A nurse is assisting in identifying clients on the medical surgical floor with skin problems. Which of the following are most likely to become chronic wounds?

Cluster of oral herpes sores

Abdominal surgical incision

Diabetic foot ulcer

Posterior scalp wound

Answer and Explanation

The Correct Answer is C

A. Cluster of oral herpes sores: Oral herpes sores typically heal within a few weeks and do not generally become chronic wounds unless there are complications or underlying immune system issues. They are more acute in nature and tend to resolve without becoming chronic.

B. Abdominal surgical incision: Surgical incisions are designed to heal within a specific timeframe, usually a few weeks to a couple of months, depending on the type of surgery and individual healing factors. While surgical wounds can sometimes have delayed healing or complications, they are not typically categorized as chronic wounds unless they fail to heal or become recurrent over an extended period.

C. Diabetic foot ulcer: Diabetic foot ulcers are highly prone to becoming chronic wounds due to the underlying pathology associated with diabetes, such as neuropathy (nerve damage), peripheral vascular disease (poor circulation), and impaired immune function. These factors can impair the normal healing process, leading to delayed healing, infection, and the potential for the wound to become chronic if not managed appropriately.

D. Posterior scalp wound: Scalp wounds can heal relatively quickly, especially with proper wound care and management. However, certain factors such as the size of the wound, depth, presence of infection, and underlying conditions can influence the likelihood of a scalp wound becoming chronic. In general, scalp wounds are less likely to become chronic compared to wounds in areas with higher risk factors, such as diabetic foot ulcers.

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Correct Answer is C

Explanation

A. Diarrhea and vomiting for 36 hours:

Diarrhea and vomiting can lead to metabolic acidosis due to loss of bicarbonate and increased hydrogen ion concentration in the blood. However, the ABG values provided indicate respiratory alkalosis (high pH and low PaCO2), which is not consistent with metabolic acidosis caused by diarrhea and vomiting. Therefore, this choice does not correlate with the ABG values.

B. Chronic obstructive pulmonary disease (COPD):

COPD is a respiratory condition characterized by airflow limitation and increased airway resistance. It can lead to respiratory acidosis due to retention of carbon dioxide (PaCO2 levels would be elevated). The ABG values in the scenario show respiratory alkalosis (low PaCO2), which is the opposite of what would be expected in COPD. Therefore, this choice does not correlate with the ABG values provided.

C. Anxiety-induced hyperventilation:

Anxiety-induced hyperventilation is a common cause of respiratory alkalosis. During hyperventilation, there is excessive elimination of carbon dioxide (PaCO2 levels decrease), leading to an increase in pH (alkalosis). The ABG values in the scenario show a high pH (7.48) and low PaCO2 (28 mm Hg), consistent with respiratory alkalosis seen in hyperventilation due to anxiety.

D. Diabetic ketoacidosis and chronic obstructive pulmonary disease (COPD):

Diabetic ketoacidosis (DKA) is a metabolic condition characterized by hyperglycemia, ketosis, and metabolic acidosis (low pH and low bicarbonate levels). COPD, as mentioned earlier, can lead to respiratory acidosis due to retained carbon dioxide. Neither of these conditions correlates with the ABG values provided, which show respiratory alkalosis (high pH and low PaCO2). Therefore, this choice does not correlate with the ABG values.

A. Measure the depth and width of the wound. B. Educate the client about the need for antibiotics. C. Consult a nutritionist for a diet plan. D. Remove any non-viable tissue.

Correct Answer is ["A","B","C","D"]

Explanation

A. Measure the depth and width of the wound. Regular assessment and documentation of the wound’s size can help track the progress of healing and effectiveness of the treatment plan.

B. Educate the client about the need for antibiotics. If an infection is present, antibiotics may be necessary. It’s important for the client to understand the purpose and proper use of these medications.

C. Consult a nutritionist for a diet plan. Good nutrition is essential for wound healing. Certain nutrients, like protein, vitamin C, and zinc, can promote wound healing.

D. Remove any non-viable tissue. Debridement, or the removal of dead (non-viable) tissue, can help promote the healing of the wound by reducing the risk of infection and allowing healthy tissue to grow.

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A nurse is assisting in identifying clients on the medical surgical floor with skin problems. Which of the following are most likely to become chronic wounds?

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Naxlex Comprehensive Predictor Exams

A nurse evaluates the following arterial blood gas values in a patient: pH 7.48, PaO 98 mm Hg, PaCO 28 mm Hg, and HCO - 22 mEq/L (22 mmol/L). Which patient condition does the nurse correlate with these results?

Correct Answer is C

Explanation

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Correct Answer is ["A","B","C","D"]

Explanation

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