A nurse is caring for a client who has a peripherally inserted central catheter (PICC) for the administration of total parenteral nutrition (TPN). The transparent dressing over the insertion site requires replacement. Which of the following actions should the nurse take?

Aspirate the catheter to check for a brisk blood return.

Use sterile technique for the procedure.

Cleanse the insertion site with hydrogen peroxide.

Flush the TPN port with 20 mL of 0.9% sodium chloride.

Answer and Explanation

The Correct Answer is B

Choice A reason: Aspirating the catheter to check for a brisk blood return is not typically recommended as a routine action when replacing the dressing of a PICC line used for TPN. This action is performed to verify patency and placement of the catheter, but it is not directly related to the dressing change procedure.

Choice B reason: Using sterile technique for the procedure is essential when replacing the dressing of a PICC line. Maintaining sterility is crucial to prevent infection, as the PICC line provides direct access to the central venous system. The nurse should use sterile gloves and follow aseptic protocols to minimize the risk of introducing pathogens at the catheter insertion site.

Choice C reason: Cleansing the insertion site with hydrogen peroxide is not recommended for PICC line care. Hydrogen peroxide can be damaging to the tissue and may delay healing. Instead, a chlorhexidine-based antiseptic is typically used to clean the skin around the insertion site during dressing changes to reduce microbial flora and prevent infection.

Choice D reason: Flushing the TPN port with 20 mL of 0.9% sodium chloride is a practice used to maintain catheter patency, but it is not part of the dressing change procedure. Flushing is usually done before and after administering medication or nutrition, not specifically during a dressing change.

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Correct Answer is C

Explanation

Choice A reason: While bladder control issues can significantly affect a client's quality of life, they are typically managed by a urologist or a specialist in continence, rather than an occupational therapist. Occupational therapy focuses on improving the ability to perform activities of daily living (ADLs), which generally does not include bladder control.

Choice B reason: Difficulty swallowing, known as dysphagia, can be a symptom of myasthenia gravis due to muscle weakness. Although it is a serious concern, it is usually managed with the help of a speech therapist who specializes in swallowing difficulties, rather than an occupational therapist.

Choice C reason: Having a hard time with brushing hair is directly related to the performance of ADLs, which is the primary focus of occupational therapy. An occupational therapist can assist the client by teaching energy conservation techniques, providing adaptive equipment, and modifying the task to make it easier for the client to maintain personal grooming independently.

Choice D reason: Preferring a wheelchair over a walker is a matter of mobility and personal preference. While occupational therapy can help with mobility issues, this statement alone does not indicate a need for occupational therapy unless the client has difficulty performing ADLs due to the choice of mobility aid.

A. Mantoux skin test revealing an induration of less than 1 mm. B. Negative sputum cultures for acid-fast bacillus. C. The client is no longer coughing up blood-tinged sputum. D. Positive Quantiferon-TB Gold test (negative).

Correct Answer is B

Explanation

Choice A reason: The Mantoux skin test, also known as the tuberculin skin test, measures the immune response to the tuberculin purified protein derivative (PPD) injected under the skin. An induration of less than 1 mm is not necessarily an indication of non-infectiousness; it may indicate a lack of infection or an inadequate immune response. This test does not reflect the current infectious status as it measures a delayed hypersensitivity reaction and can remain positive for life once someone has been exposed to TB or has received the BCG vaccine.

Choice B reason: Negative sputum cultures for acid-fast bacillus are a strong indication that the client is no longer infectious. Pulmonary tuberculosis is diagnosed and monitored through sputum cultures to detect the presence of Mycobacterium tuberculosis. A series of negative cultures typically indicates that the client is not excreting the bacteria and is, therefore, not contagious.

Choice C reason: While the cessation of coughing up blood-tinged sputum is a positive sign of clinical improvement, it does not conclusively indicate that the client is no longer infectious. The absence of blood in the sputum may simply mean that the damage to lung tissues is healing, but the client could still be harboring and potentially spreading TB bacteria.

Choice D reason: The Quantiferon-TB Gold test is a blood test that measures the immune system's response to TB bacteria. A positive result indicates TB infection, but it does not distinguish between latent infection and active disease, nor does it provide information on infectiousness. The parenthetical "negative" is confusing and should be clarified in the context of the test results.

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A nurse is caring for a client who has a peripherally inserted central catheter (PICC) for the administration of total parenteral nutrition (TPN). The transparent dressing over the insertion site requires replacement. Which of the following actions should the nurse take?

Nursing Test Bank

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