The nurse is caring for a client with a large venous ulcer on the leg. What intervention should the nurse implement to promote healing and prevent infection?
Apply an antibiotic ointment on the surrounding skin with each dressing change
Apply a clean occlusive dressing once daily and whenever soiled
Abstain from wearing graduated compression stockings
Provide a high-calorie, high-protein diet
The Correct Answer is D
A. Routine use of antibiotic ointment on surrounding skin is not standard unless infection is present.
B. Occlusive dressings help maintain a moist wound environment but must be managed carefully; frequency depends on wound status.
C. Graduated compression stockings are recommended to improve venous return and aid ulcer healing; abstaining from them is not advised.
D. A high-calorie, high-protein diet supports tissue repair and immune function, promoting healing and preventing infection in clients with venous ulcers.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Assessing for dizziness and hypotension helps prevent falls and complications related to orthostatic changes during position changes.
B. Moving quickly increases the risk of dizziness and falls, which is unsafe.
C. Elevating the head of the bed quickly can cause sudden blood pressure drops and dizziness.
D. Allowing the client to stand unassisted postoperatively is unsafe due to potential weakness or hypotension.
Correct Answer is A
Explanation
A. Hypertension (blood pressure ≥130/85 mm Hg) is a component of metabolic syndrome and is associated with an increased risk of developing type 2 diabetes mellitus. The elevated blood pressure here indicates increased risk.
B. A triglyceride level of 100 mg/dL is within normal limits (<150 mg/dL) and does not increase diabetes risk.
C. An abdominal girth of 32 inches is below the risk threshold for women (≥35 inches), so this is not a significant risk factor.
D. A fasting blood glucose of 98 mg/dL is within the normal range (<100 mg/dL) and does not indicate increased diabetes risk.
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