A nurse is caring for a client who has a Jackson-Pratt (JP) drain in place after surgery for an open reduction and internal fixation (ORIF). The nurse should understand that the JP drain was placed for which of the following purposes?
To provide a means for medication administration
To prevent fluid from accumulating in the wound
To eliminate the need for wound irrigations
To limit the amount of bleeding from the surgical site
The Correct Answer is B
A. A JP drain is not used for medication administration; its purpose is to remove fluid from the wound area.
B. The primary purpose of a JP drain is to prevent fluid from accumulating in the wound, which helps reduce the risk of infection and promotes healing by allowing continuous drainage of postoperative fluids.
C. While a JP drain helps manage fluid accumulation, it does not eliminate the need for wound irrigations if prescribed as part of the care plan.
D. A JP drain helps manage excess fluid but is not specifically designed to limit bleeding from the surgical site. Bleeding control is generally managed through other measures and monitoring.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Metabolic alkalosis is characterized by an elevated pH and elevated bicarbonate, which is not consistent with these ABG values.
B. Respiratory alkalosis presents with an elevated pH and decreased PaCO2, opposite of the client's findings.
C. Metabolic acidosis would show a decreased pH with a low bicarbonate level, but this client's bicarbonate is within normal range.
D. Respiratory acidosis is indicated by a low pH and elevated PaCO2 due to hypoventilation, which aligns with the client's ABG values and respiratory rate.
Correct Answer is C
Explanation
A. A platelet count of 150,000/mm³ is within the lower end of the normal range and might be monitored but is not the highest priority for intervention in the context of HIV.
B. A positive Western blot test confirms HIV infection but does not provide information on the current immune status or disease progression.
C. A CD4-T-cell count of 180 cells/mm³ indicates significant immunosuppression and is critical as it reflects the progression of HIV and the risk of opportunistic infections. This value is a priority because it directly affects the client’s immune status and potential treatment strategies.
D. A WBC count of 5,000/mm³ is within the normal range and is less critical compared to the CD4-T-cell count, which provides more specific information regarding the client’s HIV status and risk for opportunistic infections.
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