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Exam (elaborations)

(answered) Pre-Quiz FUN: Scenario 11 – Kyle M

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(answered) Pre-Quiz FUN: Scenario 11 – Kyle M-If a patient presents with a wound that has damaged the dermis and epidermis, with the edges of the wound torn or jagged, the wound should be identified as a/an: A. laceration. B. puncture wound. C. abrasion. D. contusion. 2. A nurse documents that a wound has "thick yellow exudate." This exudate could be described as: A. serous. B. sanguineous. C. serosanguineous. D. purulent. 3. A nurse is preparing a patient with a minor open wound for discharge to home. Which statements by the patient indicate that the patient understands discharge teaching? Select all that apply. A. "I should contact my health care provider if I develop a fever and become extremely tired." B. "I should contact my health care provider if my wound starts looking swollen, red, or becomes painful." C. "I should expect my wound to start showing signs of healing in about 2 to 3 weeks." D. "I should contact my health care provider if my wound has thick drainage for more than 1 week." 4. A nurse is caring for a patient whose wound is draining heavy serosanguineous exudate. Which nursing intervention would be most effective for preventing infection for this patient? A. Notifying the health care provider if the patient develops a fever or an increased WBC count B. Monitoring the wound for redness, swelling, and purulent drainage C. Changing the dressing as ordered when it becomes soiled D. Wearing gloves, gown, mask, and eyewear during dressing changes 5. When monitoring a patient receiving IV therapy, a nurse must assess the IV site for phlebitis. Which sign and/or symptom would be most indicative of phlebitis? A. Skin cool to touch surrounding the IV siteB. Edema surrounding the IV site C. Erythema and pain at the IV site D. Skin blanched around the IV site 6. A nurse is correct in using an alcohol-based hand rub when providing patient care as long as the hands are not visibly soiled. A. True B. False 7. A nurse correctly obtains a wound specimen for culture and sensitivity testing by first cleansing the wound with: A. hydrogen peroxide. B. betadine. C. sterile water. D. alcohol. 8. Which is the normal white blood cell (WBC) count for an adult? A. 5,000-10,000/mm3 B. 1,000-5,000/mm3 C. 10,000-15,000/mm3 D. 15,000-19,000/mm3 9. A nurse must choose a semi-permeable dressing for a patient with a small wound with minimal tissue loss. The nurse is correct in choosing: A. hydrogel. B. transparent film. C. hydrocolloid. D. dry gauze. 10. If a nurse describes a wound as being "approximated," the wound is: A. stapled with some of the wounds edges separated. B. being left open for the wound bed to fill in with scar tissue. C. sutured with wound edges together. D. infected.Post-Quiz FUN: Scenario 11 – Kyle M. 1. Identify which nursing diagnosis is the highest priority for Kyle Miller. A. Impaired skin integrity B. Ineffective coping C. Acute pain D. Impaired physical mobility Based on assessment findings, isolation precautions should be observed while changing Kyle Miller's dressing. A. standard B. contact C. droplet D. protective 3. Kyle Miller and/or his wife will be performing dressing changes at home. Which statement by the Millers conveys an understanding of discharge teaching for home dressing changes? A. "We need to wash our hands before and after changing the dressing." B. "We will have to learn how to put on sterile gloves to change the gauze." C. "We should clean the skin around the wound, then the wound itself." D. "We will moisten the gauze before applying to the wound." Which sign is indicative of infiltration? A. Purulent drainage from IV site B. Numbness around IV site C. Erythema at IV access site D. Red streak along the vein 5. Vitamin A plays an essential role in wound healing and promotes epithelialization, wound closure, angiogenesis, collagen formation, and inflammation control. A. True B. False 6. A medication order reads "Nafcillin 2 g IV q4h." The nurse correctly interprets the order as: A. Nafcillin, 2 grams, IV, 4 doses every day B. Nafcillin, 2 milligrams, IV, 4 times a day C. Nafcillin, 2 grams, injection into a vein, every 4 hoursD. Nafcillin, 0.02 of a milligram, injection into a vein, every 4 hours 7. Identify the benefit(s) of administering Kyle Miller's IV antibiotic via saline lock. A. Restoring hydration status B. Preventing hypovolemia C. Balancing fluid and electrolyte levels D. Providing mobility and comfort 8. Kyle Miller's description of pain from his wound and cellulitis is most accurately classified as: A. radiating. B. cutaneous. C. visceral. D. referred. 9. Following patient teaching regarding Kyle Miller's antibiotics, he asks, "Can you tell me again why I have to take the en

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