Ch. 8 - Skin Integrity and Wound Care

The nurse is collecting a wound culture from a client's puncture wound. What is the nurse's first step in the procedure?

1. Clean the wound Rationale: Cleaning the wound before obtaining culture ensures that there is no excess debris and drainage that could contaminate the specimen.

A nurse is collecting a wound culture from a client from two different sites. Which actions should the nurse take while performing this procedure? Select all that apply.

1. Insert swab into wound. 2. Press and rotate swab multiple times over the wound. 3. Place swab in culture tube when finished.

The nurse is obtaining a wound culture and has removed the old dressing and discarded it, performed hand hygiene and applied fresh gloves. What should the nurse do next?

Cleanse the wound with a non antimicrobial cleanser. Rationale: Assessing for drainage color, consistency, odor, etc. should have been done as the nurse was removing the old dressing.

The nurse is caring for a client with an abdominal wound and prescriptions from the health care provider. Which prescription will the nurse initiate first?

Obtain a sterile wound culture. Rationale: If a culture and an antibiotic are ordered at the same time, ensure you get the culture first so that the antibiotic doesn't affect the specimen.

The nurse is collecting a wound culture and has removed the current dressing and discarded it. What should the nurse do next?

Perform hand hygiene and put on clean gloves.

When collecting a culture from a client's wound, according to evidence-based practice, which type of motion will the nurse use when applying the swab to the wound tissue to obtain the most accurate results?

Rolling motion