A nurse is assisting with preparing a client who is to have a central venous catheter inserted for the administration of total parenteral nutrition (TPN. Which of the following actions should the nurse take?

Verify the amount of TPN solution the client is receiving every 4 hr.

Prepare the client for a chest x-ray to verify catheter placement.

Place the client in Sims' position for catheter insertion.

Use a clean technique when changing the catheter dressing.

Answer and Explanation

The Correct Answer is B

A.   Incorrect. Verifying the TPN solution amount is not directly related to preparing for central venous catheter insertion.
B.   Correct. Chest X-rays are typically done after central venous catheter insertion to confirm proper catheter placement.
C.   Incorrect. Sims' position is not the appropriate position for central venous catheter insertion.
The Trendelenburg position is commonly used for this purpose.
D.   Incorrect. Sterile technique, not clean technique, is used for changing the catheter dressing to prevent infection.

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Correct Answer is A

Explanation

A. Correct. A health care surrogate (also known as a health care proxy or agent. is designated by the individual to make medical decisions on their behalf if they are unable to do so. This individual should be someone the client trusts and is aware of the client's preferences.
B. Incorrect. A living will can be changed or updated by the individual at any time if their preferences change. It is important for the client to review and revise their living will as needed.
C. Incorrect. While legal assistance may be helpful, designating a healthcare surrogate does not necessarily require an attorney.
D. Incorrect. The choice of a healthcare surrogate is a personal decision, and the individual can choose any trusted person to fulfill this role, not just a family member.

A. "I will wipe away yellow crusts that form around the incision." B. "I will apply pressure with gauze if I see bleeding." C. "I will make sure that my baby's diaper is applied snugly." D. "I will apply antibiotic ointment to my baby's penis."

Correct Answer is B

Explanation

A. Incorrect. Yellow crusts around the incision site are a normal part of healing after circumcision. Wiping them away can disrupt the healing process.

B. Correct. Applying pressure with gauze if bleeding occurs helps control bleeding and supports the healing process after circumcision.

C. Incorrect. A snug diaper might cause friction and discomfort for the healing circumcision site.

Diapers should be applied loosely to avoid rubbing against the area.

D. Incorrect. Applying antibiotic ointment is generally not recommended for circumcision care, especially after a Plausible circumcision. It can interfere with healing and increase the risk of infection.

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A nurse is assisting with preparing a client who is to have a central venous catheter inserted for the administration of total parenteral nutrition (TPN. Which of the following actions should the nurse take?

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