A nurse is caring for a client who had abdominal surgery 3 days ago.
Exhibits
Select words from the choices below to fill in each blank in the following
sentence.
The client is at risk for developing Target 1 dropdown Target 2 dropdown and ___Target 3 dropdown .
The Correct Answer is {"dropdown-group-1":"E","dropdown-group-2":"E","dropdown-group-3":"B"}
Wound infection: The presence of purulent drainage and redness at the incision site indicates a risk for infection, especially given the client's surgical history and risk factors (obesity, diabetes).
Dehiscence: The noted separation of the top edges of the incision and stretched upper staples increases the risk of dehiscence, which can occur due to tension, infection, or inadequate healing.
Pneumonia: The client is febrile, has crackles upon auscultation, and may be at risk for pneumonia due to decreased mobility and shallow breathing, which can occur post-surgery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Pressure points are critical to assess when evaluating skin integrity, particularly in patients who are immobile or bedridden, as these areas are at high risk for pressure ulcers.
B. Breath sounds are important but are not the priority in assessing skin integrity.
C. Pulse points assess circulation, but they are not directly related to skin integrity.
D. Bowel sounds are relevant for digestive assessments, not for skin integrity.
Correct Answer is D
Explanation
A. Telling the patient to close their eyes may not alleviate their anxiety and does not provide comfort or education.
B. Asking the family to leave could increase the patient's anxiety, especially if the family provides emotional support.
C. Turning on the television may distract the patient, but it doesn't address their anxiety.
D. Explaining the procedure helps reduce anxiety by informing the patient about what to expect, which promotes trust and understanding.
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