A nurse is assessing a client’s wound and notes there is slough present. What would be an appropriate intervention for this wound?
Cover
Clean
Debride
Leave alone
The Correct Answer is C
Choice A reason: Cover
Covering a wound with slough is not an appropriate intervention. Slough is a type of necrotic tissue that can impede the healing process by providing a medium for bacterial growth and preventing the formation of healthy granulation tissue. Simply covering the wound without addressing the slough can lead to infection and delayed healing.
Choice B reason: Clean
Cleaning the wound is a necessary step in wound care, but it is not sufficient on its own to address the presence of slough. While cleaning can help reduce the bacterial load and remove some debris, it does not effectively remove the slough itself. Slough often requires more targeted interventions such as debridement to be effectively managed.
Choice C reason: Debride
Debridement is the most appropriate intervention for a wound with slough. Debridement involves the removal of necrotic tissue, including slough, to promote a clean wound bed and facilitate the healing process. There are several methods of debridement, including autolytic, enzymatic, mechanical, and surgical, each with its own indications and benefits. Removing the slough allows for better assessment of the wound and promotes the formation of healthy granulation tissue.
Choice D reason: Leave Alone
Leaving a wound with slough alone is not advisable. Slough can harbor bacteria and impede the healing process, leading to chronic wounds and potential infection. Without intervention, the wound is unlikely to progress through the normal stages of healing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Defamation of character is incorrect. Defamation of character involves making false statements about someone that damage their reputation. This can be in the form of slander (spoken) or libel (written). Applying restraints without proper justification does not fall under defamation of character.
Choice B Reason:
Invasion of privacy is incorrect. Invasion of privacy involves intruding into someone’s personal life without consent. This can include unauthorized access to personal information or spaces. Applying restraints without proper justification is not an invasion of privacy.
Choice C Reason:
Slander is incorrect. Slander is a form of defamation that involves making false spoken statements that damage someone’s reputation. Applying restraints without proper justification does not involve making false statements.
Choice D Reason:
False imprisonment is correct. False imprisonment involves restraining a person without legal justification or their consent. In a healthcare setting, applying restraints without proper justification or following legal and ethical guidelines constitutes false imprisonment and violates the client’s rights.
Correct Answer is ["A","C","D","E"]
Explanation
Choice A Reason:
Cured fat foods, such as bacon, sausages, and other processed meats, are high in saturated fats and sodium. Consuming these foods in excess can lead to increased cholesterol levels and a higher risk of heart disease. Limiting these foods is essential for maintaining a healthy diet and reducing the risk of chronic diseases.
Choice B Reason:
Vegetables are generally low in calories and high in essential nutrients, including vitamins, minerals, and fiber. They are an important part of a balanced diet and should not be limited. Instead, increasing vegetable intake is often recommended for better health outcomes.
Choice C Reason:
Canned soups often contain high levels of sodium, which can contribute to high blood pressure and other cardiovascular issues. Limiting the intake of canned soups can help manage sodium consumption and promote better heart health.
Choice D Reason:
Processed snacks, such as chips, crackers, and packaged baked goods, are typically high in unhealthy fats, sugars, and sodium. These foods can contribute to weight gain, high blood pressure, and other health problems. Reducing the intake of processed snacks is beneficial for overall health.
Choice E Reason:
Sugary drinks, including sodas, fruit juices with added sugars, and energy drinks, are high in calories and can lead to weight gain and increased risk of type 2 diabetes. Limiting sugary drinks is crucial for maintaining a healthy weight and preventing chronic diseases.
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