A nurse is caring for a client who has a large wound that has a vacuum-assisted closure device placed over it. Which of the following findings by the nurse indicates healing of the wound?
Sanguineous drainage in the suction device
Granulation tissue on the surface of the wound
Musty odor from the foam dressing upon removal
Peeling of the edges of the transparent dressing
The Correct Answer is B
A. Sanguineous drainage in the suction device:
May occur early on, but persistent sanguineous drainage is not a sign of healing.
B. Granulation tissue on the surface of the wound:
Granulation tissue is pink, healthy tissue that indicates wound healing.
C. Musty odor from the foam dressing upon removal:
Could indicate infection or dressing degradation, not healing.
D. Peeling of the edges of the transparent dressing:
Could compromise the seal of the VAC system and does not reflect wound healing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. To prevent infection in burn wounds:
Analgesics like Dilaudid do not prevent infection; antibiotics and wound care do.
B. To promote wound healing in burn patients:
Pain control may aid indirectly, but opioids do not promote wound healing directly.
C. To decrease the risk of hypothermia in burn patients:
Hypothermia prevention involves warm blankets, warming devices, and fluid management-not PCA.
D. To provide controlled and individualized pain relief in burn patients:
PCA pumps allow patients to self-administer opioid analgesia, offering consistent, effective pain control with less risk of overdose when properly programmed.
Correct Answer is C
Explanation
A. A shallow, ruptured or intact skin blister without slough:
Describes a Stage 2 pressure ulcer.
B. Unbroken skin with un-blancheable erythema:
This is a Stage 1 pressure ulcer.
C. A deep crater without visible bone, tendon, or muscle:
Correct. This describes a Stage 3 pressure ulcer with full-thickness tissue loss and subcutaneous damage.
D. Full-thickness tissue loss extending to underlying support structures:
This describes a Stage 4 pressure ulcer.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
