The nurse is assessing a wound that is healing by secondary intention. Which of the following assessments are important to address? (Select all that apply.)
a. Wound dimensions
b. Tissue type
c. Wound edges
d. Periwound skin
e. Pain
f. Undermining
A, B, C, D, E, F
When assessing a wound that is healing by secondary intention (e.g., pressure ulcer or contami-nated surgical or traumatic wound), it is important to assess the anatomical location of the wound, the wound dimensions, undermining, the extent of tissue loss, the tissue type, the presence of exudate, the wound edges, and the periwound skin.
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An 80-year-old patient has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What patient education should be provided?
A) "Avoid high environmental temperatures." B) "Anticholinergics increase mental alertness." C) "It is safe to take Sudafed for a cold." D) "You may experience urinary incontinence."
The perinatal nurse explains to the student nurse that which of the following may increase labor discomfort?
A. Amniotomy B. Correct use of breathing methods C. Fetus in an occiput anterior position D. Positional changes during active labor
Which behavior demonstrated by an adolescent should alert the school nurse to a problem of substance abuse?
a. States feelings of worthlessness b. Increased desire for social conformity c. Does not feel need for peer approval d. Deterioration of relationships with family members
In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible
Within a year, the number of adverse events on the units had doubled. This may be attributable to: a. The overload of staff nurses. b. Resistance to change by staff. c. A change in reporting systems. d. Fewer clinical leaders to remove barriers to care.