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NUR 352 EXAM QUESTIONS AND ANSWERS 100% CORRECT LATEST UPDATE
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NUR 352 EXAM QUESTIONS AND ANSWERS 100% CORRECT LATEST UPDATE...
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NUR 352 EXAM QUESTIONS AND ANSWERS 100% CORRECTLATEST UPDATE
Integument Physical Assessment Techniques - ANSWER -Inspection
-Palpaiton
Integument health promotion - ANSWER -Sunscreen
-Monthly self-checks
-diet (avoiding saturated fats and processed foods)
Braden Scale - ANSWER A tool for predicting pressure ulcer risk
-Out of 23, the lower the score the higher the risk
ABCDE - ANSWER skin cancer screening
asymmetry, border, color, diameter, evolving
Expected skin color + temp findings - ANSWER -color variation (scars, genetic, age, sun
damage, pregnancy)
-temperature (environmental or chronic perfusion issue)
Unexpected skin color +temp findings - ANSWER -Color (pallor, cyanosis, jaundice,
erythema, ecchymosis, hematoma, petechiae)
-hypo or hyperthermia
Skin integrity expected - ANSWER -scars
-good hygiene
-chart the beginning of any sores
,Skin integrity unexpected - ANSWER -Lesions; need investigation
-Primary lesions are the direct result of something (a burn)
-Secondary lesions occur when a primary is untreated
-Obtain subjective history of new changes
-ABCDE
-infestation
Pressure wound risk factors - ANSWER - location
-mobility
-age
-weight
-nutrition
-chronic conditions (diabetes)
-moisture/friction
-Braden scale!
Bronden scale categories - ANSWER sensory perception, moisture, activity, mobility,
nutrition, friction and shear
Stage of pressure wound - ANSWER 1. Nonblanchable; intact skin with redness
2. Partial loss on outermost layers; shiny
3.Full thickness loss through subQ
4.Full thickness loss with necrosis or damage to bone/muscle
-nurses cannot stage, and they cannot be staged if the bottom is not visible
Pressure wound care - ANSWER -Advocate for pain control
, -Administer pain meds before wound changes
Integument primary pressure wound interventions - ANSWER -Reposition every 2 hrs
-can be delegated after assessment is performed
-nutrition/hygien
Secondary pressure wound interventions- ANSWER -wound care
-gel pads
-pillows
Pressure wound documentation- ANSWER -time observed
-treatment provided
-size/ depth
Integument expected moisture/turgor/texture- ANSWER -Age/genetics/weight gain/loss
variations
-trauma/procedures
-Age may result in dryness and decreased elasticity
Integument unexpected moisture/turgor/texture- ANSWER -severe dryness, flakiness,
roughness
-velvety /thickening texture(thyroid)
-diaphoresis
-tenting
-edema
Hair expected findings- ANSWER -well distributed
-adequate amount
-good hygiene
hair unexpected findings - ANSWER -hair loss; alopecia
-uneven distribution
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