NSE 211 Final Exam Questions And
Answers Verified 100% Correct
Principles of Surgical Asepsis - ANSWER -- *a sterile object remains sterile only
when touched by another sterile object*
- a sterile object or field out of range of vision or an object held below a person's
waist is contaminated
- a sterile objective or field becomes contaminated by prolonged exposure to air.
complications of wound healing - ANSWER -hemorrhage, infection, dehiscence,
evisceration, fistula formation
hemorrhage nsg dx d/t - ANSWER -slipped suture, dislodged clot, infection, or
eroded blood vessel
hemorrhage nsg dx manifested by - ANSWER -- external-saturated sanguinous
dressings
- internal-distension of body part
- change in drain output
- signs of hypovolemic shock
infection nsg dx d/t - ANSWER -- exposure to bacteria, contaminated or trauma
wound shows S&S, surgical post-op infection.
infection nsg dx manifested by - ANSWER -fever, tenderness, pain @ wound site,
erythema, edema, induration, warmth, elevated WBC, inflamed edges, foul odor,
purulent drainage, delayed healing
life threatening infection S&S - ANSWER -- pain
- swelling, induration
- erythema
- wound breakdown
- increased size
,- undermining or tunneling
- probing to bone
- anorexia
- flu-like symptoms
- erratic glucose control
- fever
- rigour
- chills
- hypotension
- multi-organ failure
non-limb threatening infection - ANSWER -- non-healing
- bright red granulation tissue
- new areas of breakdown/necrosis
- increased exudates
- bridging of soft tissue & epithelium
- foul odor
dehiscence - ANSWER -partial or total separation of (skin & tissue) wound layers:
when a wound fails to heal properly.
evisceration - ANSWER -*total separation of wound layers*, protrusion of
visceral organs through opening
fistula - ANSWER -abnormal passage b/w 2 organs, or an organ & external part of
body.
- trauma, infection, radiation, cancer prevent tissue from closing --> fistula
types of wounds - ANSWER -venous, arterial, diabetic, malignant or fungating, PI
venous ulcer S&S - ANSWER -- superficial & irreg. in shape
- large amount of exudate d/t edema
- pain
causes of venous ulcer - ANSWER -- venous insufficiency (weak vein walls)
, - limited ROM in ankle --> poor blood return
- accumulation of serum & RBC in surrounding tissues
- in chronic venous ulcer: edema becomes firm, wood-like appearance.
- in chronic venous ulcer, lipodermatosclerosis: inflammation of SC fat due to
venous insufficiency
treatment of venous ulcers - ANSWER -diminish/control edema in LLs, simple
natural products
arterial ulcers aka - ANSWER -ischemic ulcers
S&S of arterial ulcers - ANSWER -- punched out appearance. deeper & smaller
than venous ulcers.
- located on the feet, tip of toes & toe joints
- may be necrotic, or pale wound beds
- legs are: thin, shiny, taut, hairless skin, almost translucent appearance
causes of venous ulcers - ANSWER -inadequate blood flow to LLs
treatment of arterial ulcers - ANSWER -"maintenance wounds", keep dry,
betadine, increase blood flow
S&S of diabetic ulcers - ANSWER -- monofilament test for assessment
- on leg, or side/bottom of foot
- persistent pain - osteomyelitis
Osteomyelitis - ANSWER -inflammation or swelling that occurs in bone
causes of diabetic ulcers - ANSWER -- neuropathic changes d/t diabetes (ex;
decreased ability to feel pain or temp changes, absence of sweating, changes in
muscle contraction)
treatment of diabetic ulcers - ANSWER -- debridement, antimicrobial dressing
Answers Verified 100% Correct
Principles of Surgical Asepsis - ANSWER -- *a sterile object remains sterile only
when touched by another sterile object*
- a sterile object or field out of range of vision or an object held below a person's
waist is contaminated
- a sterile objective or field becomes contaminated by prolonged exposure to air.
complications of wound healing - ANSWER -hemorrhage, infection, dehiscence,
evisceration, fistula formation
hemorrhage nsg dx d/t - ANSWER -slipped suture, dislodged clot, infection, or
eroded blood vessel
hemorrhage nsg dx manifested by - ANSWER -- external-saturated sanguinous
dressings
- internal-distension of body part
- change in drain output
- signs of hypovolemic shock
infection nsg dx d/t - ANSWER -- exposure to bacteria, contaminated or trauma
wound shows S&S, surgical post-op infection.
infection nsg dx manifested by - ANSWER -fever, tenderness, pain @ wound site,
erythema, edema, induration, warmth, elevated WBC, inflamed edges, foul odor,
purulent drainage, delayed healing
life threatening infection S&S - ANSWER -- pain
- swelling, induration
- erythema
- wound breakdown
- increased size
,- undermining or tunneling
- probing to bone
- anorexia
- flu-like symptoms
- erratic glucose control
- fever
- rigour
- chills
- hypotension
- multi-organ failure
non-limb threatening infection - ANSWER -- non-healing
- bright red granulation tissue
- new areas of breakdown/necrosis
- increased exudates
- bridging of soft tissue & epithelium
- foul odor
dehiscence - ANSWER -partial or total separation of (skin & tissue) wound layers:
when a wound fails to heal properly.
evisceration - ANSWER -*total separation of wound layers*, protrusion of
visceral organs through opening
fistula - ANSWER -abnormal passage b/w 2 organs, or an organ & external part of
body.
- trauma, infection, radiation, cancer prevent tissue from closing --> fistula
types of wounds - ANSWER -venous, arterial, diabetic, malignant or fungating, PI
venous ulcer S&S - ANSWER -- superficial & irreg. in shape
- large amount of exudate d/t edema
- pain
causes of venous ulcer - ANSWER -- venous insufficiency (weak vein walls)
, - limited ROM in ankle --> poor blood return
- accumulation of serum & RBC in surrounding tissues
- in chronic venous ulcer: edema becomes firm, wood-like appearance.
- in chronic venous ulcer, lipodermatosclerosis: inflammation of SC fat due to
venous insufficiency
treatment of venous ulcers - ANSWER -diminish/control edema in LLs, simple
natural products
arterial ulcers aka - ANSWER -ischemic ulcers
S&S of arterial ulcers - ANSWER -- punched out appearance. deeper & smaller
than venous ulcers.
- located on the feet, tip of toes & toe joints
- may be necrotic, or pale wound beds
- legs are: thin, shiny, taut, hairless skin, almost translucent appearance
causes of venous ulcers - ANSWER -inadequate blood flow to LLs
treatment of arterial ulcers - ANSWER -"maintenance wounds", keep dry,
betadine, increase blood flow
S&S of diabetic ulcers - ANSWER -- monofilament test for assessment
- on leg, or side/bottom of foot
- persistent pain - osteomyelitis
Osteomyelitis - ANSWER -inflammation or swelling that occurs in bone
causes of diabetic ulcers - ANSWER -- neuropathic changes d/t diabetes (ex;
decreased ability to feel pain or temp changes, absence of sweating, changes in
muscle contraction)
treatment of diabetic ulcers - ANSWER -- debridement, antimicrobial dressing
