A new nurse reads a client has a wound "healing by second intention" and asks what that means.
Which description by the charge nurse is most accurate?
"The wound edges have been approximated and stitched together.”.
"The wound was stapled together after an infection was cleared up.”.
"The wound is an open cavity that will fill in with granulation tissue.”.
"The wound was contaminated by debris and cannot be closed at all.”.
The Correct Answer is C
Choice A rationale
Healing by primary intention, also known as primary union, occurs when a wound has clean edges that are approximated and sutured, stapled, or glued together. This process minimizes tissue loss and results in a fine scar. The wound's integrity is re-established with minimal granulation tissue formation.
Choice B rationale
This describes a form of delayed primary closure or tertiary intention healing. The wound is initially left open to allow for drainage and to clear infection. Once the wound is considered clean and free of infection, the edges are then approximated and closed, often with staples, to promote healing.
Choice C rationale
Healing by secondary intention, or secondary union, occurs in large, open wounds with significant tissue loss and non-approximated edges. The wound heals from the base up. This process involves the formation of new connective tissue and capillaries, called granulation tissue, to fill the defect before epithelialization can occur.
Choice D rationale
While contaminated wounds can heal by secondary intention, this description is not a complete definition. Secondary intention healing is a specific biological process involving granulation tissue, not just a description of a wound that is open due to contamination or debris. The defining characteristic is the formation of granulation tissue.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["300"]
Explanation
Step 1 is 300 mL ÷ 60 minutes = 5 mL/min.
Step 2 is 5 mL/min × 60 min/hr = 300 mL/hr. The final answer is 300 mL/hr.
Correct Answer is C
Explanation
Choice A rationale
While occlusive agents like Vaseline can smother lice, this method is messy and generally not as effective as targeted pediculicides. It mainly suffocates the live lice but does not consistently eliminate the nits (eggs), which are tightly attached to the hair shaft and must be removed to prevent reinfestation.
Choice B rationale
A soda-vinegar solution has no proven efficacy in eradicating lice. The acetic acid in vinegar can help loosen the glue-like substance that attaches nits to the hair shaft, but it is not a standalone treatment. Baking soda does not have any scientific basis for being effective against pediculosis.
Choice C rationale
A vinegar-water solution, specifically the acetic acid in vinegar, helps to dissolve the proteinaceous cement substance that glues nits to the hair shaft. This makes the nits easier to remove with a fine-toothed nit comb, which is a crucial step in the eradication process to prevent the hatching of new lice.
Choice D rationale
Dish detergents are not formulated to be effective against lice and can be harsh on the scalp, causing irritation. They lack the specific neurotoxic agents or suffocation properties found in approved pediculicide shampoos that are designed to kill lice and their eggs. This method is ineffective and potentially harmful. .
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