A nurse is caring for a group of clients on a surgical unit. Which of the following images should the nurse identify as evisceration?

A
B
The Correct Answer is B
A. The first image depicts a finger injury with partial nail and tissue trauma, which represents a localized hand wound but does not involve internal organs. This is not evisceration.
B. The second image shows abdominal organs protruding through a surgical incision, which is the defining feature of evisceration. Evisceration is a surgical emergency requiring immediate intervention to protect the exposed organs and prevent infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Reduce intake of whole grains: Whole grains contain fiber, antioxidants, and phytonutrients that help lower cancer risk by supporting healthy digestion and reducing inflammation. Limiting them removes protective nutrients that assist in regulating cell growth. Reduced whole-grain intake is not recommended in cancer-prevention guidelines.
B. Increase intake of saturated fats: Saturated fats are associated with inflammation, obesity, and cardiovascular strain, all of which can raise overall cancer risk. Higher intake contributes to hormone-related cancers and metabolic stress. Dietary guidelines consistently encourage limiting, not increasing, saturated fats.
C. Reduce intake of legumes: Legumes supply fiber, plant protein, and micronutrients that support colon health and reduce carcinogenic processes in the bowel. They help stabilize blood glucose and decrease inflammatory responses. Reducing them removes valuable cancer-protective dietary components.
D. Increase intake of fatty fish: Fatty fish contain omega-3 fatty acids that reduce inflammation, support cellular health, and may inhibit tumor growth. Regular intake is associated with lower risk of several cancers, including colorectal and breast cancer. Including fatty fish aligns with major cancer-prevention nutritional guidelines.
Correct Answer is A
Explanation
A. Diarrhea: Cephalexin, like other antibiotics, can disrupt normal gut flora and lead to antibiotic-associated diarrhea. Severe or persistent diarrhea may indicate a more serious condition, such as Clostridioides difficile infection, which requires prompt medical evaluation. Monitoring and reporting this symptom is important for preventing complications.
B. Insomnia: Insomnia is not a common adverse effect of cephalexin. While some medications can cause sleep disturbances, cephalexin’s side-effect profile primarily involves gastrointestinal and hypersensitivity reactions rather than central nervous system effects.
C. Vertigo: Vertigo is not typically associated with cephalexin therapy. Neurological symptoms are rare and usually linked to other drug classes or preexisting conditions. Persistent dizziness would require evaluation, but it is not expected with standard cephalexin use.
D. Hypotension: Cephalexin does not normally cause hypotension. Blood pressure changes are uncommon unless a severe allergic reaction occurs, which would present with multiple systemic symptoms, such as rash, swelling, or difficulty breathing.
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