Mrs. Jenkins is a 78-year-old patient who was admitted to the hospital for a bowel obstruction. She is immobile and the nurse has noticed that she has a reddened area on her right heel
When the nurse presses on the area it does not turn lighter in color. She knows that the skin injury is reversible if the pressure is relieved and she uses measures to protect the tissue. How should the nurse document the tissue condition? A. Reactive hyperemia
B. Blanchable hyperemia
C. Nonblanchable hyperemia
D. Cachexia
C
Nonblanchable hyperemia is redness that persists after palpation and indicates tissue damage. When you press a finger against the red or purple area, it does not turn lighter in color. Deep tis-sue damage is present and is commonly the first stage of pressure ulcer development.
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Identify which of the following would be detrimental for the nurse desiring to manage stress when working with a client/family in crisis
1. Drink plenty of water and eat a balanced and healthy diet 2. Participate in memorials and rituals 3. Talk about your emotions 4. Maintain a consistent work assignment
A 3-year-old child with right-sided heart failure has been admitted for worsening of his condition. Which of the following assessments would be considered one of the earliest signs of systemic venous congestion in this toddler?
A) Breathlessness with activity B) Excessive crying C) Enlargement of the liver D) Increased urine output
A client just involved in a motor vehicle accident has sustained blunt chest trauma as part of his injuries
The nurse assessment reveals absent breath sounds in the left lung field. A left-sided pneumothorax is suspected and is further validated when assessment of the trachea reveals a. a shift to the right. b. a shift to the left. c. no deviation. d. subcutaneous emphysema.
A nurse is organizing a round table presentation at a conference. The nurse asks the other participants for suggestions on actions that nurses can take to reduce national health disparities
Which of the following suggestions are known to be effective measures for the reduction of health disparities? Select all that apply. A. Volunteer with an international organization that supports building infrastructure in underdeveloped areas. B. Support initiatives that increase physical education classes and healthy school meals. C. Design and create research studies that address inequities and support vulnerable populations. D. Discuss social and health disparity information with coworkers to promote awareness. E. Act as advocates for patients, families, and communities in reducing inequities.