A patient has a pooling of blood under unbroken skin of the hip after a fall.
The nurse should document that this patient has a(n):
abrasion.
avulsion.
hematoma.
laceration.
The Correct Answer is C
Choice A rationale:
An abrasion is a superficial injury to the skin caused by scraping or rubbing, which does not match the description of a pooling of blood under unbroken skin.
Choice B rationale:
An avulsion is a wound where a chunk of tissue is torn away, which does not match the description of a pooling of blood under unbroken skin.
Choice C rationale:
A hematoma is a pooling of blood outside of blood vessels, typically caused by trauma. It matches the description of a pooling of blood under unbroken skin.
Choice D rationale:
A laceration is a deep cut or tear in the skin, which does not match the description of a pooling of blood under unbroken skin.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
The side-lying position allows gravity to assist in wound irrigation and prevent pooling of the solution.
Choice B rationale:
High-Fowler’s position is not ideal for abdominal wound irrigation as it can lead to pooling of the solution.
Choice C rationale:
In the supine position, the solution can pool around the wound and not effectively irrigate it.
Choice D rationale:
The dorsal recumbent position is not ideal as it can also lead to pooling of the solution.
Correct Answer is D
Explanation
Choice A rationale:
Sharp debridement involves the use of a sharp instrument or heat to remove dead tissue, which is not achieved with a hydrocolloid dressing.
Choice B rationale:
Chemical debridement involves the use of chemicals to remove dead tissue, which is not the function of a hydrocolloid dressing.
Choice C rationale:
Enzymatic debridement involves the use of enzymes to soften and remove dead tissue, which is not the function of a hydrocolloid dressing.
Choice D rationale:
Autolytic debridement uses the body’s own enzymes and moisture to soften and remove dead tissue. A hydrocolloid dressing helps maintain a moist wound environment, promoting autolytic debridement.
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