A nurse is assisting with performing a skin preparation for a client who is scheduled for surgery. Which of the following actions should the nurse take?
Use a new sponge each time the surgical site is scrubbed.
Cleanse the surgical site with a povidone-iodine solution.
Shave the client’s hair near the surgical site.
Scrub the surgical site starting at the outer edge and moving inwards
The Correct Answer is A
A. This is because using the same sponge repeatedly can introduce bacteria and other contaminants to the surgical site, increasing the risk of infection.
B. Cleansing the surgical site with a povidone-iodine solution is not recommended because it can cause skin irritation and allergic reactions. The nurse should use a chlorhexidine-based antiseptic solution instead, which is more effective and less toxic.
C. Shaving the client's hair near the surgical site is generally avoided, as it can increase the risk of infection. Hair removal, if needed, is often done with clippers.
D. The surgical site should be scrubbed starting at the center and moving outwards in a circular motion.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Fever is not a common side effect of allopurinol.
B. Allopurinol is usually taken with food to minimize gastrointestinal upset.
C. If a rash develops, the client should stop taking allopurinol and notify their healthcare provider rather than self-medicating with an antihistamine.
D. Drinking an adequate amount of water helps prevent kidney stones, a potential side effect of allopurinol.
Correct Answer is B
Explanation
A. A client who has a sprained left ankle is typically categorized as a lower priority in triage.
B. A client who has an open traumatic brain injury and agonal breaths should be assigned a red tag and indicates immediate or emergent care; this client requires immediate attention.
C. A client who has sustained a partial amputation of the right leg requires urgent care but may not be as immediately life-threatening as option B.
D. A client who is deceased typically does not receive further medical intervention in a mass casualty situation.
E. While serious, the severity may not necessitate immediate intervention compared to option B.
F. This is typically categorized as a lower priority in triage.
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