The nurse is alert to the indication of possible dehiscence of an abdominal surgical wound, which would be evidenced by:
Increased pallor of the surgical site.
Increased serosanguineous drainage from the wound.
Excessive gas.
Complaint of constipation.
The Correct Answer is B
Choice A rationale:
Increased pallor of the surgical site is not a typical sign of wound dehiscence. It could indicate poor blood flow to the area, but it’s not directly related to dehiscence.
Choice B rationale:
Increased serosanguineous drainage from the wound is a common sign of wound dehiscence. This type of drainage is a mixture of blood and serum, and an increase could indicate that the wound edges are separating.
Choice C rationale:
Excessive gas is not a typical sign of wound dehiscence. It could be related to other postoperative complications, such as ileus or bowel obstruction, but not specifically to dehiscence.
Choice D rationale:
Complaint of constipation is not a typical sign of wound dehiscence. It could be related to other postoperative complications, such as side effects of pain medication or decreased mobility, but not specifically to dehiscence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
E. Using a thermometer to check the temperature of the pad, Securing the pad to the patient, Instructing the patient not to sleep on the pad, Inspecting the plug and cord for cracks or fraying.
Choice A rationale:
It’s important to check the temperature of the pad to prevent burns.
Choice B rationale:
Securing the pad ensures it stays in place and provides consistent heat.
Choice C rationale:
Patients should not lie on top of the pad as it can lead to burns.
Choice D rationale:
Patients should not sleep on the pad to prevent prolonged exposure which can lead to burns.
Choice E rationale:
Inspecting the plug and cord prevents electrical hazards.
Correct Answer is A
Explanation
Choice A rationale:
Tertiary intention, also known as delayed primary closure or secondary suture, is a type of wound healing where the wound is initially left open and closed after several days.
Choice B rationale:
The remodeling phase is not a type of wound healing, but a stage of wound healing where the wound fully closes and the new tissue slowly gains strength and flexibility.
Choice C rationale:
Primary intention is a type of wound healing where the wound edges are approximated (brought together) and the wound heals by the process of epithelialization.
Choice D rationale:
Secondary intention is a type of wound healing where the wound is left open and heals by granulation, contraction, and epithelialization.
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