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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
A. Hematuria:
Hematuria, or blood in the urine, is a common finding in urinary tract infections (UTIs). It occurs due to irritation and inflammation of the urinary tract lining, causing small blood vessels to leak blood into the urine.
B. Urinary frequency:
Urinary frequency, or the need to urinate more often than usual, is a classic symptom of a UTI. It occurs because the infection irritates the bladder lining, leading to a frequent urge to urinate even when the bladder is not full.
C. Polyuria:
Polyuria, or excessive urination, is not typically associated with uncomplicated urinary tract infections. Instead, UTIs usually cause urinary frequency without necessarily increasing the total volume of urine produced (polyuria).
D. Dependent edema:
Dependent edema, or swelling in the lower extremities due to fluid accumulation, is not a typical finding in urinary tract infections. UTIs primarily affect the urinary system and do not typically cause systemic fluid retention.
E. Dysuria:
Dysuria, or painful urination, is another hallmark symptom of urinary tract infections. It occurs due to inflammation and irritation of the urinary tract lining, making urination uncomfortable or even painful.
Correct Answer is D
Explanation
A. Broth:
Broth is not typically recommended for children with acute diarrhea because it lacks the necessary electrolytes to adequately replace those lost through diarrhea. While it can help provide some fluids, it may not be sufficient for rehydration and could potentially worsen dehydration if electrolytes are not adequately replaced.
B. Apple juice:
While apple juice may seem like a hydrating option, it is not the best choice for children with acute diarrhea. Apple juice contains a high amount of sugar, which can draw water into the intestines and worsen diarrhea. Additionally, it lacks the necessary electrolytes needed for rehydration.
C. Cherry gelatin:
Cherry gelatin is not recommended for rehydrating a child with acute diarrhea. Like apple juice, it contains sugar, which can exacerbate diarrhea by drawing water into the intestines. Gelatin also lacks the electrolytes needed to replace those lost through diarrhea.
D. Pedialyte:
Pedialyte is the preferred choice for rehydrating a child with acute diarrhea. It is specifically formulated to replace lost fluids and electrolytes and is less likely to worsen diarrhea compared to sugary beverages like juice or gelatin. Pedialyte helps prevent dehydration by providing a balanced mixture of water, sugar, and electrolytes, making it an effective choice for managing diarrhea in children.
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