A nurse is preparing to assist with irrigating a wound for a client.
Which of the following actions should the nurse plan to take?

Irrigate the wound until the solution that is draining is clear.

Chill the irrigant prior to the procedure.

Hold the tip of the syringe at least 1.3 cm (0.5 in) above the wound while irrigating.

Flush the wound from the most contaminated area to the cleanest area.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

The goal of wound irrigation is to clean the wound, so the nurse should continue to irrigate until the drainage is clear.

Choice B rationale:

The irrigant should be at room temperature, not chilled.

Choice C rationale:

The syringe should be held 1 inch (not 0.5 inch) from the wound.

Choice D rationale:

The wound should be flushed from the cleanest area to the most contaminated, not the other way around.

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Correct Answer is C

Explanation

Choice A rationale:

Repositioning the patient for bed changing does not directly contribute to skin breakdown or infection.

Choice B rationale:

While shearing can cause skin breakdown, it is not directly related to incontinence or wet sheets.

Choice C rationale:

Moisture from incontinence can create an environment suitable for the growth of microorganisms in a wound, leading to infection and skin breakdown.

Choice D rationale:

A wet bed does not exert greater pressure on the patient’s skin.

A. Abdominal pads. B. Hydrogel. C. Wet-to-dry. D. Dry gauze.

Correct Answer is B

Explanation

Choice A rationale:

Abdominal pads are not designed to minimize pain during dressing changes.

Choice B rationale:

Hydrogel dressings are known to minimize pain during dressing changes.

Choice C rationale:

Wet-to-dry dressings can cause discomfort during dressing changes.

Choice D rationale:

Dry gauze can stick to the wound bed and cause pain during dressing changes.

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A nurse is preparing to assist with irrigating a wound for a client.Which of the following actions should the nurse plan to take?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

Correct Answer is B

Explanation

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A nurse is preparing to assist with irrigating a wound for a client.
Which of the following actions should the nurse plan to take?