Difficulty: Medium
Average Score: 87%
Simulated
The client has a documented stage II pressure ulcer on the right hip. What NANDA nursing diagnosis problem statement is most appropriate to use with this client?
Correct answer
D
Rationale
The correct answer is D: Impaired Skin Integrity. This NANDA nursing diagnosis is most appropriate because a stage II pressure ulcer indicates damage to the skin, making impaired skin integrity the primary issue. Choice A (Risk for Injury) is incorrect as the injury has already occurred. Choice B (Altered Tissue Perfusion) is incorrect as it refers to circulation issues, not skin damage. Choice C (Impaired Tissue Integrity) is incorrect as it is a broader term and doesn't specifically address the skin.