A nurse is caring for a client who has a Jackson-Pratt drain in place after surgery for an open reduction and internal fixation. The nurse should understand that the JP drain was placed for which of the following purposes?

To eliminate the need for wound irrigations.

To limit the amount of bleeding from the surgical site.

To prevent fluid from accumulating in the wound.

To provide a means for medication administration.

Answer and Explanation

The Correct Answer is C

Choice A reason:

The purpose of a Jackson-Pratt (JP) drain is not to eliminate the need for wound irrigations. Wound irrigation is a critical step in wound care that helps remove debris, reduce bacterial load, and create an optimal environment for healing. The JP drain helps manage fluid accumulation but does not replace the need for proper wound irrigation.

Choice B reason:

While a JP drain can help manage bleeding by providing a pathway for blood to exit the wound, its primary purpose is not to limit bleeding. Instead, it is designed to prevent the accumulation of fluids such as blood, serous fluid, and other exudates that can impede healing and increase the risk of infection. Managing bleeding typically involves other interventions such as surgical hemostasis techniques.

Choice C reason:

The primary purpose of a Jackson-Pratt drain is to prevent fluid from accumulating in the wound. After surgery, wounds can produce various fluids, including blood and lymphatic fluid. Accumulation of these fluids can delay healing and increase the risk of infection. The JP drain uses gentle suction to draw these fluids away from the wound site, promoting faster healing and reducing the risk of complications.

Choice D reason:

A JP drain is not typically used to provide a means for medication administration. Medications are usually administered through other routes such as oral, intravenous, or through specialized catheters designed for medication delivery. The JP drain is specifically designed for fluid drainage and not for delivering medications.

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Correct Answer is A

Explanation

Choice A reason:

The statement “Muffled heart sounds” is a classic sign of cardiac tamponade. This condition occurs when fluid accumulates in the pericardium (the sac around the heart), compressing the heart and preventing it from functioning properly. Muffled heart sounds are due to the fluid dampening the sound of the heartbeats. This is part of Beck’s triad, which also includes hypotension and jugular venous distension.

Choice B reason:

The statement “Sudden lethargy” is not a specific indicator of cardiac tamponade. While lethargy can occur due to decreased cardiac output and poor perfusion, it is not a definitive sign of cardiac tamponade. Lethargy can be caused by various conditions and is not specific enough to support the suspicion of cardiac tamponade.

Choice C reason:

The statement “Flattened neck veins” is incorrect. In cardiac tamponade, one would expect to see distended (bulging) neck veins due to increased central venous pressure. Flattened neck veins are not consistent with the hemodynamic changes seen in cardiac tamponade.

Choice D reason:

The statement “Bradycardia” is not typically associated with cardiac tamponade. Instead, tachycardia (an increased heart rate) is more commonly seen as the body attempts to compensate for decreased cardiac output. Bradycardia can occur in severe cases or as a pre-terminal event, but it is not a primary indicator of cardiac tamponade.

A. Raw celery B. Grapes C. Peanut butter D. Sliced bananas

Correct Answer is D

Explanation

Choice A reason: Raw celery is not recommended for toddlers as it can be a choking hazard due to its stringy texture and difficulty in chewing. Toddlers have smaller airways and less developed chewing skills, making raw celery a risky snack option.

Choice B reason: Grapes can also be a choking hazard for toddlers if not prepared properly. Whole grapes are the perfect size to block a toddler’s airway. If grapes are to be given, they should be cut into small, manageable pieces to reduce the risk of choking.

Choice C reason: Peanut butter is a nutritious option but should be given with caution. It can be sticky and difficult for toddlers to swallow, posing a choking risk. It is best to spread peanut butter thinly on bread or mix it with other foods to make it easier to consume.

Choice D reason: Sliced bananas are an excellent snack for toddlers. They are soft, easy to chew, and unlikely to cause choking. Bananas are also rich in essential nutrients like potassium and vitamins, making them a healthy choice.

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A nurse is caring for a client who has a Jackson-Pratt drain in place after surgery for an open reduction and internal fixation. The nurse should understand that the JP drain was placed for which of the following purposes?

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