Nokea
Lack of adequate nutrition in older adults may lead to:
- A. Delayed wound healing
- B. Shorter hospital stays
- C. Improved immune status
- D. Decreased mortality rates
Correct Answer: A
Rationale: Poor nutrition weakens tissues and impairs the body's ability to repair itself, resulting in delayed wound healing and increased susceptibility to infections.
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A client had a hemicolectomy performed two days ago. Today, the nurse assessed the incision and discovered a small part of the abdominal viscera protruding through the incision. This complication of wound healing is known as:
- A. excoriation.
- B. dehiscence.
- C. decortication.
- D. evisceration.
Correct Answer: D
Rationale: Excoriation is an abrasion of the epidermis, or of any organ coating of the body, caused by trauma, chemicals, burns, or other causes. Dehiscence is a partial to complete separation of the wound edges with no abdominal tissue protrusion. Decortication is removal of the surface layer of an organ or structure, such as removing the fibrinous peel from the visceral pleura in thoracic surgery. Evisceration occurs when the incision separates and the contents of the cavity spill out.
A patient with a second-degree burn has a greater risk for
- A. Constipation.
- B. Infection.
- C. Hypotension.
- D. Hyperglycemia.
Correct Answer: B
Rationale: Burns disrupt skin integrity, increasing infection risk.
Sue is having a minor procedure performed. Which type of anesthesia is most likely to be used?
- A. General.
- B. Epidural.
- C. Regional.
- D. Conscious sedation.
Correct Answer: D
Rationale: Conscious sedation is often used for minor procedures.
Which are implications of stress?
- A. Valvular conditions
- B. Inflammatory GI disorders
- C. Fluid imbalance
- D. Electrolyte imbalance
Correct Answer: B
Rationale: Stress can lead to gastrointestinal inflammation, which may manifest as ulcers, irritable bowel syndrome, or other digestive issues.
What is the priority nursing diagnosis?
- A. Risk for Injury related to seizures
- B. Risk for Other-Directed Violence related to hallucinations
- C. Risk for Situational Low Self-esteem related to police custody
- D. Risk for Nutritional Deficit related to chronic alcohol abuse
Correct Answer: A
Rationale: Seizures pose an immediate risk to the patient's safety.