Chapter 26: Wound Care - Nurselytic

Questions 29

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Study Guide for Fundamentals of Nursing Care: Concepts, Connections & Skills

Chapter 26 : Wound Care Questions

Question 1 of 5

If a patient had a stage 3 pressure injury, you would expect to see which of the following on assessment?

Correct Answer: D

Rationale: Stage 3 pressure injuries involve full-thickness loss of skin and subcutaneous tissue, often with undermining or tunneling.

Question 2 of 5

While assessing the skin of a patient on bedrest, you notice a pale area over the left hip with a small blister in the center. What action will you take?

Correct Answer: B

Rationale: A pale area with a blister suggests a developing pressure injury, requiring immediate notification of the provider for intervention.

Question 3 of 5

A patient comes to the clinic where you are working as a nurse. He had surgery 2 months ago and is very concerned. He asks you to feel the scar on his side. You feel a hard ridge beneath the incision scar extending about 1 cm on either side of the scar. Which response is most appropriate?

Correct Answer: A

Rationale: A hard ridge under a scar is normal during the maturation phase of healing and typically softens over time.

Question 4 of 5

When you assess a patient's skin, you will pay special attention to the color, noting which of the following?

Correct Answer: B,D,E,F

Rationale: Skin color changes like erythema, pallor, bruising, and jaundice indicate inflammation, poor perfusion, trauma, or liver issues, respectively.

Question 5 of 5

A patient is at risk for wound dehiscence as a result of nutritional issues and medical history. Which interventions should be included in the care plan?

Correct Answer: A,C

Rationale: Splinting the incision and preventing straining (via stool softeners/antinausea meds) reduce stress on the wound, preventing dehiscence.

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