A nurse is caring for a client who has methicillinresistant Staphylococcus aureus (MRSA) in an abdominal wound. The nurse prepares to enter the room to check the client's pulse. What personal protective equipment (PPE) should the nurse wear?
Gown
Sterile gloves
PAPR mask
Surgical mask
The Correct Answer is A
Choice A reason: Wearing a gown is the correct answer, because it is the appropriate PPE for contact precautions, which are required for clients who have MRSA. MRSA is a type of bacteria that is resistant to many antibiotics and can cause serious infections in the skin, blood, lungs, or other organs. MRSA can be transmitted by direct or indirect contact with the infected wound or contaminated surfaces. Wearing a gown can protect the nurse's clothing and skin from exposure to MRSA.
Choice B reason: Wearing sterile gloves is not the correct answer, because it is not the appropriate PPE for contact precautions, which are required for clients who have MRSA. Sterile gloves are used for sterile procedures, such as inserting a catheter or changing a dressing, not for routine assessments, such as checking the pulse. Wearing sterile gloves can be wasteful and unnecessary, and it does not provide adequate protection from MRSA.
Choice C reason: Wearing a PAPR mask is not the correct answer, because it is not the appropriate PPE for contact precautions, which are required for clients who have MRSA. PAPR stands for powered airpurifying respirator, and it is a type of mask that filters the air and provides positive pressure to the wearer. PAPR masks are used for airborne precautions, which are required for clients who have diseases that can be spread through the air, such as tuberculosis or measles, not for clients who have MRSA.
Choice D reason: Wearing a surgical mask is not the correct answer, because it is not the appropriate PPE for contact precautions, which are required for clients who have MRSA. Surgical masks are used for droplet precautions, which are required for clients who have diseases that can be spread through respiratory droplets, such as influenza or pertussis, not for clients who have MRSA.
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Related Questions
Correct Answer is C
Explanation
Choice A reason: A bone fragment has injured the nerve supply in the area is not the best response by the nurse. This may be a possible complication of a fracture, but it does not explain the mechanism of compartment syndrome. Compartment syndrome is a condition where the pressure within a closed space (such as a muscle compartment) exceeds the perfusion pressure and causes ischemia and necrosis of the tissues. A bone fragment may damage the nerve, but it does not cause increased pressure in the compartment.
Choice B reason: An injured artery causes impaired arterial perfusion through the compartment is not the best response by the nurse. This may be a possible cause of compartment syndrome, but it is not the most common one. Compartment syndrome is more often caused by venous obstruction than arterial obstruction. An injured artery may reduce the blood flow to the compartment, but it does not cause increased pressure in the compartment.
Choice C reason: Bleeding and swelling cause increased pressure in an area that cannot expand is the best response by the nurse. This is the most common cause of compartment syndrome and explains the pathophysiology of the condition. Bleeding and swelling are the result of inflammation and tissue injury that occur after a fracture. They increase the volume of fluid in the compartment, which cannot expand due to the rigid fascia that surrounds it. This leads to increased pressure in the compartment, which compresses the blood vessels, nerves, and muscles and causes ischemia and necrosis of the tissues.
Choice D reason: The fascia expands with injury, causing pressure on underlying nerves and muscles is not the best response by the nurse. This is not a correct statement, as the fascia does not expand with injury. The fascia is a tough connective tissue that encloses the muscle compartments and limits their expansion. The fascia is part of the problem, not the cause, of compartment syndrome. The fascia prevents the compartment from accommodating the increased volume of fluid and causes increased pressure in the compartment.
Correct Answer is B
Explanation
Choice A reason: Nociceptive pain is not the type of pain that the client is experiencing. Nociceptive pain is caused by the stimulation of nociceptors, which are sensory receptors that detect tissue damage or potential harm. Nociceptive pain is usually localized, sharp, throbbing, or aching. It is associated with injuries such as cuts, burns, sprains, or fractures. The client's pain is not caused by any tissue damage or harm in the distal part of the amputated limb, as there is no tissue left there.
Choice B reason: Neuropathic pain is the type of pain that the client is experiencing. Neuropathic pain is caused by the damage or dysfunction of the nervous system, such as the peripheral nerves, the spinal cord, or the brain. Neuropathic pain is usually chronic, burning, shooting, or tingling. It is associated with conditions such as diabetes, shingles, stroke, or amputation. The client's pain is caused by the disruption of the nerve signals from the amputated limb, which creates a phantom sensation of pain in the missing part.
Choice C reason: Cutaneous pain is not the type of pain that the client is experiencing. Cutaneous pain is caused by the stimulation of the cutaneous receptors, which are sensory receptors that detect touch, temperature, or pressure on the skin. Cutaneous pain is usually superficial, brief, or pricking. It is associated with stimuli such as pinching, scratching, or cold. The client's pain is not caused by any touch, temperature, or pressure on the skin of the distal part of the amputated limb, as there is no skin left there.
Choice D reason: Visceral pain is not the type of pain that the client is experiencing. Visceral pain is caused by the stimulation of the visceral receptors, which are sensory receptors that detect stretch, inflammation, or ischemia in the internal organs. Visceral pain is usually deep, dull, or cramping. It is associated with conditions such as appendicitis, pancreatitis, or bowel obstruction. The client's pain is not caused by any stretch, inflammation, or ischemia in the internal organs of the distal part of the amputated limb, as there are no organs left there.
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