NSE 211 FINAL EXAM REVIEW
QUESTIONS AND ANSWERS 2026
VERIFIED.
Wound - ANS break in the continuity of body structure, caused by violence, trauma, or
surgery to tissue bodies
ex; of acute wounds - ANS surgical incisions, traumatic wounds, lacerations, burns
ex; of chronic wounds - ANS PI, diabetic ulcers, malignant
acute wound - ANS wound that proceeds through an orderly & timely reparative process -
-> sustained restoration of anatomical & functional integrity
phases of wound healing - ANS 1) inflammatory phase
2) proliferative phase
3) remodelling phase
what's a part of the proliferative phase? - ANS proliferation, granulation & contraction
what happens during inflammatory phase? - ANS 1) hemostasis. (vasoconstriction)
1
,2) platelets + fibrin forms, clot formation
3) histamina, vasodilation, increased capillary permeability, erythema, swelling & warmth
what happens day 1-3 inflammatory phase? - ANS neutrophils released to injury site,
phagocytosis of debris beings.
what happens during day 3-24 of proliferative phase? - ANS 1) granulation tissue appears
in wound
2) contraction of wound edges
3) resurfacing by epithelialization --> dermal regen.
4) vascular bed reestablished
what happens during day 24-2 yrs of remodelling phase? - ANS 1) collagen fibers
reorganize & remodel
2) permanent scar
3) attains 80% of original strength
Primary intention healing - ANS wound that is closed by suture or wound closers &
healing occurs by collagen synthesis; lower risk of infection, and heals quickly w/ minimal
scarring.
secondary intention healing - ANS wound edges are not approximated. heals by
granulation tissue formation, wound contraction & epithelialization.
has a prolonged phase of inflammation due to increased time needed for phagocytosis of
necrotic tissue.
2
,tertiary intention healing - ANS wound is left open for several days as it could be
contaminated. has an increased risk of infection, so closure of wound is done later until risk of
infection is resolved.
why is the wound kept open for tertiary healing? - ANS to allow exudate to drain, prevent
the spread of deep infection & aiding granulation.
medical asepsis - ANS aka, *clean technique*.
includes procedures used to reduce & prevent the spread of microorganisms
ex; of medical asepsis - ANS hand washing, clean gloves, cleaning environment routinely.
ex; of surgical asepsis - ANS aka *surgical technique*.
requires more stringent techniques, *eliminating all microorganisms*.
when do you use surgical asepsis? - ANS when a patient's kin is broken, or if the nurse
performs an invasive procedure in a body cavity that is normally free of microorganisms.
ex; of surgical asepsis procedures - ANS - protective clothing
- opening sterile packages
- sterile field
- pouring sterile solns
- surgical hand scrub
- gowning & gloving
Principles of Surgical Asepsis - ANS - *a sterile object remains sterile only when touched
by another sterile object*
3
, - a sterile object or field out of range of vision or an object held below a person's waist is
contaminated
- a sterile objective or field becomes contaminated by prolonged exposure to air.
complications of wound healing - ANS hemorrhage, infection, dehiscence, evisceration,
fistula formation
hemorrhage nsg dx d/t - ANS slipped suture, dislodged clot, infection, or eroded blood
vessel
hemorrhage nsg dx manifested by - ANS - external-saturated sanguinous dressings
- internal-distension of body part
- change in drain output
- signs of hypovolemic shock
infection nsg dx d/t - ANS - exposure to bacteria, contaminated or trauma wound shows
S&S, surgical post-op infection.
infection nsg dx manifested by - ANS fever, tenderness, pain @ wound site, erythema,
edema, induration, warmth, elevated WBC, inflamed edges, foul odor, purulent drainage,
delayed healing
life threatening infection S&S - ANS - pain
- swelling, induration
- erythema
- wound breakdown
- increased size
4
QUESTIONS AND ANSWERS 2026
VERIFIED.
Wound - ANS break in the continuity of body structure, caused by violence, trauma, or
surgery to tissue bodies
ex; of acute wounds - ANS surgical incisions, traumatic wounds, lacerations, burns
ex; of chronic wounds - ANS PI, diabetic ulcers, malignant
acute wound - ANS wound that proceeds through an orderly & timely reparative process -
-> sustained restoration of anatomical & functional integrity
phases of wound healing - ANS 1) inflammatory phase
2) proliferative phase
3) remodelling phase
what's a part of the proliferative phase? - ANS proliferation, granulation & contraction
what happens during inflammatory phase? - ANS 1) hemostasis. (vasoconstriction)
1
,2) platelets + fibrin forms, clot formation
3) histamina, vasodilation, increased capillary permeability, erythema, swelling & warmth
what happens day 1-3 inflammatory phase? - ANS neutrophils released to injury site,
phagocytosis of debris beings.
what happens during day 3-24 of proliferative phase? - ANS 1) granulation tissue appears
in wound
2) contraction of wound edges
3) resurfacing by epithelialization --> dermal regen.
4) vascular bed reestablished
what happens during day 24-2 yrs of remodelling phase? - ANS 1) collagen fibers
reorganize & remodel
2) permanent scar
3) attains 80% of original strength
Primary intention healing - ANS wound that is closed by suture or wound closers &
healing occurs by collagen synthesis; lower risk of infection, and heals quickly w/ minimal
scarring.
secondary intention healing - ANS wound edges are not approximated. heals by
granulation tissue formation, wound contraction & epithelialization.
has a prolonged phase of inflammation due to increased time needed for phagocytosis of
necrotic tissue.
2
,tertiary intention healing - ANS wound is left open for several days as it could be
contaminated. has an increased risk of infection, so closure of wound is done later until risk of
infection is resolved.
why is the wound kept open for tertiary healing? - ANS to allow exudate to drain, prevent
the spread of deep infection & aiding granulation.
medical asepsis - ANS aka, *clean technique*.
includes procedures used to reduce & prevent the spread of microorganisms
ex; of medical asepsis - ANS hand washing, clean gloves, cleaning environment routinely.
ex; of surgical asepsis - ANS aka *surgical technique*.
requires more stringent techniques, *eliminating all microorganisms*.
when do you use surgical asepsis? - ANS when a patient's kin is broken, or if the nurse
performs an invasive procedure in a body cavity that is normally free of microorganisms.
ex; of surgical asepsis procedures - ANS - protective clothing
- opening sterile packages
- sterile field
- pouring sterile solns
- surgical hand scrub
- gowning & gloving
Principles of Surgical Asepsis - ANS - *a sterile object remains sterile only when touched
by another sterile object*
3
, - a sterile object or field out of range of vision or an object held below a person's waist is
contaminated
- a sterile objective or field becomes contaminated by prolonged exposure to air.
complications of wound healing - ANS hemorrhage, infection, dehiscence, evisceration,
fistula formation
hemorrhage nsg dx d/t - ANS slipped suture, dislodged clot, infection, or eroded blood
vessel
hemorrhage nsg dx manifested by - ANS - external-saturated sanguinous dressings
- internal-distension of body part
- change in drain output
- signs of hypovolemic shock
infection nsg dx d/t - ANS - exposure to bacteria, contaminated or trauma wound shows
S&S, surgical post-op infection.
infection nsg dx manifested by - ANS fever, tenderness, pain @ wound site, erythema,
edema, induration, warmth, elevated WBC, inflamed edges, foul odor, purulent drainage,
delayed healing
life threatening infection S&S - ANS - pain
- swelling, induration
- erythema
- wound breakdown
- increased size
4
