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 A
Explanation
Choice A rationale
The stoma for a sigmoid colostomy is typically located in the lower left abdomen. This is because the sigmoid colon is a part of the large intestine that is located in the lower left quadrant of the abdomen.
Choice B rationale
A stoma should appear pink or red and moist. A purple stoma could indicate a lack of blood supply, which is a medical emergency.
Choice C rationale
A sigmoid colostomy will produce formed stool because the sigmoid colon is the last part of the colon, where water is absorbed and stool is formed.
Choice D rationale
The end of the stoma (the part that sticks out from the abdomen) should not be painful after the procedure. If a patient experiences pain, it could indicate a complication such as a blockage or infection.
Correct Answer is ["24"]
Explanation
Step 1 is: To find out how many mL/hr the IV pump should be set to deliver, we need to set up a proportion with the prescribed units of heparin on one side and the available units of heparin on the other side. So, the calculation is: (1,200 units/hr ÷ 25,000 units) × 500 mL = 24 mL/hr.
Therefore, the IV pump should be set to deliver 24 mL/hr.
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