While assessing the client’s abdomen, you note that the Jackson-Pratt drain’s reservoir is expanded and half full of blood. Which is the appropriate action for you to take at this time?

Empty the reservoir.

Notify the surgeon about the drainage.

Remove the drain

Leave it until the end of the shift

Answer and Explanation

The Correct Answer is A

Choice A:

This is the correct choice. The Jackson-Pratt drain incorporates a flexible bulb that aspirates drainage from the wound by self-suction. When the reservoir is half full, the suction pressure is diminished. Thus it is appropriate to empty it and record the amount of drainage you discard.

Choice B:

While it's important to keep the surgeon informed about the patient's condition, in this case, the purpose of the Jackson-Pratt drain is to aspirate drainage, such as excess blood, from the wound. Many factors are involved in determining what an acceptable amount of drainage is; however, excessive blood loss that must be reported is likely to affect the patient's vital signs.

Choice C:

The surgeon determines when to remove the drain, and in most cases, a patent and functioning drain remains in place for a few days.

Choice D:

Leaving the reservoir half full until the end of the shift is not recommended. The suction pressure is diminished when the reservoir is half full, which could affect the drain's effectiveness.

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Correct Answer is C

Explanation

Choice A rationale
Applying oxygen at 2 L/min via nasal cannula is not typically indicated in the initial stage of wound healing. Oxygen therapy is used for clients with respiratory distress or hypoxia, not as a standard wound care procedure.

Choice B rationale
Mechanical debridement is a method used to remove dead tissue from wounds, but it is not usually part of the initial wound care plan. Debridement is considered when there is necrotic tissue present that may impede healing.

Choice C rationale
Leaving non-bleeding wounds open to air can be beneficial during the initial stage of wound healing. Exposure to air can help to dry out the wound and prevent maceration of the surrounding skin. It also allows for the observation of the wound and easy access for dressing changes if needed.

Choice D rationale
Administering a corticosteroid medication is not a standard part of initial wound care. Corticosteroids can actually delay wound healing and are generally avoided unless there is a specific indication, such as an inflammatory skin condition.

A. Anticholinergics B. Corticosteroids C. Beta-blockers D. Tricyclic antidepressants

Correct Answer is B

Explanation

Choice A rationale
Anticholinergics are not typically associated with delayed wound healing. These medications affect the parasympathetic nervous system and are used to treat a variety of conditions, but they do not have a direct impact on the wound healing process.

Choice B rationale
Corticosteroids can delay wound healing. They are known to have anti-inflammatory properties, which can suppress the immune response necessary for wound healing. They also reduce the production of collagen and other proteins essential for tissue repair.

Choice C rationale
Beta-blockers are primarily used to manage cardiovascular conditions and are not known to have a significant impact on wound healing. They work by blocking the effects of adrenaline on the heart and blood vessels.

Choice D rationale
Tricyclic antidepressants are used to treat depression and certain types of pain. While they can have various side effects, they are not commonly associated with delayed wound healing.

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While assessing the client’s abdomen, you note that the Jackson-Pratt drain’s reservoir is expanded and half full of blood. Which is the appropriate action for you to take at this time?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

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