Tuesday, 5 January 2021

SURGERY AND WOUND CARE

Why is it important that patients are effectively fasted prior to surgery?

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To reduce the risk of vomiting

To reduce the risk of reflux and inhalation of gastric contents

To prevent vomiting and chest infections

To prevent the patient gagging

 

Correct answer

To reduce the risk of reflux and inhalation of gastric contents

 

Who should mark the skin with an indelible pen ahead of surgery?

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The nurse should mark the skin in consultation with the patient

 

A senior nurse should be asked to mark the patient's skin

 

The surgeon should mark the skin

 

It is best not to mark the patient's skin for fear of distressing the patient

 

Which of the following medications should be continued in the perioperative period and can be given up to 2 hours before surgery with a sip of water?

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Beta-blockers

 

ACE inhibitors

 

Drugs for dementia

 

Potassium-sparing diuretics

 

Correct answer

Beta-blockers

 

Optimal pre-operative care is underpinned by thorough assessment and planning. Social history encompasses social situations such as home life and occupation of the patient. When exploring the smoking, drug and alcohol use of the patient, what should the nurse tolerate as it is accepatable?

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The recommended maximum intake for males is 7 units and for females is 5 units per week

 

The recommended maximum intake for males is 14 units and for females is 10 units per week

 

The recommended maximum intake for males is 21 units and for females is 14 units per week

 

The recommended maximum intake for males is 20 units and for females is 12 units per week

 

Correct answer

The recommended maximum intake for males is 21 units and for females is 14 units per week

 

It is vital to assess smoking behaviours as pre-operative smoking cessation is important and help with this should be offered by the nurse during assessment. What dangers can a history of smoking pose on a patient scheduled for surgery?

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Smokers have hyperactive airways that can lead them to become more susceptible to incidents of laryngospam or bronchospasm and nicotine has the potential to affect post-operative healing

 

Smokers have hypoactive airways that can lead them to become more susceptible to incidents of laryngospam or bronchospasm and nicotine has the potential to affect post-operative healing

 

Smokers have hyper-reactive cough reflex that can increase the chance of developing post-operative lung infections due to a compromised ability to clear secretions and nicotine affects the liver which require higher dosages of medications

 

Smokers have hyporeactive cough reflex that can increase the chance of developing post-operative lung infections due to a compromised ability to clear secretions and nicotine affects the liver which require higher dosages of medications

 

A patient is being prepared for a surgery and was placed on NPO. What is the purpose of NPO?

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Prevention of aspiration pneumonia

To facilitate induction of pre-op meds

 

For abdominal procedures

To decrease production of fluids

 

Correct answer

Prevention of aspiration pneumonia

 

Recommended preoperative fasting times are:

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2-4 hours

 

6-12 hours

12-14 hours

 

Correct answer

6-12 hours

 

It is important that patients are effectively fasted prior to surgery in order to:

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Reduce the risk of vomiting

Reduce the risk of reflux and inhalation of gastric contents

Prevent vomiting and chest infections

 

Prevent the patient gagging

 

Correct answer

Reduce the risk of reflux and inhalation of gastric contents

 

Safe moving and handling of an anaesthetized patient is imperative to reduce harm to both the patient and staff. What is the minimum number of staff required to provide safe manual handling of a patient in theatre?

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3 (1 either side, 1 at head)

5 (2 each side, 1 at head)

 

4 (1 each side, 1 at head, 1 at feet)

6 (2 each side, 1 at head, 1 at feet)

 

Correct answer

4 (1 each side, 1 at head, 1 at feet)

 

You are looking after a postoperative patient and when carrying out their observations, you discover that they are tachycardic and anxious, with an increased respiratory rate. What could be happening? What would you do?

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The patient is showing symptoms of hypovolaemic shock Investigate source of fluid loss, administer fluid replacement and get medical support

 

The patient is demonstrating symptoms of atelectasis Administer a nebulizer, refer to physiotherapist for assessment

 

The patient is demonstrating symptoms of uncontrolled pain Administer prescribed analgesia, seek assistance from medical team

 

The patient is demonstrating symptoms of hyperventilation Offer reassurance, administer oxygen

 

When a patient is being monitored in the PACU, how frequently should blood pressure, pulse and respiratory rate be recorded?

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Every 5 minutes

Every 15 minutes

 

Once an hour

Continuously

Correct answer

Every 5 minutes

 

How soon after surgery is the patient expected to pass urine?

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1-2 hours

 

2-4 hours

4-6 hours

6-8 hours

 

Correct answer

6-8 hours

 

Most post-operative patients would require patient-centred care. Which of the following should the nurse prioritise?

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Maintain a patent airway

 Prevent bleeding

Relief of pain

Prevent pressure ulcers

 

Correct answer

Relief of pain

 

A patient is in the immediate recovery post-surgery. What should you monitor?

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Breathing

Temperature

 Blood loss

Pain

 

Correct answer

Breathing

 

As a registered nurse in a unit what would consider as a priority to a patient immediately post operatively?

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Pain relief

Blood loss

 Airway patency

 

Correct answer

Airway patency

 

What is the purpose of NPO after surgery?

0/1

To prevent a blood clot

To prevent aspiration

To facilitate respiration

To prevent embolism

 

Correct answer

To prevent aspiration

 

You are the named nurse of Mr Corbyn who has just undergone an abdominal surgery 4 hours ago. You have administered his regular analgesia 2 hours ago and he is still complaining of pain. Your most immediate, most appropriate nursing action?

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Call the doctor

Assist patient in a comfortable position

Give another dose

 Look for a heating pad

 

Correct answer

Assist patient in a comfortable position

 

Early ambulation prevents all complications except:

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Chest infection and lung collapse

Muscle wasting

Thrombosis

Surgical site infection

 

 

You are the nurse assigned in recovery room or post anaesthetic care unit. The main priority of care in such area is:

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Keeping airway intact

Keeping patient pain free

 

Keeping neurological condition stable

Keeping relatives informed of patient’s condition

 

Correct answer

Keeping airway intact

 

A patient is recovering from surgery has been advanced from a clear diet to a full liquid diet. The patient is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse should offer which full liquid item to the patient

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Custard

 

Black Tea

Gelatin

Ice pop

 

You are nursing an adult patient with a long-bone fracture. You encourage your patient to move fingers and toes hourly, to change positions slightly every hour, and to eat high-iron foods as part of a balanced diet. Which of the following foods or beverages should you advise the client to avoid whilst on bed rest?

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Fruit juices

 Large amounts of milk or milk products

Cranberry juice cocktail

No need to avoid any foods while on bed rest

 

Correct answer

Large amounts of milk or milk products

 

Now the medical team encourages early ambulation in the post-operative period. which complication is least prevented by this?

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Tissue wasting

 

Thrombophlebitis

Wound infection

Pneumonia

 

Correct answer

Wound infection

 

If a client is experiencing hypotension post operatively, the head is not tilted in which of the following surgeries

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Chest surgery

Abdominal surgery

 Gynaecological surgery

Lower limb surgery

 

Correct answer

Gynaecological surgery

 

Gurgling sound from airway in a postoperative client indicates what

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Complete obstruction of lower airway

 

Partial obstruction of upper airway

Common sign of a post-operative patient

Indicates immediate insertion of laryngeal airway

 

Correct answer

Partial obstruction of upper airway

 

Day 4 postoperatively, a patient hears a popping sound on her post abdominal surgery. You realize that “something” viscera is exposed from the wound. What do you do?

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Do nothing

Call the surgical team that operated on the patient

 

Apply a pressure bandage and call the doctor and monitor vital observations

 

Apply a sterile saline dressing using sterile gloves, stay with the patient and instruct the healthcare assistant to call the doctor

 

Correct answer

Apply a sterile saline dressing using sterile gloves, stay with the patient and instruct the healthcare assistant to call the doctor

 

Inadequate post-operative pain management can lead to physiological, behavioural and physiological effects. Thus, when a patient is assessed the nurse must be alert for:

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Respiratory, cardiovascular and endocrine complications

 

Respiratory, cardiovascular and genitourinary complications

Respiratory, cardiovascular and gastric complications

 

Respiratory, cardiovascular and musculoskeletal complications

 

Correct answer

Respiratory, cardiovascular and endocrine complications

 

The concentration of analgesics needed to provide sufficient analgesia for patients with chronic cancer pain is often higher than the concentrations used postoperatively. All but one exemplifies drug-related side effects associated with epidural or intrathecal analgesia:

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Respiratory depression can occur due to the action of opioids on the respiratory centre which can emerge 6-12 hours after administration

 

Motor blockade will depend on the type of local anaesthetic agent used and total dose which occurs when the anaesthetic blocks the large diameter motor nerves

 

Nausea and vomiting is caused by the action of opioids on the vomiting centre in the brainstem and stimulation of the chemoreceptor trigger zone in the fourth ventricle of the brain

 

Urinary retention is the result of the blockade of nerves supplying the bladder sphincter which can cause urinary retention

 

Which of the following is a complication specific to intrathecal analgesia?

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Haematoma

Dural puncture

 

Catheter migration

Meningitis

 

Correct answer

Meningitis

 

Regional analgesia can be used for acute postoperative pain, trauma pain and chronic pain. Which is not part of the nurse's roles when handling patients with Continuous Peripheral Nerve Block (CPNB)?

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Observations for pain, side-effects and complications

Reinforcing dressings as necessary

 

Understanding the untoward reactions

Documentation of care

 

Correct answer

Understanding the untoward reactions

 

The duration and frequency of Entonox administration should always be tailored to individual patient needs. Which of the following is not an absolute contraindication to the use of Entonox?

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First 16 weeks of pregnancy and those breastfeeding

Head injuries with impairment of consciousness

 

Drowsy and intoxicated patients

Any condition in which gas is entrapped within the body

 

Correct answer

First 16 weeks of pregnancy and those breastfeeding

 

Inappropriate inhalation of Entonox will ultimately result in:

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Nausea and vomiting

Increased lightheadedness

Drowsiness and intoxication

 

Loss of consciousness

 

Correct answer

Loss of consciousness

 

If daily use of Entonox is required for more than 4 days, this should be accompanied by:

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Close supervision and haematological monitoring

 

Close supervision and oxygen saturation monitoring

Close supervision and arterial blood gas monitoring

Close supervision and renal function monitoring

 

When would it be beneficial to use a wound care plan?

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On all chronic wounds

On all infected wounds

On all complex wounds

 

On every wound

 

Correct answer

On every wound

 

Wound care management plan should be done with what type of wound?

1/1

Complex wound

Infected wound

Any type of wound

 

 

When would it be beneficial to use a wound care plan?

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On initial assessment of wound

During pre-assessment admission

 

After surgery

During wound infection, dehiscence or evisceration

 

 

Correct answer

On initial assessment of wound

 

Which solution use minimum tissue damage while providing wound care?

0/1

Hydrogen peroxide

 

Povidine iodine

Saline

Gention violet

 

Correct answer

Saline

 

Mr Connor’s neck wound needed some cleaning to prevent complications. Which of the following concept will you apply when doing a surgical wound cleaning?

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Surgical asepsis

Aseptic non-touch technique

Medical asepsis

 

Dip-tip technique

 

Correct answer

Aseptic non-touch technique

 

What are the four stages of wound healing in the order they take place?

1/1

Proliferative phase, inflammation phase, remodelling phase, maturation phase

Haemostasis, inflammation phase, proliferation phase, maturation phase

 

Inflammatory phase, dynamic stage, neutrophil phase, maturation phase

Haemostasis, proliferation phase, inflammation phase, remodelling phase

 

A new postsurgical wound is assessed by the nurse and is found to be hot, tender and swollen. How could this wound be best described?

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In the inflammation phase of healing

In the haemostasis phase of healing

In the reconstructive phase of wound healing

 

As an infected wound

Correct answer

In the inflammation phase of healing

 

How long does the ‘inflammatory phase’ of wound healing typically last?

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24 hours

Just minutes

1-5 days

 

3-24 days

 

Wound proliferation starts after?

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1-5 days

3-24 days

24 days

 

Correct answer

1-5 days

 

How long does the proliferation phase of a wound occur?

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3-24 days

5-21 days

 

3-30 days

4-18 days

Correct answer

3-24 days

 

You would refer to the early phase of scar tissue formation as which of the following kinds of tissue?

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Granulation

Fibrous

 

Keloid

Cicatrix

 

Correct answer

Granulation

 

Which stage of pressure ulcer involves loss of dermis, deep ulcer without slough?

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Stage 1

 

Stage 2

Stage 3

Stage 4

 

Correct answer

Stage 2

 

What stage of pressure ulcer includes tissue involvement and crater formation?

0/1

Stage 1

 

Stage 2

Stage 3

Stage 4

 

Correct answer

Stage 3

 

A patient has been confined in bed for months now and has developed pressure ulcers in the buttocks area. When you checked the Waterlow it is at level 20. Which type of bed is best suited for this patient?

0/1

Water mattress

Egg crater mattress

 

Air mattresses

Dynamic mattress

 

Correct answer

Dynamic mattress

 

Waterlow score of 20 indicates what type of mattress to use?

0/1

Standard-specification foam mattresses

High-specification foam mattresses

 

Dynamic support surface

Correct answer

Dynamic support surface

 

What do you expect to assess in a grade 3 pressure ulcer?

0/1

Blistered wound on the skin

Open wound showing tissue

Open wound exposing muscles

Open wound exposing bones

 

Correct answer

Open wound showing tissue

 

When doing your shift assessment, one of your patient has waterlow score of 20. Which of the following mattress is appropriate for this score?

0/1

Water bed

Fluidized airbed

 

Low air loss

Alternating pressure

 

Correct answer

Low air loss

 

Breid, 76 years old, developed a pressure ulcer whilst under your care. On assessment, you saw some loss of dermis, with visible redness, but not sloughing off. Her pressure ulcer can be categorised as:

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Moisture lesion

2nd stage

3rd stage

 

4th stage

 

Correct answer

2nd stage

 

Joshua, son of Breid went to the station to see the nurse as she was complaining of severe pain on her pressure ulcer. What will be your initial action?

0/1

Check analgesia on the chart

 

Tell you will come as soon as you can

Find the nurse in charge

Go immediately to see the patient

 

Correct answer

Go immediately to see the patient

 

If an elderly immobile patient had a "grade 3 pressure sore", what would be your management?

0/1

Film dressing, mobilization, positioning, nutritional support

Foam dressing, pressure relieving mattress, nutritional support

Dry dressing, pressure relieving mattress, mobilization

Hydrocolloid dressing, pressure relieving mattress, nutritional support

 

Correct answer

Foam dressing, pressure relieving mattress, nutritional support

 

External factors which increase the risk of pressure damage are:

0/1

Equipment, age and pressure

Moisture, pressure and diabetes

 

Pressure, shear and friction

Pressure, moisture and age

 

Correct answer

Pressure, shear and friction

 

You were assigned to change the dressing of a patient with diabetic foot ulcer. You were not sure if the wound has sloughy tissues or pus. How will you carry out your assessment?

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Sloughy tissue is a mass of dead tissues in your wound bed, while pus is a thick yellowish/greenish opaque liquid produced in an infected wound

 

Sloughy tissues are exactly the same as pus, and they both have a yellowish tinge

 

Sloughy tissues and pus are similar to each other; both are found on the wound bed tissue and indicative of a dying tissue

 

The presence of sloughy tissues and pus are an indication of non-surgical debridement

 

Correct answer

Sloughy tissue is a mass of dead tissues in your wound bed, while pus is a thick yellowish/greenish opaque liquid produced in an infected wound

 

Which of the following actions would place a client at the greatest risk for a shearing force injury to the skin?

0/1

Walking without shoes

 

Sitting in Fowler's position

Lying supine in bed

Using a heating pad

 

Correct answer

Sitting in Fowler's position

 

Black wounds are treated with debridement. Which type of debridement is most selective and least damaging?

0/1

Debridement with scissors

Debridement with wet to dry dressings

Mechanical debridement

 

Chemical debridement

 

Correct answer

Chemical debridement

 

All are appropriate wound dressing criteria except:

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High humidity

Adherent

Non-absorbent

Provide thermal insulation

 

Correct answer

Non-absorbent

 

What functions should a dressing fulfil for effective wound healing?

0/1

High humidity, insulation, gaseous exchange, absorben

Anaerobic, impermeable, conformable, low humidity

Insulation, low humidity, sterile, high adherence

Absorbent, low adherence, anaerobic, high humidity

 

All but one, are characteristics of an ideal wound dressing:

0/1

Cost-effective

Allows gaseous exchange

Low humidity

Absorbent

 

Correct answer

Low humidity

 

Appropriate wound dressing criteria includes all but one:

0/1

Allows gaseous exchange

Maintains optimum temperature and pH in the wound

 

Forms an effective barrier to

Allows removal of the dressing without pain or skin stripping

Is non-absorbent

 

Correct answer

Is non-absorbent

 

Proper Dressing for wound care should be all except?

0/1

High humidity

 

Low humidity

Adherent

Absorbent / Provide thermal insulation

Correct answer

Low humidity

 

Which of the following conditions can be observed in a proper wound dressing:

0/1

Absorbent, humid, aerated

Non-absorbent, humid, aerated

Non-humid, absorbent, aerated

 

Non-humid, non absorbent, aerated

Correct answer

Absorbent, humid, aerated

 

How do you remove a negative pressure dressing?

0/1

Remove pressure then detach dressing gently

Get TVN nurse to remove dressing

 

Remove in a quick fashion

Correct answer

Remove pressure then detach dressing gently

 

How would you care for a patient with a necrotic wound?

0/1

Systemic antibiotic therapy and apply a dry dressing

Debride and apply a hydrogel dressing

Debride and apply an antimicrobial dressing

 

Apply a negative pressure dressing

 

Correct answer

Debride and apply a hydrogel dressing

 

Which one of the following types of wound is not suitable for negative pressure wound therapy?

0/1

Partial thickness burns

 

Contaminated wounds

Diabetic and neuropathic ulcers

Traumatic wounds

 

Correct answer

Contaminated wounds

 

Mr Smith has been diagnosed with Multiple Sclerosis 20 years ago. Due to impaired mobility, he has developed a Grade 4 pressure sore on his sacrum. Which health professional can provide you prescriptions for his dressing?

0/1

Dietician

Tissue Viability Nurse

Social Worker

 

Physiotherapist

Correct answer

Tissue Viability Nurse

 

The nurse cares for a patient with a wound in the late regeneration phase of tissue repair. The wound may be protected by applying a:

0/1

Transparent film

Hydrogel dressing

 

Collagenases dressing

Wet dry dressing

 

Correct answer

Transparent film

 

A client has a diabetic stasis ulcer on the lower leg. The nurse uses a hydrocolloid dressing to cover it. The procedure for application includes:

0/1

Cleaning the skin and wound with betadine

Removing all traces of residues for the old dressing

 

Choosing a dressing no more than quarter-inch larger than the wound size

Holding in place for one minute to allow it to adhere

 

Correct answer

Holding in place for one minute to allow it to adhere

 

Which are not the benefits of using negative pressure wound therapy?

0/1

Can reduce wound odour

Increases local blood flow in peri-wound area

 

Can be used on untreated osteomyelitis

Can reduce use of dressings

 

Correct answer

Can be used on untreated osteomyelitis

 

Which of the following methods of wound closure is most suitable for a good cosmetic result following surgery?

0/1

Skin clips

Tissue adhesive

Adhesive skin closure strips

 

Interrupted sutures

 

Correct answer

Tissue adhesive

 

A client's wound is draining thick yellow material. The nurse correctly describes the drainage as:

0/1

Sanguineous

Serous-sanguineous

 

Serous

Purulent

 

Correct answer

Purulent

 

A client is admitted to the Emergency Department after a motorcycle accident that resulted in the client's skidding across a cement parking lot. Since the client was wearing shorts, there are large areas on the legs where the skin is ripped off. This wound is best described as:

0/1

Abrasion

Unapproximated

Laceration

 

Eschar

 

Correct answer

Abrasion

 

A nurse is assessing several patients with a variety of wounds. Which type of wound should the nurse anticipate will heal by secondary intention?

1/1

Paper cut

Pressure ulcer

 

Abdominal incision from surgery

Superficial slash caused by a knife

 

A nurse is assessing a patient who had numerous stitches several days ago for a traumatic injury to the base of the right index finger. Which assessment of the site indicates that the inflammatory response has progressed to an infectious process?

0/1

Yellow discharge

Swelling around the site

Inability to flex the finger

 

Feeling of heat when touched

 

Correct answer

Yellow discharge

 

A nurse is changing a patient's sterile dressing and performing wound irrigation. Which action by the nurse maintained sterile technique?

0/1

Used the piston syringe from the previous time the wound was irrigated

Dried the skin on either side of the wound by using one gauze pad for each swipe

Held sterile gloved hands below the waist as much as possible during the procedure

 

Poured fluid from an opened bottle of normal saline sitting on the patient's bedside table

 

Correct answer

Dried the skin on either side of the wound by using one gauze pad for each swipe

 

You are caring for an older adult who sustained a skin tear on the forearm. What type of dressing should the nurse anticipate the doctor might order for this injury?

0/1

Hydrogel dressing

 

Dry sterile dressing

Wet-to-moist dressing

Transparent film dressing

 

Correct answer

Transparent film dressing

 

You are caring for a patient with an abdominal wound with a vacuum-assisted closure device. What should the tissue viability nurse do when applying this device?

0/1

Place the suction apparatus over a hole at the edge of the transparent film

 

Cut the foam dressing so that it extends 1 inch beyond the wound cavity

Connect the tubing to the positive pressure machine as ordered

Apply the transparent film 2 inches beyond the wound margins

 

Correct answer

Apply the transparent film 2 inches beyond the wound margins

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