A nurse in a long-term care facility is caring for a client who had abdominal surgery 6 weeks ago.
Which of the following images indicates the client's wound is healing by primary intention?
The wound has edges that are well-approximated.
The wound shows signs of granulation tissue formation.
The wound has a scab covering the surface.
The wound is oozing serous drainage.
The Correct Answer is A
Choice A rationale
Healing by primary intention occurs when wound edges are approximated, promoting direct tissue regeneration. This process minimizes scarring and involves epithelial cell migration and collagen synthesis.
Choice B rationale
Granulation tissue formation is characteristic of secondary intention healing. In this method, wounds heal from the base upward, requiring granulation tissue to fill the wound bed before epithelialization occurs.
Choice C rationale
Scab formation indicates that healing is in progress but does not specifically represent primary intention. Scabs form during secondary or tertiary healing phases to protect the underlying tissue.
Choice D rationale
Serous drainage is associated with the inflammatory phase of wound healing and does not signify primary intention. Excessive drainage may indicate impaired healing or infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Hepatitis A virus is transmitted through the fecal-oral route via contaminated food or water. The virus replicates in hepatocytes and spreads through feces, causing acute liver inflammation.
Choice B rationale
Hepatitis A is not transmitted in utero from mother to infant. Vertical transmission is associated with other viruses such as hepatitis B or C, but not hepatitis A.
Choice C rationale
Sexual contact is not a typical transmission route for hepatitis A virus. Hepatitis A does not rely on sexual fluids for transmission.
Choice D rationale
Blood transfusion is not a recognized transmission route for hepatitis A. The virus is enteric, favoring gastrointestinal spread rather than bloodborne transmission.
Correct Answer is A
Explanation
Choice A rationale
A high-calorie diet is crucial for clients with AIDS and malnutrition to meet the increased metabolic demands caused by the disease and to compensate for nutrient deficiencies. Proper nutrition supports immune function and aids in maintaining muscle mass and energy levels, which are often compromised in malnourished clients.
Choice B rationale
Encouraging three large meals daily may not be appropriate, as clients with AIDS and malnutrition often experience gastrointestinal discomfort, nausea, or early satiety. Smaller, more frequent meals are typically better tolerated and can improve overall nutritional intake compared to larger meals.
Choice C rationale
Administering an antiemetic after each meal may help reduce nausea and improve food intake in some cases. However, this action should be based on the client's specific needs and symptoms. It is not a universal intervention for malnutrition in clients with AIDS and does not directly address the need for adequate calorie intake.
Choice D rationale
Including seasonings and spices may enhance the flavor of meals and encourage food intake. However, strong spices can sometimes exacerbate gastrointestinal symptoms in clients with AIDS. This action is not as effective or essential as providing a high-calorie diet to address malnutrition.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.