A nurse is performing wound care for an older adult patient who has a stage I pressure ulcer. Which of the following types of dressings should the nurse apply to the wound?
Antimicrobial.
Wet-to-dry.
Transparent.
Dry, sterile.
The Correct Answer is C
Choice A rationale
Antimicrobial dressings are typically used for wounds that are infected or at high risk of infection. A stage I pressure ulcer, which involves intact skin with non-blanchable redness, would not typically require an antimicrobial dressing.
Choice B rationale
Wet-to-dry dressings are used for mechanical debridement of wounds with necrotic tissue. A stage I pressure ulcer does not involve necrotic tissue, so this type of dressing would not be appropriate.
Choice C rationale
Transparent dressings are often used for stage I pressure ulcers. They provide a protective layer over the wound, promoting a moist environment and facilitating the healing process.
Choice D rationale
Dry, sterile dressings are typically used for wounds that need to be kept dry. A stage I pressure ulcer benefits from a moist healing environment, which can be provided by a transparent dressing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Full-thickness tissue loss extending to underlying support structures such as muscle, tendon, or bone is characteristic of a stage 4 pressure ulcer, not a stage 312.
Choice B rationale
A stage 3 pressure ulcer involves full-thickness skin loss and may appear as a deep crater. There may be damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. This description matches the statement in Choice B, making it the correct answer.
Choice C rationale
A shallow, ruptured or intact skin blister without slough is more indicative of a stage 2 pressure ulcer. In a stage 2 pressure ulcer, there is partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed.
Choice D rationale
Unbroken skin with un-blancheable erythema is characteristic of a stage 1 pressure ulcer, not a stage 3. In a stage 1 pressure ulcer, the skin is not broken, but it has redness that does not lighten (or blanch) when you press on it.
Correct Answer is B
Explanation
Choice A rationale
Using a humidifier beside the bed at night may not necessarily decrease the number of apneic episodes in a client with obstructive sleep apnea. While a humidifier can help moisten the airways and may provide some relief from symptoms such as dry mouth or throat, it does not address the underlying issue of airway obstruction.
Choice B rationale
Losing weight can indeed help decrease the number of apneic episodes in a client with obstructive sleep apnea. Obesity is a major risk factor for sleep apnea, as excess fat tissue can thicken the wall of the windpipe, making it narrower and making it harder to keep open.
Therefore, losing weight can help reduce this fat and widen the airway, leading to fewer apneic episodes.
Choice C rationale
Taking a sleeping pill at night may actually worsen obstructive sleep apnea. While it might help the client fall asleep, it can also relax the muscles of the throat, which can make the airway more likely to collapse during sleep, leading to more apneic episodes.
Choice D rationale
Drinking a glass of red wine before bedtime is not recommended for a client with obstructive sleep apnea. Alcohol can relax the muscles in the throat and can disrupt the normal sleep cycle, both of which can lead to more apneic episodes.
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