Question

SELECT THE RIGHT ANSWER

QUES :

The nurse is preparing to perform a moist-to-dry dressing change on a patient with a large dehisced surgical wound of the abdomen. The nurse begins to organize the supplies and knows to prioritize which nursing intervention?

Select one:

a. Gather all the needed dressing and treatment supplies.

b. Protect the patient’s bedding using waterproof pads.

c. Ensure privacy during the dressing change.

d. Administer pain medication before the dressing change.

QUES :

The nurse is performing skin check rounds on the stroke rehabilitation unit. While assessing a patient’s skin, the nurse notices an unstageable pressure injury on the left heel covered with a layer of dark, dry eschar. Which intervention is the appropriate next action?

Select one:

a. Obtain an order for enzymatic debridement.

b. Obtain an order for moist-to-dry debridement interventions.

c. Complete a vascular assessment to determine if debridement is appropriate.

d. Document the presence of the wound and notify the practitioner.

QUES :

A 52-year-old person with diabetes presents for ankle–brachial index (ABI) assessment. The left leg is dusky red and cool to touch while the right leg appears normal. The person has no sensation from the knees and reports no pain. ABI calculation is 1.1 on the left side and 1.3 on the right side. What is the correct interpretation?

Select one:

a. ABI is normal but clinical indications are inconsistent; further testing is recommended.

b. ABI is low; client should be referred for vascular surgery.

c. ABI is normal; no further action required.

d. ABI is elevated; client should be referred for toe–brachial index.

QUES :

The patient’s postoperative wound drain was removed yesterday. Today, the nurse notes increased drainage on the dressing, pain at the wound site, and a low-grade fever. What should the nurse conclude from these findings?

Select one:

a. These signs and symptoms suggest an infection at the wound site.

b. These changes in wound drainage require replacement of the wound drain.

c. These changes indicate a normal postoperative wound healing process.

d. These changes indicate a normal postoperative wound healing process.

Answer 1

Que1. Correct option is A . All the articles should Which are needed. Before doing any procedure in nursing all articles should be gathered to prevent enrgy loss, fatigue, and interruption in mid of procedure.

Not other why.

B) yes , we need to protect the bed sheet but when we star the nursing procedure on Patient . But firstly we need collect the all the articles.

C) this is also before starting procedure. But article need to be collected first

Mostly we give local anesthesia at wound site . not oral medication. LA is given during procedure.

Que 2 correct option is D. Report to physician and document in documentation. Because reporting to physician is important step for preventing complications to patient.after that according to order of physician we have to take next step

Not others why

A)and B ) we can not perform by self without order of the doctor or physician.

C) yes . after reporting this would be next step to complete vascular assessment for assurance of debridement procedure.

Que 3. Correct option is A . Clinically left leg ABI must be lower than 1 . But its normal 1.1. so we need to reassess this. For assurance.

Not others why

B)no ABI VALUE is normal , not low

C) ABI. Value is normal but clinically it's so we need to take action.

D) client is only referred for toe brachial index only if ABI Value is more than 1.3 for left lag...which occur because of calcification.in person. But left leg ABI is 1.1

Que 4 .Correct option isA . This is infection of .The wound which increases the drainage of the wound , low grad fever , and pain.  

Not others.

B) wound should be open or covered with a gauze to heal it from inside to outside .

C) not its not normal wound healing process.