A nurse is preparing to assist with irrigating a wound for a client.
Which of the following actions should the nurse plan to take?

Irrigate the wound until the solution that is draining is clear.

Chill the irrigant prior to the procedure.

Hold the tip of the syringe at least 1.3 cm (0.5 in) above the wound while irrigating.

Flush the wound from the most contaminated area to the cleanest area.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

The goal of wound irrigation is to clean the wound, so the nurse should continue to irrigate until the drainage is clear.

Choice B rationale:

The irrigant should be at room temperature, not chilled.

Choice C rationale:

The syringe should be held 1 inch (not 0.5 inch) from the wound.

Choice D rationale:

The wound should be flushed from the cleanest area to the most contaminated, not the other way around.

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Correct Answer is B

Explanation

Choice A rationale:

Decreased serum calcium does not directly contribute to pressure injury development.

Choice B rationale:

Decreased circulation can lead to tissue ischemia and necrosis, increasing the risk of pressure injury.

Choice C rationale:

Increased collagen is beneficial for wound healing and does not increase the risk of pressure injury.

Choice D rationale:

Increased muscle mass can actually provide more padding over bony prominences, reducing the risk of pressure injury.

A. Wet-to-dry dressings. B. Negative pressure treatment. C. NPWT therapy. D. Hydrocolloid dressings. E. Promoting protein in the diet.

Correct Answer is ["B","C","D","E"]

Explanation

Choice A rationale:

Wet-to-dry dressings are not typically used for chronic wounds as they can cause tissue damage.

Choice B rationale:

Negative pressure treatment can promote healing by removing excess fluid and promoting blood flow to the wound.

Choice C rationale:

NPWT therapy, or Negative Pressure Wound Therapy, can help heal chronic wounds by removing excess fluid and promoting blood flow.

Choice D rationale:

Hydrocolloid dressings maintain a moist wound environment, which can promote healing.

Choice E rationale:

Protein is essential for wound healing as it is needed for the growth and repair of tissues.

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A nurse is preparing to assist with irrigating a wound for a client.Which of the following actions should the nurse plan to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data on a client who has impaired mobility.The nurse should monitor the client for a pressure injury due to which of the following factors?

Correct Answer is B

Explanation

Chronic wounds that are not healing well may benefit from (Select all that apply.)

Correct Answer is ["B","C","D","E"]

Explanation

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A nurse is preparing to assist with irrigating a wound for a client.
Which of the following actions should the nurse plan to take?