Question 1

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.)

Accepted Answer

A)  excessive production of blood factors. 
B)  atherosclerosis. 
C)  diminished lung function. 
D)  slow metabolism. 
E)  increased immunity. 
A)  excessive production of blood factors. 
B)  atherosclerosis. 
C)  diminished lung function. 
D)  slow metabolism. 
E)  increased immunity.

Question 2

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

Accepted Answer

keloid
Keloids are large raise

Question 3

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:

Accepted Answer

A)  drinking. 
B)  using marijuana. 
C)  smoking cigarettes. 
D)  eating excessive fats. 
A)  drinking. 
B)  using marijuana. 
C)  smoking cigarettes. 
D)  eating excessive fats.

Question 4

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

Accepted Answer

A)  is smaller and less bulky and will absorb more drainage. 
B)  retains sterility longer than plain gauze. 
C)  allows drainage to seep through the barrier and be absorbed on the other side. 
D)  does not require the use of tape to make it adhere to the skin. 
A)  is smaller and less bulky and will absorb more drainage. 
B)  retains sterility longer than plain gauze. 
C)  allows drainage to seep through the barrier and be absorbed on the other side. 
D)  does not require the use of tape to make it adhere to the skin.

Question 5

A nurse performing a right eye irrigation will position the patient:

Accepted Answer

A)  upright with the head hyperextended. 
B)  upright with the head tilted toward the left eye. 
C)  supine with the head hyperextended. 
D)  supine with the head tilted toward the right eye. 
A)  upright with the head hyperextended. 
B)  upright with the head tilted toward the left eye. 
C)  supine with the head hyperextended. 
D)  supine with the head tilted toward the right eye.

Question 6

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

Accepted Answer

A)  hemoglobin. 
B)  adequate fibroblast function. 
C)  synthesis of collagen. 
D)  intrinsic factor. 
E)  adequate phagocytosis. 
A)  hemoglobin. 
B)  adequate fibroblast function. 
C)  synthesis of collagen. 
D)  intrinsic factor. 
E)  adequate phagocytosis.

Question 7

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:

Accepted Answer

A)  an infection is in progress at the wound site. 
B)  vessels have dilated and allowed plasma to leak into the wound site. 
C)  he has lain in one position for such a long time that swelling has occurred. 
D)  there is probably a deeper injury than what appears on the surface. 
A)  an infection is in progress at the wound site. 
B)  vessels have dilated and allowed plasma to leak into the wound site. 
C)  he has lain in one position for such a long time that swelling has occurred. 
D)  there is probably a deeper injury than what appears on the surface.

Question 8

A patient has a pooling of blood under unbroken skin of the hip after a fall. The nurse should document that this patient has a(n):

Accepted Answer

A)  abrasion. 
B)  laceration. 
C)  hematoma. 
D)  avulsion. 
A)  abrasion. 
B)  laceration. 
C)  hematoma. 
D)  avulsion.

Question 9

A patient who underwent removal of a breast must be discharged home with a Jackson-Pratt wound drain in place. As the patient demonstrates the procedure for emptying it, the nurse should correct her if she:

Accepted Answer

A)  uses one alcohol wipe to clean both the spout and the plug. 
B)  compresses the device in the hand before closing. 
C)  refrains from touching the drainage spout with the hand. 
D)  points the device away from herself while opening it. 
A)  uses one alcohol wipe to clean both the spout and the plug. 
B)  compresses the device in the hand before closing. 
C)  refrains from touching the drainage spout with the hand. 
D)  points the device away from herself while opening it.

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 assesses the large raised scar on the African American patient. The nurse documents the lesion 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:

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

A nurse performing a right eye irrigation will position the patient:

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

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 patient has a pooling of blood under unbroken skin of the hip after a fall. The nurse should document that this patient has a(n):

A patient who underwent removal of a breast must be discharged home with a Jackson-Pratt wound drain in place. As the patient demonstrates the procedure for emptying it, the nurse should correct her if she:

Nursing and the Health Care System

Concepts of Health, Illness, Stress, and Health Promotion

Legal and Ethical Aspects of Nursing

The Nursing Process and Critical Thinking

Assessment, Nursing Diagnosis, and Planning

Implementation and Evaluation

Documentation of Nursing Care

Communication and the Nurse Patient Relationship

Patient Education and Health Promotion

Delegation, Leadership, and Management

Growth and Development: Infancy Through Adolescence

Adulthood and the Family

Promoting Healthy Adaptation to Aging

Cultural and Spiritual Aspects of Patient Care

Loss, Grief, and End-of-Life Care

Infection Prevention and Control: Protective Mechanisms and Asepsis

Infection Prevention and Control in the Hospital and Home

Safe Lifting, Moving, and Positioning of Patients

Assisting with Hygiene Personal Care Skin Care and the Prevention of Pressure Ulcers

Patient Environment and Safety

Measuring Vital Signs

Assessing Health Status

Admitting Transferring and Discharging Patients

Diagnostic Tests and Specimen Collection

Fluid, Electrolyte, and Acid-Base Balance

Concepts of Basic Nutrition and Cultural Considerations

Nutritional Therapy and Assisted Feeding

Assisting with Respiration and Oxygen Delivery

Promoting Urinary Elimination

Promoting Bowel Elimination

Pain Comfort and Sleep

Complementary and Alternative Therapies

Pharmacology and Preparation for Drug Administration

Administering Oral, Topical, and Inhalant Medications

Administering Intradermal, Subcutaneous, and Intramuscular Injections

Administering Intravenous Solutions and Medications

Care of the Surgical Patient

Promoting Musculoskeletal Function

Common Physical Care Problems of the Older Adult

Common Psychosocial Care Problems of Older Adults

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