A wound is draining thick, green fluid with a foul odor. What should the nurse suspect?
The wound is contaminated with dirt or debris.
The wound is healing normally.
The wound is showing signs of older bleeding.
The wound is infected with Pseudomonas aeruginosa.
The Correct Answer is D
A. The wound is contaminated with dirt or debris: While dirt can cause discoloration, the thick, foul-smelling, green nature of the drainage strongly suggests an active, specific bacterial infection, not just simple contamination.
B. The wound is healing normally: Normal healing involves serous (clear/watery) or serosanguineous (pink/watery) drainage. Thick, colored, purulent drainage with a foul odor is a cardinal sign of infection.
C. The wound is showing signs of older bleeding: Older bleeding would result in sanguineous (dark red/brown) or serosanguineous drainage. Green, thick fluid is pus, indicative of infection.
D. The wound is infected with Pseudomonas aeruginosa: The classic clinical presentation of wound drainage that is green or blue-green, often with a distinctly sweet, musty, or foul odor, is highly characteristic of an infection caused by the bacterium Pseudomonas aeruginosa. Immediate wound culture and treatment based on facility protocol are required.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. The wound is contaminated with dirt or debris: While dirt can cause discoloration, the thick, foul-smelling, green nature of the drainage strongly suggests an active, specific bacterial infection, not just simple contamination.
B. The wound is healing normally: Normal healing involves serous (clear/watery) or serosanguineous (pink/watery) drainage. Thick, colored, purulent drainage with a foul odor is a cardinal sign of infection.
C. The wound is showing signs of older bleeding: Older bleeding would result in sanguineous (dark red/brown) or serosanguineous drainage. Green, thick fluid is pus, indicative of infection.
D. The wound is infected with Pseudomonas aeruginosa:The classic clinical presentation of wound drainage that is green or blue-green, often with a distinctly sweet, musty, or foul odor, is highly characteristic of an infection caused by the bacterium Pseudomonas aeruginosa. Immediate wound culture and treatment based on facility protocol are required.
Correct Answer is A
Explanation
A. Faster healing with minimal scar formation.Primary intention occurs in clean, surgically incised wounds with minimal tissue loss, where the edges are closely approximated (e.g., with sutures). This method allows for rapid epithelialization and healing with a minimal formation of granulation tissue and resulting in a fine, linear scar.
B. Higher risk of infection.Wounds healing by primary intention generally have a lower risk of infection because the edges are closed, preventing microbial entry and reducing the exposed surface area compared to open wounds.
C. Increased granulation tissue formation.Secondary intentionhealing, which occurs in open, contaminated, or tissue-loss wounds (like large pressure injuries or burns), requires the formation of a large amount of granulation tissue to fill the wound bed before epithelialization can occur. Primary intention healing requires very little granulation tissue.
D. Enhanced epidermal migration.While epidermal migration (epithelialization) occurs in both, the overall process is much faster in primary intention because the epithelial cells only need to migrate across a very narrow gap. In secondary intention, the epithelium must migrate across a large surface area once the granulation tissue has filled the defect.
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