A nurse is caring for a client who has a peritoneal catheter that requires a dressing change. Identify the sequence of actions the nurse should take. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Remove the old dressing.
Create a sterile field.
Apply precut gauze pads to the site.
Mask self and the client.
The Correct Answer is D,A,B,C
the correct sequence is D, A, B, C. Rationale: D (Mask self and the client): First, both the nurse and the client should wear masks to reduce the risk of infection during the procedure. A (Remove the old dressing): Next, the old dressing should be removed to expose the site. B (Create a sterile field): After removing the old dressing, a sterile field is created to maintain aseptic conditions. C (Apply precut gauze pads to the site): Finally, sterile precut gauze pads are applied to the site to protect the catheter.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "Place the patch on your upper arm": Transdermal scopolamine patches are typically applied behind the ear, not on the upper arm. Placing the patch behind the ear allows for optimal absorption of the medication through the skin.
B. "Replace a dislodged patch onto the same location": If the patch becomes dislodged, it should not be reattached. Instead, a new patch should be applied to a different area behind the ear to prevent skin irritation and ensure continuous drug delivery.
C. "Apply the patch prior to traveling": This is the correct instruction. Transdermal scopolamine patches are applied to the skin at least 4 hours before travel to prevent motion sickness during the journey. Applying the patch in advance allows time for the medication to be absorbed into the bloodstream and provide effective symptom relief.
D. "Store unused patches in the refrigerator": Transdermal scopolamine patches do not typically require refrigeration. They should be stored at room temperature in a cool, dry place. Refrigeration may alter the integrity of the patch and affect its effectiveness.
Correct Answer is A
Explanation
Answer: A
Rationale: A) "Empty your ostomy pouch when it is half full.": This instruction is essential to prevent the pouch from becoming too heavy, which can cause leakage or discomfort. Regular emptying also helps maintain the integrity of the pouching system and prevents leaks.
B) "Notify the provider if your stoma becomes pink and moist.": While it's crucial to monitor the stoma's appearance for signs of complications, a pink and moist stoma typically indicates healthy tissue. This instruction may cause unnecessary concern for the client.
C) "Use a moisturizing soap to cleanse your stoma.": Moisturizing soap is not recommended for stoma cleansing, as it may leave a residue that interferes with the pouch's adhesion and can lead to skin irritation. Instead, the client should use warm water and a mild, non-moisturizing soap.
D) "Apply sterile gloves when changing your ostomy pouch.": While hand hygiene is essential when managing an ostomy, sterile gloves are not necessary for routine pouch changes. Clean, non-sterile gloves or thorough handwashing with soap and water are sufficient to prevent infection.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.