A nurse is changing the dressing on a client’s wound. The nurse should recognize that which of the following findings is an indication of a wound infection?

Edema

Crusting over granulated tissue

Petechiae

Urticaria

Answer and Explanation

The Correct Answer is A

A.   Edema, which is swelling caused by fluid accumulation in the tissues. Edema is a common sign of inflammation and infection in wounds.
B.   Crusting over granulated tissue may indicate normal wound healing and is not necessarily a sign of infection.
C.   Petechiae are small red or purple spots on the skin caused by bleeding under the skin. They are usually associated with blood disorders or trauma, not infection.
D.   Urticaria (hives) is typically associated with allergic reactions and is not a typical sign of wound infection.

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Correct Answer is A

Explanation

A. Standards of care published by reputable organizations, such as the Oncology Nursing Society, provide evidence-based guidelines and best practices.
B. While the experience of a nurse in a chemotherapy clinic is valuable, it may not represent standardized, evidence-based practices.
C. A qualitative study may provide insights into clients' perspectives but may not necessarily offer specific interventions for oral care.
D. Published textbooks can be valuable resources, but standards of care from professional organizations are generally more up-to-date and evidence-based.

A. Decrease in systolic blood pressure. B. Increase in percentage of body water C. Decrease in kidney function. D. Increase in saliva production.

Correct Answer is C

Explanation

A. While blood pressure changes may occur with aging, it is not a direct cause of dehydration.
B. Older adults tend to have a decrease in the percentage of body water, contributing to a higher risk of dehydration.
C. Aging can lead to a decrease in renal function, affecting the body's ability to concentrate urine and conserve water.
D. Saliva production typically decreases with aging and is not a significant factor in dehydration.

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A nurse is changing the dressing on a client’s wound. The nurse should recognize that which of the following findings is an indication of a wound infection?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is contributing to the development of an oral care protocol for clients who are receiving chemotherapy. Which of the following resources should the nurse utilize to identify interventions?

Correct Answer is A

Explanation

A nurse is caring for an older adult client. The client has an increased risk for dehydration due to which of the following physiological changes that can occur with aging?

Correct Answer is C

Explanation

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