Author Question: The nurse identifies the diagnosis Risk for Impaired Skin Integrity as applicable for a client with ... (Read 231 times)

lak · **on:** Jun 25, 2018

The nurse identifies the diagnosis Risk for Impaired Skin Integrity as applicable for a client with heart failure. Which assessment finding supports the use of this diagnosis for the client?

A) Shortness of breath with ambulation
B) Productive cough
C) + 3 pitting edema both feet
D) Heart rate 104 and regular

Question 2

A client with frequent urinary tract infections in seen in the urology clinic and is at risk for acute renal failure. The nurse reviews the client's medical history. Which item support the client's being at risk for acute renal failure?

Select all that apply.
A) Dehydration
B) Renal calculi
C) Ineffective would healing
D) Low serum albumin
E) Hypertension

cassie_ragen · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Answer: C

Edema of the feet increases the client's risk for impaired skin integrity. Activity Intolerance would be a diagnosis applicable for shortness of breath with ambulation. Risk for Impaired Gas Exchange would be a diagnosis applicable for a productive cough. Risk for Impaired Perfusion would be a diagnosis applicable for a heart rate of 104 and regular.

Answer to Question 2

Answer: A, B, E

Dehydration, renal calculi, and hypertension can all precipitate acute renal failure (ARF). Ineffective wound healing has not been shown to cause renal failure unless the infection becomes systemic. A low serum albumin does not cause ARF.
B) Dehydration, renal calculi, and hypertension can all precipitate acute renal failure