Author Question: Which of the following is an appropriate procedure for the nurse to implement during the application ... (Read 43 times)

BRWH · **on:** Jul 24, 2018

Which of the following is an appropriate procedure for the nurse to implement during the application of an absorption or alginate dressing?

a. Never cut the dressing to fit the wound.
b. Irrigate the wound gently to remove residual gel.
c. Fill the wound cavity entirely with the dressing material.
d. Never use a secondary dressing.

Question 2

When teaching a client how to take his or her own pulse, a nurse should instruct the client to:

A. Press hard over the pulse site
B. Assess the pulse before taking medications
C. Massage the neck to get the carotid pulse
D. Count the rate for 15 seconds and multiply by 4

DylanD1323 · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

B
Cleanse the area gently with moist 4 4 sterile gauze pads, swabbing exudate away from the wound, or spray with a wound cleanser. Cleansing effectively removes any residual dressing gel without injuring newly formed delicate granulation tissue formed in the healing wound bed. With some brands, dressings can be trimmed to fit wound size, whereas other brands of dressings cannot be cut. Fill the wound cavity only one-half to two-thirds full to allow for expansion with absorption. Apply a secondary dressing, such as transparent film, hydrogen, foam, or hydrocolloid.

Answer to Question 2

B
B. Pulse should be measured before and after taking heart medications; before, during, and after exercise.
A. Instruct use of gentle pressure. Reinforce not to press hard over pulse site.
C. If carotid is chosen, caution client against vigorously massaging neck while attempting to locate pulse. Stimulation of carotid sinus could lead to reflex slowing of heart rate from vagal stimulation.
D. Instruct to count for a full 60 seconds, starting with second hand at 12:00 position.