A nurse is documenting a dressing change for a client who has a pressure injury. Which of the following entries by the nurse demonstrates correct documentation?
"No changes noted to the wound from previous nursing notes.".
"New dressing applied as prescribed; no drainage on old dressing.".
"The wound seems clean and does not appear to be infected.".
"Client premedicated with MSO4 subq prior to dressing change.".
The Correct Answer is B
The nurse’s entry “New dressing applied as prescribed; no drainage on old dressing” demonstrates correct documentation because it includes specific details about the wound and the dressing change.
Choice A is wrong because it does not provide specific details about the wound or the dressing change.
Choice C is wrong because it includes subjective language (“seems” and “does not appear”) rather than objective observations.
Choice D is wrong because it only documents medication administration and does not provide any information about the wound or the dressing change.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
“Contract your pelvic muscle when performing the exercises.” Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum.
To do Kegels correctly, you need to contract and relax your pelvic floor muscles.
Choice A is wrong because you should avoid holding your breath while doing Kegel exercises.
Instead, breathe freely during the exercises.
Choice C is wrong because you should focus on tightening only your pelvic floor muscles and be careful not to flex the muscles in your buttocks.
Choice D is wrong because it takes time to strengthen pelvic floor muscles.
You should aim for at least three sets of 10 to 15 repetitions a day and give it 3 to 6 weeks before expecting improvement12.
Correct Answer is C
Explanation
The Weber test is a screening test for hearing performed with a tuning fork that can detect unilateral conductive hearing loss and unilateral sensorineural hearing loss.
To perform Weber’s test, strike the fork against your knee or elbow, then place the base of the fork in the midline, high on the patient’s forehead.
Choice A is wrong because delivering a series of high-pitched sounds at random intervals is not part of Weber’s test.
Choice B is wrong because holding an activated tuning fork against the client’s mastoid process is part of Rinne’s test, not Weber’s test.
Choice D is wrong because whispering a series of words softly into one ear is not part of Weber’s test.
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