A nurse is planning care for a client who has an infected wound with significant exudate.
The nurse should plan to use which of the following dressings to cover the wound?
Polymeric membrane dressing
Hydrofiber dressing
Hydrogel dressing
Hydrocolloid dressing
The Correct Answer is B
Choice A rationale: this is a type of non-adherent dressing that can be used for wounds with minimal exudates hence this is not suitable for wounds with significant exudate since it causes maceration and leakage.
Choice B rationale: this is an absorbent dressing that can be used in wounds with moderate-significant exudate since it moistens the wound environment while facilitating autolytic debridement by forming a gel in contact with the exudate.
Choice C rationale: this is a type of hydrating dressing containing water or glycerin-based gel that is suitable for use in wounds with minimal exudate.
Choice D rationale: this is a type of occlusive dressing suitable for wounds with minimal-moderate exudates. It is unsuitable for wounds with significant exudate since it can result in maceration and leakage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale: individuals with extensive burn wounds are highly likely to develop metabolic acidosis and not metabolic alkalosis due to the increased risk of tissue hypoxia, increased lactic acid levels, and renal failure.
Choice B rationale: low hemoglobin is not an expected finding in individuals with extensive burn wounds but instead increased hemoglobin levels are expected due to hemoconcentration resulting from excessive fluid loss.
Choice C rationale: A patient with extensive burn wounds is expected to have hypovolemia and not hypervolemia due to increased fluid loss from the burned tissues and increased capillary permeability.
Choice D rationale: hyperkalemia is a common finding in individuals with extensive burn wounds due to massive cell destruction which releases potassium from the intracellular compartment to the extracellular compartment.
Correct Answer is D
Explanation
Choice A rationale: This describes a full-thickness burn with eschar formation, not a deep partial-thickness burn.
Choice B rationale: This may indicate a deeper burn involving the subcutaneous tissue, but the absence of blisters makes it less characteristic of a deep partial-thickness burn.
Choice C rationale: This suggests a full-thickness burn with damage to nerve endings, not a deep partial-thickness burn.
Choice D rationale: A deep partial-thickness burn is characterized by a pink or mottled appearance with the presence of blisters. This type of burn involves damage to the epidermis and portions of the dermis, causing pain and sensitivity to touch.
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