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 A
Explanation
Choice A rationale: the epidermis which is the most superficial layer of the skin relies on the dermis for nutrition since it lacks its own blood supply.
Choice B rationale: adipose tissue is contained in the hypodermis which is part of the dermis layer of the skin and not the epidermis.
Choice C rationale: nerve fibers are contained in the dermis layer of the skin and not the epidermis.
Choice D rationale: blood vessels are contained in the dermis layer of the skin and not the epidermis.
Correct Answer is C
Explanation
Choice A rationale: this is important to assess the individual’s blood level and risk of infection but it is not a priority action compared to airway management.
Choice B rationale: The insertion of an indwelling urinary catheter is crucial for urine output monitoring but is not a priority action to take.
Choice C rationale: Inspection of the mouth for signs of inhalation injuries is a priority action for burns patients, especially those who have sustained facial burns since they can result in airway compromise and subsequent respiratory failure. The signs to look out for include; soot in the mouth and mouth, hoarseness, stridor, wheezes, or singed nasal hairs. In cases of suspected inhalation injuries, the nurse should inform the healthcare provider to assess for the need for intubation.
Choice D rationale: administration of analgesics is crucial for pain relief for all burn patients. However, this is not a priority action to take compared to airway management.
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