While assessing the client's abdomen, you note that the Jackson-Pratt drain's reservoir is expanded and half full of blood.
Which is the appropriate action for you to take at this time?
Leave it until the end of the shift.
Remove the drain.
Empty the reservoir.
Notify the surgeon about the blood loss.
The Correct Answer is C
Choice A rationale:
Leaving the reservoir until the end of the shift could lead to overfilling and ineffective drainage.
Choice B rationale:
Removing the drain is not within the nurse’s scope of practice and could lead to complications.
Choice C rationale:
Emptying the reservoir ensures effective drainage and allows for accurate measurement of output.
Choice D rationale:
Notifying the surgeon about the blood loss may be necessary if the amount is significant, but it is not the immediate action.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Refraining from touching the drainage spout with the hand is a correct practice. This helps to prevent contamination of the drain.
Choice B rationale:
Using one alcohol wipe to clean both the spout and the plug is incorrect. Each part should be cleaned with a separate alcohol wipe to prevent cross-contamination.
Choice C rationale:
Pointing the device away from oneself while opening it is a correct practice. This helps to prevent accidental exposure to the drainage fluid.
Choice D rationale:
Compressing the device in the hand before closing is a correct practice. This helps to maintain the suction in the drain.
Correct Answer is D
Explanation
Choice A rationale:
Hydrocolloid dressings do not keep the wound dry; they maintain a moist environment.
Choice B rationale:
These dressings do not have antimicrobial properties.
Choice C rationale:
While these dressings can be left in place for several days, it is not their major purpose.
Choice D rationale:
Hydrocolloid dressings occlude air and promote autolytic debridement of necrotic tissue.
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