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 is positioned to minimize pressure on the skin.
The client is covered with a cooling blanket during surgery.
The client's surgical site is shaved with a razor.
The Correct Answer is B
A. The grounding pad is positioned near the client's surgical site: The grounding pad for electrosurgery should be placed on a large, well-vascularized muscle mass away from the surgical site to ensure proper dispersion of electrical current and prevent burns. Placing it near the site increases risk of injury.
B. The client is positioned to minimize pressure on the skin: Proper positioning during surgery helps prevent pressure ulcers and nerve injuries by reducing prolonged pressure on bony prominences and delicate tissues, supporting a safe and therapeutic environment.
C. The client is covered with a cooling blanket during surgery: Maintaining normothermia is critical; cooling blankets can cause hypothermia, which increases the risk of complications such as infection and coagulopathy. Warm blankets or forced-air warming devices are preferred.
D. The client's surgical site is shaved with a razor: Shaving with a razor can cause microabrasions that increase the risk of surgical site infections. Clipping hair with electric clippers is the recommended practice to reduce infection risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The grounding pad is positioned near the client's surgical site: The grounding pad for electrosurgery should be placed on a large, well-vascularized muscle mass away from the surgical site to ensure proper dispersion of electrical current and prevent burns. Placing it near the site increases risk of injury.
B. The client is positioned to minimize pressure on the skin: Proper positioning during surgery helps prevent pressure ulcers and nerve injuries by reducing prolonged pressure on bony prominences and delicate tissues, supporting a safe and therapeutic environment.
C. The client is covered with a cooling blanket during surgery: Maintaining normothermia is critical; cooling blankets can cause hypothermia, which increases the risk of complications such as infection and coagulopathy. Warm blankets or forced-air warming devices are preferred.
D. The client's surgical site is shaved with a razor: Shaving with a razor can cause microabrasions that increase the risk of surgical site infections. Clipping hair with electric clippers is the recommended practice to reduce infection risk.
Correct Answer is C
Explanation
A. Ask the assistive personnel to document the client's time of death: Documenting the time of death is a critical nursing responsibility and should be done by the nurse or healthcare provider, not delegated to assistive personnel. Accurate documentation is essential for legal and medical records, especially when an autopsy is planned.
B. Wear sterile gloves when cleaning the client's body: Sterile gloves are not necessary for routine postmortem care; clean gloves are sufficient. Sterile gloves are reserved for invasive procedures to prevent infection, whereas postmortem care focuses on hygiene and respect for the deceased.
C. Place an identification tag on the outside of the client's shroud: Proper identification of the deceased is crucial, especially when an autopsy is required. Placing an identification tag on the shroud ensures correct identification during transport and handling, preventing misidentification and maintaining respect for the client.
D. Remove the client's dentures and give them to the client's family: Dentures should typically remain in the client's mouth during postmortem care to preserve facial structure and appearance. Removing them can alter the deceased’s appearance, which may be distressing to the family and is generally avoided unless specifically requested.
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