RNSG 1341 - Exam 2 - NCLEX questions and answers rated A 2024

A patient 1 day post-op after abdominal surgery has incisional pain, 99.5 (°F) temperature, slight erythema at the incision margins, & 30 mL serosanguineous drainage in the Jackson-Pratt drain. Based on this assessment, what conclusion would the nurse make? - ANSWER-The patient is having a normal inflammatory response. The nurse assessing a patient with a chronic leg wound finds local signs of erythema & the patient complains of pain at the wound site. What would the nurse anticipate being ordered to assess the patient's systemic response? - ANSWER-White Blood Cell count and differential A patient in the unit has a 103.7(°F) temperature. Which intervention would be most effective in restoring normal body temperature? - ANSWER-Administer antipyretics on an around-the-clock schedule. A nurse is caring for a patient who has a pressure ulcer that is treated with debridement, irrigations, & moist gauze dressings. How should the nurse anticipate healing to occur? - ANSWER-Secondary intention A nurse is caring for a patient with diabetes who is scheduled for amputation of his necrotic left great toe. - ANSWER-The patient's White Blood Cell count is 15.0 (× 106/µL), & he has coolness of the lower extremities, weighs pounds more than his ideal body weight, & smokes 2 packs of cigarettes per day. Which priority nursing diagnosis addresses the primary factor affecting the patient's ability to heal? - ANSWER-Impaired tissue integrity related to decreased blood flow second