BSN 206 Wound Care
Study online at https://quizlet.com/_i5zuls
1. Prevent skin break- The nurse understands which rationale to be appropriate for drying a wound
down from mois- after irrigation?
ture. Ensure the new dressing remains occlusive.
Ensure the new dressing adheres to the wound.
Prevent skin breakdown from moisture.
Prevent infection from irrigate solution.
2. Characteristics of When the nurse is performing a focused wound assessment on a client, what
the wound bed information should be included in the documentation? (Select all that apply.)
Presence of
drainage Characteristics of the wound bed
Location and size Presence of drainage
Client's response Client's pain level
to wound treat- Location and size
ment Client's response to wound treatment
3. By compressing How is the vacuum re-established after emptying a drain such as a Jackson-Pratt
the drain reservoir. drain or Hemovac?
By turning the suction on.
By "milking" the tubing.
By compressing the drain reservoir.
By keeping the drain lower than the insertion site.
4. A client on bed The nurse knows which factors contribute to the development of wounds and
rest who is reposi- lead to delays in wound healing? (Select all that apply.)
tioned.
A client who has di- A client on bed rest who is repositioned.
abetes. A client who has diabetes.
A client with A client with COPD.
COPD. A client on long-term steroid therapy.
A client on A client who is obese and sweats excessively.
1/5
, BSN 206 Wound Care
Study online at https://quizlet.com/_i5zuls
long-term steroid
therapy.
A client who is
obese and sweats
excessively.
5. Determine the The nurse caring for an immobile client wants to decrease the risk of the
client's risk factors. formation of pressure ulcers. Which action will the nurse take first?
Turn the client every 2 hours.
Determine the client's risk factors.
Offer favorite fluids.
Encourage increased quantities of carbohydrates and fats.
Determine the client's risk factors.
6. Label each drain The nurse is caring for a postoperative orthopedic client who has two Hemovac
and record them drains in place. Which interventions will the nurse perform? (Select all that
separately. apply.)
Recompress the
device after empty- Label each drain and record them separately.
ing. Measure the amount of drainage in the device prior to emptying.
Check for kinks in Recompress the device after emptying.
the tubing. Check for kinks in the tubing.
Secure the device to the client's gown above the level of the wound.
7. Fecal incontinence Which nursing observation will indicate the patient is at risk for pressure ulcer
formation?.
A raised, red rash on the right shin
Fecal incontinence
Ate two-thirds of breakfast
Capillary refill is less than 2 seconds
2/5
Study online at https://quizlet.com/_i5zuls
1. Prevent skin break- The nurse understands which rationale to be appropriate for drying a wound
down from mois- after irrigation?
ture. Ensure the new dressing remains occlusive.
Ensure the new dressing adheres to the wound.
Prevent skin breakdown from moisture.
Prevent infection from irrigate solution.
2. Characteristics of When the nurse is performing a focused wound assessment on a client, what
the wound bed information should be included in the documentation? (Select all that apply.)
Presence of
drainage Characteristics of the wound bed
Location and size Presence of drainage
Client's response Client's pain level
to wound treat- Location and size
ment Client's response to wound treatment
3. By compressing How is the vacuum re-established after emptying a drain such as a Jackson-Pratt
the drain reservoir. drain or Hemovac?
By turning the suction on.
By "milking" the tubing.
By compressing the drain reservoir.
By keeping the drain lower than the insertion site.
4. A client on bed The nurse knows which factors contribute to the development of wounds and
rest who is reposi- lead to delays in wound healing? (Select all that apply.)
tioned.
A client who has di- A client on bed rest who is repositioned.
abetes. A client who has diabetes.
A client with A client with COPD.
COPD. A client on long-term steroid therapy.
A client on A client who is obese and sweats excessively.
1/5
, BSN 206 Wound Care
Study online at https://quizlet.com/_i5zuls
long-term steroid
therapy.
A client who is
obese and sweats
excessively.
5. Determine the The nurse caring for an immobile client wants to decrease the risk of the
client's risk factors. formation of pressure ulcers. Which action will the nurse take first?
Turn the client every 2 hours.
Determine the client's risk factors.
Offer favorite fluids.
Encourage increased quantities of carbohydrates and fats.
Determine the client's risk factors.
6. Label each drain The nurse is caring for a postoperative orthopedic client who has two Hemovac
and record them drains in place. Which interventions will the nurse perform? (Select all that
separately. apply.)
Recompress the
device after empty- Label each drain and record them separately.
ing. Measure the amount of drainage in the device prior to emptying.
Check for kinks in Recompress the device after emptying.
the tubing. Check for kinks in the tubing.
Secure the device to the client's gown above the level of the wound.
7. Fecal incontinence Which nursing observation will indicate the patient is at risk for pressure ulcer
formation?.
A raised, red rash on the right shin
Fecal incontinence
Ate two-thirds of breakfast
Capillary refill is less than 2 seconds
2/5
