AMSN Wound Care and Skin Integrity 2

Question 1

A postoperative patient's abdominal wound has separated with the bowel protruding through the incision. The nurse's immediate action is:

Accepted Answer

Cover the wound with moist sterile saline gauze, keep the patient supine with knees flexed, and call the provider STAT

Answer

Evisceration requires covering exposed bowel with moist sterile saline gauze to prevent drying, keeping the patient still, and calling the surgical team for emergency closure.

Question 2

A patient with a venous stasis ulcer on the lower leg is prescribed compression therapy. The nurse should apply compression wraps:

Accepted Answer

After assessing for arterial insufficiency — do not apply if ABIs are below 0.5

Answer

Compression is contraindicated in severe arterial disease (ABI <0.5); assessing ankle-brachial index (ABI) before applying compression prevents dangerous ischemia.

Question 3

A patient has a wound with red, moist, granulating tissue filling the wound bed. The nurse correctly identifies this as:

Accepted Answer

Healthy granulation tissue indicating the wound is healing

Answer

Bright red, moist, granulating tissue is healthy new tissue forming during the proliferative phase of wound healing.

Question 4

Which Braden Scale score indicates the HIGHEST risk for pressure injury development?

Accepted Answer

6

Answer

The Braden Scale scores from 6 (lowest possible) to 23 (no risk); a score of 6 indicates the most severe risk for pressure injury across all subscales.

Question 5

A nurse is debriding a wound using wet-to-dry dressing changes. The nurse understands this method works by:

Accepted Answer

Mechanically removing necrotic tissue as the gauze dries and adheres to the wound

Answer

Wet-to-dry debridement works mechanically — the moist gauze dries and adheres to necrotic tissue, which is removed when the dressing is changed.

AMSN - Academy of Medical-Surgical Nurses Practice Test

AMSN - Academy of Medical-Surgical Nurses Practice Test

AMSN Wound Care and Skin Integrity 2