A nurse in an outpatient clinic is caring for a client. Which of the following findings indicates the client is experiencing a hearing deficit?

Rationale

A. Replace the NPWT dressing every 12 hours: NPWT dressings are typically changed every 48–72 hours, or sooner if the dressing is saturated or malfunctioning. Changing the dressing every 12 hours is excessive and can disrupt wound healing and increase infection risk.

B. Allow the wound to be open to air at least once per shift: Negative-pressure wound therapy requires a sealed environment to maintain suction and promote healing. Exposing the wound to air would compromise negative pressure, delay healing, and increase infection risk.

C. Shave the skin around the wound prior to applying the wound therapy device: Shaving can cause microabrasions and increase the risk of infection. Hair should be gently trimmed if necessary, but shaving is not recommended prior to applying NPWT dressings.

D. If client reports pain, decrease the suction to 75 mm Hg: Pain during NPWT can occur if suction pressure is too high. Reducing suction to 75 mm Hg helps minimize discomfort while maintaining therapeutic negative pressure. Adjusting suction appropriately promotes client comfort and adherence to therapy.

Rationale

A. Advance the needle 6 mm (1/4 in) below the skin's surface: The needle should not be advanced below the dermis because intradermal injections require placement within the superficial skin layers. Advancing too deeply can result in subcutaneous injection, which may produce a false-negative result.

B. Insert the needle at a 20° angle to the client's skin: Intradermal injections should be administered at a very shallow angle, typically 5–15°, to ensure proper placement just under the epidermis. A 20° angle risks injecting too deeply and compromising test accuracy.

C. Point the bevel of the needle upward prior to insertion: Keeping the bevel upward allows for smooth entry into the dermis and helps form a visible wheal, which is necessary to confirm correct intradermal placement. This technique minimizes tissue trauma and ensures the test can be accurately read.

D. Administer the injection on the dorsal forearm: The recommended site for a tuberculin skin test is the inner surface of the forearm, not the dorsal side. The inner forearm provides a flat, easily accessible area that allows for accurate observation and measurement of induration.