A nurse is caring for a client with a wound on the lower extremity. What findings would the nurse observe that would indicate a wound infection?
The wound base appears pink to red, with serous drainage, and the client's oral temperature is 99.0°F.
The wound base appears yellow, with serosanguineous drainage, and the client's oral temperature is 100°F.
The wound base appears red, skin is warm to touch with foul odor, and the client's oral temperature is 101.5°F.
The wound base appears yellow, with serous drainage, and the client's oral temperature is 99°F.
The Correct Answer is C
The correct answer is choice C. Signs of a wound infection include redness, warmth, and tenderness around the wound, as well as fever, chills, and malaise. The wound base may appear yellow, indicating the presence of pus, and may have a foul odor. Serous drainage is typically clear and does not indicate infection, while serosanguineous drainage may indicate a mild infection or normal healing process. An oral temperature of 101.5°F is elevated and may indicate an infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C, "Can you tell me more about why you are undecided?"
When a patient is undecided about receiving recommended chemotherapy treatment, the most therapeutic response from the nurse would be to ask the patient to tell more about why they are undecided. This approach allows the patient to express their feelings and concerns about the treatment, which may help them come to a decision. The nurse should not tell the patient what they should do or criticize them for taking time to decide. The decision to undergo chemotherapy is a significant one, and the patient needs to feel that they have support and guidance from their healthcare provider to make an informed decision.
Correct Answer is ["59.1"]
Explanation
The patient's weight in kg would be:
130 lbs ÷ 2.2 lbs/kg = 59.09 kg
Rounded to the nearest tenth, the patient weighs 59.1 kg.
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