the nurse assesses a wound with exudate what should not be included when documenting the exudate
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Nursing Elites

ATI RN

Multi Dimensional Care | Exam | Rasmusson

1. The nurse assesses a wound with exudate. What should not be included when documenting the exudate?

Correct answer: C

Rationale:

2. A nurse is admitting a client who has tuberculosis. What transmission-based precautions should the nurse initiate?

Correct answer: C

Rationale:

3. A client has sustained an open fracture. What nursing intervention will best prevent osteomyelitis in this client?

Correct answer: C

Rationale: Proper hand hygiene is crucial in preventing infections such as osteomyelitis in clients with open fractures. Keeping the hands clean helps reduce the risk of introducing harmful pathogens to the wound site. Delegating all client personal care to specific unlicensed assistive personnel (Choice A) is not appropriate as direct involvement in wound care is essential in preventing infections. Placing the client in contact precautions (Choice B) is not directly related to preventing osteomyelitis in this context. Administering pain medication (Choice D) is important for managing the client's pain but does not directly address the prevention of osteomyelitis.

4. Dry skin (Xerosis) can lead to itching (Pruritis). What statement by the client indicates need for further teaching about preventing dry skin?

Correct answer: B

Rationale:

5. A client with systemic lupus erythematous complains of flank pain. Which laboratory test does the nurse anticipate will be ordered?

Correct answer: C

Rationale:

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