WGU D439 Foundations of Nursing OA |
Complete Study Guide 2026 | Verified
Answers | Graded A+ | Pass Guaranteed
S SBAR - ANSWER situation: identify yourself & unit, identify pt (name and
DOB), symptom onset and severity
B SBAR - ANSWER background: date/time of admission, admitting Dx,
relevant Hx, lab & test results
A SBAR - ANSWER assessment: what do you think is wrong, suspected
underlying cause, or concerns
R SBAR - ANSWER recommendation: how would you fix it, clear and specific
about the urgency of the request, and expected time frame
HIPAA/emancipated minors - ANSWER legally treated as adults and CAN
ONLY GIVE MEDICAL INFORMATION TO SAID MINOR (ADULT)
ear drops administration for adults - ANSWER HOLD EARLOBE UP AND
BACK
, Urine Residual - ANSWER Urine residual refers to the amount of urine left in
the bladder after a person has attempted to empty it completely.
Measuring Urine Residual - ANSWER There are 2 methods you can use for
measuring for a urine residual: Bladder Ultrasound (painless, quick, low infection
risk, can be repeated easily) and Intermittent (Straight) Catheterization (more
accurate but invasive, potential risks of UTIs, requires trained personnel).
Reasons for Urine Residual - ANSWER A patient may have urine residual
when their bladder does not empty completely after urination, which can result
from various physical, neurological, or functional issues, increasing the risk of
UTIs, bladder damage, or kidney problems if left untreated.
Braden Scale - ANSWER The Braden Scale is a clinical assessment tool used
to predict a patient's risk of developing pressure ulcers, helping nurses and
healthcare providers identify at-risk individuals for early preventive measures.
Braden Scale Components - ANSWER 1. Sensory perception: Ability to feel
and respond to discomfort or pressure; 2. Moisture: The degree to which the skin is
exposed to moisture; 3. Activity: Level of physical activity; 4. Mobility: Ability to
change and control body position; 5. Nutrition: Usual food intake pattern; 6.
Friction and shear: The amount of assistance needed to move, and whether skin
rubs against surfaces.
Braden Scale Scoring - ANSWER The total score ranges from 6-23, and the
lower the score, the higher the risk of developing a pressure ulcer.
, Wound Classifications - ANSWER Wounds are classified based on various
factors, including their cause, depth, level of contamination, and healing status.
Stage 2 - ANSWER Partial-thickness skin loss with exposed dermis
Stage 3 - ANSWER Full-thickness skin loss; fat may be visible
Stage 4 - ANSWER Full-thickness tissue loss with exposed bone, muscle, or
tendon
Unstageable - ANSWER Base of wound covered by slough or eschar (dead
tissue)
Deep tissue injury - ANSWER Skin intact or discolored, with deep soft tissue
damage
Serous - ANSWER Clear, watery, normal healing
Sanguineous - ANSWER Bright red, thin, suggests blood vessel injury
Serosanguineous - ANSWER Pink/light red, watery, normal, suggests healing
phase
Purulent - ANSWER Yellow/green, thick, not normal, suggests infection
, Foul Purulent - ANSWER Dark yellow/green, thick, smelly, not normal,
suggests severe infection
Hemorrhagic - ANSWER Red, thick, not normal, suggests active bleeding
Water intoxication - ANSWER A potentially dangerous condition that occurs
when a person drinks too much water too quickly, diluting their sodium levels in
their blood dangerously low
Foot care for diabetic patient - ANSWER Proper foot care is essential to help
prevent infections, ulcers, and amputations due to high risk from poor circulation,
neuropathy, and slower healing
Footwear for mobility issues - ANSWER Non-slip shoes with a rubber sole for
good grip, closed-toed, adjustable fastenings, a wide toe box, and lightweight
Interventions for diarrhea - ANSWER Monitor for signs of dehydration,
maintain fluid and electrolyte balance, dietary adjustments including the BRAT
diet, and encourage small, frequent meals
Interventions for constipation - ANSWER Assess bowel movement patterns,
increase fiber intake, encourage hydration, avoid processed foods, and promote
physical activity
Hospice care - ANSWER A specialized form of palliative care focused on
providing comfort and support to patients who are terminally ill and have a limited
life expectancy, usually six months or less
Complete Study Guide 2026 | Verified
Answers | Graded A+ | Pass Guaranteed
S SBAR - ANSWER situation: identify yourself & unit, identify pt (name and
DOB), symptom onset and severity
B SBAR - ANSWER background: date/time of admission, admitting Dx,
relevant Hx, lab & test results
A SBAR - ANSWER assessment: what do you think is wrong, suspected
underlying cause, or concerns
R SBAR - ANSWER recommendation: how would you fix it, clear and specific
about the urgency of the request, and expected time frame
HIPAA/emancipated minors - ANSWER legally treated as adults and CAN
ONLY GIVE MEDICAL INFORMATION TO SAID MINOR (ADULT)
ear drops administration for adults - ANSWER HOLD EARLOBE UP AND
BACK
, Urine Residual - ANSWER Urine residual refers to the amount of urine left in
the bladder after a person has attempted to empty it completely.
Measuring Urine Residual - ANSWER There are 2 methods you can use for
measuring for a urine residual: Bladder Ultrasound (painless, quick, low infection
risk, can be repeated easily) and Intermittent (Straight) Catheterization (more
accurate but invasive, potential risks of UTIs, requires trained personnel).
Reasons for Urine Residual - ANSWER A patient may have urine residual
when their bladder does not empty completely after urination, which can result
from various physical, neurological, or functional issues, increasing the risk of
UTIs, bladder damage, or kidney problems if left untreated.
Braden Scale - ANSWER The Braden Scale is a clinical assessment tool used
to predict a patient's risk of developing pressure ulcers, helping nurses and
healthcare providers identify at-risk individuals for early preventive measures.
Braden Scale Components - ANSWER 1. Sensory perception: Ability to feel
and respond to discomfort or pressure; 2. Moisture: The degree to which the skin is
exposed to moisture; 3. Activity: Level of physical activity; 4. Mobility: Ability to
change and control body position; 5. Nutrition: Usual food intake pattern; 6.
Friction and shear: The amount of assistance needed to move, and whether skin
rubs against surfaces.
Braden Scale Scoring - ANSWER The total score ranges from 6-23, and the
lower the score, the higher the risk of developing a pressure ulcer.
, Wound Classifications - ANSWER Wounds are classified based on various
factors, including their cause, depth, level of contamination, and healing status.
Stage 2 - ANSWER Partial-thickness skin loss with exposed dermis
Stage 3 - ANSWER Full-thickness skin loss; fat may be visible
Stage 4 - ANSWER Full-thickness tissue loss with exposed bone, muscle, or
tendon
Unstageable - ANSWER Base of wound covered by slough or eschar (dead
tissue)
Deep tissue injury - ANSWER Skin intact or discolored, with deep soft tissue
damage
Serous - ANSWER Clear, watery, normal healing
Sanguineous - ANSWER Bright red, thin, suggests blood vessel injury
Serosanguineous - ANSWER Pink/light red, watery, normal, suggests healing
phase
Purulent - ANSWER Yellow/green, thick, not normal, suggests infection
, Foul Purulent - ANSWER Dark yellow/green, thick, smelly, not normal,
suggests severe infection
Hemorrhagic - ANSWER Red, thick, not normal, suggests active bleeding
Water intoxication - ANSWER A potentially dangerous condition that occurs
when a person drinks too much water too quickly, diluting their sodium levels in
their blood dangerously low
Foot care for diabetic patient - ANSWER Proper foot care is essential to help
prevent infections, ulcers, and amputations due to high risk from poor circulation,
neuropathy, and slower healing
Footwear for mobility issues - ANSWER Non-slip shoes with a rubber sole for
good grip, closed-toed, adjustable fastenings, a wide toe box, and lightweight
Interventions for diarrhea - ANSWER Monitor for signs of dehydration,
maintain fluid and electrolyte balance, dietary adjustments including the BRAT
diet, and encourage small, frequent meals
Interventions for constipation - ANSWER Assess bowel movement patterns,
increase fiber intake, encourage hydration, avoid processed foods, and promote
physical activity
Hospice care - ANSWER A specialized form of palliative care focused on
providing comfort and support to patients who are terminally ill and have a limited
life expectancy, usually six months or less
