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Author Question: A nurse is caring for a client with autonomic dysreflexia. The nurse has been ordered to monitor the ... (Read 35 times)

shenderson6

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A nurse is caring for a client with autonomic dysreflexia. The nurse has been ordered to monitor the client's blood pressure regularly because it is dangerously elevated.
 
  The nurse should be aware that a sudden onset of hypertension can result in which of the following? A) Chills and severe headache
  B) Seizures and strokes
  C) Respiratory distress
  D) Visual disturbances

Question 2

A client had a colon resection that required a large abdominal incision. Wound healing differs according to how much tissue has been damaged. The client asks the nurse about the healing process for the surgical incision.
 
  Based on this information, how will wound healing occur for the client's surgical incision? A) First-intention
  B) Second-intention
  C) Third-intention
  D) Fourth-intention



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swimkari

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Answer to Question 1

B
Feedback:
The nurse should be aware that the sudden onset of hypertension in clients with autonomic dysreflexia causes seizures or strokes. Autonomic dysreflexia is characterized by a sudden and dangerous elevation of blood pressure owing to autonomic response to various stimuli. A sudden onset of hypertension may not result in chills and severe headache, respiratory distress, or visual disturbances.

Answer to Question 2

A
Feedback:
First-intention healing occurs in wounds with minimal tissue loss, such as surgical incisions or wounds sutured soon after injury. Second-intention healing occurs with tissue loss, such as lacerations, burns, and pressure ulcers. Third-intention healing occurs when there is a delay in the time between the injury and wound closure. It occurs after surgery when there is an infection or in a large open wound when the wound is closed later. There is no fourth-intention healing.





 

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