D439 NURSING CARE & FUNDAMENTALS STUDY GUIDE
UPDATED ACTUAL QUESTIONS AND CORRECT
ANSWERS
Question:
1. Phase 1 of wound healing (Hemostasis)
Answer:
Bleeding stops and platelets form a clot within minutes to hours.
Question:
2. Phase 2 of wound healing (Inflammatory)
Answer:
Days 1-4; characterized by redness, heat, swelling, pain, and debris cleanup.
Question:
3. Phase 3 of wound healing (Proliferative)
Answer:
Days 4-21; granulation tissue forms, fibroblasts lay collagen, and wound contracts.
Question:
4. Phase 4 of wound healing (Remodeling)
Answer:
21 days to 2 years; scar tissue strengthens and collagen reorganizes.
Question:
5. Memory hook for wound healing phases
Answer:
H-I-P-R: Hemostasis, Inflammatory, Proliferative, Remodeling.
Question:
6. Stage 1 Pressure Injury
Answer:
Intact skin with non-blanchable redness.
Question:
7. Stage 2 Pressure Injury
Answer:
Partial thickness skin loss; shallow open ulcer with no slough.
Question:
8. Stage 3 Pressure Injury
Answer:
Full thickness skin loss; visible fat, but no bone, tendon, or muscle.
, Question:
9. Stage 4 Pressure Injury
Answer:
Full thickness tissue loss with exposed bone, tendon, or muscle.
Question:
10. Unstageable Pressure Injury
Answer:
Base covered by slough or eschar, making depth impossible to determine.
Question:
11. Deep Tissue Pressure Injury
Answer:
Purple or maroon intact skin or a blood-filled blister.
Question:
12. First step of the nursing process (ADPIE)
Answer:
Assessment: Gathering complete and accurate subjective and objective data.
Question:
13. Planning step of the nursing process
Answer:
Setting patient-centered, measurable, and time-bound SMART goals.
Question:
14. Evaluation step of the nursing process
Answer:
Comparing patient outcomes against the goals established during planning.
Question:
15. Volume of 1 cup in milliliters
Answer:
240 mL
Question:
16. Volume of 1 ounce (oz) in milliliters
Answer:
30 mL
Question:
17. Minimum acceptable hourly urine output
Answer:
30 mL/hr; call the provider if it falls below this.
UPDATED ACTUAL QUESTIONS AND CORRECT
ANSWERS
Question:
1. Phase 1 of wound healing (Hemostasis)
Answer:
Bleeding stops and platelets form a clot within minutes to hours.
Question:
2. Phase 2 of wound healing (Inflammatory)
Answer:
Days 1-4; characterized by redness, heat, swelling, pain, and debris cleanup.
Question:
3. Phase 3 of wound healing (Proliferative)
Answer:
Days 4-21; granulation tissue forms, fibroblasts lay collagen, and wound contracts.
Question:
4. Phase 4 of wound healing (Remodeling)
Answer:
21 days to 2 years; scar tissue strengthens and collagen reorganizes.
Question:
5. Memory hook for wound healing phases
Answer:
H-I-P-R: Hemostasis, Inflammatory, Proliferative, Remodeling.
Question:
6. Stage 1 Pressure Injury
Answer:
Intact skin with non-blanchable redness.
Question:
7. Stage 2 Pressure Injury
Answer:
Partial thickness skin loss; shallow open ulcer with no slough.
Question:
8. Stage 3 Pressure Injury
Answer:
Full thickness skin loss; visible fat, but no bone, tendon, or muscle.
, Question:
9. Stage 4 Pressure Injury
Answer:
Full thickness tissue loss with exposed bone, tendon, or muscle.
Question:
10. Unstageable Pressure Injury
Answer:
Base covered by slough or eschar, making depth impossible to determine.
Question:
11. Deep Tissue Pressure Injury
Answer:
Purple or maroon intact skin or a blood-filled blister.
Question:
12. First step of the nursing process (ADPIE)
Answer:
Assessment: Gathering complete and accurate subjective and objective data.
Question:
13. Planning step of the nursing process
Answer:
Setting patient-centered, measurable, and time-bound SMART goals.
Question:
14. Evaluation step of the nursing process
Answer:
Comparing patient outcomes against the goals established during planning.
Question:
15. Volume of 1 cup in milliliters
Answer:
240 mL
Question:
16. Volume of 1 ounce (oz) in milliliters
Answer:
30 mL
Question:
17. Minimum acceptable hourly urine output
Answer:
30 mL/hr; call the provider if it falls below this.
