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NURS MISC Inflammation and Wound Healing Test Bank,100% CORRECT
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NURS MISC Inflammation and Wound Healing Test Bank MULTIPLE CHOICE 1. The nurse assesses a patient’s surgical wound on the first postoperative day and notes redness and warmth around the incision. Which action by the nurse is most appropriate? a. Obtain wound cultures. b. Document the a...

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  • November 8, 2022
  • 15
  • 2022/2023
  • Exam (elaborations)
  • Questions & answers

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  • nurs misc inflammation and wound healing test bank

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  • NURS MISC
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NURS MISC Inflammation and Wound Healing Test Bank

MULTIPLE CHOICE

1. The nurse assesses a patient’s surgical wound on the first postoperative day and
notes redness and warmth around the incision. Which action by the nurse is
most appropriate?
a. Obtain wound cultures.
b. Document the assessment.
c. Notify the health care provider.
d. Assess the wound every 2 hours.

ANS: B
The incisional redness and warmth are indicators of the normal initial
(inflammatory) stage of wound healing by primary intention. The nurse should
document the wound appearance and continue to monitor the wound. Notification
of the health care provider, assessment every 2 hours, and obtaining wound
cultures are not indicated because the healing is progressing normally.

DIF: Cognitive Level: Apply (application) REF: 177-178
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

2. A patient with an open leg wound has a white blood cell (WBC) count of 13,
500/µL and a band count of 11%. What action should the nurse take first?
a. Obtain wound cultures.
b. Start antibiotic therapy.
c. Redress the wound with wet-to-dry dressings.
d. Continue to monitor the wound for purulent drainage.

ANS: A
The increase in WBC count with the increased bands (shift to the left) indicates
that the patient probably has a bacterial infection, and the nurse should obtain
wound cultures. Antibiotic therapy and/or dressing changes may be started, but
cultures should be done first. The nurse will continue to monitor the wound, but
additional actions are needed as well.

DIF: Cognitive Level: Apply (application) REF:173
OBJ: Special Questions: Prioritization TOP: Nursing
Process: Planning MSC: NCLEX: Physiological Integrity

3. A patient with a systemic bacterial infection feels cold and has a shaking
chill. Which assessment finding will the nurse expect next?
a. Skin flushing
b. Muscle cramps
c. Rising body temperature
This study source was downloaded by 100000802531269 from CourseHero.com on 10-05-2022 14:34:56 GMT -05:00


https://www.coursehero.com/file/13099980/ch12/

, d. Decreasing blood pressure
ANS: C




This study source was downloaded by 100000802531269 from CourseHero.com on 10-05-2022 14:34:56 GMT -05:00


https://www.coursehero.com/file/13099980/ch12/

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