A nurse caring for a post-operative client observes the drainage in the client's closed wound drainage system. The drainage is dark red in color. The nurse documents the drainage as which of the following?
Serosanguineous
Sanguinous
Purulent
Serous
The Correct Answer is B
The correct answer is B. Sanguinous. Sanguinous drainage is bright red, indicating fresh bleeding, and may be seen in the first few hours after surgery. Dark red drainage may indicate that there is an increase in bleeding, and the nurse should notify the provider immediately. Serosanguineous drainage is pink in color and consists of both blood and serum. Purulent drainage is thick, yellow or green in color and consists of pus, indicating an infection. Serous drainage is clear or light yellow in color and contains serum without red blood cells.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","E"]
Explanation
The nursing actions that best represent the step of performing interventions in the nursing process are:
C. The nurse ambulates a post-operative patient in the hall during their shift.
E. The nurse turns a patient every 2 hours to prevent pressure injuries.
Explanation: In the step of performing interventions, the nurse takes action to implement the nursing care plan and achieve the identified goals. The interventions should be specific, measurable, and realistic to address the patient's needs. Ambulating a post-operative patient in the hall during their shift and turning a patient every 2 hours to prevent pressure injuries are both specific interventions that address patient needs and promote positive health outcomes. Removing bandages from a burn victim's arm and performing sterile dressing change once a shift is more related to the step of assessment or implementation, while identifying a patient's priority health problem or assessing a patient's nutritional status are more related to the step of analysis and diagnosis in the nursing process.
Correct Answer is B
Explanation
The correct answer is B. Sanguinous. Sanguinous drainage is bright red, indicating fresh bleeding, and may be seen in the first few hours after surgery. Dark red drainage may indicate that there is an increase in bleeding, and the nurse should notify the provider immediately. Serosanguineous drainage is pink in color and consists of both blood and serum. Purulent drainage is thick, yellow or green in color and consists of pus, indicating an infection. Serous drainage is clear or light yellow in color and contains serum without red blood cells.
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