The nurse is caring for a client who is diagnosed with an arterial insufficiency ulcer. The nurse should plan interventions to address which priority issue?
Chronic pain
Impaired skin integrity
Risk for injury
Ineffective tissue perfusion
The Correct Answer is D
A. Chronic pain - Chronic pain is a concern for the client, but addressing the underlying issue of ineffective tissue perfusion will help alleviate pain by promoting healing and reducing tissue damage.
B. Impaired skin integrity - Impaired skin integrity is a result of ineffective tissue perfusion. By addressing perfusion issues, skin integrity can be improved as tissues receive adequate oxygen and nutrients for healing.
C. Risk for injury - While clients with arterial insufficiency ulcers are at risk for injury, the immediate concern is addressing the ineffective tissue perfusion to prevent complications related to poor circulation, such as tissue necrosis and infection.
D. Ineffective tissue perfusion- Arterial insufficiency ulcers are caused by inadequate blood flow to the tissues. The priority issue for a client with an arterial insufficiency ulcer is ineffective tissue perfusion. Due to decreased blood flow, tissues do not receive enough oxygen and nutrients, leading to delayed wound healing, tissue damage, and potential complications. Interventions should focus on improving circulation, promoting vasodilation, and enhancing perfusion to facilitate wound healing and prevent further tissue damage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["25"]
Explanation
To calculate the number of hours required to infuse two 1L bags of normal saline at a rate of 80 ml/hr, you can use the following formula:
Time (hours) = Total volume (ml) / Infusion rate (ml/hr)
First, calculate the total volume of normal saline to be infused:
Total volume = 2 bags x 1L/bag x 1000 ml/L = 2000 ml
Now, plug this into the formula:
Time (hours) = 2000 ml / 80 ml/hr
Time (hours) = 25 hours
So, it will take 25 hours to infuse the total amount of normal saline at a rate of 80 ml/hr, assuming no interruptions in the infusion. Rounded to the nearest whole number, it will take 25 hours.
Correct Answer is A
Explanation
A. Broccoli with cheese
Broccoli is a good source of calcium and is also low in lactose, making it suitable for lactose-intolerant individuals. Advising the client to consume broccoli with cheese provides a calcium-rich option without relying on dairy products. Cheese can contribute additional calcium to the diet, and for many lactose-intolerant individuals, small amounts of cheese can be well-tolerated.
B. Glazed carrots - Carrots are not a substantial source of calcium.
C. Grilled cabbage - While cabbage is a healthy vegetable, it does not contain a significant amount of calcium compared to other sources.
D. Fried potatoes - Potatoes do not contain a significant amount of calcium and are not a suitable choice for increasing calcium levels.Explanation:
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