A nurse is assessing a client who has a wound that is healing by primary intention. Which of the following findings should the nurse expect?

Granulation tissue forming at the bottom of the wound bed.

Healing of the wound is prolonged.

Skin edges of the wound are sutured closed.

Wound is contaminated at the time of injury

Answer and Explanation

The Correct Answer is C

A) Granulation tissue forming at the bottom of the wound bed:
Granulation tissue typically forms in wounds that heal by secondary intention. This type of healing occurs when the wound edges are not approximated (e.g., a large or open wound), and new tissue must form to fill the gap. In primary intention healing, the wound edges are well approximated, and granulation tissue is not the hallmark of the healing process, although some may appear early on.

B) Healing of the wound is prolonged:
Wounds healing by primary intention generally heal more quickly than those healing by secondary intention. In primary intention, the wound edges are approximated with sutures, staples, or adhesive, allowing for a faster and more efficient healing process. Therefore, prolonged healing is not expected with primary intention]

C) Skin edges of the wound are sutured closed:
This is the correct finding for a wound healing by primary intention. Primary intention healing occurs when the wound edges are brought together (approximated) and secured with sutures, staples, or adhesive strips. This method promotes faster healing and minimal scarring because the tissue is directly aligned.

D) Wound is contaminated at the time of injury:
Wounds that heal by primary intention are generally clean and not contaminated. If a wound is contaminated or infected at the time of injury, it is more likely to heal by secondary intention, where the tissue must fill in from the base upwards, which takes longer and may result in more scarring.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is C

Explanation

A) "I will wear earphones during this test":
This statement is incorrect. The Rinne test is a hearing test used to compare air conduction to bone conduction of sound. It is performed by placing a vibrating tuning fork near the ear canal (for air conduction) and then on the mastoid bone behind the ear (for bone conduction). Earphones are not used in this test.

B) "A small probe is placed inside my ear":
This statement is incorrect. A probe is typically used for other types of hearing tests, such as tympanometry or an auditory brainstem response (ABR) test, not the Rinne test. The Rinne test involves using a tuning fork, not a probe, and the tuning fork is placed near the ear canal (for air conduction) and on the mastoid bone (for bone conduction).

C) "A tuning fork is placed on my head":
This statement is correct. In the Rinne test, the tuning fork is initially struck to produce sound and then placed on the mastoid bone (behind the ear) to test bone conduction. Afterward, the vibrating tuning fork is moved to the front of the ear canal to test air conduction. The purpose of the test is to compare these two types of conduction. If air conduction is better than bone conduction, this suggests normal hearing, while equal or better bone conduction can indicate conductive hearing loss.

D) "Small electrodes are placed on my scalp":
This statement is incorrect. Electrodes on the scalp are typically used in an electroencephalogram (EEG) or other neurodiagnostic tests, not the Rinne test. The Rinne test focuses on hearing and does not require the use of electrodes. It uses a tuning fork to assess how well sound travels through air and bone.

A. Potassium level 3 mEq/L. B. BUN 9.5 mg/dl C. Creatinine 0.4 mg/dl D. Sodium 135 mEq/L

Correct Answer is A

Explanation

A) Potassium level 3 mEq/L:
A potassium level of 3 mEq/L is below the normal range (which is typically 3.5-5.0 mEq/L) and represents hypokalemia. Potassium is crucial for normal muscle and nerve function, including cardiac function. Low potassium levels can lead to dangerous arrhythmias, muscle weakness, and cardiac arrest if not addressed promptly. This is the priority value because hypokalemia can be life-threatening and requires immediate attention from the healthcare provider to correct the imbalance.

B) BUN 9.5 mg/dl:
A BUN (blood urea nitrogen) level of 9.5 mg/dL is within the normal reference range for most adults (typically 7-20 mg/dL). While an abnormal BUN level could indicate kidney dysfunction or dehydration, this value is not immediately concerning and does not represent a critical finding that requires urgent attention.

C) Creatinine 0.4 mg/dl:
A creatinine level of 0.4 mg/dL is below the normal range (usually around 0.6-1.2 mg/dL), which might indicate low muscle mass or a transient decrease in kidney function. However, a low creatinine level is generally not as urgent or concerning as an elevated level, and it does not typically require immediate intervention

D) Sodium 135 mEq/L:
A sodium level of 135 mEq/L is slightly below the normal range (135-145 mEq/L), indicating mild hyponatremia. Although this can be concerning if the drop is acute or symptomatic (e.g., causing confusion, seizures, or lethargy), a mild decrease in sodium is not immediately life-threatening unless it worsens rapidly.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is assessing a client who has a wound that is healing by primary intention. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client about the Rinne test. Which of the following client statements indicates an understanding of the teaching?

Correct Answer is C

Explanation

A nurse on a medical unit is reviewing the laboratory reports for a client. Which of the following laboratory values is the priority to report to the provider?

Correct Answer is A

Explanation

A nurse is assessing a client who has fluid overload. Which of the following findings should the nurse expect? (Select all that apply.)

A nurse is working with a social worker and a physical therapist in preparing a discharge projection for client who is postoperative. Which of the following steps of the nursing process is the nurse engaging in?

A nurse is preparing to administer an ophthalmic medication to a client. Which of the following actions should the nurse plan take?

A nurse is assessing a client who has an oral temperature of 39 C (102.27 F). Which of the following findings should the nurse expect?

A nurse is assessing a client who has a wound that is healing by primary intention. Which of the following findings should the nurse expect?

A nurse is teaching a class about pharmacodynamics. The nurse should include that which of the following medication levels occurs when a medication is at the lowest serum concentration?

A nurse in public clinic is planning a health fair for older adult clients in the community. In teaching medication safety, which of the following foods should the nurse advise the clients to avoid when taking their prescriptions?

The nurse is caring for client who has had partial removal the parathyroid gland. The client reports numbness and tingling of the hands and fingers. Which lab value would the nurse expect to see?