Exam 38: Providing Wound Care and Treating Pressure Ulcers

The nurse reminds the 85-year-old patient that his healing will be slower because of age- related changes such as: (Select all that apply.)

The nurse explains to the patient that the foot will be submerged in warm water for a maximum of ______ minutes.

The nurse is aware that the only necrotic wound for which debridement is not recommended is a pressure ulcer located on the:

The nurse is taking care of a post-surgical patient and notes the incision is clean and dry, with sutures intact. The nurse further assesses that the wound is healing by _____ intention.

The nurse recognizes that of the drugs a patient is currently taking, several contribute to delayed healing, such as: (Select all that apply.)

The nurse is performing a dry sterile dressing change for an abdominal wound. The nurse should use a swab to clean:

The nurse clarifies that a vacuum-assisted closure supports healing of a wound by:

The nurse chooses a nonadherent dressing to apply to a wound because the nonadherent dressing:

When the patient complains that he feels he is getting worse because of the increased swelling at his wound site on his leg, the nurse's most helpful response would be that swelling indicates that:

A nurse removing wound staples would engage the staple puller and squeeze the handles completely and:

The nurse assesses the large raised scar on the African-American patient. The nurse documents the lesion as a ___________.

A nurse is assessing a surgical patient for internal hemorrhage, which would be indicated by _____ blood pressure.

A nurse is ambulating a patient in the hall a few days after abdominal surgery and the patient says, "I think something just let go." The initial intervention by the nurse should be to:

The nurse is concerned about an HIV immunocompromised patient's ability to heal because of the lack of: (Select all that apply.)

The nurse irrigating an infected wound of the hand would: (Prioritize the steps. Separate the letters by a comma and a space as follows: A, B, C, D, E, F, G.) A) Open sterile irrigation basin and solution. B) Don sterile gloves to apply dressing. C) Pour irrigating solution in basin. D) Irrigate keeping the syringe tip 1 inch from the wound surface. E) Document procedure F) Pat wound dry and redress G) Place pad under the infected hand.

A nurse caring for a patient with a stage I pressure ulcer would most appropriately select a(n) _____ dressing.

The nurse places Dakin's solution in a wound to accomplish chemical ___________.

The nurse is alert to the indication of possible dehiscence of an abdominal surgical wound, which would be evidenced by:

The nurse gives an example of a wound that heals by second (secondary) intention as a:

The nurse warns the patient that one of the patient's habits has caused the reduction of functional hemoglobin, which limits the hemoglobin's oxygen-carrying ability. To improve this situation, the nurse suggests that the patient quit: