A nurse is assessing a patient’s wound dressing and observes a watery red drainage. How should the nurse document this type of drainage?
Purulent.
Sanguineous.
Serosanguineous.
Serous.
The Correct Answer is C
Choice A rationale
Purulent drainage is thick and opaque. It can have a yellow, tan, green, or brown color and is a sign of infection.
Choice B rationale
Sanguineous drainage is bright red and indicates active bleeding3.
Choice C rationale
Serosanguineous drainage is typically pink-red and thin. It is made up of blood and serous fluid and is typically seen in a normal, non-infected wound3.
Choice D rationale
Serous drainage is clear and thin, like the fluid from a blister3.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Discarding any residual gastric contents before administering the tube feeding is not necessary and could lead to unnecessary loss of nutrients and electrolytes.
Choice B rationale
Positioning the patient in a low Fowler’s position is not the optimal position for administering a tube feeding. The patient should be in an upright position to reduce the risk of aspiration.
Choice C rationale
Testing the pH of the gastric aspirate is an important step before administering a tube feeding. This helps to verify that the feeding tube is in the stomach and not in the lungs.
Choice D rationale
Warming the feeding solution to body temperature is not necessary and could potentially lead to bacterial growth in the feeding solution.
Correct Answer is C
Explanation
If the nurse suspects the catheter is not in the urethra, they should leave the catheter in the vagina as a landmark for insertion of a new, sterile catheter.
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