A nurse is caring for a female client who had a stroke. Which of the following findings should indicate to the nurse that the client has an increased risk of developing skin breakdown?
Hgb 18 g/dL (12 to 16 g/dl)
WBC 12.000/mm3 (5,000 to 10,000/mm3)
25-Hydroxyvitamin D 92 ng/ml. (25 to 80 ng/mL)
Albumin 3.1 g/dL (3.5 to 5 g/dL)
The Correct Answer is D
Albumin is a protein that plays a crucial role in maintaining skin health. Low albumin levels (hypoalbuminemia) can lead to poor wound healing and skin vulnerability.
Hemoglobin level, white cell count and 25-hydroxyvitamin have no direct role in skin breakdown.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
B. Painless vaginal bleeding, especially after sexual intercourse or between menstrual periods, can be an early sign of cervical cancer. This bleeding may occur due to cervical lesions or abnormalities, such as cervical dysplasia or cervical cancer. It is important for individuals to report any abnormal vaginal bleeding to their healthcare provider for further evaluation.
A. Urinary hesitancy, which is difficulty starting urination or a delay in the initiation of the urinary stream, is not typically associated with cervical cancer.
C. Unexplained weight gain is not typically associated with cervical cancer.
D. Frequent diarrhea is not typically associated with cervical cancer.
Correct Answer is C
Explanation
C. It acknowledges the client's symptoms and provides a likely explanation related to hormonal changes associated with aging. It opens the door for further discussion and potential interventions to address the underlying cause.
A. This response dismisses the client's symptoms without addressing the underlying cause or providing potential solutions.
B. The opposite tends to occur with age – vaginal tissue can become thinner and drier due to decreasing estrogen levels, leading to symptoms like vaginal dryness and itching.
D. While avoiding intercourse may be recommended in certain situations, such as if there is discomfort or pain, it does not address the underlying cause of the symptoms. Additionally, it may not be necessary if appropriate treatments are pursued to alleviate vaginal dryness and itching.
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