The nurse is taking care of a post-surgical patient and notes the incision is clean and dry, with sutures intact. The nurse further assesses that the wound is healing by:
Second intention.
Fourth intention.
Third intention.
First intention.
The Correct Answer is D
Choice A rationale
Healing by second intention occurs when a wound is left open and allowed to close by granulation, epithelialization, and contraction. This method is used for wounds that are infected, have lost tissue, or where there is a delay in suturing. It is not applicable in this case as the wound is sutured and healing cleanly.
Choice B rationale
There is no recognized method of wound healing known as fourth intention. This option does not exist in medical terminology related to wound healing and is therefore not a correct choice.
Choice C rationale
Third intention, also known as delayed primary closure, is when a wound is initially left open due to contamination or infection and is not closed until it is clean. This is not the case here as the wound has been sutured closed from the beginning.
Choice D rationale
First intention, also known as primary intention, is when a clean wound is immediately closed with sutures, staples, or adhesive, leading to minimal scarring. This is the method described in the scenario, where the post-surgical wound is clean, dry, and the sutures are intact, indicating healing by first intention. This method is typically used for surgical incisions under sterile conditions.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Keeping a superficial wound moist can promote faster healing. A moist environment helps to protect the new tissue, prevent the wound from drying out and forming a scab, which can slow down the healing process. It also allows cells to move across the wound more easily, which can speed up healing.
Choice B rationale
While it was once common practice to keep wounds dry, research has shown that a dry environment can actually slow down the healing process by causing cells to dehydrate and scabs to form, which can impede the growth of new tissue.
Choice C rationale
A wet-to-dry dressing is typically used for mechanical debridement and not for the purpose of speeding up healing. This type of dressing can be useful for removing dead tissue but is not necessarily conducive to the fastest healing of superficial wounds.
Choice D rationale
Debridement is the removal of dead or infected tissue from a wound to help healing. While it is an important part of wound care, the act of debridement itself does not speed up healing; rather, it sets the stage for it by cleaning the wound.
Correct Answer is B
Explanation
Choice A rationale
A contusion, commonly known as a bruise, is characterized by bleeding under the skin, causing discoloration and swelling. It does not involve a break in the skin and therefore does not match the description of the wound with torn skin tissue.
Choice B rationale
A laceration refers to a deep cut or tear in the skin or flesh. Because the nurse discovered torn skin tissue, this type of wound is consistent with the client’s injury described in the scenario.
Choice C rationale
An abrasion is a wound caused by superficial damage to the skin, usually no deeper than the epidermis. It is typically caused by a scrape against a rough surface and is not associated with torn skin tissue.
Choice D rationale
A puncture is a small hole caused by a long, pointed object, such as a nail or needle. This type of wound usually does not result in torn skin tissue but rather a deeper, more narrow penetration.
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