A nurse is caring for a client following an open colectomy. Which of the following findings places the client at risk for delayed wound healing?
INR 1.1
Hyperemesis
HbA1C 5.6%
Uncontrolled pain
The Correct Answer is B
- A: An INR of 1.1 is within the normal range, indicating normal blood clotting ability, which is essential for wound healing. A normal INR does not pose a risk for delayed wound healing.
- B: Hyperemesis can lead to dehydration and malnutrition, both of which are detrimental to wound healing. Dehydration reduces blood volume and flow, impairing the delivery of oxygen and nutrients to the wound site, while malnutrition can weaken the immune response and the formation of new tissue.
- C: An HbA1C level of 5.6% is at the high end of the normal range and does not typically indicate diabetes or impaired glucose control, which are risk factors for delayed wound healing.
- D: While uncontrolled pain can be a concern for patient comfort and may indirectly affect wound healing by reducing mobility, it is not a direct risk factor for delayed wound healing like hyperemesis is.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. While a blood pressure of 156/90 mm Hg may be elevated, it is not necessarily an indication to withhold propranolol, which is commonly used to treat hypertension.
B. A pulse rate of 54/min suggests bradycardia, which is a potential side effect of propranolol and may warrant withholding the medication.
C. A potassium level of 5.2 mEq/L is within the normal range (3.5-5.0 mEq/L) and is not typically a reason to withhold propranolol.
D. A sodium level of 130 mEq/L is within the normal range (135-145 mEq/L) and is not typically a reason to withhold propranolol.
Correct Answer is D
Explanation
A. Herpes simplex virus 2: Herpes simplex virus infections are not typically reportable to the
Centers for Disease Control and Prevention (CDC). These infections are commonly managed at the local level.
B. Candida albicans: Candida albicans infections are not typically reportable to the CDC. Candida species are common pathogens and are usually managed at the local level.
C. Staphylococcus aureus: Staphylococcus aureus infections, including methicillin-resistant
Staphylococcus aureus (MRSA), are not typically reportable to the CDC unless part of a larger outbreak or public health concern.
D. Lyme disease: Lyme disease is a reportable infection that requires notification to public health authorities, including the Centers for Disease Control and Prevention (CDC). Lyme disease is a vector-borne illness transmitted through the bite of infected ticks.
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