A nurse is collecting data from a client who has diabetes mellitus and reports foot pain. The nurse should evaluate the client for which of the following alterations as indications that the client has an infection? (Select all that apply.)

Bradycardia

An increase in platelets

An increase in RBCs

An increase in neutrophils

Localized edema

Answer and Explanation

Correct Answer : D,E

A. Bradycardia is not typically a sign of infection. Infections usually lead to tachycardia (increased heart rate) rather than bradycardia.
B. An increase in platelets An increase in the platelet count can reflect malignancies, not infection.
C. An increase in RBCs is not typically associated with infection. Infection generally does not increase the number of red blood cells but may lead to changes in white blood cell counts.
D. An increase in neutrophils is a common response to bacterial infection. Neutrophils are white blood cells that increase in number to fight off infections.
E. Localized edema is often present in areas of infection due to inflammation and fluid accumulation in response to infection and tissue damage.

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Correct Answer is A

Explanation

A. Partial-thickness skin loss with red tissue in the wound bed is characteristic of a stage 2 pressure injury, which involves damage to the epidermis and possibly the dermis. The red tissue is typically granulation tissue or viable tissue.
B. Intact skin with localized erythema would be indicative of a stage 1 pressure injury, where the skin remains intact but shows redness or non-blanching erythema.
C. Full-thickness skin loss with visible adipose tissue would describe a stage 3 pressure injury, which involves damage to the full dermis and subcutaneous tissue, exposing fat.
D. Full-thickness skin loss with visible bone would describe a stage 4 pressure injury, which extends through all layers of the skin and tissue to expose bone, tendon, or muscle.

A. Constipation B. Memory loss C. Brittle hair D. Bleeding gums

Correct Answer is A

Explanation

A. A lack of dietary fiber is commonly associated with constipation. Fiber is essential for proper bowel function, as it helps form bulk in stool and promotes regular bowel movements. Insufficient fiber can lead to sluggish bowel movements and discomfort.
B. Memory loss is not directly related to inadequate fiber intake. It is more commonly linked to other factors such as vitamin deficiencies or neurological conditions.
C. Brittle hair is typically a sign of protein or vitamin deficiencies, particularly biotin or other B vitamins, rather than being directly related to inadequate fiber intake.
D. Bleeding gums are more commonly associated with vitamin C deficiency (scurvy) rather than fiber deficiency, which does not have a direct impact on gum health.

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A nurse is collecting data from a client who has diabetes mellitus and reports foot pain. The nurse should evaluate the client for which of the following alterations as indications that the client has an infection? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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Correct Answer is A

Explanation

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