The nurse is alert to the indication of possible dehiscence of an abdominal surgical wound, which would be evidenced by:
Increased pallor of the surgical site.
Increased serosanguineous drainage from the wound.
Excessive gas.
Complaint of constipation.
The Correct Answer is B
Choice A rationale:
Increased pallor of the surgical site is not a typical sign of wound dehiscence. It could indicate poor blood flow to the area, but it’s not directly related to dehiscence.
Choice B rationale:
Increased serosanguineous drainage from the wound is a common sign of wound dehiscence. This type of drainage is a mixture of blood and serum, and an increase could indicate that the wound edges are separating.
Choice C rationale:
Excessive gas is not a typical sign of wound dehiscence. It could be related to other postoperative complications, such as ileus or bowel obstruction, but not specifically to dehiscence.
Choice D rationale:
Complaint of constipation is not a typical sign of wound dehiscence. It could be related to other postoperative complications, such as side effects of pain medication or decreased mobility, but not specifically to dehiscence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Reconstruction is incorrect because it is not the second stage of wound healing.
Choice B rationale:
Maturation is incorrect because it is not the second stage of wound healing.
Choice C rationale:
Proliferation is incorrect because it is not the second stage of wound healing.
Choice D rationale:
Inflammation is the correct answer because it is the second stage of wound healing.
Correct Answer is B
Explanation
Choice A rationale:
Numbing the area treated is not a physiological effect of moist heat. Moist heat primarily works by increasing blood flow to the treated area.
Choice B rationale:
Dilating the blood vessels is the correct answer. Moist heat therapy works by increasing the temperature of the skin/soft tissue, which leads to vasodilation and increased blood flow to the treated area.
Choice C rationale:
Drawing fluid to the site of application is not a physiological effect of moist heat. Moist heat primarily works by increasing blood flow to the treated area.
Choice D rationale:
Constricting the blood vessels is not a physiological effect of moist heat. Moist heat primarily works by increasing blood flow to the treated area through vasodilation.
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