A nurse is caring for a client whose hysterectomy wound has eviscerated. Which of the following actions should the nurse take?

Turn the client onto her side.

Cover the wound with a moist sterile dressing

Apply an abdominal binder to the wound area.

Assure the client that this is an expected occurrence after surgery.

Answer and Explanation

The Correct Answer is B

A. Turning the client onto her side could worsen the situation by increasing pressure on the abdominal area and potentially further damaging the eviscerated tissue. The priority is to manage the wound.
B. The correct intervention is to cover the wound with a moist sterile dressing to prevent further contamination and to protect the exposed organs. The nurse should also notify the surgical team immediately.
C. Applying an abdominal binder could put pressure on the wound and exacerbate the evisceration. It is not appropriate for the immediate care of an eviscerated wound.
D. Evisceration is a medical emergency and should never be considered an expected occurrence. The nurse should provide reassurance, but the primary focus should be on immediate wound care and notifying the healthcare team.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is D

Explanation

A. Orange juice is high in potassium, and therefore it should be avoided on a low potassium diet. Apple juice typically has a lower potassium content, so it is a better choice.
B. Molasses is high in potassium and should be avoided on a low potassium diet. Replacing sugar with molasses would increase the potassium intake, which could be harmful for someone on a low potassium diet.
C. Granola can be high in potassium if it contains nuts, dried fruits, or other potassium-rich ingredients. It may not be suitable for a low potassium diet.
D. Salt substitutes often contain potassium chloride as a replacement for sodium chloride. This can increase potassium levels, so the nurse should instruct the client to avoid using salt substitutes to maintain proper potassium balance.

A. Fruity breath odor B. Dry mucous membranes C. Diaphoresis D. Polyuria

Correct Answer is C

Explanation

A. Fruity breath odor is more commonly associated with hyperglycemia and diabetic ketoacidosis, not hypoglycemia. Hypoglycemia usually presents with symptoms like shakiness, confusion, and sweating.
B. Dry mucous membranes are typically associated with dehydration, which is more common in hyperglycemia, not hypoglycemia.
C. Diaphoresis (excessive sweating) is a classic manifestation of hypoglycemia, as the body responds to low blood sugar by activating the sympathetic nervous system.
D. Polyuria (increased urination) is a symptom of hyperglycemia, not hypoglycemia. It occurs when the blood glucose levels are high and the kidneys try to excrete excess glucose.

View Question and Answer

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

A nurse is caring for a client whose hysterectomy wound has eviscerated. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with teaching a client who is on a low potassium diet. Which of the following instructions should the nurse include?

Correct Answer is D

Explanation

A nurse is teaching the parents of a child who has diabetes mellitus about the manifestations of hypoglycemia. Which of the following manifestations should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is caring for a client who has capillary blood glucose 48 mg/dL. Which of the following findings should the nurse expect?

A nurse is preparing for a client who is at risk for a pressure injury. Which of the following actions should the nurse take?

A charge nurse observes a nurse administer intermittent tube feedings via an NG tube to a client. Which of the following actions should prompt the charge nurse to intervene?

A nurse is caring for a client who has a large surgical wound healing by secondary intention. The nurse should recommend a diet high in protein and which of the following nutrients?

A nurse is caring for a client who has gestational diabetes and reports feeling shaky, sweaty, and having blurred vision. The client's blood glucose level is 48 mg/dL. Which of the following foods should the nurse give to the client? (Select all that apply).

A nurse is caring for a client who receives intermittent enteral feedings through an NG tube. Before administering a feeding, the nurse should measure the gastric residual for which of the following purposes?

A nurse is caring for a client who frequently attempts to remove his feeding tube. A family member requests that a restraint be applied. Which of the following statements by the nurse is appropriate?