A charge nurse is reinforcing teaching about infection control with a newly licensed nurse. Which of the following actions by the newly licensed nurse indicates an understanding of the teaching?

Rolls soiled linen with the clean side in before placing it in the laundry bag.

Cleans a blood spill with chlorine bleach.

Performs hand hygiene with hands at elbow level.

Instructs a female client to wipe the perineal area from back to front.

Answer and Explanation

The Correct Answer is B

The correct answer is choice B, which cleans a blood spill with chlorine bleach. This is an appropriate action for infection control because bleach is an effective disinfectant that can kill most pathogens, including bloodborne viruses such as HIV and hepatitis B and C.

A. Rolling soiled linen with the clean side in it before placing it in the laundry bag is not the correct answer because it can spread pathogens and cause cross-contamination.

Performing hand hygiene with hands at elbow level is not the correct answer because it is not the correct technique for hand hygiene, which involves washing hands with soap and water or using an alcohol-based hand sanitizer.

Instructing a female client to wipe the perineal area from back to front is not the correct answer because it can cause contamination of the urethra and increase the risk of urinary tract infections.

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Correct Answer is D

Explanation

The correct answer is choice D. During injection of the contrast medium, the client may experience a feeling of heat. Choices A and C are incorrect because numbness in the fingertips and pain in the jawline are not expected during the procedure. Choice B is incorrect because the urge to urinate is associated with cystoscopy. Choice A is not correct because numbness in the fingertips is not expected during the procedure. Choice B is not correct because the urge to urinate is associated with cystoscopy. Choice C is not correct because pain in the jawline is not expected during the procedure.

A. Obtain a set of vital signs. B. Flex the client's knees and hips. C. Apply a moist saline dressing to the area. D. Elevate the head of the client's bed 20°.

Correct Answer is C

Explanation

The correct answer is c. Apply a moist saline dressing to the area.

Choice A reason: Obtaining a set of vital signs is important, but it is not the immediate priority in this situation. The vital signs will not address the protruding organs directly.

Choice B reason: Flexing the client’s knees and hips may provide comfort but does not directly address the issue of the open incision and protruding organs.

Choice C reason: Applying a moist saline dressing to the area is the correct action. It helps to protect the protruding organs by keeping them moist and reduces the risk of organ damage or infection. This is the priority action to keep the organs moist and reduce the risk of tissue damage until surgical repair can be done.

Choice D reason: Elevating the head of the client’s bed 20° may be part of the overall care plan, but it is not the immediate priority when dealing with protruding organs from an open abdominal incision.

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A charge nurse is reinforcing teaching about infection control with a newly licensed nurse. Which of the following actions by the newly licensed nurse indicates an understanding of the teaching?

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Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who is scheduled for a cardiac catheterization. Which of the following should the nurse tell the client to expect during injection of the contrast medium?

Correct Answer is D

Explanation

A nurse is caring for a client who is 4 hr postoperative following an abdominal surgery and notes that the client's abdominal incision is open and the internal organs are protruding. After contacting the rapid response team, which of the following actions should the nurse take next?

Correct Answer is C

Explanation

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