A nurse is evaluating a 3-day diet history with a client who has an elevated lipid panel.
What meal selection indicates that the client is managing this condition well with diet?

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

While a cough is a known side effect of lisinopril due to bradykinin accumulation, a new-onset cough in a client with heart failure and hypertension could also signal worsening heart failure, particularly pulmonary edema. Assessing lung sounds for crackles and monitoring oxygenation is paramount to differentiate between these two distinct etiologies and guide appropriate intervention.

Choice B rationale

Changing antihypertensives is a medical decision made by the provider. The nurse's role is to assess the client's symptoms and provide objective data to the provider. Switching medications without a thorough assessment could be premature and might delay the diagnosis of a more serious condition like decompensated heart failure.

Choice C rationale

Obtaining vital signs is a fundamental nursing action, but it is not the most appropriate initial action in this specific clinical scenario. The report of a new cough in a client with heart failure necessitates a targeted assessment of the respiratory system, including auscultating lung sounds and evaluating for signs of hypoxemia, to rule out a life-threatening complication.

Choice D rationale

While a cough is a known side effect of lisinopril, dismissing the symptom could be dangerous. The cough may not be benign; it could be an early sign of pulmonary congestion from heart failure. The nurse must perform a comprehensive assessment to ensure the client's safety and to avoid misattributing a serious finding to a common medication side effect.