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CNA 2016 C 30*

Wound Care

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