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 ["A","B","C","E"]
Explanation
A. "UTI’s can be caused by urethrovesical reflux which is the backward flow of urine from the urethra to the bladder after coughing, sneezing, or straining":
This statement is correct. Urethrovesical reflux can contribute to UTIs, especially in women, as it can introduce bacteria from the urethra back into the bladder.
B. "UTI’s are more common in women due to their longer urethras":
This statement is correct. Women have shorter urethras than men, which makes it easier for bacteria to travel into the bladder, increasing the risk of UTIs.
C. "Glycosaminoglycan (GAG) is a protein in the urinary tract that exerts a nonadherent protective effect against various bacteria":
This statement is correct. Glycosaminoglycan is a substance that lines the urinary tract and helps prevent bacterial adherence, thereby protecting against UTIs.
D. "The organism most often responsible for UTI's in older adults is staphylococcus":
This statement is incorrect. The most common bacteria responsible for UTIs are Escherichia coli (E. coli), not staphylococcus.
E. "The normal urinary tract is sterile above the urethra":
This statement is correct. Normally, the urinary tract above the urethra is sterile, devoid of bacteria. UTIs occur when bacteria enter and multiply in the urinary system, leading to infection.
Correct Answer is ["438"]
Explanation
To calculate the high-end dosage for a 125 kg patient, you can multiply the weight in kilograms (125 kg) by the high-end dosage range (3.5 mg/kg):
High-end dosage = 125 kg * 3.5 mg/kg = 437.5 mg
Rounded to whole number give 438mg.
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