A nurse is caring for an older adult who is alert and competent and comes to the facility with her adult son for elective cataract extraction. After the provider explains the procedure, who should the nurse have sign the consent form?

The correct answer is Choice A

Choice A rationale: Placing the patient in a supine position with knees flexed reduces tension on the abdominal wall and minimizes strain on the surgical site. This position promotes relaxation of the rectus muscles and decreases intra-abdominal pressure, which helps prevent further wound separation and evisceration. It also facilitates optimal circulation and allows for rapid assessment and intervention. Scientifically, this positioning is a first-line response to wound dehiscence and aligns with evidence-based emergency protocols.

Choice B rationale: Covering the wound with a clean towel does not meet sterile technique standards required for exposed internal tissues. In cases of dehiscence, especially with evisceration, sterile saline-soaked gauze is necessary to maintain tissue moisture and prevent infection. A clean towel may introduce contaminants and lacks the moisture-retaining properties needed to protect exposed organs. This action fails to meet scientific wound care principles and may compromise patient safety and healing.

Choice C rationale: Applying an abdominal binder to a dehisced wound can exert pressure on the compromised tissue and exacerbate separation. Binders are used prophylactically or postoperatively for support, not in acute dehiscence. Compression over an open or unstable wound risks ischemia, tissue damage, and impaired healing. Scientifically, this intervention is contraindicated during active wound separation and does not align with emergency wound management protocols.

Choice D rationale: Offering a drink of water is inappropriate during an acute surgical complication like wound dehiscence. Oral intake may be contraindicated due to potential need for surgical intervention or anesthesia. Additionally, hydration does not address the immediate risk of infection, tissue exposure, or hemorrhage. Scientifically, this action lacks relevance to the pathophysiology of dehiscence and may delay critical care. Priority should be stabilization and surgical evaluation, not fluid intake.

Choice A reason: Diarrhea can lead to metabolic acidosis due to the loss of bicarbonate, which is a base, leading to a relative increase in acidity.

Choice B reason: Salicylate intoxication can initially cause respiratory alkalosis due to hyperventilation, but may later lead to metabolic acidosis as the body compensates.

Choice C reason: Vomiting typically leads to a loss of gastric acid, which would cause metabolic alkalosis, not acidosis.

Choice D reason: Hyperventilation is more commonly associated with respiratory alkalosis due to the excessive loss of CO2, which is an acid, not metabolic acidosis.