The nurse is assessing an older patient's stage III pressure ulcer. What would be indicative of proper wound healing?
1. An increase in wound depth
2. Large amount of undermining
3. Presence of leathery black tissue
4. Beefy red and moist, grainy appearance
4. Beefy red and moist, grainy appearance
Explanation: 1. The wound increasing depth is indicative of improper healing.
2. The wound's undermining does not indicate an improvement in healing.
3. Eschar is a sign of delayed wound healing.
4. Healing of a decubitus fills from the wound bottom so the depth decreases before the wound width decreases. The beefy red and grainy appearance is evidence of granulation tissue as the capillary bed builds. These are all indicators of good wound healing.
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The nurse is caring for a patient with a large bore catheter for total parenteral nutrition. Which of the following would indicate to the nurse that the patient might be experiencing catheter related sepsis?
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What is the lower single dosage?
What will be an ideal response?
A forensic nurse is demonstrating the role of advocate. Which of the following best describes the intervention being performed by the nurse?
a. Partner with public health professionals to implement programming b. Promote programs that prevent injuries c. Investigate injuries in the community d. Provide holistic care to victims of violence
The nurse is assessing the client's BMI during a routine physical examination. The client is a 19-year-old male who stands 6 ft tall and weighs 235 pounds. The nurse determines the client falls into which BMI category?
A) Healthy weight C) Obesity class 1 B) Overweight D) Obesity class 2