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    Ati lpn level 2 med surg proctored exam

    A nurse is collecting data from four clients who have wounds. The nurse should recognize that which of the following clients has a manifestation of a wound infection?

    Explanation & Rationale

    A. A client who has serosanguineous drainage from the wound: Serosanguineous drainage is a normal mixture of clear and blood-tinged fluid often seen during the healing process. It does not necessarily indicate infection unless accompanied by other signs such as odor or increased redness. B. A client who has urticaria and itching around the wound: Urticaria and itching may indicate an allergic reaction or irritation rather than an infection. While uncomfortable, these symptoms are not typical signs of wound infection. C. A client who has swelling, tenderness and purulent drainage around the wound: These are classic signs of wound infection. Purulent drainage, along with localized swelling and tenderness, suggests the presence of bacterial colonization and inflammation requiring medical intervention. D. A client who has brown crusting over the wound: Crusting can be part of the normal healing process where a scab forms. Brown crusting alone does not indicate infection unless accompanied by redness, warmth, or purulent discharge.

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