Many factors aid in healing. You can assist the patient in improving their healing ability by encouraging the following (Select all that apply):
Keeping skin and surrounding tissue clean and dry.
Proper nutrition with adequate protein and vitamins.
Resting as much as possible and keeping the incisional area still.
Increasing fluid intake to at least 4000 mL per day.
Exercise and deep breathing to increase oxygen.
Correct Answer : A,B,C,E
Choice A rationale
Keeping the skin and surrounding tissue clean and dry helps prevent infection, which is crucial for proper wound healing. A clean environment is less likely to harbor bacteria that can cause complications.
Choice B rationale
Proper nutrition, particularly adequate protein and vitamins, provides the necessary building blocks for tissue repair and supports the immune system, which is essential for healing.
Choice C rationale
Resting and minimizing movement of the incisional area help prevent further injury and allow the body’s resources to focus on the healing process.
Choice D rationale
While fluid intake is important, 4000 mL per day may be excessive unless specifically recommended for the patient’s condition. Overhydration can be harmful.
Choice E rationale
Exercise and deep breathing increase blood flow and oxygenation to tissues, which are vital for healing. Oxygen is needed for cellular functions that repair tissue.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Moisture from incontinence can compromise skin integrity and create a favorable environment for bacterial growth, increasing the risk of infection and skin breakdown.
Choice B rationale
While a wet bed may be uncomfortable, it does not exert greater pressure that would lead to skin breakdown or infection.
Choice C rationale
Shearing can occur from moving a patient on any surface; however, wet sheets do not inherently increase the likelihood of shearing.
Choice D rationale
Repositioning the patient is necessary for comfort and to prevent pressure ulcers, but it is not a direct cause of skin breakdown or infection due to incontinence.
Correct Answer is D
Explanation
Choice A rationale
An abrasion occurs when the skin is scraped off, usually due to a surface rubbing or scraping against the skin. It does not involve pooling of blood under the skin but rather an injury to the top layer of the skin.
Choice B rationale
An avulsion is a severe type of wound that occurs when a portion of the skin and sometimes the tissue beneath is partially or completely torn away. It is not characterized by pooling of blood under unbroken skin.
Choice C rationale
A laceration refers to a deep cut or tear in the skin or flesh. Because lacerations imply that the skin is broken and torn, it does not describe the condition where blood pools under unbroken skin.
Choice D rationale
A hematoma is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This is the correct term for a pooling of blood under unbroken skin, as described in the scenario following the patient’s fall. Hematomas can be caused by injury, such as a fall, that causes blood vessels to break and bleed into the surrounding tissues.
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