A client with an infected four-day-old postoperative wound has been readmitted to the unit for wound debridement and antibiotic therapy

The wound is sutured with a scab that is pulling away from the edges of the skin, is draining pus and serosanguinous fluid, and is swollen and reddened. The nurse classifies the wound at what stage of healing? 1. Secondary intention healing
2. Proliferative phase
3. Maturation phase
4. Inflammatory phase


4
Rationale: The wound was sutured and therefore intended to heal as primary intention. The wound is red and inflamed with serosanguinous drainage, and is four days old, which is the inflammatory phase. In the proliferative phase, the skin is still reddened but is no longer greatly inflamed. The maturation phase is characterized by a scar that continues to grow stronger with tissue growth. Secondary intention healing occurs when the wound is left open to heal rather than being sutured or approximated.

Nursing

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A 13-year-old female is undergoing rapid development of her breasts after experiencing menarche several months ago. Which of the following hormones are active in the development of her breasts? Select all that apply

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A male patient has reported to the nurse that he is experiencing sharp, intense pain when he blinks, and he claims that he has not previously experienced this problem

The nurse reports this finding to the primary care provider in the knowledge that the patient may have which of the following health problems? A) Impaired pupil function B) A cataract C) A sudden increase in intraocular pressure (IOP) D) An abrasion of the cornea

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A father tells the nurse that his daughter wants the same plate and cup used at every meal, even if they go to a restaurant. The nurse should explain that this is

a. A sign the child is spoiled b. A way to exert unhealthy control c. Regression, common at this age d. Ritualism, common at this age

Nursing

The nurse should implement which interventions for an infant experiencing apnea? Select all that apply

a. Stimulate the infant by gently tapping the foot. b. Shake the infant vigorously. c. Have resuscitative equipment available. d. Suction the infant. e. Maintain a neutral thermal environment.

Nursing