While changing the dressing of a client who is immobile, the practical nurse (PN) observes a red and swollen wound with a moderate amount of yellow and green drainage and a foul odor. Before reporting this finding to the healthcare provider, the PN should evaluate which of the client's laboratory values?
C-reactive protein level.
Culture for sensitive organisms.
Serum albumin.
Serum blood glucose (BG) level.
The Correct Answer is B
The correct answer is choice B. Culture for sensitive organisms.
Choice A rationale:
C-reactive protein (CRP) levels are indicative of inflammation in the body and can help identify the presence of an infection. However, CRP levels do not provide specific information about the type of organism causing the infection, which is crucial for targeted treatment.
Choice B rationale:
A culture for sensitive organisms is essential in this scenario because it identifies the specific bacteria or other pathogens present in the wound. This information is critical for selecting the appropriate antibiotic therapy to treat the infection effectively.
Choice C rationale:
Serum albumin levels are important for assessing nutritional status and overall health, which can impact wound healing. Low albumin levels can indicate poor nutritional status and delayed wound healing, but they do not provide immediate information about the infection itself.
Choice D rationale:
Serum blood glucose (BG) levels are crucial for managing diabetes and can affect wound healing. High blood glucose levels can impair the immune response and slow down the healing process. However, like CRP, BG levels do not provide specific information about the type of infection present in the wound.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This is the action that the PN should emphasize for the client to take before self-administration of the nasal spray because it clears the nasal passages of mucus and debris and allows for better absorption of the medication. The PN should also instruct the client to shake the botle well, tilt the head slightly forward, insert the nozzle into one nostril, close the other nostril with a finger, and press the pump while inhaling gently.
Correct Answer is C
Explanation
Choice A rationale:
Reporting the incident to the family is not the first action the PN should take in this situation. It may be appropriate to inform the family later if necessary, but immediate action is needed to address the boundaries being crossed in the client's room.
Choice B rationale:
Requesting that the man get up and leave is not the first action the PN should take. This situation involves delicate and sensitive issues, and the PN should prioritize the client's privacy, dignity, and emotional well-being.
Choice C rationale:
The most appropriate first action is for the PN to exit the room and quietly close the door. This action respects the client's privacy and allows the couple to have some space and time to compose themselves.
Choice D rationale:
Asking when the nurse should return is not the first action to take. The PN needs to ensure the client's privacy and deal with the situation at hand discreetly. Later, the PN can discuss the incident with the client if necessary, or involve the appropriate authorities as per the facility's policy.
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