze is a method of debridement and is not the most effective choice for a wound with copious exudate. This dressing type is less absorbent and would quickly become saturated, requiring frequent changes. Frequent changes and wetness can lead to periwound skin maceration and irritation, hindering the healing process.

Choice B rationale

Leaving a stage 3 pressure injury open to the air is contraindicated. A stage 3 pressure injury involves full-thickness skin loss and is susceptible to infection. Leaving the wound open would not manage the copious exudate, would expose the wound bed to pathogens, and would lead to dehydration of the wound bed, which impairs cellular migration and proliferation necessary for healing.

Choice C rationale

A transparent film is a moisture-retaining dressing that is inappropriate for a wound with copious exudate. This dressing is designed for superficial wounds with minimal exudate. Applying a transparent film to a heavily draining wound would lead to the accumulation of exudate underneath the dressing, causing maceration of the surrounding skin and potential for infection.

Choice D rationale

A multi-fiber superabsorbent dressing is the most appropriate choice for a stage 3 pressure injury with copious exudate. These dressings are designed to absorb large volumes of fluid, wicking it away from the wound bed and periwound skin. This action helps to manage moisture, protect the surrounding skin from maceration, and maintain a moist environment ideal for wound healing.

While nutritional status is crucial for wound healing, and labs such as albumin (normal range 3.5-5.0 g/dL) and prealbumin (normal range 15-36 mg/dL) are important indicators, assessing the underlying cause of non-healing is a priority. Drawing labs is a subsequent step after a thorough assessment has been completed to rule out circulatory issues as the primary cause.

Choice B rationale

A wound culture is performed to identify pathogens that may be causing a non-healing wound. However, it should only be done after assessing for other potential causes, such as poor circulation, which can compromise the delivery of immune cells and antibiotics to the wound site, making it impossible for the wound to heal regardless of the presence of bacteria.

Choice C rationale

Elevating the foot may be beneficial for reducing edema if present, which can impede circulation. However, this intervention should be based on a comprehensive circulatory assessment. Without first assessing the vascular status of the leg, this action is premature and may not be the most critical first step to take in addressing the underlying problem.

Choice D rationale

Assessing the right leg for pulses, skin color, and temperature is the most critical first step. A non-healing wound on an extremity, particularly an ankle, may indicate underlying peripheral arterial disease. Inadequate blood flow compromises oxygen and nutrient delivery to the wound bed, preventing cellular repair and growth. Ruling out or identifying circulatory compromise is the initial priority.

Choice A rationale

This meal provides carbohydrates and fiber, but it lacks sufficient protein, which is essential for tissue repair and collagen synthesis. Protein intake is crucial for wound healing. A green salad provides vitamins, but the overall meal composition is not optimal for providing the building blocks necessary for skin and tissue regeneration.

Choice B rationale

This dietary choice is excellent for promoting wound healing. Chicken breast provides a high-quality source of protein, which is essential for rebuilding damaged tissue and forming new collagen. Broccoli provides vitamin C, a co-factor in collagen synthesis, while a baked potato offers carbohydrates for energy to fuel the healing process.

Choice C rationale

Vegetable lasagna and green salad provide some vitamins and nutrients, but they are often lower in protein than meat-based options, especially if the lasagna filling is not fortified with high-protein ingredients like cottage cheese. Protein is a critical macronutrient for tissue repair, and the lack of a concentrated source makes this choice suboptimal.

Choice D rationale

This meal is low in essential nutrients. While a hamburger provides some protein, it is often high in saturated fat. The fruit cup and cookie provide simple sugars, which can lead to inflammation and have minimal nutritional value for wound healing. The diet pop offers no nutritional benefit and may contain artificial ingredients that are not beneficial.

Choice A rationale

The presentation of scratching and rubbing white ridges between the fingers and on the wrists is a classic sign of a parasitic mite infestation, specifically scabies. Scabies is caused by Sarcoptes scabiei mites that burrow into the skin. Permethrin is a topical insecticide that is the first-line treatment for scabies because it effectively kills the mites and their eggs.

Choice B rationale

Administering an antihistamine would address the symptom of itching, which is a common manifestation of scabies due to the body's allergic reaction to the mites and their feces. However, it does not treat the underlying cause, which is the parasitic infestation. Antihistamines provide symptomatic relief but will not eradicate the mites, allowing the infestation to persist and potentially spread.

Choice C rationale

Assessing the client's airway is an intervention for a client experiencing an anaphylactic reaction or other respiratory distress. Scabies is a dermatological condition and does not pose a direct threat to a client's airway unless the client has a severe and rare allergic reaction. This action is not relevant to the presenting signs and symptoms of scabies.

Choice D rationale

Applying gloves to minimize friction would not address the underlying pathology of scabies. The purpose of this intervention is to protect the skin from further mechanical damage, but it does not treat the parasitic cause of the condition. While gloves may prevent some scratching, they do not eradicate the mites and are not a primary treatment. .

Choice A rationale

Tazarotene, a retinoid, increases photosensitivity by thinning the stratum corneum, the skin's outermost layer. This reduces the protective barrier against ultraviolet (UV) radiation, making the skin more susceptible to sunburn and UV-induced DNA damage. Patients must be educated to use sun protection, but it is not the most critical question.

Choice B rationale

While a history of skin cancer can influence dermatological treatment plans, it is not the primary contraindication for tazarotene. Tazarotene is an analog of vitamin A, and its mechanism involves regulating cell proliferation and differentiation, which is not directly related to a personal or family history of skin cancer.

Choice C rationale

Tazarotene is a potent teratogen, meaning it can cause severe congenital malformations if taken during pregnancy. This teratogenic risk necessitates that all female patients of child-bearing potential use reliable contraception to prevent pregnancy. A pregnancy test is also required before initiation of therapy.

Choice D rationale

While some medications interact with alcohol, tazarotene is a topical retinoid primarily metabolized in the liver to its active form, tazarotenic acid. There is no significant systemic absorption or direct interaction with alcohol consumption that would cause a major adverse effect, making it a less critical question than contraception.

Choice A rationale

Healing by primary intention, also known as primary union, occurs when a wound has clean edges that are approximated and sutured, stapled, or glued together. This process minimizes tissue loss and results in a fine scar. The wound's integrity is re-established with minimal granulation tissue formation.

Choice B rationale

This describes a form of delayed primary closure or tertiary intention healing. The wound is initially left open to allow for drainage and to clear infection. Once the wound is considered clean and free of infection, the edges are then approximated and closed, often with staples, to promote healing.

Choice C rationale

Healing by secondary intention, or secondary union, occurs in large, open wounds with significant tissue loss and non-approximated edges. The wound heals from the base up. This process involves the formation of new connective tissue and capillaries, called granulation tissue, to fill the defect before epithelialization can occur.

Choice D rationale

While contaminated wounds can heal by secondary intention, this description is not a complete definition. Secondary intention healing is a specific biological process involving granulation tissue, not just a description of a wound that is open due to contamination or debris. The defining characteristic is the formation of granulation tissue.

Choice A rationale

Isotretinoin is a highly effective medication for severe acne, but it is a potent human teratogen. It can cause severe birth defects, miscarriage, and premature birth if a patient becomes pregnant while taking it. The iPLEDGE program mandates two forms of contraception and monthly pregnancy tests for all female patients.

Choice B rationale

The dose of isotretinoin is carefully titrated based on the patient's weight and response to therapy. Increasing the dose without a physician's order is extremely dangerous and can lead to severe side effects such as cheilitis, xerosis, and potential liver damage. Doses are not to be altered by the patient.

Choice C rationale

There is no credible scientific evidence that the intake of specific foods like chocolate, cola, or peanuts causes or exacerbates acne. This is a common misconception. Acne pathogenesis involves sebum production, follicular hyperkeratinization, and bacterial proliferation, not dietary intake of these items.

Choice D rationale

Isotretinoin increases the skin's sensitivity to sunlight and UV radiation, a condition known as photosensitivity. This effect is due to the drug's impact on skin cell turnover and thinning of the stratum corneum. Patients are advised to limit sun exposure and use broad-spectrum sunscreens to prevent severe sunburn.

Choice A rationale

There is no known or documented significant drug-food interaction between griseofulvin and citrus fruits or juice. Griseofulvin absorption is actually enhanced by a high-fat meal. The biological mechanism of action for griseofulvin does not involve competition with compounds found in citrus.

Choice B rationale

Shellfish allergies are a common food allergy, but there is no specific interaction between griseofulvin, an antifungal, and shellfish consumption. Griseofulvin's mechanism of action involves disrupting fungal mitosis, which is not affected by dietary intake of shellfish.

Choice C rationale

Alcohol consumption while taking griseofulvin can lead to a disulfiram-like reaction, which is a severe adverse response. This reaction is characterized by flushing, headache, nausea, vomiting, and a rapid heartbeat. The exact mechanism is not fully understood, but it is a significant and dangerous interaction.

Choice D rationale

Griseofulvin is an antifungal medication, while corticosteroids are anti-inflammatory and immunosuppressive agents. There is no known direct pharmacological interaction between these two drug classes. Taking them concurrently is not contraindicated, although they treat different conditions.

Choice A rationale

While occlusive agents like Vaseline can smother lice, this method is messy and generally not as effective as targeted pediculicides. It mainly suffocates the live lice but does not consistently eliminate the nits (eggs), which are tightly attached to the hair shaft and must be removed to prevent reinfestation.

Choice B rationale

A soda-vinegar solution has no proven efficacy in eradicating lice. The acetic acid in vinegar can help loosen the glue-like substance that attaches nits to the hair shaft, but it is not a standalone treatment. Baking soda does not have any scientific basis for being effective against pediculosis.

Choice C rationale

A vinegar-water solution, specifically the acetic acid in vinegar, helps to dissolve the proteinaceous cement substance that glues nits to the hair shaft. This makes the nits easier to remove with a fine-toothed nit comb, which is a crucial step in the eradication process to prevent the hatching of new lice.

Choice D rationale

Dish detergents are not formulated to be effective against lice and can be harsh on the scalp, causing irritation. They lack the specific neurotoxic agents or suffocation properties found in approved pediculicide shampoos that are designed to kill lice and their eggs. This method is ineffective and potentially harmful. .