Clients who will go through operations and who have undergone surgery need the proper observation, treatment and care. Implementing the nursing process to these patients will help reduce complications. Nurse Maria checks on Mr. Alberto who had abdominal surgery, and finds that the edges of the incision have separated. Also, a small portion of the bowel is sticking out through the incision. Nurse Maria would:

Correct Answer: A

Rationale: Nurse Maria should immediately cover the wound with a moist sterile dressing to protect the exposed tissue and prevent infection. This action will help maintain the moisture needed for wound healing and reduce the risk of further complications. It is important to cover the exposed area to prevent any external contaminants from entering the wound, while also keeping the area moist to promote healing. It is crucial to seek medical attention promptly to address the situation and ensure proper care for the patient.

Correct Answer: C

Rationale: Atelectasis typically causes dullness to percussion due to lung collapse. It pulls the mediastinum toward the affected side and leads to decreased breath sounds.

Correct Answer: D

Rationale: Anemia is a poor prognostic factor in acute lymphoblastic leukemia as it reflects the extent of bone marrow infiltration and disease severity.

Correct Answer: C

Rationale: Epstein-Barr virus is less commonly associated with postinfectious arthritis.

Correct Answer: D

Rationale: Takayasu arteritis primarily affects large arteries.