A nurse is caring for several clients with wounds. Which of the following clients is at the highest risk for delayed wound healing?
Client who urinates frequently due to diuretic therapy
Client with limited mobility recovering from knee surgery
Client who is NPO one day before abdominal surgery
Client with diabetes, obesity and current cigarette smoker
The Correct Answer is D
A. Client who urinates frequently due to diuretic therapy: Increased urination may lead to fluid loss and potential dehydration if not managed, which can affect skin turgor and perfusion. However, with adequate fluid replacement, this factor alone does not significantly impair the physiological processes required for wound healing.
B. Client with limited mobility recovering from knee surgery: Limited mobility can increase the risk of pressure injuries due to prolonged pressure over bony prominences and reduced circulation. While this may contribute to delayed healing if a wound develops, it does not inherently impair systemic healing processes as chronic metabolic and vascular conditions.
C. Client who is NPO one day before abdominal surgery: Short-term NPO status typically does not result in significant nutritional deficiency or impair wound healing. The body’s nutrient stores and perioperative management generally compensate for this brief period without oral intake, making it a minimal risk factor.
D. Client with diabetes, obesity and current cigarette smoker: Diabetes impairs wound healing through microvascular damage, reduced tissue perfusion, and impaired leukocyte function, increasing infection risk. Obesity decreases vascularity of adipose tissue and places mechanical stress on wounds, while smoking causes vasoconstriction and reduces oxygen delivery due to carbon monoxide exposure. These factors significantly disrupt all phases of wound healing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Active listening: Active listening is a therapeutic communication skill that involves attentiveness, validation, and appropriate responses to the patient’s concerns. Elderspeak, which includes patronizing language, exaggerated intonation, and simplified speech, does not promote engagement or mutual respect, and therefore does not enhance active listening behaviors.
B. Short-term memory loss: Short-term memory loss is a cognitive impairment commonly associated with aging or neurological conditions such as dementia. Elderspeak does not directly cause memory deficits; rather, it can negatively impact emotional well-being and communication effectiveness without altering cognitive function.
C. Resistance to care: Elderspeak can be perceived as demeaning, infantilizing, or disrespectful by older adults. This can lead to frustration, decreased autonomy, and behavioral responses such as refusal of care, agitation, or withdrawal. That such communication styles are associated with increased resistance to care, particularly in individuals with cognitive impairment.
D. Compliance: Compliance implies cooperation with care and adherence to treatment plans. Elderspeak often undermines patient dignity and autonomy, which can reduce trust and willingness to cooperate, making increased compliance an unlikely outcome.
Correct Answer is A
Explanation
A. Metabolic acidosis: The patient’s pH of 7.13 indicates acidemia, and the HCO3- is significantly decreased at 13.2 mEq/L, showing a primary metabolic derangement. The PaCO2 of 38.8 mmHg is within normal limits (35–45 mmHg), suggesting that respiratory compensation has not yet fully occurred. The base excess of -14.5 further supports a significant metabolic acid load. These findings are consistent with metabolic acidosis.
B. Respiratory acidosis: Respiratory acidosis is characterized by elevated PaCO2 (>45 mmHg) due to hypoventilation, which leads to a decreased pH. In this case, the patient’s PaCO2 is normal, indicating that CO2 retention is not the primary cause of acidemia. The primary disturbance is metabolic rather than respiratory.
C. Normal ABG results: Normal arterial blood gas values include pH 7.35–7.45, PaCO2 35–45 mmHg, HCO3- 22–28 mEq/L, and PaO2 80–100 mmHg. In this ABG, the pH is acidotic, HCO3- is low, and base excess is markedly negative, which clearly deviates from normal ranges, indicating a pathological process.
D. Respiratory alkalosis: Respiratory alkalosis is characterized by decreased PaCO2 (<35 mmHg) due to hyperventilation, resulting in an elevated pH. In this ABG, PaCO2 is normal and pH is low, which contradicts the pattern seen in respiratory alkalosis. The acidemia is therefore not caused by a respiratory mechanism.
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