A nurse is caring for a client who is 5 days postoperative after abdominal surgery. The client reports a sudden pulling sensation and pain in his surgical incision. Upon examination, the nurse finds an evisceration. Which of the following interventions is appropriate?
Use sterile gloves to place gentle pressure on the exposed organs.
Have the client lie supine with legs straight.
Gently suction secretions from the wound bed using a 12-gauge sterile catheter.
Cover the area with saline-soaked sterile dressings.
The Correct Answer is D
Choice A reason: Applying gentle pressure on the exposed organs is not recommended as it can cause further damage.
Choice B reason: Having the client lie supine with legs straight is part of the correct positioning, but it does not address the need to protect the exposed organs.
Choice C reason: Suctioning secretions from the wound bed is not the immediate priority and can be harmful to the exposed tissues.
Choice D reason: Covering the area with saline-soaked sterile dressings is the correct intervention to keep the organs moist and reduce the risk of organ damage until surgical repair can be performed.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Evaluation is the final step of the nursing process, where the nurse determines the effectiveness of the nursing care provided.
Choice B reason: Assessment is the correct part of the nursing process for the mental status examination, as it involves collecting data about the patient.
Choice C reason: Planning involves setting goals and choosing appropriate nursing actions based on the assessment data.
Choice D reason: Implementation is the step where the nurse carries out the planned interventions.
Correct Answer is ["B","D","E"]
Explanation
Choice A reason: People with Narcissistic Personality Disorder (NPD) typically do not give credit to others; they are more likely to take credit for themselves.
Choice B reason: Giving grandiose credit to oneself is a common behavior in NPD, as individuals with this disorder often exaggerate their achievements and talents.
Choice C reason: Being unable to make decisions is not a typical characteristic of NPD.
Choice D reason: "Blowing their own horns" is an expression that means to boast about oneself, which is a behavior often associated with NPD.
Choice E reason: Individuals with NPD may choose friends based on how good they make them feel, often seeking out people who will admire them.
Choice F reason: NPD is not similar to Schizoid Personality Disorder; they are distinct conditions with different characteristics.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.