A nurse has just finished a wound care procedure for a client. Which of the following should the nurse remove first?

Goggles

Gloves

Mask

Gown

Answer and Explanation

The Correct Answer is B

A. Goggles: Goggles protect the eyes from splashes and should be removed after gloves and gown, once the risk of contamination is lower. Removing them too early can increase the risk of contamination if hands are still contaminated.

B. Gloves: Gloves are the most contaminated item after wound care and should be removed first to prevent spreading microorganisms to other personal protective equipment or the nurse’s skin. Proper glove removal technique reduces the risk of self-contamination.

C. Mask: Masks protect the respiratory tract and are typically removed last, after gloves, gown, and goggles, to maintain protection as long as possible. Removing the mask too early can expose the nurse to airborne particles.

D. Gown: The gown is removed after gloves because it is also contaminated but less so than gloves. Removing gloves first minimizes transferring contaminants from the gloves to the gown or other surfaces during removal.

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Correct Answer is C

Explanation

A. Gather additional information from the caller to verify their identity: Even if the caller's identity is verified, HIPAA regulations prohibit disclosing a client's medical information without the client’s explicit authorization. Verifying identity alone does not grant permission to release confidential health information.

B. Request that the caller contact the client's provider directly for information: Redirecting the caller to the provider does not resolve the issue of confidentiality. Healthcare providers are also bound by HIPAA regulations and cannot release information without proper consent, regardless of who is making the request.

C. Ask the caller to contact the client directly for information: This action respects the client’s privacy and autonomy. Under HIPAA, healthcare professionals may not disclose health information without client authorization. Advising the sibling to speak directly with the client is the appropriate response to safeguard confidentiality.

D. Provide the caller with a brief update about the client's condition: Sharing any health information without the client’s express consent is a violation of HIPAA. Even a brief update constitutes a breach of confidentiality and could result in legal and professional consequences.

A. Overweight B. Underweight C. Obesity class I D. Normal weight

Correct Answer is C

Explanation

A. Overweight: A body mass index (BMI) between 25 and 29.9 is classified as overweight. Since the client’s BMI is 32, this category does not apply.

B. Underweight: A BMI less than 18.5 is considered underweight. The client’s BMI of 32 is well above this range, ruling out this classification.

C. Obesity class I: A BMI between 30 and 34.9 falls into obesity class I. The client’s BMI of 32 fits into this category, indicating a level of obesity that increases the risk for chronic health conditions.

D. Normal weight: Normal weight is defined as a BMI between 18.5 and 24.9. Since the client’s BMI exceeds this range, this classification is not appropriate.

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A nurse has just finished a wound care procedure for a client. Which of the following should the nurse remove first?

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