A nurse is assisting with staff education about hand hygiene.
Which of the following instructions should the nurse include in the teaching?
Wear sterile gloves when in contact with body fluids.
Use alcohol-based cleanser when hands are visibly soiled.
Artificial nails can be worn when performing direct client care.
Wash hands with soap and water for 20 seconds.
The Correct Answer is D
Explanation
D, Wash hands with soap and water for 20 seconds
Hand hygiene is a critical practice in preventing the transmission of infections in healthcare settings. Here's why the other options are incorrect:
Wearing sterile gloves when in contact with body fluids in (option A) is incorrect because it is important for preventing the transmission of pathogens, but it is not directly related to hand hygiene. Hand hygiene refers to the cleaning of hands to remove pathogens, and sterile gloves provide a barrier to protect the healthcare worker and the patient.
B. Using an alcohol-based cleanser when hands are visibly soiled in (option B) is not recommended. Alcohol-based cleansers are effective in killing many types of germs, but they are not as effective in removing visible dirt, blood, or body fluids. In such cases, it is important to wash hands with soap and water to thoroughly clean them.
Artificial nails should not be worn when performing direct client care in (option C). They can harbor and transmit pathogens and make it more difficult to effectively clean hands. The Centres for Disease Control and Prevention (CDC) recommends that healthcare workers maintain short, clean, and natural nails without the use of artificial nails or nail extensions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Correct answer: A
Preschool-aged children (around 3 to 5 years old) have a limited understanding of death compared to older children or adults. They may not fully grasp the finality and permanence of death. They often have a more concrete and literal understanding of death.
A. Believing the death is punishment for bad behavior: Preschool-aged children (typically 3 to 5 years old) often have magical thinking and may believe that their thoughts or actions can cause events to happen. They may think that the death of a parent is a punishment for something they did or thought, reflecting their egocentric view of the world.
B. Recognizing the parent will never wake up: This understanding is more commonly seen in older children who have a more mature grasp of death. Preschool-aged children may not fully comprehend that death is irreversible and permanent.
C. While preschoolers might ask questions about the funeral out of curiosity, this is not the primary way they process or react to the death of a loved one. Their questions are often more about trying to understand what is happening rather than a genuine curiosity about the specifics of the service.
D. Understanding that everyone dies eventually: While preschool-aged children may have some understanding that death is a natural part of life, their comprehension of its full implications is limited. They may not fully grasp the universality of death and its inevitability for all living beings.
Correct Answer is C
Explanation
The presence of edema and coolness around the catheter's insertion site suggests that infiltration may have occurred. Infiltration refers to the unintended leakage of fluid into the surrounding tissues instead of flowing into the vein. It can lead to tissue damage and compromised circulation. Stopping the infusion is the initial priority to prevent further infiltration and minimize potential harm to the client.
Applying a warm compress may be appropriate to promote comfort and circulation in some cases, but it should be done after stopping the infusion and assessing the severity of the infiltration.
Documenting the infiltration is necessary for accurate record-keeping and to communicate the occurrence to the healthcare team. However, it is not the first immediate action required in this situation.
Elevating the arm can help reduce swelling and promote venous return. It can be done after stopping the infusion, but it is not the first action to address the potential infiltration.
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