2024 NUR155 GALEN (UNITS 6
(11-13) ,7 (24-26) ,8(11-13) EXAM
3 WITH ANSWERS
T/F, When collecting a culture from a wound, do not use pus or pooled
exudates. - CORRECT-ANSWERSTrue
To prevent skin trauma from shearing the nurse should consider using -
CORRECT-ANSWERSalcohol free barrier film
Using the RYB color code of wounds, Red would what kind of dressing or
treatment? - CORRECT-ANSWERScover with hydrocolloid dressing
Using the RYB color code of wounds, YELLOW would what kind of dressing or
treatment? - CORRECT-ANSWERSclean to remove nonviable tissue
The nurse is caring for a patient with a Stage IV pressure ulcer. Which
nursing diagnosis does the nurse add to the care plan?
A
Readiness for enhanced nutrition
B
Impaired physical mobility
C
Impaired skin integrity
D
Chronic pain - CORRECT-ANSWERSImpaired skin integrity
The nurse collects the following assessment data: right heel with reddened
area that does not blanch. Which nursing diagnosis will the nurse assign to
this patient?
A
Imbalanced nutrition: less than body requirements
B
Ineffective peripheral tissue perfusion
C
Risk for infection
D
Acute pain - CORRECT-ANSWERSIneffective peripheral tissue perfusion
, The nurse is caring for a patient who is immobile. The nurse wants to
decrease the formation of pressure ulcers. Which action will the nurse take
first?
A
Offer favorite fluids.
B
Turn the patient every 2 hours.
C
Determine the patient's risk factors.
D
Encourage increased quantities of carbohydrates and fats. - CORRECT-
ANSWERSDetermine the patient's risk factors.
Afterload - CORRECT-ANSWERSResistance to left ventricular ejection; high B/
P; vasoconstriction
Vasodialation; low B/P
**venous return - CORRECT-ANSWERSThe amount of blood returned to the
heart by the veins
**Non-modifiable risk factors - CORRECT-ANSWERSGenetics (parent with CVD
increases your risk
African Americans
Age - older increases risk
Males have higher risk than women until women reach menopause (estrogen
protects)
**aerobic exercise - CORRECT-ANSWERS30 mins a day, 5 days a week
**arterial insufficiency - CORRECT-ANSWERSdeficiency or occlusion of blood
flow through an artery
Hairless, red, mild edema, weak pulse, ulceration
**venous insufficiency - CORRECT-ANSWERSCyanotic; thick, coarse brown
skin around ankles; marked edema, ulcerations, itchy skin
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