Which statement(s) are true when selecting and applying a dressing for a client with a wound? Select all that apply.

A dressing helps protect the wound from contamination.

The wound and the surrounding skin need to be cleaned with each dressing change.

A dressing is required for an open wound with extensive tissue loss.

The dressing type should stay the same throughout the course of wound treatment.

The dressing should control drainage without fully drying out the wound bed.

Answer and Explanation

Correct Answer : A,B,C,E

A. A dressing helps protect the wound from contamination: Dressings act as a physical barrier against microorganisms, debris, and external trauma. Maintaining a protected environment reduces the risk of local infection and supports optimal healing conditions. This is a fundamental purpose of wound dressings.

B. The wound and the surrounding skin need to be cleaned with each dressing change: Cleansing removes exudate, necrotic debris, and surface bacteria that can delay healing. Cleaning the surrounding skin also prevents maceration and skin breakdown from drainage. Consistent cleansing supports accurate wound assessment.

C. A dressing is required for an open wound with extensive tissue loss: Open wounds with significant tissue loss require coverage to maintain moisture balance and protect exposed structures. Dressings support granulation tissue formation and reduce evaporative fluid loss. Leaving such wounds uncovered increases infection risk.

D. The dressing type should stay the same throughout the course of wound treatment: Dressing selection should change as the wound progresses through healing phases. Variations in exudate level, tissue type, and infection risk require different dressing properties. Ongoing reassessment guides appropriate modification.

E. The dressing should control drainage without fully drying out the wound bed: A moist wound environment promotes epithelialization and cellular migration. Dressings should absorb excess exudate while preventing desiccation of viable tissue. Proper moisture balance accelerates healing and reduces pain.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

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

Explanation

A. Blood pressure: The client’s blood pressure is 120/82 mm Hg, which is within normal limits for a 68-year-old adult and does not require immediate follow-up.

B. Respiration rate: A respiratory rate of 26 breaths per minute is elevated (normal 12–20) and may indicate pain, anxiety, or early respiratory compromise. Further assessment is needed to determine the cause and prevent complications such as hypoxia or pulmonary embolism.

C. Lack of ambulation: The client has not been out of bed since surgery, despite orders to ambulate three times daily. Immobility increases the risk of complications such as deep vein thrombosis, pulmonary embolism, and delayed functional recovery, requiring prompt intervention.

D. Body mass index: A BMI of 26.6 indicates overweight but is not an acute concern requiring immediate follow-up in the postoperative setting.

E. Oxygen saturation: An oxygen saturation of 88% on room air is below the expected range (≥92%) and signals hypoxemia. Immediate follow-up is necessary to assess respiratory status, provide supplemental oxygen, and prevent respiratory complications.

A. An adolescent client with diabetes mellitus who is admitted for hyperglycemia. B. A middle-aged adult client who is comatose following a stroke. C. An older adult client who is recovering from a sinus infection. D. An adult client with a spinal cord injury who engages in daily physical therapy.

Correct Answer is B

Explanation

A. An adolescent client with diabetes mellitus who is admitted for hyperglycemia: Diabetes can impair circulation and wound healing, but adolescents are generally mobile and able to reposition independently. Short-term hyperglycemia alone does not create sustained pressure over bony prominences. Mobility significantly reduces pressure injury risk.

B. A middle-aged adult client who is comatose following a stroke: Coma results in complete immobility, loss of protective reflexes, and inability to reposition or perceive discomfort. Prolonged pressure over bony areas compromises tissue perfusion and increases ischemic injury. Neurologic impairment and immobility place this client at the highest risk.

C. An older adult client who is recovering from a sinus infection: Advanced age can increase vulnerability to skin breakdown, but a sinus infection does not typically limit mobility or sensation. Clients who are alert and ambulatory can relieve pressure independently. Risk remains relatively low without immobility.

D. An adult client with a spinal cord injury who engages in daily physical therapy: Although spinal cord injury increases baseline risk due to sensory deficits, regular physical therapy promotes mobility, circulation, and pressure relief. Active repositioning and therapeutic movement reduce prolonged pressure exposure. Consistent mobility lowers overall risk.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Which statement(s) are true when selecting and applying a dressing for a client with a wound? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The following six questions are part of an unfolding case study. Review the electronic health record. Which 3 assessment finding(s) require follow-up by the nurse? Select three findings.

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

Explanation

A nurse provides care for several clients. Which client is at greatest risk of developing a pressure injury?

Correct Answer is B

Explanation

The nurse is watching a new nurse ventilate a client using a bag-valve mask with capnography capabilities. The nurse notices that the client's PaCO2 level is 30 mm Hg. How should the nurse interpret this finding?

A nurse is caring for a group of clients who need positioning. Which client should the nurse prioritize?

The nurse is caring for a client with a surgical incision. Which action should the nurse take to reduce the client's risk of infection?

Review the electronic health record. Complete the diagram by selecting from the choices below to specify what isolation precaution the client requires, 2 actions the nurse should take to address the isolation, and 2 parameters the nurse should monitor to assess the client's progress.

The nurse cares for a group of clients. Which client should the nurse prioritize?

The nurse is making an occupied bed. What action should the nurse implement?

The nurse is planning care for a client after surgery. Which nutrition intervention should the nurse include in the plan of care?

The nurse provided discharge teaching to the client's family on preventing pressure injuries at home. Which statement made by the family member indicates a need for further instruction?