A male client on prolonged bed rest has developed a pressure ulcer. The wound shows no signs of healing even though the client has received skin care and has been turned every 2 hours. Which factor is most likely responsible for the failure to heal?

Correct Answer: B

Rationale: Pressure ulcers require optimal nutrition for healing, and inadequate protein intake (Choice B) is the most likely reason for non-healing despite repositioning and skin care. Protein is essential for collagen synthesis, tissue repair, and immune function; deficiency causes negative nitrogen balance, stalling granulation and epithelialization. Prolonged bed rest already reduces muscle mass, exacerbating protein needs. Vitamin D (Choice A) aids calcium absorption for bone health, not directly wound healing, though it supports overall recovery. Massaging the affected area (Choice C) is contraindicated, as it damages fragile tissue, and isn't part of standard care here. Low calcium (Choice D) affects bones more than soft tissue repair. For example, a client needing 1.5-2 g/kg protein daily but receiving less won't heal, even with turning, as protein fuels fibroblast activity and angiogenesis. Thus, Choice B is the correct and primary factor.

Correct Answer: C

Rationale: The rhythmic biologic clock in humans is the 'circadian rhythm' , a roughly 24-hour cycle governed by the hypothalamic suprachiasmatic nucleus (SCN), syncing bodily functions like sleep, temperature, and hormone release to day-night cues. 'Sleep-wake cycle' is a component of this rhythm, not its name; it's the observable outcome, not the mechanism. 'Alert-unaware process' is fictitious, lacking scientific basis. 'Yo-yo theory' doesn't exist in sleep science. For instance, the SCN adjusts melatonin release at dusk, promoting sleep, and cortisol at dawn, enhancing alertnessdisruptions (e.g., jet lag) show its 24-hour rule. Nursing education, per Taylor, emphasizes circadian rhythm as the internal pacemaker, evident in shift workers' struggles. Unlike a mere cycle, it's a genetically driven clock, making Choice C the precise term and correct answer.

Correct Answer: D

Rationale: Medications impact sleep via physiological or neurological effects. 'Ambien' , or zolpidem, is least likely to harm sleep quality; it's a sedative-hypnotic designed to induce and maintain sleepe.g., shortening sleep latency to 15 minuteswithout altering architecture long-term, per prescribing data. 'Diuretic' disrupts sleep via nocturiae.g., waking 3 times to void after furosemide. 'Steroid' , like prednisone, causes insomniae.g., 20% of users report wakefulness from CNS stimulation. 'Antidepressant' , like SSRIs, alters REMe.g., fluoxetine delays REM onset by 30 minutesdisrupting quality. Ambien's targeted action (GABA enhancement) contrasts with others' side effects, aligning with Taylor's pharmacology. Choice D is correct as it enhances, not impairs, sleep.

Correct Answer: D

Rationale: Sleepwalking (somnambulism), a parasomnia, occurs in NREM stage 3, posing risks. 'Safety' is key; a 10-year-old might wandere.g., downstairs or outsiderisking falls or injury, per sleep disorder texts. 'Sleep deprivation' might exacerbate it but isn't the discussion's focuse.g., it's a trigger, not the issue. 'Privacy' is irrelevant; sleepwalking isn't about exposuree.g., no dignity loss. 'Schoolwork' might reflect fatigue but isn't immediatee.g., a sprained ankle trumps grades. Nurses, per Taylor, advise locks, alarms, or floor paddinge.g., 80% of sleepwalkers injure themselves yearly. Choice D addresses this primary concern correctly.

Correct Answer: A

Rationale: Pain is subjective, per IASP's definition. 'The person who has the pain' best determines ite.g., only they feel 'stabbing' vs. 'dull,' guiding care, per Taylor's patient-centered ethos. 'The person's immediate family' guessese.g., 'He looks bad'but lacks internal insight. 'The nurse caring for the patient' assesses signs (e.g., grimacing) but can't feel ite.g., rating 8 might seem 4 outwardly. 'The physician diagnosing the cause' identifies etiologye.g., fracturebut not sensation. A patient's self-reporte.g., 'It's 10/10'trumps all, making Choice A correct.