A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) in an abdominal wound and is about to check the patient’s pulse.
What precautions should the nurse take?
Wear sterile gloves.
Wear protective eyewear.
Wear clean gloves.
Wear an N95 respirator mask.
The Correct Answer is C
Choice A rationale
Sterile gloves are not necessary when checking a patient’s pulse. They are typically used for procedures that require aseptic technique, such as wound dressing changes or insertion of a central venous catheter.
Choice B rationale
Protective eyewear is used to protect the healthcare provider from splashes or sprays of blood, body fluids, secretions, or excretions. It is not necessary when checking a patient’s pulse.
Choice C rationale
Clean gloves should be worn when touching blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. This includes when caring for a patient with MRSA in an abdominal wound.
Choice D rationale
An N95 respirator mask is used to protect the healthcare provider from airborne pathogens, such as tuberculosis. It is not necessary when checking a patient’s pulse.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["5.6"]
Explanation
Step 1: Convert the toddler’s weight from pounds to kilograms. 1 kg is approximately 2.2 lb. So, 33 lb ÷ 2.2 = 15 kg.
Step 2: Calculate the total daily dose of amoxicillin. The prescribed dose is 30 mg/kg/day. So, 30 mg/kg/day × 15 kg = 450 mg/day.
Step 3: Since the dose is divided into 2 equal doses every 12 hours, each dose will be half of the total daily dose. So, 450 mg/day ÷ 2 = 225 mg/dose.
Step 4: Calculate the volume of the suspension to administer per dose. The available suspension is 200 mg/5 mL. So, (225 mg/dose ÷ 200 mg) × 5 mL = 5.625 mL/dose. Therefore, the nurse should administer approximately 5.6 mL of the amoxicillin suspension per dose.
Correct Answer is C
Explanation
Choice A rationale
Full-thickness skin loss with visible bone is characteristic of a stage 4 pressure injury, not a stage 1 pressure injury.
Choice B rationale
Full-thickness skin loss with visible adipose tissue is characteristic of a stage 3 pressure injury, not a stage 1 pressure injury.
Choice C rationale
In a stage 1 pressure injury, the skin remains intact with localized erythema. The area may be painful, firm, soft, warmer, or cooler compared to adjacent tissue.
Choice D rationale
Partial-thickness skin loss with red tissue in the wound bed is characteristic of a stage 2 pressure injury, not a stage 1 pressure injury.
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