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CNA 2016 C 30*
Wound Care
| Question | Answer |
|---|---|
| A partial-thickness wound caused by the scraping away or rubbing of the skin is a(n) | abrasion |
| A resident has an open wound on the lower left leg. It is caused by poor arterial blood flow. This wound is a(n) ___________ ulcer. | arterial |
| A wound does not heal easily. It is a ___________wound. | chronic |
| A resident has an open wound on her left foot. She has poor circulation in her veins. Her wound is a(n) ___________ulcer. | venous |
| A wound is not infected. It is a(n) | clean wound |
| A resident had lung surgery. The person’s incision is best described as a(n) | clean-contaminated wound |
| Tissues are injured, but the skin is not broken. This is a(n) | closed wound |
| A wound has a high risk for infection. This is a(n) ___________wound. | contaminated |
| A closed wound caused by a blow to the body is a(n) | contusion |
| Wound layers have separated. This is | dehiscence |
| An infected wound is a(n) ___________wound. | full thickness |
| A wound has separated. Abdominal organs are protruding through the wound. This is | evisceration |
| A wound involves the skin, muscle, and bone. This is | full thickness wound |
| A condition in which there is death of tissue is | gangrene |
| A cut has clean, straight edges. It was produced with a sharp instrument. The wound is a(n) | incision |
| A wound has large amounts of microbes. It shows signs of infection. It is a(n) _______ wound. | infected |
| A wound created for therapy is a(n) ___________wound. | intentional |
| A wound has torn tissues and jagged edges. This is a(n) | laceration |
| The skin or mucous membrane is broken. This is a(n) ___________wound. | open |
| The dermis and epidermis of the skin are broken. This is | a partial thickness wound |
| The skin and underlying tissues are pierced. This is a(n) | penetrating wound |
| Phlebitis is | inflammation of a vein |
| An open wound made by a sharp object is a(n) | puncture wound |
| Drainage that is thick green, yellow, or brown is ___________drainage. | purulent |
| Thin, watery, blood-tinged drainage is ___________drainage. | serosanguineous |
| Clear, watery fluid from a wound is ___________drainage. | serous |
| Bloody drainage is ___________drainage. | sanguineous |
| A resident has a rip in the skin. The epidermis is separated from underlying tissue. This is a(n) | skin tear |
| A resident has an open wound on the right lower leg. The person has poor blood return through her veins. Her wound is a(n) | stasis ulcer |
| An accident or violent act that causes injury is | trauma |
| A thrombus is a | blood clot |
| The skin is injured. ___________is a major threat. | infection |
| What are common sites for skin tears? | hands, legs, arms |
| Skin tears are caused by | friction and shearing |
| Skin tears can cause an infection. | True |
| To prevent skin tears, you need to follow the | care plan |
| You are helping a resident dress. What clothing will help prevent skin tears? ___________ | a soft, fleece sweatshirt and sweatpants |
| A resident is in bed. The person needs re-positioning. What will prevent skin tears? | using an assist device to move a person |
| Keep your fingernails sort and smoothly filed will help prevent | skin tears |
| Vascular ulcers occur | on the legs and feet |
| Itching is common with | venous ulcers |
| The person with venous ulcers has difficulty walking. | True |
| What will help prevent circulatory ulcers? | keeping the linens clean and dry |
| A resident has a venous ulcer. The person needs re-positioning at least every | 2 hours |
| A resident has a venous ulcer. You are helping the person dress. The person can wear what? | a sweatshirt |
| A resident has a venous ulcer. Your care should include keeping the person’s linens | dry and wrinkle free |
| A resident has a venous ulcer. The doctor ordered elastic stockings. What size should you use? | the size directed by the nurse |
| Elastic bandages and elastic stockings do what? | prevent injury |
| Elastic stockings also are called | anti-embolism stockings |
| Elastic stockings are removed every __ hours for ________ minutes. | 8 30 |
| Elastic bandages are applied to the | arms and legs |
| An elastic bandage is applied from the | lower part to the top part |
| A resident has an elastic bandage on the right leg. The bandage is loose and wrinkled. What should you do? | reapply the bandage |
| The nurse asks you to apply an elastic bandage to a resident’s left arm. You should apply the bandage | with firm, even pressure |
| A resident has an elastic bandage. How often should you check the color and temperature in the bandaged part? | every 60 minutes |
| You are applying an elastic bandage to a person’s left leg. Face the person during the procedure. | True |
| A resident has an arterial ulcer. Remind the person not to sit with | their legs crossed |
| A resident has an arterial ulcer. What will promote healing? | having a bed cradle |
| Bleeding stops and a scab forms during the ___________phase of wound healing. | inflammatory |
| A wound was closed with staples. Wound healing will occur through ___________intention. | secondary |
| ___________wound healing involves leaving the wound open and closing it later. | tertiary intention |
| A wound is contaminated and infected. Wound edges are not brought together and the wound gaps. Healing will occur through ___________intention. | secondary |
| Which nutrient is needed for wound healing? | protein |
| When observing a wound, you can | observe the surrounding skin |
| A drain is inserted into a wound. What is its purpose? | drainage leaves the wound through the drain |
| The nurse weighs dressings before and after applying them. Why are they weighed? | to measure the amount of drainage |
| Which is a purpose of wound dressings? | protect the wound, cover the wound |
| ______________________ absorb drainage. | gauze dressings |
| Which dressing will most likely stick to a wound? | dry dressings |
| A dressing is loose. What can happen? | microbes can enter the wound |
| A dressing is secured with tape. When the tape is removed, some skin is removed. This causes a(n) | abrasion |
| Which type of tape allows movement of a body part? | elastic tape |
| You are securing a dressing with tape. Where do you apply the tape? | to the top, middle, and bottom of the dressing |
| The nurse asks you to apply a dry, non-sterile dressing. Remove the old dressing | gently |
| The nurse asks you to apply a dry, non-sterile dressing. The dressing change causes pain and discomfort. What should you do? | ask the nurse when a pain-relief drug was given |
| When changing dressings you need to control your | body language and nonverbal communication |
| The nurse asks you to apply a dry, non-sterile dressing. What should you do after removing the old dressing? | remove your gloves, decontaminate your hands |
| Binders are applied to what areas? | abdomen |
| Pins are used to secure a binder. Pins should point | away from the wound |
| A binder is loose and out of position. What should you do? | re-apply the binder |
| A binder is wet. What should you do? | apply a new binder |
| A person has a wound. You are concerned with the person’s basic needs. A wound can affect breathing and movement. | True |
| A compress is | a soft pad applied over a body area |
| Constrict means to | narrow |
| Dilate means to | expand or open wider |
| Cyanosis is | bluish color |
| Hyperthermia means that the person’s body temperature is | much higher than the normal range |
| Hypothermia means that the person’s body temperature is | very low |
| A pack is a treatment that involves | wrapping a body part with a wet or dry application |
| Warm and cold applications do what? | reduce tissue swelling |
| Warm applications relieve pain. | True |
| Warm applications promote healing. | True |
| When blood vessels dilate, blood flow | increases |
| When blood vessels constrict, blood flow | decreases |
| When heat is applied, the skin is | red and warm |
| When heat is applied too long, blood vessels | constrict |
| When heat is applied too long, blood flow | decreases |
| When heat is applied, older persons are at risk for | burns |
| Heat is applied to a wrist. You need to report excessive redness to | the nurse at once |
| A person has a joint replacement. Heat applications are allowed except | over the implant |
| An aquathermia pad is | a dry warm application |
| In __________________________ applications, water is in contact with the skin. | moist heat |
| Heat and cold applications are applied for ___________minutes. | 15-50 |
| Before applying moist heat or cold applications, ________________ the water temp. | measure |
| Before applying dry heat or cold applications, cover the device. | True |
| Aquathermia pad is an electrical device. | True |
| When applying warm or cold applications, place the call light | within reach |
| When applying an aquathermia pad follow electrical safety precautions. | True |
| An aquathermia pad is set at 105° F. It is a _____ application. | hot |
| The nurse delegates you to apply a warm compress. To maintain its temperature, the nurse might ask you to | apply an aquathermia pad over the compress |
| A sitz bath involves | the perineal and rectal areas |
| A disposable sitz bath fits on | the toilet seat |
| During a sitz bath, you need to carefully observe the person for | weakness and faintness |
| The nurse delegates you to give a sitz bath. What action protects the person from burns? | measuring the water temperature |
| The nurse delegates you to give a sitz bath. How often should you check the person? | every 5 minutes |
| The nurse asks you to apply a commercial hot pack. How should you warm the pack? | follow the manufactures instructions |
| A hot pack is re-usable. Before storing the pack for future use, | clean it following center policy |
| You are going to apply an aquathermia pad. Pins are used to secure the pad. | False |
| The temperature of an aquathermia pad is usually | 105 degrees |
| You are going to apply an aquathermia pad. You fill the heating unit with | distilled water |
| An aquathermia pad is not placed under a body part because | heat cannot escape |
| Before applying an aquathermia pad, you need to | put the pad in a cover |
| When cold is applied to the skin, blood vessels | constrict |
| When cold is applied to the skin, blood flow | decreases |
| A person has a sprained ankle. Cold applications are best applied _______after the injury. | right |
| Cold has what effects? | numbing the skin |
| What can occur from applications that are very cold? | blisters and burns |
| When cold is applied for a long time, blood vessels | dialate |
| Persons with ___________impairment are at risk for complications from cold applications. | sensory |
| Example of moist cold application | cold compress |
| ______________________are filled with crushed ice. | ice collar |
| Before applying a dry cold application, put it in a cover. | True |
| When using a commercial cold pack, follow | manufactures instructions |
| After applying a dry cold application, you need to check the application site every _____ minutes. | 5 |
| You applied a cold compress. How often should you check the application site? | every 5 minutes |
| A cooling blanket is needed. After placing it on the bed, it is covered with a | sheet |
| A warming blanket is needed. After placing it on the bed, it is covered with a | sheet |
| What measurements are needed when a cooling blanket or warming blanket is used? | vital signs |
| A safe, comfortable setting is needed when applying heat or cold. Place the call light within reach to promote the person’s comfort and safety. | True |
| Only the body part involved in the procedure is exposed. This action | protects the right to privacy |
Created by:
heatherhibbs
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