A nurse is assisting with the care of a client who has partial-thickness and full-thickness burns to his upper torso and face. Which of the following actions should the nurse take to prevent infection?

Place new linen on the client's bed every other day.

Change gloves between sites when providing wound care to multiple wounds.

Change the dressing on infected wounds first.

Monitor vital signs every 4 hr.

Answer and Explanation

The Correct Answer is B

A. Place new linen on the client's bed every other day: While changing linen regularly is important for maintaining cleanliness and preventing infection, waiting every other day may not be sufficient for a client with burns, especially if there is wound drainage or soiling. Linens should be changed more frequently, ideally daily or as needed, to ensure cleanliness and prevent the spread of infection.

B. Change gloves between sites when providing wound care to multiple wounds: This is a correct action. Changing gloves between sites when providing wound care helps prevent the spread of infection from one wound to another. It reduces the risk of cross-contamination and helps maintain a sterile environment during wound care procedures.

C. Change the dressing on infected wounds first: This is incorrect. Dressings on infected wounds should be changed promptly to prevent the spread of infection. However, changing the dressing on infected wounds first may lead to contamination of other wound sites if proper precautions are not taken. It's important to follow proper infection control procedures, including changing gloves between wound sites and using aseptic technique.

D. Monitor vital signs every 4 hr: Monitoring vital signs is important for assessing the client's overall condition, but it is not directly related to preventing infection. Vital signs may indicate signs of infection, such as fever or increased heart rate, but they do not prevent infection on their own. Other measures, such as wound care and infection control practices, are more directly related to preventing infection in clients with burns.

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Correct Answer is A

Explanation

A. Firmly attached white particles on the hair:

Firmly attached white particles on the hair are characteristic of nits, which are the eggs of lice. While this finding supports the diagnosis of pediculosis capitis, it is not a definitive indication on its own.

B. Itching and scratching of the head:

Itching and scratching of the head are common symptoms of pediculosis capitis. However, they are also common symptoms of various other scalp conditions, so they are not definitive indications.

C. Thick, yellow-crusted lesions on a red base:

This description is more characteristic of impetigo, a bacterial skin infection, rather than pediculosis capitis. Impetigo typically presents with yellow-crusted lesions on a red base, but it does not involve lice infestation.

D. Patchy areas of hair loss:

Patchy areas of hair loss are not typically associated with pediculosis capitis. This finding is more suggestive of conditions like alopecia areata or fungal infections.

A. Bed in highest position B. Remove restrictive objects or clothing from patients’ body C. Remove all pillows from the patient's head D. Oxygen and suction at bedside E. Padded bed rails

Correct Answer is ["B","D","E"]

Explanation

A. Bed in highest position:
The height of the bed is not directly related to seizure precautions.

B. Remove restrictive objects or clothing from patients’ body:
This is important to prevent injury during a seizure episode.

C. Remove all pillows from the patient's head:
While it's generally a good practice to remove pillows to prevent suffocation or obstruction, it's not specifically related to seizure precautions.

D. Oxygen and suction at bedside:
Oxygen and suction should be readily available to support the patient's respiratory status and clear any secretions or vomit during or after a seizure.

E. Padded bed rails:
Padded bed rails can help prevent injury if the patient thrashes or moves violently during a seizure.

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A nurse is assisting with the care of a client who has partial-thickness and full-thickness burns to his upper torso and face. Which of the following actions should the nurse take to prevent infection?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is checking a school-age child for pediculosis capitis. Which of the following findings is a definitive indication of this condition?

Correct Answer is A

Explanation

You have a patient who has a brain tumor and is at risk for seizures. In the patient's plan of care you incorporate seizure precautions. Select the 3 choices below for all the proper steps to take in initiating seizure precautions. (Select All that Apply.)

Correct Answer is ["B","D","E"]

Explanation

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