In a clinical setting, a patient with a chronic wound is scheduled for debridement. Which of the following is the primary purpose of wound debridement?

To increase blood flow to the wound site

To remove necrotic tissue to promote healing

To apply antibiotics directly to the wound

To prevent scar formation

Answer and Explanation

The Correct Answer is B

A. To increase blood flow to the wound site: While debridement may indirectly help improve blood flow by removing barriers to healing, its primary purpose is not to increase blood flow. Increased blood flow is a result of improved wound bed conditions rather than the main goal of the procedure.

B. To remove necrotic tissue to promote healing: The primary purpose of wound debridement is to remove necrotic (dead) or devitalized tissue from the wound bed. This process promotes healing by creating a clean wound environment, facilitating granulation tissue formation, and reducing the risk of infection, making this option the most accurate.

C. To apply antibiotics directly to the wound: While antibiotics may be part of the overall wound care plan, debridement itself is not intended for the direct application of antibiotics. The focus is on removing non-viable tissue rather than applying medications during the procedure.

D. To prevent scar formation: While proper wound care, including debridement, can help improve healing outcomes and potentially minimize scarring, the primary aim of debridement is not to prevent scars. Scarring is influenced by multiple factors, including the type of wound, depth, and individual healing responses.

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Correct Answer is B

Explanation

A. "If you wear gloves, you do not have to wash your hands.": Hand hygiene must still be performed even when gloves are worn. Gloves can become contaminated, and not washing hands after removing them can lead to the spread of pathogens. It is crucial to wash hands before putting on gloves and after removing them to ensure proper infection control.

B. "Rub all surfaces of your hands with an alcohol rub for 20 to 30 seconds.": This emphasizes the importance of thoroughly applying an alcohol-based hand rub to all areas of the hands, including the back, between fingers, and under nails. Using the rub for 20 to 30 seconds allows for effective disinfection, reducing the risk of transmitting infections.

C. "Use an alcohol rub when your hands are visibly soiled.": When hands are visibly soiled, soap and water should be used instead of an alcohol rub. Alcohol-based hand rubs do not effectively clean dirt or organic matter, which makes proper handwashing essential in such cases to ensure all contaminants are removed.

D. "If you don't have an infection, your hands won't infect others.": It is possible for hands to carry microorganisms that can cause infections even if the person does not have an active infection. Regular hand hygiene practices are necessary to prevent the transmission of pathogens to others, highlighting the importance of maintaining clean hands regardless of one's health status.

A. Move the client's limbs through their complete range of motion. B. Have the client move each limb independently through its complete range of motion. C. Ask the client to move her arms and legs while applying slight resistance. D. Instruct the client to tighten muscle groups for a short period, and then relax.

Correct Answer is D

Explanation

A. Move the client's limbs through their complete range of motion: This action describes passive range-of-motion exercises, where the nurse assists the client in moving their limbs. While this is beneficial for clients who cannot move independently, it does not align with the plan for isometric exercises, which focus on muscle contraction without joint movement.

B. Have the client move each limb independently through its complete range of motion: This describes active range-of-motion exercises, which involve the client actively moving their limbs. Although these exercises are important for maintaining joint flexibility and preventing stiffness, they are not isometric exercises, which are intended to be performed without changing the length of the muscle.

C. Ask the client to move her arms and legs while applying slight resistance: This action combines movement with resistance training, which is not consistent with isometric exercises. Isometric exercises focus solely on muscle contraction without joint movement or changing muscle length, making this option inappropriate for the prescribed plan of care.

D. Instruct the client to tighten muscle groups for a short period, and then relax: This accurately describes isometric exercises, where the client contracts specific muscle groups (e.g., arms, legs, abdomen) without moving the joints. These exercises help maintain muscle strength and prevent atrophy while the client is on bedrest. The nurse should guide the client to perform these contractions for a few seconds, followed by relaxation, as directed by the plan of care.

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In a clinical setting, a patient with a chronic wound is scheduled for debridement. Which of the following is the primary purpose of wound debridement?

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