A nurse is making initial rounds on patients. Which intervention for a patient with poor wound healing should the nurse perform first?
A) Reinforce the wound dressing as needed with 4 * 4 gauze.
B) Perform the ordered dressing change twice daily.
C) Observe wound appearance and edges.
D) Document wound characteristics.

Question

Quizplus · Accepted Answer

The most appropriate initial intervention is to assess the wound (observe wound appearance and edges). The nurse must assess the wound first before the findings can be documented, reinforcement of the dressing, and the actual skill of dressing changes.

A Nurse Is Making Initial Rounds on Patients