NCLEX-RN (Registered Nurse) Practice Exam · Question
A 55-year-old client with type 2 diabetes and a history of peripheral neuropathy reports a new, non-healing ulcer on their left great toe. The toe appears red and swollen, and the client reports a sensation of throbbing pain. Which action should the registered nurse (RN) prioritize?
While all options are important, assessing for systemic infection (e.g., fever, elevated white blood cell count) is the priority. Localized infection of a non-h
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Question: A 55-year-old client with type 2 diabetes and a history of peripheral neuropathy reports a new, non-healing ulcer on their left great toe. The toe appears red and swollen, and the client reports a sensation of throbbing pain. Which action should the registered nurse (RN) prioritize?
Answer options:
- Educating the client on proper foot care techniques.
- Arranging for a sterile dressing change and wound care.
- Administering a prescribed oral pain medication. ✅ Assessing for signs of systemic infection, such as fever.
Correct answer: Assessing for signs of systemic infection, such as fever.
Explanation: While all options are important, assessing for systemic infection (e.g., fever, elevated white blood cell count) is the priority. Localized infection of a non-healing diabetic ulcer can rapidly progress to osteomyelitis or sepsis, which is a life-threatening condition.
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