Exam (elaborations)
2024 NUR 336 FINAL EXAM WITH CORRECT ANSWERS
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2024 NUR 336 FINAL EXAM WITH CORRECT ANSWERS
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2024 NUR 336 FINAL EXAM WITHCORRECT ANSWERS
INJECTIONS (8 questions) - CORRECT-ANSWERS8 questions
medication safety in giving injections - CORRECT-ANSWERS6 rights
care of surgical incision: wet to dry - CORRECT-ANSWERS10. Remove old
dressing using sterile Q-tips to remove packing from inside the wound and
inspect wound and drainage on dressing
13. Remove and dispose of gloves and dressing
14. Wash hands
15. Prepare sterile dressing supplies and open packages
16. "Lip" bottle of sterile saline, if previously opened, by pouring a small
amount into the garbage.
17. Pour sterile normal saline into basin or gauze tray
18. Don sterile gloves
19. Wring woven mesh gauze until damp, unfold and apply as a single layer
directly on the wound. Loosely pack wound assuring the packing fills all
wound dead space without contaminating dressing or gloves by touching
surrounding skin during the packing process. Can use Q-tips as needed.
20. Apply external dressing to wound and secure with tape or other
appropriate fixative. Remove gloves
complications of wound healing - CORRECT-ANSWERSinadequate scar
formation - leading to wound dehiscence
excessive scar formation - either hypertrophic or 'keloid' scarring
contracture formation - an exaggeration of normal wound edge contraction
forming deformities (particularly after burn injuries)
wound drainage - CORRECT-ANSWERSserous: clear
serosanguineous: clear/bloody
sanguineous: red/bloody
purulent: yellow/pus
OSTOMY (5 questions) - CORRECT-ANSWERS5 questions
assessment of ostomy - CORRECT-ANSWERS1) Perform assessments of:
abdomen; check existing pouch for leaks, surrounding skin for irritation, and
last placement date of pouch.
2) Place patient in position supine, semi- fowlers or seated on/ or near toilet
, 3) Put on clean gloves, and place a disposable water proof barrier or towel
under patient.
4) Gently remove the existing pouch and skin barrier by pushing the skin
away from the barrier. If needed, use a warm washcloth or adhesive
remover. Then dispose of the old pouch.
5) Now assess the size, shape, type, and color of the stoma. Also note the
amount and consistency of effluent; check for leakage and skin irritation.
care of ostomy - CORRECT-ANSWERS6) Next, gently clean the patient's
peristomal skin, using warm tap water and gauze pads or a clean washcloth.
Do not scrub their skin. Afterward, dry it completely by patting with gauze
pads or a towel.
7) Measure the stoma to determine the correct size pouching system to use.
If the surrounding skin is irritated, apply ostomy powder or ordered
treatment to treat the skin.
8) Remove your gloves; perform hand hygiene
9) Now put on gloves again. If the patient has creases near his stoma, fill
them with Stomahesive barrier paste, use wet gauze to spread paste if
needed, and let the area dry for 1 to 2 minutes.
11) With any type of pouching system, add a small amount of ostomy
deodorant to the pouch, if desired.
12) If the patient desires, apply an ostomy belt. To make sure it's not too
tight, slip two fingers between the belt and their skin. Your fingers should fit
comfortably.
13) If your patient has a drainable open-ended pouch, fold its bottom up
once and close it with a clamp or as instructed by the manufacturer.
types of stools - CORRECT-ANSWERSType 1: Separate hard lumps, like nuts
(hard to pass)
Type 2: Sausage-shaped, but lumpy
Type 3: Like a sausage but with cracks on its surface
Type 4: Like a sausage or snake, smooth and soft
Type 5: Soft blobs with clear cut edges (passed easily)
Type 6: Fluffy pieces with ragged edges, a mushy stool
Type 7: Watery, no solid pieces, entirely liquid
Types 1-2: indicate constipation
Types 3-5: considered to be ideal (especially 4), normal poops
Type 6-7: considered abnormal and indicate diarrhea
NG (4 questions) - CORRECT-ANSWERS4 questions
skin breakdown sites - CORRECT-ANSWERSPrevent skin irritation and
breakdown at the nares by appropriately taping the tube and providing
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