CORRECTLY TO SCORE A+
A patient who had surgery yesterday has the initial dressing covering the
surgical site. What is the nurse's responsibility in assessing this patient's
wound? Answer - Wait until the health care provider orders the removal of the
surgical dressing
Which wound would be allowed to heal by secondary intention? Answer -
Infected hysterectomy incision
Before performing a wound assessment, which nursing action would reduce
the patient's risk for infection? Answer - Applying clean gloves
Which intervention can the nurse delegate to nursing assistive personnel (NAP)
in caring for a patient with a wound? Answer - Reporting the presence of
wound odour
The nurse notes that a patient's surgical wound is healing slowly. Which health
problem would contribute to slow wound healing? Answer - Diabetes mellitus
When irrigating a wound, how would the nurse know the right amount of
pressure to apply? Answer - Follow the general rule of keeping the pressure
between 4 and 15 psi
,Which action should the nurse avoid before irrigating a patient's foot wound?
Answer - Warm the irrigant to body temperature in the microwave
Which device is used for wound irrigation? Answer - A 19-G needle attached to
a 35 mL syringe
Which imaging study or diagnostic test would the nurse review to determine if
the pressure injury on a patient's left heel is infected? Answer - Culture and
sensitivity test
A nurse is irrigating a patient's abdominal wound 2 days postoperatively. Which
finding would need to be reported to the health care provider? Answer -
Drainage that was not present previously
The health care provider writes an order for a culture specimen to be collected
from a patient with a dog bite wound. What would the nurse do first? Answer -
Review the order to determine the type of specimen to be collected
Which action would the nurse take to reduce the risk for wound infection when
collecting a specimen for culture? Answer - Collect the specimen while
wearing sterile gloves
Which question might the nurse ask the patient when an aerobic wound
culture has been ordered? Answer - Do you have any pain at the wound site
Which instruction might the nurse give to the NAP to help ensure that a wound
culture specimen will be transported properly? Answer - Take this specimen to
the lab immediately
, Which nursing action demonstrates proper procedure in the collection of a
wound culture specimen? Answer - Wearing clean gloves to remove the soiled
dressings
What is the proper method for cleansing the evacuation port of a wound
drainage system? Answer - Wipe it with an alcohol sponge
What is the nursing action to set up suction for a Hemovac drainage system?
Answer - Compress the hemovac, creating suction
When emptying a Jackson-Pratt drain, which issue should nursing assistive
personnel (NAP) report immediately to the nurse as a potential abnormality?
Answer - The amount of drainage was greater today than yesterday
Which action might the nurse perform to ensure that the wound drainage
tubing does not pull on the insertion site? Answer - Attach the tubing to the
patient's gown with a safety pin
Which action would maximize the suction produced by the Jackson-Pratt
drainage system after the system has been emptied? Answer - Compressing
the bulb while replacing the port cap
The nurse is preparing to perform a sterile procedure for a patient. Which
action will best minimise the risk of infection during the procedure? Answer -
Follow sterile technique during the procedure
While preparing a sterile field, the nurse determines that additional supplies
are needed. What will the nurse do to ensure that the sterile field is
maintained? Answer - Ask the assistant who has been helping with the
procedure to bring back the supplied