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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

A. Peanut butter: Peanut butter is typically thick and sticky, which can pose a choking hazard for individuals with dysphagia, especially if they have difficulty swallowing thicker textures. Therefore, peanut butter is not a suitable recommendation for a client with dysphagia.
B. Crispy rice bar: Crispy rice bars are often dry and crunchy, which can be challenging for individuals with dysphagia to swallow safely. Foods with dry or brittle textures can increase the risk of aspiration or choking, particularly in those with swallowing difficulties.
C. Scrambled eggs: Scrambled eggs are a suitable option for individuals with dysphagia, especially if they are prepared to a soft and moist consistency. Eggs are a good source of protein and can be easily modified to meet the texture requirements of a dysphagia diet. Soft and moist foods are generally safer for individuals with swallowing difficulties.
D. Soda crackers: Soda crackers are dry and crumbly, which can present a choking risk for individuals with dysphagia. Foods with a dry and crumbly texture should be avoided or modified to a safer consistency for individuals with swallowing difficulties. Therefore, soda crackers are not recommended for a client with dysphagia.

A. The nurse wears an N95 respirator when performing client care. B. The nurse places the client on airborne precautions. C. The nurse ensures the client's room maintains a positive airflow. D. The nurse has the client wear a mask for transport to radiology.

Correct Answer is C

Explanation

A. The nurse wears an N95 respirator when performing client care: Measles is highly contagious and spreads through respiratory droplets. Wearing an N95 respirator provides appropriate respiratory protection for the nurse when caring for a client with measles. This action is appropriate and does not require intervention by the charge nurse.
B. The nurse places the client on airborne precautions: Measles is transmitted via airborne droplets, so placing the client on airborne precautions is necessary to prevent the spread of the disease to others. This action is appropriate and aligns with infection control guidelines.
C. The nurse ensures the client's room maintains a positive airflow: Positive airflow can potentially contribute to the spread of airborne pathogens outside the room, increasing the risk of transmission to others. For clients with airborne infections like measles, negative airflow rooms are required to minimize the risk of transmission to healthcare workers and other clients. Therefore, the charge nurse should intervene and correct this action.
D. The nurse has the client wear a mask for transport to radiology: Having the client wear a mask during transport helps minimize the spread of infectious droplets to others in the facility. This action is appropriate and aligns with infection control measures for airborne precautions

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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.)

Nursing Test Bank

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