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The nurse notes that a patient has a black pressure ulcer on the left hip. Which event will the nurse anticipate when planning care for this patient?

Surgical debridement of the wound

Increased drainage from the wound

Documenting the wound status daily

Increased monitoring of the wound condition

Answer and Explanation

The Correct Answer is A

Choice A rationale

A black pressure ulcer indicates necrotic tissue, which often requires surgical debridement.

Choice B rationale

Increased drainage from the wound is not typically associated with a black pressure ulcer.

Choice C rationale

While documenting the wound status daily is part of wound care, it is not a specific event anticipated when planning care for a patient with a black pressure ulcer.

Choice D rationale

Increased monitoring of the wound condition is part of wound care, but it is not a specific event anticipated when planning care for a patient with a black pressure ulcer.

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Correct Answer is D

Explanation

Choice A rationale

Discarding the dressing in the bedside trash receptacle is not recommended because it can lead to the spread of infection. The dressing is contaminated with blood and purulent drainage, which are considered biohazardous waste.

Choice B rationale

Double-bagging the dressing in clear bags and labeling it “biohazard” is not sufficient. While it’s important to label biohazardous waste, the dressing should be disposed of in a designated biohazardous waste container.

Choice C rationale

Enclosing the dressing in a single clear plastic bag and discarding it in the bedside trash receptacle is also not recommended. This method does not provide adequate containment for biohazardous waste.

Choice D rationale

Disposing of the dressing in a biohazardous waste container is the correct method. This ensures that the biohazardous waste is properly contained and reduces the risk of spreading infection.

A. Use soap to clean the patient’s skin. B. Apply a barrier cream to the patient’s skin. C. Avoid applying friction when drying the patient’s skin. D. Use warm water to clean the patient’s skin.

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

Explanation

Choice A rationale

Using soap to clean the patient’s skin is not the best practice. Soap can dry out and irritate the skin, especially in patients with urinary incontinence. It can disrupt the skin’s natural pH balance and make it more susceptible to damage.

Choice B rationale

Applying a barrier cream to the patient’s skin is a recommended practice. Barrier creams provide a protective layer on the skin that can help prevent irritation from urine. They can also help to keep the skin moisturized, which is important for maintaining skin integrity.

Choice C rationale

Avoiding friction when drying the patient’s skin is crucial. Friction can cause further damage to the skin, especially in areas that are already irritated or broken down due to incontinence. It’s recommended to gently pat the skin dry rather than rubbing it.

Choice D rationale

Using warm water to clean the patient’s skin is a good practice. Warm water is less irritating to the skin than hot water and can help to cleanse the area without causing additional discomfort or damage.

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The nurse notes that a patient has a black pressure ulcer on the left hip. Which event will the nurse anticipate when planning care for this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse caring for a client who has an infected wound removes a dressing saturated with blood and purulent drainage. How should the nurse dispose of the dressing material?

Correct Answer is D

Explanation

A nurse is providing skin care for a patient with urinary incontinence. What actions should the nurse take?

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

Explanation

A nurse is assessing a patient who has a wound that is healing by first intention. What findings should the nurse expect?

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