Correct answer: D) Reposition the client to relieve pressure on the wound.

Rationale: The nurse should follow the ABCDE priority-setting framework when caring for a client with a pressure ulcer. The first priority is to address airway, breathing, and circulation (ABC) issues, which include relieving pressure on the wound to prevent further tissue damage and promote blood flow to the area. The other interventions are also important, but they are not the first priority.

Incorrect options:

A) Apply a hydrocolloid dressing to the wound. - This is an appropriate intervention, as hydrocolloid dressings provide a moist environment that promotes wound healing and prevents bacterial contamination. However, this is not the first priority, as it does not address ABC issues.

B) Assess the wound for signs of infection. - This is an appropriate intervention, as assessing the wound for signs of infection, such as redness, swelling, warmth, drainage, odor, or increased pain, is essential to monitor the wound healing process and identify any complications. However, this is not the first priority, as it does not address ABC issues.

C) Cleanse the wound with normal saline solution. - This is an appropriate intervention, as cleansing the wound with normal saline solution helps to remove debris and bacteria from the wound and prevent infection. However, this is not the first priority, as it does not address ABC issues.

Correct answer: D) Consult with the provider about surgical debridement.

Rationale: The nurse should consult with the provider about surgical debridement for a wound that has a black, dry, and hard eschar covering most of its surface. This type of eschar indicates necrotic tissue that impairs wound healing and increases the risk of infection. Surgical debridement is the most effective method of removing large amounts of necrotic tissue from a wound.

Incorrect options:

A) Debride the wound using wet-to-dry dressings. - This is not an appropriate intervention, as wet-to-dry dressings are not recommended for wounds with dry eschar, as they can cause trauma and bleeding to healthy tissue. Wet-to-dry dressings are used for wounds with moist necrotic tissue or slough that needs to be removed.

B) Cover the wound with a transparent film dressing. - This is not an appropriate intervention, as transparent film dressings are not indicated for wounds with necrotic tissue or infection. Transparent film dressings are used for wounds with minimal drainage that need protection from external contamination and moisture loss.

C) Leave the wound open to air without any dressing. - This is not an appropriate intervention, as leaving the wound open to air without any dressing can expose it to further trauma and infection. Wounds need to be covered with an appropriate dressing that maintains a moist environment and supports wound healing.

Correct answer: D) Hydrogel dressing

Rationale: The nurse should use a hydrogel dressing to promote autolytic debridement of the wound. Autolytic debridement is a natural process that uses the body's own enzymes and moisture to liquefy and remove necrotic tissue from a wound. Hydrogel dressings provide hydration and moisture to dry wounds and facilitate autolytic debridement.

Incorrect options:

A) Alginate dressing - This is not an appropriate dressing for autolytic debridement, as alginate dressings are used for wounds with moderate to heavy exudate that need absorption and hemostasis. Alginate dressings form a gel-like substance when in contact with wound fluid and help to maintain a moist environment for wound healing.

B) Foam dressing - This is not an appropriate dressing for autolytic debridement, as foam dressings are used for wounds with moderate to heavy exudate that need insulation and protection. Foam dressings have a soft and absorbent layer that cushions the wound and prevents maceration of the surrounding skin.

C) Gauze dressing - This is not an appropriate dressing for autolytic debridement, as gauze dressings are used for wounds with minimal to moderate exudate that need cleansing and packing. Gauze dressings can adhere to the wound surface and cause trauma and bleeding when removed.

Correct answer: C) Discontinue the NPWT and apply a moist dressing.

Rationale: The nurse should discontinue the NPWT and apply a moist dressing when the wound edges are approximated and granulation tissue is filling the wound bed. This indicates that the wound is healing well and does not need further NPWT. NPWT is a type of advanced wound therapy that uses a vacuum device to apply negative pressure to a wound, which helps to remove excess fluid, reduce edema, increase blood flow, and stimulate granulation tissue formation. NPWT should be discontinued when the wound has achieved sufficient granulation tissue or epithelialization, or when there are signs of infection or bleeding.

Incorrect options:

A) Increase the frequency of dressing changes. - This is not an appropriate action, as increasing the frequency of dressing changes can disrupt the wound healing process and cause trauma and pain to the client. Dressing changes for NPWT are usually done every 48 to 72 hours, depending on the type of dressing and the amount of drainage.

B) Decrease the amount of negative pressure applied. - This is not an appropriate action, as decreasing the amount of negative pressure applied can reduce the effectiveness of NPWT and delay wound healing. The amount of negative pressure applied should be determined by the provider based on the type and location of the wound, the amount of drainage, and the client's tolerance.

D) Continue the NPWT until the wound is completely closed. - This is not an appropriate action, as continuing the NPWT until the wound is completely closed can cause overgranulation or maceration of the wound and surrounding skin. NPWT should be discontinued when the wound has achieved sufficient granulation tissue or epithelialization, or when there are signs of infection or bleeding.