NURSING 106 EXAM 1 QUESTIONS WITH VERIFIED
ANSWERS
A patient comes in with a cut on their arm and is concerned of infection. What is the
nurses first step in care? - Answers - Check their tissue integrity. Ask questions about
the injury. (subjective data) Inspect the injury for redness, warmth, swelling. (objective
data)
When doing an admission skin assessment, what areas should be assessed? -
Answers - Bony prominences, checking for pressure injuries. Areas of high moisture,
armpits, groin, behind knees.
What are signs of skin breakdown? - Answers - Redness, non-blanching, lesion
When palpating, what should the nurse be checking for? - Answers - Moisture,
temperature, edema (excess fluid in tissues), skin turgor (check for hydration)
Why are newborn patients a higher risk factor for skin breakdown? - Answers - Thinner
skin, less subcutaneous fat, more susceptible to bacteria
Why are elderly patients a higher risk factor for skin breakdown? - Answers - Thinner
skin, less subcutaneous fat, reduced cell turnover, poor nutrition
What are risk factors for pressure wounds? - Answers - Immobility, fecal/urinary
incontinence, decreased mental state, skin excoriation (moist skin)
What is a nursing intervention for a Stage 1 pressure injury? - Answers - Hydrocolloid
dressing
What is a nursing intervention for a Stage 2 pressure injury? - Answers - Hydrocolloid
dressing
What is a nursing intervention for a Stage 3 pressure injury? - Answers - wet-to-dry
dressing, hydrocolloid dressing
What is a nursing intervention for a Stage 4 pressure injury? - Answers - Vacuum
assisted closure (wound vac)
What is a nursing intervention to prevent a pressure injury? - Answers - Turn patient
every 2 hours, check skin integrity every 2 hours
An increased number of Neutrophils on WBC count indicates which type of infection? -
Answers - Neutrophils
ANSWERS
A patient comes in with a cut on their arm and is concerned of infection. What is the
nurses first step in care? - Answers - Check their tissue integrity. Ask questions about
the injury. (subjective data) Inspect the injury for redness, warmth, swelling. (objective
data)
When doing an admission skin assessment, what areas should be assessed? -
Answers - Bony prominences, checking for pressure injuries. Areas of high moisture,
armpits, groin, behind knees.
What are signs of skin breakdown? - Answers - Redness, non-blanching, lesion
When palpating, what should the nurse be checking for? - Answers - Moisture,
temperature, edema (excess fluid in tissues), skin turgor (check for hydration)
Why are newborn patients a higher risk factor for skin breakdown? - Answers - Thinner
skin, less subcutaneous fat, more susceptible to bacteria
Why are elderly patients a higher risk factor for skin breakdown? - Answers - Thinner
skin, less subcutaneous fat, reduced cell turnover, poor nutrition
What are risk factors for pressure wounds? - Answers - Immobility, fecal/urinary
incontinence, decreased mental state, skin excoriation (moist skin)
What is a nursing intervention for a Stage 1 pressure injury? - Answers - Hydrocolloid
dressing
What is a nursing intervention for a Stage 2 pressure injury? - Answers - Hydrocolloid
dressing
What is a nursing intervention for a Stage 3 pressure injury? - Answers - wet-to-dry
dressing, hydrocolloid dressing
What is a nursing intervention for a Stage 4 pressure injury? - Answers - Vacuum
assisted closure (wound vac)
What is a nursing intervention to prevent a pressure injury? - Answers - Turn patient
every 2 hours, check skin integrity every 2 hours
An increased number of Neutrophils on WBC count indicates which type of infection? -
Answers - Neutrophils
