A client is admitted to the hospital with a burn injury covering $30% of the body surface area. The nurse anticipates that the client will require which type of dressing for wound care?

Correct Answer: D

Rationale: Silver dressing is the correct answer because it's ideal for burn injuries covering 30% of the body surface area due to its antimicrobial properties, reducing infection risk a major concern in burns where skin barriers are compromised. Silver ions kill bacteria, manage pain, inflammation, and odor, supporting healing in high-risk wounds. Hydrocolloid dressing is occlusive, suited for minimal-drainage wounds, but can trap bacteria in infected or heavily exudative burns, risking maceration. Hydrogel dressing hydrates dry wounds but lacks sufficient absorption for burn exudate and isn't antimicrobial, making it less suitable. Alginate dressing absorbs heavy exudate but isn't ideal for dry or minimally draining burns and lacks inherent infection control. Given the burn's extent and infection vulnerability, silver dressing offers the best protective and therapeutic benefits.

Correct Answer: D

Rationale: Increased granulation tissue in the ulcer is the correct outcome indicating hyperbaric oxygen therapy (HBOT) effectiveness for a chronic venous ulcer. HBOT delivers high-pressure oxygen to enhance tissue oxygenation, stimulating angiogenesis, collagen synthesis, and fibroblast activity, which directly boost granulation tissue formation a hallmark of healing. Reduced pain may occur but isn't specific to HBOT, as analgesics or other factors could contribute, and pain isn't a reliable healing metric. Increased blood oxygen saturation reflects systemic levels, not local tissue oxygenation, which HBOT targets, making it less relevant. Decreased edema could result from compression or elevation, not uniquely HBOT, and isn't a direct healing indicator. Granulation tissue growth ties directly to HBOT's mechanism, providing clear evidence of improved wound bed vitality and progression toward closure.

Correct Answer: B

Rationale: Instructing the client to splint the incision when coughing is the correct intervention to prevent wound dehiscence the separation of wound layers. Coughing increases intra-abdominal pressure, stressing staples, and splinting with a pillow or hands reduces tension, protecting the closure. Steri-strips approximate edges but lack the strength to prevent dehiscence under pressure, used more for minor wounds. Changing dressings every 8 hours prevents infection but doesn't address mechanical stress, and frequency depends on drainage, not a fixed schedule. Irrigating with saline cleanses but risks disrupting healing tissue, unrelated to dehiscence prevention. Splinting directly counters physical strain, aligning with post-surgical care to maintain incision integrity and promote healing.

Correct Answer: A

Rationale: Autograft is the correct term for a graft taken from the client's thigh to treat an arm wound. It uses the patient's own skin, minimizing rejection and infection risks while offering superior cosmetic and functional outcomes, ideal for large wounds. Allograft involves donor human skin, typically temporary, from cadavers or living donors, not the client's own tissue. Xenograft uses animal skin (e.g., pig), also temporary, for protection until an autograft is viable. Mesh graft describes a technique, not a source, where skin is slit to expand coverage, applicable to autografts or allografts. Autograft's self-sourcing distinguishes it, ensuring compatibility and long-term healing, making it the precise term for this scenario.

Correct Answer: D

Rationale: All of the above,' as age, amount of underlying tissue, and illness all influence skin integrity resistance. Age (A) affects skin thickness and elasticity elderly skin thins, losing resilience, while youthful skin is more robust. Amount of underlying tissue (B), like subcutaneous fat, cushions and protects skin; less tissue increases vulnerability to breakdown, as in malnourishment. Illness (C) weakens skin through impaired immunity or circulation, as in diabetes or infection, reducing repair capacity. Each factor independently impacts durability, and together, they compound risk, making 'All of the above' correct. In nursing, this holistic view guides risk assessment e.g., an elderly, thin patient with chronic illness is prone to ulcers. No single factor suffices; their synergy is critical, distinguishing D as the comprehensive choice per wound care principles.