1.

A nurse is assessing pressure ulcers on four clients to evaluate the effectiveness of a change in the wound care procedure. Which of the following findings indicate wound healing.

a. Erythema on the skin surrounding a client's wound

b. Deep red color on the center of the clients wound

c. Inflammation noted on the tissue edges of a client's wound

d. Increase in serosanguineous exudate from the clients wound

2.

A nurse received change of shift report at 0700 for four clients. Which of the following actions should the nurse perform first?

a. Obtain a breakfast tray for a client who received a morning dose of insulin aspart

b. Administer pain medication to a client who has rheumatoid arthritis and received the last dose at 0400

c. Restart an infiltrated IV for a client whose IV antibiotic is scheduled for 0900

d. Replace a client's enteral nutrition feeding solution that has been hanging for 24 hours. (To prevent bacterial contamination, fill the bag with only enough formula to last over a 4-8 hour period, and change the feeding bag every 24 hours)