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CHRONIC WOUNDS PRESSURE ULCERS
DIABETIC FOOT ULCERS AND VENOUS STASIS
ULCERS ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT ANSWERS
GRADED A+ 2026
◉Chapter 19 and 30 Answer: ◉What does the ANA code of ethics say is the nurses responsibility? Answer: Nurses are responsible for promoting and protecting health, safety, and rights of patients. ◉The joint commission requires hospitals, who have their accreditation to have standards with their education what six aspects are required? Answer: Literacy, developmental, limitations, physical limitations, financial limitations, language, barriers, culture, religious practices of every patient. ◉The American hospital associations, patient care partnership states information should be, and Answer: Accurate; easy
◉Teaching requires good communication skills. Why? Teachers must Answer: Adequately convey information Assess verbal and nonverbal feedback Accommodate various learning styles ◉KeyPoint. Learning is a. Answer: Change in behavior, knowledge, skills, or attitudes ◉Five rights of teaching Answer: Right time Right context Right goal Right content Right method ◉Why do you think the five rates of teaching are valuable? Answer: A checklist to make sure you are on track. ◉Domains of learning Answer: a) Cognitive - obtaining new information, being able to apply the information, and able to evaluate the information. b) Affective - involves feelings, beliefs and ideals. c) Psychomotor - learning how to complete a physical activity or motor skill
Reinforcement Practice are necessary for retention and so is info made memorable ◉Parts of nervous system Answer: Reception, stimulus, perception, arousal mechanism ◉What are the two most likely sensory deficits? Answer: Impaired vision and hearing ◉Diagnosis for sensory overload Answer: Anxiety related to excess sensory stimulation ◉Interventions for sensory overload Answer: Minimize unnecessary noise ◉Common visual deficits Answer: presbyopia, cataracts, glaucoma, macular degeneration, diabetic retinopathy, astigmatism, detached retina. ◉Common hearing deficits Answer: Presbycusis, tinnitus, impacted cerumen, Otitis media ◉Common olfactory disorder Answer: Hyposmia
◉Who gets a comprehensive assessment? Answer: People who are bedbound or homebound Patients in intensive care units Those with acute or chronic brain injury, limited mobility, deficits ◉.right time - Example: Answer: is the learner ready, free of pain and motivated? ◉Right context - Example: Answer: is the environment quiet, free of distractions, and private? ◉right goal - Example: Answer: is the learner actively involved in planning the learning ◉Right content - Example: Answer: is the content appropriate for the client's needs? ◉Right method - Example: Answer: do the teaching strategies fit the learning style of the learner? ◉Cognitive skills are: Answer: mental activities for processing incoming information.
Learning environment Session Scheduling Amount and complexity of content Teacher/learner communication Special populations Developmental stage Culture Healthy literacy Health Illiteracy Promoting Health Literacy
◉Example of "the amount and complexity of content" Answer: Insulin ◉What is health literacy? Answer: The degree to which an individual has the capacity to obtain, communicate, process, and understand basic health info and services to make appropriate health decisions. ◉ 9 - 10 adults struggle with Answer: Health literacy ◉Promoting Health Literacy Answer: 1. Ask questions that involve: how and what
- Assist patients in: completing forms
- Organize: information
- Present information in: 3 to 5 chunks
- Use: headings
- For those with low health litercy, provide printed: materials with words of 3 or fewer syllables
- Speak: using simple words, short sentences
- poor learner motivation ◉What two strategies might you use with a learner functioning with low cognitive ability? Answer: Talk slow Have patience ◉Effective client teaching begins with: assessment of learning Answer: Needs ◉When should you use the diagnosis "deficit knowledge" as the primary problem? Answer: Only if you believe that poor understanding or incorrect info is the primary problem Or needs new additional knowledge ◉Example^^ Answer: Related to lack of prior experience, as manifested by anxiety and many questions about foot care. ◉What is a learning contract? Answer: Usually informal is a statement of understanding between teacher and learning about how to achieve neutrally, set teaching and behavioral goals
◉Process of creating a teaching plan differs from that of creating a nursing care plan and two keyways Answer: In a teaching plan, the interventions are actually teaching strategies When planning teaching, you will plan content sequencing in the types of instructional materials to be used. ◉What content should your teaching include? Answer: Information the learner must understand to reach the desired goal, facts soil, or emotions. ◉How is the timing of teaching scheduled? Answer: Based on clients and teacher needs ◉What question can you ask to help keep conversation open? Answer: What questions do you have? Do you understand? ◉Two common ways for nurses to teach patients Answer: Demonstration and return demonstration One-to-one instruction and mentoring ◉Patient education materials should not exceeded Answer: 6th grade reading level
patients with vision, speech, hearing language and cognitive impairments ◉What is the purpose of sensation? Answer: To allow the body to respond to changing situations and maintain homeostasis ◉Parts of nervous system Answer: ◉Stimulus is Answer: Anything that stimulates a nerve receptor ◉Reception Answer: Process of receiving stimuli from nerve endings in the skin and inside body ◉Example of sensory receptors Answer: Mechanoreceptors Hair cells thermoreceptors proprioreceptors photoreceptors chemoreceptors ◉Perception Answer: Ability to interpret the impulses, transmitted from the receptors, and give meaning to the stimuli ◉Arousal mechanism Answer: For central nervous system to perceive, interpret and react to incoming stimuli, must be active
◉What does the brain do once a stimulus is perceived Answer: The neurons of RAS make connections among spinal cord, cerebellum, thalamus, and cerebral cortex. ◉The response to the stimulus is based upon what factors Answer: Intensity, contrast, adaptation, previous experience, developmental, variations, culture, illness, medication's, stress, personality, and lifestyle ◉By early adulthood, since this are at their unless they are affected by illness or injury Answer: Peak ◉What can affect brain cells? Answer: Aspirin CNS depressants, furosemide's ◉What are stresses that can lead to sensory overload? Answer: Physical illness, pain, hospitalization, test, and surgery ◉Why would a person have sensory deprivation? Answer: When there is a disruption or dysfunction with the nervous system ◉Who is more common to have this issue? Answer: Hospitalized, patients, elderly, ill or injured people ◉Why would sensory overload occur Answer: Stimuli such as pain unfamiliar sites sounds in odors, overwhelm senses
Open blinds during the day, except when patient is sleeping ◉When should you teach a patient with sensory deprivation? Answer: When they are able to concentrate ◉Example of sensory overload Answer: ◉Definition of sensory overload Answer: Environmental stimuli exceeded the ability of one or more of the body senses to process and adapt, especially when stimuli are persistent, and non-meaningful ◉Assessments for sensory overload Answer: Irritability, anxiety, restlessness, confusion Reduced attention span Decreased problem-solving skills ◉Analysis of sensory overload Answer: Acute confusion non-adherence to treatments ◉Outcomes for sensory overload Answer: Effectively copes with excessive environmental stimuli Reports adequate sleep and rest
Identifies correct season ◉Interventions for sensory overload Answer: Minimize unnecessary noise, reduce noise levels, especially at night speak using a calm, confident voice ◉Teaching for sensory overload Answer: Avoid screen time for one hour before sleep ◉Common visual deficit Answer: ◉Myopia Answer: Sees close ◉Presbyopia Answer: Can't see well up close ◉astigmatism Answer: Curvature of the cornea or lens scatter light rays blurs ◉Cataracts Answer: Lens change becomes clouding of the lens, blurred vision ◉Glaucoma Answer: Increases in pressure changes shape of cornea results in loss of peripheral vision or blindness
◉Otis media Answer: Middle ear infection, common and childhood illness caused by viruses or bacteria ◉Common all factory disorder Answer: Hyposmia ◉In hyposmia Answer: Reduced ability to smell and detect odor ◉Phantom sensation Answer: Hypersensitivite nerve conduction involving agitated nerve endings that conduct sensation for a limb that is not there ◉Hyperkinetic Answer: Often with repetitive and voluntary motor activity example dystonia trimmers, tardive dyskinesia, restless, leg, movement, tics cramps spasms ◉What do you think a person with impaired tactile perception might be at increased risk for injury Answer: Can burn themselves and not know ◉Overall Sensory-Perceptual Assessment Answer: ◉During the Nursing interview, what do you assess? Answer: Usual sensory function, risk factors for impaired sensory mental status, level of consciousness, support work environment
◉What do you assess with sensory function? Answer: Obtain a history of the clients, usual sensory function as well as information about the clients current status ◉Include in your assessment the clients use of Answer: Sensory aids devices that assist with sensory function ◉Sensory aids include Answer: Glasses, contact lenses, hearing aids, canes, and walkers ◉What are you check with assessing mental status? Answer: Assessment of behavior appearance response to stimuli, speech, memory, and judgment ◉Normal findings after assessing mental status include Answer: Ability to express and explain realistic thoughts with clear speech, follow directions listen answer questions, and recall significant past events ◉Level of consciousness includes arousal from Answer: Alert to deeply comatose time place person situation in orientation ◉Why would you assess a patient support network? Answer: For client with sensory deficit or overload
