N5451 Skills Lab Video Quizzes - Module 9 Skin Integrity and Wound Care
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Course
N5451
Institution
N5451
N5451 Skills Lab Video Quizzes - Module 9 Skin Integrity and Wound Care The nurse is preparing to clean a client's surgical wound. What would the nurse assess before beginning the procedure? The client's comfort and effectiveness of pain medication The nurse is preparing to perform wound care. Wh...
N5451 Skills Lab Video Quizzes - Module 9 Skin
Integrity and Wound Care
The nurse is preparing to clean a client's surgical wound. What would the nurse assess
before beginning the procedure?
The client's comfort and effectiveness of pain medication
The nurse is preparing to perform wound care. Which intervention should be
implemented to protect the nurse from injury?
Raise the bed to elbow height.
After setting up a sterile field and putting on sterile gloves, the nurse prepares to clean a
client's surgical wound. Which cleaning technique would the nurse use to prevent
contamination of the wound? The nurse cleans the wound from the:
top to the bottom using a new gauze for each wipe.
The nurse has finished cleaning a client's surgical wound. What would be the nurse's
next action in this procedure?
Pat the wound dry with a sterile gauze sponge.
The nurse assesses the surgical dressing of a client who has just arrived from the
post-anesthesia care unit (PACU) and observes the dressing has a moderate area of
serous drainage on it. What is the best action by the nurse?
Reinforce the dressing and assess site frequently
The nurse is removing the dressing from an abdominal surgical wound during wound
care and notices that the wound edges are not intact, there are multiple staples on the
dressing, and the surrounding tissue is red with purulent drainage. The chart reports
that the incision was clean and dry with the approximated edges and staples intact upon
the last assessment. What would be the first recommended nursing intervention in this
situation?
Assess for pain, shortness of breath, and abdominal pressure.
When removing a client's surgical wound dressing, the nurse notes that there is wound
separation and rupture. What is the term for this wound complication?
Dehiscence.
The nurse is changing the dressing on a client's surgical wound and notices that part of
the dressing is sticking to the underlying skin. What is the recommended nursing
intervention in this situation?
Use small amounts of sterile saline to help loosen and remove the dressing.
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