FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

Chapter 26: Wound Care Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The nurse is caring for a client admitted through the emergency department (ED) following an accident. The client’s injuries include an open fracture of the leg and multiple bruises. Which terminology will the nurse use to document the client’s wounds? 1. Closed leg injury with multiple cuts 2. Massive bruising with broken bones 3. Compound leg fracture with multiple contusions 4. Puncture leg wound with surface skin scrapes ____ 2. The nurse is providing care for a client after surgery for repair for a penetrating wound to the abdomen. Which characteristic of the wound will make the nurse most vigilant for signs of infection? 1. The object that entered the client’s abdomen remained embedded until surgery. 2. The object was removed by first responders and the wound flushed for foreign bodies. 3. The object inflicted no injury on the client’s internal organs or boney structures. 4. The object was smooth, nonporous metal, and a diameter of less than one inch. ____ 3. The nurse is caring for a client with diabetes mellitus who has a non-healing wound on the bottom of the foot. Which assessment finding causes the nurse to conclude that the wound is likely infected with Clostridia? 1. A crackling sensation under the skin can be felt when palpating around the wound. 2. The area surrounding the wound is dark red, swollen, and draining yellow exudate. 3. The infected area around the wound appears to be expanding to surrounding tissue. 4. The wound drainage has a strong smell of rotten grapes and appears green in color.