The nurse observes the skin over a client's greater trochanter, as seen in the picture with pressure sores.
What actions should the nurse implement?
Instruct the unlicensed assistive personnel to frequently offer oral fluids.
Prepare to implement a pressure redistribution mattress.
Explain to the client that the wound needs debridement.
Obtain hemoglobin of the side to check for anemia and sensitivity.
The Correct Answer is B
Pressure redistribution is an important part of preventing and treating pressure sores1.
Choice A is not the answer because offering oral fluids does not directly address the issue of pressure sores.
Choice C is not the answer because debridement is a surgical procedure that removes dead tissue from a wound and may not be necessary in this case.
Choice D is not the answer because checking for anemia and sensitivity does not directly address the issue of pressure
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["16"]
Explanation
The healthcare provider prescribed 800,000 units of penicillin and the vial available is labeled 50,000 units/mL.
To calculate the number of mL to administer, you need to divide the total number of units prescribed (800,000) by the number of units per mL (50,000).
This gives you a result of 16 mL.
Therefore, the nurse should administer 16 mL of penicillin to the patient.
Correct Answer is C
Explanation
This response shows that the nurse is willing to listen and provide support to the client.
It also allows the client to decide if they want to talk and share their feelings.
Choice A is not correct because it is not the most therapeutic response.
While it does encourage the client to talk about their visit with their significant other, it does not show that the nurse is willing to listen and provide support.
Choice B is not correct because it is not the most therapeutic response.
While it does acknowledge that the client may be feeling lonely, it does not show that the nurse is willing to listen and provide support.
Choice D is not correct because it is not the most therapeutic response.
While it does encourage the client to talk about their visit, it does not show that the nurse is willing to listen and provide support.
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