A patient has a hemoglobin of 7.1 g/dL. The nurse understands that anemia is likely to result in which of the following?

Choice A reason: Instructing repositioning every 2 hours is appropriate but not the first action for a progressing ulcer, seen on video. Verification via in-person assessment ensures accuracy, as video may not capture depth or infection. A home visit confirms the stage, guiding intervention, per pressure ulcer management protocols.

Choice B reason: Asking the daughter to take pictures is unreliable, as non-professional images may lack clarity or accuracy. A nurse’s in-person assessment is needed to evaluate ulcer progression, ensuring proper staging and treatment, avoiding misdiagnosis, per telehealth and wound care standards.

Choice C reason: Contacting the provider for a hydrocolloid dressing is premature without verifying the ulcer’s stage in person. Stage 1 ulcers typically require pressure relief, not advanced dressings. A home visit confirms progression, ensuring appropriate intervention, per evidence-based wound care guidelines.

Choice D reason: Making a home visit to verify ulcer changes is the priority, as video may not fully capture progression (e.g., depth, infection). In-person assessment confirms the stage, guiding accurate treatment like dressings or repositioning, preventing deterioration, per telehealth wound assessment and pressure injury protocols.

Choice A reason: Hypertension is defined by elevated blood pressure, not an irregular heart rate. An irregular pattern at 72 bpm suggests a rhythm abnormality, not a pressure issue. Hypertension affects vascular resistance, not cardiac rhythm directly, making this incorrect for the observed finding, per cardiovascular physiology.

Choice B reason: A dysrhythmia is indicated by an irregular heart rate pattern at 72 bpm, as it reflects abnormal electrical conduction, such as atrial fibrillation or premature beats. Notifying the provider is appropriate, as dysrhythmias may impair cardiac output or indicate underlying pathology, requiring prompt evaluation, per cardiac monitoring protocols.

Choice C reason: Tachycardia is a heart rate above 100 bpm, not applicable to 72 bpm. The irregularity, not speed, is the concern. Tachycardia involves rapid but often regular rhythms, whereas this finding suggests a dysrhythmia, making this choice incorrect for the described clinical presentation, per cardiac assessment.

Choice D reason: Bradycardia is a heart rate below 60 bpm, not matching 72 bpm. The irregular pattern points to a dysrhythmia, not a slow rate. Bradycardia affects heart rate frequency, not rhythm irregularity, making this irrelevant to the finding, which requires rhythm-focused intervention, per cardiac physiology.