FULLY ANSWERED #2
The nurse is completing an admission assessment on a patient admitted for an infected,
non-healing wound. Which factors in the patient's history may contribute to this
condition? (Select all the apply.) - correct answer Poor hygiene
Diabetes mellitus
Poor circulation
Obesity
The nurse assess a wound and documents it as stage iii. What did the nurse observe
when the would was assessed. - correct answer Full-thickness tissue loss, possibly with
visible subcutaneous fat.
The nurse is performing an assessment of Ms. Morrow's wound. What should be
included in the documentation? (Select all that apply.) - correct answer Odor
Drainage
Tunneling
Location
The nurse is preparing to irrigate a patient's wound. Upon assessment, the wound
appears be healing and the wound bed is beefy red. What solution should the nurse
select for this procedure? - correct answer Normal saline
The nurse is irrigating a patient's wound when the patient complains of pain. What is the
appropriate action by the nurse? - correct answer Stop the procedure and administer
the ordered analgesic.
The nurse is caring for a patient with lower extremity edema resulting from chronic
venous insufficiency. What should the nurse include in the plan of care for this patient?
(Select all that apply.) - correct answer Provide meticulous skin care.
Perform neurovascular checks to look for changes.
Monitor patient for signs of skin breakdown.
Assist with range of motion exercises to lower extremities.
The nurse is providing education to Ms. Morrow and her daughter on management of
venous stasis in the lower extremities. What would be appropriate for the nurse to
include in the teaching sessions? - correct answer Put an anti embolism stockings as
soon as you get up in the morning and wear them all day.
The nurse is providing education to Ms. Morrow and her daughter on nutrition. What is
the best dietary choice to promote wound healing? - correct answer Baked chicken
The nurse has received an order to apply a hydrocolloid dressing to Ms. Morrow's right
lower extremity. Which statement, if made by the nurse, would indicate the need for