A nurse is caring for a client who has Clostridium difficile. When applying a cover gown, which of the following techniques should the nurse use?

Tie the gown with the gloves on.

Tuck the glove cuffs under the gown sleeves.

Apply the gown before the gloves.

Push the gown sleeves up to the elbows.

Answer and Explanation

The Correct Answer is C

A. Tying the gown with the gloves on is incorrect. The correct order of donning personal protective equipment (PPE. is to apply the gown first, followed by gloves. Tying the gown after the gloves may compromise proper gown coverage.

B. Tucking the glove cuffs under the gown sleeves is incorrect. The glove cuffs should be pulled over the gown sleeves to ensure a secure, closed barrier between the gown and gloves, helping to prevent contamination.

C. Applying the gown before the gloves is correct. According to infection control guidelines, the gown should be worn first, followed by gloves. This technique ensures that the gown covers the sleeves properly and that the gloves are overlapping the gown cuffs, reducing the risk of contamination.

D. Pushing the gown sleeves up to the elbows is incorrect. Gown sleeves should remain down to cover the wrists to protect the forearms from contamination, especially when caring for a patient with Clostridium difficile, which requires contact precautions.

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Correct Answer is A

Explanation

A. Telling the APs to stop the conversation is correct. Discussing client information in a public area violates HIPAA (Health Insurance Portability and Accountability Act) privacy regulations. The nurse should immediately intervene and remind the APs about maintaining client confidentiality.

B. Documenting the event in the client's progress notes is incorrect. Client progress notes should contain only information relevant to client care. Documenting an overheard conversation about a privacy violation does not belong in the medical record.

C. Informing the client of the APs' actions is incorrect. While privacy is essential, informing the client may cause unnecessary distress. The nurse should focus on correcting the behavior of the APs rather than alarming the client.

D. Submitting an incident report to the risk manager is incorrect. While some breaches of confidentiality require reporting, the first step is to address the issue directly with the APs. If the behavior continues or is severe, reporting to a supervisor may be necessary.

A. Positive clonus B. Urinary output 20 mL/hr C. Respiratory rate 10/min D. Deep tendon reflexes 2+

Correct Answer is D

Explanation

A. Positive clonus is a sign of hyperreflexia and can indicate worsening preeclampsia or severe central nervous system irritability. It is not a therapeutic effect of magnesium sulfate.

B. Urinary output 20 mL/hr is below the minimum expected urine output (which is generally 30 mL/hr). This finding suggests oliguria and may be a sign of worsening renal function, which is not a therapeutic effect of magnesium sulfate.

C. Respiratory rate 10/min is too low. Magnesium sulfate can cause respiratory depression, and a respiratory rate of 10/min may indicate toxicity. This is not a therapeutic effect.

D. Deep tendon reflexes 2+ is the correct answer. Magnesium sulfate is used to prevent seizures in preeclampsia by acting as a CNS depressant. A normal response of 2+ for deep tendon reflexes indicates that magnesium sulfate is having a therapeutic effect and the client is not experiencing magnesium toxicity (which would typically cause a decreased reflex response..

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A nurse is caring for a client who has Clostridium difficile. When applying a cover gown, which of the following techniques should the nurse use?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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