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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

Choice A rationale
Healing by secondary intention occurs when a wound is left open and closes naturally through granulation tissue formation, contraction, and epithelialization. This process is typically for wounds that cannot be closed with sutures due to infection or other factors.

Choice B rationale
The remodeling phase is the final stage of the healing process where the wound strength increases and scar tissue forms. It is not a type of wound healing but rather a phase that can occur in both primary and secondary intention healing.

Choice C rationale
Primary intention healing is when the wound edges are brought together, typically with sutures, staples, or adhesive tape. This method minimizes scarring and speeds up the healing process, making it the preferred method for surgical incisions.

Choice D rationale
Tertiary intention, also known as delayed primary closure, involves initially leaving the wound open due to contamination or infection and then closing it surgically once it is clean. This is not the type of healing described in the question.

A. The moisture creates an environment suitable for the growth of microorganisms in a wound. B. Greater pressure is exerted by a wet bed. C. Shearing is more likely from wet sheets. D. The patient has to be repositioned for the bed to be changed.

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.

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Many factors aid in healing. You can assist the patient in improving their healing ability by encouraging the following (Select all that apply):

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What type of wound heals by edges approximating with a suture?

Correct Answer is C

Explanation

A patient is incontinent on the first day after surgery. This is a risk factor for the development of skin breakdown and infection primarily because:

Correct Answer is A

Explanation

What is the physiological effect of moist heat on the treated area?

What stage is a wound if the epidermis is closed and has unblanchable redness?

The nurse is caring for a 48-year-old female patient with diabetes mellitus (DM), hypertension (HTN), and limited mobility. Upon assessment, she notes that there is a pink, viable wound bed with partial-thickness skin loss. Which stage of wound healing does this describe?

The nurse is taking care of a post-surgical patient and notes the incision is clean and dry, with sutures intact. The nurse further assesses that the wound is healing by:

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When applying an ice pack, it is necessary to:

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When the patient complains of worsening due to increased swelling at the wound site on his leg, the nurse explains that the swelling indicates: