NUR 155 EXAM 3 GALEN COLLEGE OF NURSING |335 COMPLETE QUESTIONS
WITH 100% GRADED EXPERT SOLUTIONS | 100% CORRECT | GET A+
1. Types of wounds: Intentional or unintentional
Open or closed
Acute or chronic
Partial thickness, full thickness, complex
2. transparent film: autolytic debridement, semi-permeable allows skin to
breathe.
uses: burns, IV sites, stage 1& 2 pressure ulcers, skin tears
3. how do you apply an abdominal binder?: start at typhoid, fasten from the
bottom up used for support to keep dressing intact
remove every two hours to asses underlying skin and wound
4. Risk factors for pressure ulcers: Fecal and unitary incontinence Friction and
shearing immobility
,inadequate nutrition (decreased
protein, Vitamin C, zinc) Decreased
mental status excessive body heat
(moisture) advanced age chronic
conditions Diminished sensation
Incorrect positioning
5. Signs of infected pressure ulcer?: Change in color, odor, or drainage. Sever
infections cause fever and increased WBC.
6. During your assessment of a new patient, the nurse notices a Stage I
pressure ulcer, what are the signs that this nurse is correct about this
pressure ulcer being a stage one?: Non-blachable
No opening
7. What do you do for a stage I pressure ulcer?: Apply barrier creams
Reposition patient Q2hr
,8. As you assess your new patient you notice a sore on a bony premise that is
blister-like, with partial thickness skin loss, pt is complaining of pain where
the wound is present which stage is this pressure ulcer?: Stage II
9. What type of dressing do you use for a stage II pressure ulcer?: Mepaplex
or Duoderm
10. Full thickness skin loss, involving damage or necrosis of subcutaneous is
what stage pressure ulcer?: Stage III
11. Full thickness skin loss with tissue necrosis, damage to the muscle and
bone, wound goes through nerves and not painful with tunneling present,
which stage is this wound?: Stage IV
12. Treating pressure ulcers: Minimize direct pressure
Reposition Q2hr
Schedule and DOCUMENT
position change use assistive
devices
Dressing changes as ordered
, Keep sheets dry and wrinkle free
Keep pt dry if incontinent
ROM 3reps 2x daily
13. What is regeneration?: replacement of destroyed tissue by the same kind
of cells
14. Primary intention healing: tissue surfaces are approximated (closed) and
there is minimal or no tissue loss, formation of minimal granulation tissue
and scarring
15. Secondary intention healing: wound in which the tissue surfaces are not
approximated and there is extensive tissue loss; formation of excessive
granulation tissue and scarring and greater risk of infection
16. tertiary intention: Wounds that are left open purposely for 3-5 days to
allow edema and infection to resolve.
17. serous: clear, watery plasma
18. purulent: containing pus, milky like
19. sanguineous: dark bloody drainage
WITH 100% GRADED EXPERT SOLUTIONS | 100% CORRECT | GET A+
1. Types of wounds: Intentional or unintentional
Open or closed
Acute or chronic
Partial thickness, full thickness, complex
2. transparent film: autolytic debridement, semi-permeable allows skin to
breathe.
uses: burns, IV sites, stage 1& 2 pressure ulcers, skin tears
3. how do you apply an abdominal binder?: start at typhoid, fasten from the
bottom up used for support to keep dressing intact
remove every two hours to asses underlying skin and wound
4. Risk factors for pressure ulcers: Fecal and unitary incontinence Friction and
shearing immobility
,inadequate nutrition (decreased
protein, Vitamin C, zinc) Decreased
mental status excessive body heat
(moisture) advanced age chronic
conditions Diminished sensation
Incorrect positioning
5. Signs of infected pressure ulcer?: Change in color, odor, or drainage. Sever
infections cause fever and increased WBC.
6. During your assessment of a new patient, the nurse notices a Stage I
pressure ulcer, what are the signs that this nurse is correct about this
pressure ulcer being a stage one?: Non-blachable
No opening
7. What do you do for a stage I pressure ulcer?: Apply barrier creams
Reposition patient Q2hr
,8. As you assess your new patient you notice a sore on a bony premise that is
blister-like, with partial thickness skin loss, pt is complaining of pain where
the wound is present which stage is this pressure ulcer?: Stage II
9. What type of dressing do you use for a stage II pressure ulcer?: Mepaplex
or Duoderm
10. Full thickness skin loss, involving damage or necrosis of subcutaneous is
what stage pressure ulcer?: Stage III
11. Full thickness skin loss with tissue necrosis, damage to the muscle and
bone, wound goes through nerves and not painful with tunneling present,
which stage is this wound?: Stage IV
12. Treating pressure ulcers: Minimize direct pressure
Reposition Q2hr
Schedule and DOCUMENT
position change use assistive
devices
Dressing changes as ordered
, Keep sheets dry and wrinkle free
Keep pt dry if incontinent
ROM 3reps 2x daily
13. What is regeneration?: replacement of destroyed tissue by the same kind
of cells
14. Primary intention healing: tissue surfaces are approximated (closed) and
there is minimal or no tissue loss, formation of minimal granulation tissue
and scarring
15. Secondary intention healing: wound in which the tissue surfaces are not
approximated and there is extensive tissue loss; formation of excessive
granulation tissue and scarring and greater risk of infection
16. tertiary intention: Wounds that are left open purposely for 3-5 days to
allow edema and infection to resolve.
17. serous: clear, watery plasma
18. purulent: containing pus, milky like
19. sanguineous: dark bloody drainage
