The nurse is caring for a patient with a healing Stage II pressure ulcer. The wound is clean and granulating. Which health care provider’s order will the nurse question?
Consult a dietitian.
Apply a hydrogel dressing.
Clean the wound with hydrogen peroxide.
Use a low-air-loss therapy unit.
The Correct Answer is C
The correct answer is C.
A: Consulting a dietitian is a beneficial order for a patient with a pressure ulcer. Proper nutrition, especially adequate protein intake, is crucial for wound healing. A dietitian can help ensure the patient receives the necessary nutrients to support tissue repair and recovery.
B: Applying a hydrogel dressing is appropriate for a clean, granulating Stage II pressure ulcer. Hydrogel dressings maintain a moist wound environment, which promotes healing and provides pain relief. They are suitable for wounds with minimal to moderate exudate.
C: Cleaning the wound with hydrogen peroxide is not recommended for a healing pressure ulcer. Hydrogen peroxide can damage healthy granulating tissue and delay the healing process. It is better to use saline or a wound cleanser that does not harm the new tissue.
D: Using a low-air-loss therapy unit is beneficial for patients with pressure ulcers. These units help reduce pressure on the skin, improve circulation, and prevent further skin breakdown. They are an effective part of pressure ulcer management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A: A simple face mask provides a moderate concentration of oxygen but does not have a one-way valve to deliver the highest concentration of oxygen.
B: A Venturi mask delivers a precise concentration of oxygen but is not designed to provide the highest concentration of oxygen with a one-way valve.
C: A non-rebreather mask is the correct choice. It has a one-way valve that prevents exhaled air from re-entering the bag, allowing the delivery of the highest concentration of oxygen to the client.
D: A partial rebreather mask provides a high concentration of oxygen but does not have a one-way valve, making it less effective than a non-rebreather mask for delivering the highest oxygen concentration.
Correct Answer is D
Explanation
A: Wearing earphones is not part of the Rinne test. Earphones are used in other types of hearing tests, such as audiometry.
B: A small probe is not used in the Rinne test. Probes are used in other diagnostic procedures, such as tympanometry.
C: Small electrodes are not used in the Rinne test. Electrodes are used in tests like electroencephalography (EEG).
D: A tuning fork is placed on the mastoid bone behind the ear and then near the ear canal during the Rinne test. This test compares air conduction to bone conduction of sound.
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