When preparing to change a sterile dressing over an incision, it is most important to remember to:

Remind him to remain very still during the procedure.

Place a discard bag close to the wound.

Change gloves after removing the old dressing.

Refrain from talking while the wound is uncovered.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

While it’s important for the patient to remain still during the procedure, this is not the most important aspect of changing a sterile dressing.

Choice B rationale:

Placing a discard bag close to the wound can increase the risk of infection.

Choice C rationale:

Changing gloves after removing the old dressing is crucial to maintain sterility and prevent infection.

Choice D rationale:

Refraining from talking while the wound is uncovered can help prevent infection, but it’s not as important as changing gloves after removing the old dressing.

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Correct Answer is C

Explanation

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.

A. Is purulent. B. Becoming infected. C. Needs to be débrided. D. Beginning to heal.

Correct Answer is D

Explanation

Choice A rationale:

Purulent indicates pus, which is not described here.

Choice B rationale:

Infection usually presents with redness, swelling, and possibly pus, which is not described here.

Choice C rationale:

Debridement is the removal of dead tissue, not indicated by a pinkish-red bumpy area.

Choice D rationale:

A pinkish-red center area that looks bumpy indicates granulation tissue, which is a sign of healing.

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When preparing to change a sterile dressing over an incision, it is most important to remember to:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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):

Correct Answer is C

Explanation

A 28-year-old male is a patient at your clinic.He states that he had a minor accident with his motorcycle 5 days ago.He sustained several scrapes and wounds.The wound on his calf has a pinkish-red center area that looks bumpy.This indicates that the wound is:

Correct Answer is D

Explanation

The nurse is performing a dry sterile dressing change for an abdominal wound.The nurse should use a swab to clean:

A nurse performing a right eye irrigation will position the patient:

A nurse is assisting with the care of a client who has an infected wound with significant exudate.Which of the following dressings should the nurse plan to cover the client's wound?

The nurse clarifies that a vacuum-assisted closure supports healing of a wound by:

The nurse on the unit is going to perform wound care for her patient.After removing the soiled dressing, the following wound is noted to have full-thickness skin and tissue loss with exposed palpable fascia.

A nurse is assessing a surgical patient for internal hemorrhage, which would be indicated by:

A patient is incontinent the first day after his surgery.This is a risk factor for the development of skin breakdown and infection because of the added moisture and because:

A nurse is ambulating a patient in the hall a few days after abdominal surgery, and the patient says, "I think something just let go.”. The initial intervention by the nurse should be to: