The nurse should plan to use a wet-to-dry dressing for which ...

[aabwk4]

The nurse should plan to use a wet-to-dry dressing for which patient?
 
  a. A patient who has a pressure ulcer with pink granulation tissue
  b. A patient who has a surgical incision with pink, approximated edges
  c. A patient who has a full-thickness burn filled with dry, black material
  d. A patient who has a wound with purulent drainage and dry brown areas

Question 2

A patient with a systemic bacterial infection feels cold and has a shaking chill. Which assessment finding will the nurse expect next?
 
  a. Skin flushing
  b. Muscle cramps
  c. Rising body temperature
  d. Decreasing blood pressure

[mariahkathleeen]

Answer to Question 1

ANS: D
Wet-to-dry dressings are used when there is minimal eschar to be removed. A full-thickness wound filled with eschar will require interventions such as surgical debridement to remove the necrotic tissue. Wet-to-dry dressings are not needed on approximated surgical incisions. Wet-to-dry dressings are not used on uninfected granulating wounds because of the damage to the granulation tissue.

Answer to Question 2

ANS: C
The patient's complaints of feeling cold and shivering indicate that the hypothalamic set point for temperature has been increased and the temperature is increasing. Because associated peripheral vasoconstriction and sympathetic nervous system stimulation will occur, skin flushing and hypotension are not expected. Muscle cramps are not expected with chills and shivering or with a rising temperature.