A nurse is assisting in the care of a client during surgery. Which of the following should the nurse identify as supporting a safe, therapeutic environment?
The grounding pad is positioned near the client's surgical site.
The client's surgical site is shaved with a razor.
The client is positioned to minimize pressure on the skin.
The client is covered with a cooling blanket during surgery.
The Correct Answer is C
A. The grounding pad is positioned near the surgical site.: The grounding pad (for electrocautery) should be placed over a large, well-vascularized muscle mass, away from the surgical site and bony prominences.
B. The client's surgical site is shaved with a razor.: Razors create "micro-cuts" that increase the risk of surgical site infections. Clippers are preferred if hair removal is necessary.
C. The client is positioned to minimize pressure on the skin.: During surgery, clients are unable to move or feel pain. Proper padding and positioning are essential to prevent pressure injuries and nerve damage.
D. The client is covered with a cooling blanket.: Maintaining normothermia (normal body temperature) is critical for healing and preventing infection; warming blankets are typically used.
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Related Questions
Correct Answer is C
Explanation
A. Goggles: These are removed after the gown and gloves in most protocols.
B. Mask: The mask (or respirator) is always removed last to protect the nurse from airborne or droplet particles.
C. Gloves: Gloves are considered the most contaminated piece of PPE and should be removed first to prevent contaminating the rest of the body or environment during the removal of other items.
D. Gown: The gown is typically removed after the gloves.
Correct Answer is B
Explanation
A. "You will have to sign a release form to perform the care yourself.": There is no standard legal release form required for family involvement in postmortem hygiene.
B. "I will assist you in any way I can during this process.": This is a culturally sensitive and therapeutic response. Allowing the family to participate in postmortem care can provide closure and honor religious or personal rituals.
C. "This care takes place after the client leaves the facility.": Postmortem care is performed immediately after death in the facility to prepare the body for the family to view and for transport.
D. "A licensed health care worker must perform postmortem care.": While the nurse is responsible for the overall process, there is no law preventing family members from assisting or performing the care themselves if they wish.
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