A nurse is caring for a male client who has a spinal cord injury. Which of the following techniques should the nurse use when providing perineal care?
Use water with no soap to prevent skin irritation.
Discard the washcloth after cleansing the urethral meatus.
Don sterile gloves to prevent infection.
Wash the penis from the scrotum to the tip using a spiral motion.
The Correct Answer is B
A. While avoiding harsh soap is important, using water alone may not adequately clean the area.
B. After cleaning the urethral meatus, the nurse should discard the washcloth or use a different part of it to prevent the spread of bacteria.
C. Clean gloves are typically sufficient unless the procedure involves a sterile environment.
D. The penis should be cleaned from the tip to the base (proximal to distal) to reduce the risk of introducing bacteria.
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Related Questions
Correct Answer is D
Explanation
A. Hemoglobin and hematocrit are important but not the focus in Alzheimer’s care unless anemia is suspected.
B. Liver function tests are not typically monitored unless the client is on hepatotoxic medications.
C. Kidney function tests are essential if there are concerns about hydration or medication clearance but are not routine in Alzheimer's care.
D. Monitoring serum sodium and potassium is critical as imbalances can lead to confusion, agitation, and worsening cognitive symptoms.
Correct Answer is C
Explanation
A. Ranitidine: An H2 receptor blocker, typically used to reduce stomach acid, is unnecessary since the stomach has been removed.
B. Vitamin K: Although important for clotting, vitamin K absorption is not significantly affected by total gastrectomy.
C. Vitamin B12: Clients require lifelong vitamin B12 supplementation (usually via intramuscular injections) after total gastrectomy to prevent deficiency and associated complications such as anemia and neurological impairments.
D. Metoclopramide: A prokinetic agent used to enhance gastric motility, which is not relevant after total gastrectomy.
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