When assessing a client's wound, the nurse observes that the damaged tissue is being replaced with fibrous tissue. What stage of the wound healing process should the nurse recognize?
A) Resolution
B) Regeneration
C) Scar formation
D) Phagocytosis
C
Feedback:
Scar formation is the replacement of damaged cells with fibrous tissue. The integrity of skin and damaged tissue is restored by resolution, which is the process by which damaged cells recover and reestablish their normal function, regeneration or cell duplication, and scar formation. Phagocytosis is the process by which types of white blood cells consume pathogens, coagulated blood, and cellular debris.
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What will be an ideal response?
A client is being discharged home after a heart transplant with a prescription for cyclosporine (Sandimmune). What priority education does the nurse provide with the client's discharge in-structions?
a. "Use a soft-bristled toothbrush and avoid flossing." b. "Avoid large crowds and people who are sick." c. "Change positions slowly to avoid hypo-tension." d. "Check your heart rate before taking the medication."
Which strategy is appropriate when feeding the infant with congestive heart failure?
a. Continue the feeding until a sufficient amount of formula is taken. b. Limit feedings to no more than 30 minutes. c. Always bottle feed every 4 hours. d. Feed larger volumes of concentrated formula less frequently.
The case manager works in a facility that supports a participative leadership style. Which of the following should the nurse recognize as an example of democratic leadership style?
a. The interdisciplinary health care team collectively developing plans of care for clients b. The dietitian completing a nutritional assessment for a registered nurse (RN) c. The nurse implementing the physician's written orders for client care d. The unlicensed assistive personnel (UAP) taking vital signs for several nurses