NUR 104 EXAM 3 MOCK TEST WITH ANSWER
RATIONALES 2026
◉ Tertiary intention healing.
Answer: CHRONIC WOUND= delay occurs between injury and
closure
ex: G.I tract surgery
◉ Vitamins aiding in healing of pressure wounds.
Answer: A.C.E
◉ Only RN's Eat.
Answer: E:valuate
A: ssess
T: each
◉ Sharp Debridement.
Answer: removal of eschar using sharp instruments, fastest way of
removing nonviable tissue, method of choice if infection is suspected
◉ Mechanical Debridement.
,Answer: removes eschar; wet/damp to dry dressings usually saline-
moistened. Quickest form
◉ Enzymatic Debridement.
Answer: applying topical agents containing enzymes that break
down fibrin and collagen.
◉ Autolytic Debridement.
Answer: Wounds have the innate ability to clean themselves of
debris and eschar. Slowest form.
EX: occlusive dressings; hydrocolloids, transparent films,
◉ Biologic Debridement.
Answer: Using sterile medicinal larvae from green bottle flies (
maggots) that secrete enzymes that break down eschar.
◉ Effects of immobility on musculoskeletal system.
Answer: predisposes a person to weakness, decreased muscle tone,
decreased bone and muscle mass, atrophy, and contracture,
anorexia, elimination alterations
◉ Assessment of the Musculoskeletal System.
Answer: -inspection of gait
,-body position and alignment
-ROM
-fall risk
◉ When prioritizing nursing diagnosis............
Answer: Address the most critical ones first
--think Maslow's--
◉ muscle atrophy.
Answer: wasting of muscles
◉ contracture.
Answer: permanent fixation of a joint
◉ aerobic exercise.
Answer: -Requires oxygen
Ex: walking, stair climbing
◉ anaerobic exercise.
Answer: -builds strength and body mass
- W/out oxygen to produce energy for activity
-short duration, more intense
, -EX: heavy weightlifting
◉ isotonic exercise.
Answer: active movement w/constant muscle contraction
ex: walking, turning in bed, self feeding
◉ active ROM.
Answer: patient performs 100% on their own
◉ partial assisted.
Answer: patient does part of ROM with help of nurse
◉ Passive ROM.
Answer: patient needs assistance with ROM
◉ How to promote lung expansion.
Answer: raise head of bed
cough-turn-
reposition
◉ preventing cardiovascular immobility.
Answer: -ankle twists
RATIONALES 2026
◉ Tertiary intention healing.
Answer: CHRONIC WOUND= delay occurs between injury and
closure
ex: G.I tract surgery
◉ Vitamins aiding in healing of pressure wounds.
Answer: A.C.E
◉ Only RN's Eat.
Answer: E:valuate
A: ssess
T: each
◉ Sharp Debridement.
Answer: removal of eschar using sharp instruments, fastest way of
removing nonviable tissue, method of choice if infection is suspected
◉ Mechanical Debridement.
,Answer: removes eschar; wet/damp to dry dressings usually saline-
moistened. Quickest form
◉ Enzymatic Debridement.
Answer: applying topical agents containing enzymes that break
down fibrin and collagen.
◉ Autolytic Debridement.
Answer: Wounds have the innate ability to clean themselves of
debris and eschar. Slowest form.
EX: occlusive dressings; hydrocolloids, transparent films,
◉ Biologic Debridement.
Answer: Using sterile medicinal larvae from green bottle flies (
maggots) that secrete enzymes that break down eschar.
◉ Effects of immobility on musculoskeletal system.
Answer: predisposes a person to weakness, decreased muscle tone,
decreased bone and muscle mass, atrophy, and contracture,
anorexia, elimination alterations
◉ Assessment of the Musculoskeletal System.
Answer: -inspection of gait
,-body position and alignment
-ROM
-fall risk
◉ When prioritizing nursing diagnosis............
Answer: Address the most critical ones first
--think Maslow's--
◉ muscle atrophy.
Answer: wasting of muscles
◉ contracture.
Answer: permanent fixation of a joint
◉ aerobic exercise.
Answer: -Requires oxygen
Ex: walking, stair climbing
◉ anaerobic exercise.
Answer: -builds strength and body mass
- W/out oxygen to produce energy for activity
-short duration, more intense
, -EX: heavy weightlifting
◉ isotonic exercise.
Answer: active movement w/constant muscle contraction
ex: walking, turning in bed, self feeding
◉ active ROM.
Answer: patient performs 100% on their own
◉ partial assisted.
Answer: patient does part of ROM with help of nurse
◉ Passive ROM.
Answer: patient needs assistance with ROM
◉ How to promote lung expansion.
Answer: raise head of bed
cough-turn-
reposition
◉ preventing cardiovascular immobility.
Answer: -ankle twists
