A nurse is collecting data from a client who has a stage III pressure ulcer and requires a dressing change. Which of the following steps should the nurse take first?
Change the dressing.
Select the appropriate dressing.
Review available dressing types.
Document the dressing change.
The Correct Answer is C
A. Changing the dressing is an action that comes after assessing and selecting the appropriate dressing. Before changing the dressing, the nurse needs to gather information and make decisions about the most suitable type of dressing based on the characteristics of the wound.
B. Selecting the appropriate dressing is an essential step, but before doing so, the nurse should review available dressing types to make an informed decision about which dressing will best meet the needs of the wound. This involves considering factors such as the wound's characteristics, exudate level, and the overall condition of the client.
C. Reviewing available dressing types is the first step because it allows the nurse to assess the wound, gather information about the client's condition, and make an informed decision about the most appropriate dressing. This step ensures that the chosen dressing aligns with the wound's characteristics and promotes optimal healing.
D. Documenting the dressing change is an important step in the process, but it typically occurs after the dressing change has been completed. Documentation is crucial for tracking the client's progress, ensuring continuity of care, and providing a record for other healthcare team members.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A.Opening windows during a fire can increase airflow, which may actually intensify the flames and spread the fire faster. Instead, clients should close doors to contain the fire and smoke, stay low to the ground to avoid inhaling smoke, and focus on evacuating the home safely.
B.Storing the fire extinguisher away from the stove ensures it remains accessible if a fire breaks out on or near the stove. If a fire occurs, the extinguisher should be in a location that is easy to access but away from the immediate fire source to prevent the person from reaching through flames to retrieve it.
C.The correct technique is to aim the nozzle at the base of the flames, where the fuel source is. This helps to smother the fire more effectively, as aiming at the base cuts off the fuel source, whereas aiming at the top would be less effective.
D.The batteries in smoke alarms should generally be changed every 6-12 months to ensure they are functioning properly. Many recommendations also suggest testing alarms monthly and replacing the entire smoke alarm every 10 years.
Correct Answer is ["0.75"]
Explanation
To calculate the volume (mL) that the nurse should administer, you can use the following formula:
Volume (mL) = Dose (mg)/Concentration (mg/mL)
In this case:
Volume=7.5 mg/10 mg/mL
Volume=0.75mL
Therefore, the nurse should administer 0.75 mL of morphine for the 7.5 mg subcutaneous dose, rounded to the nearest hundredth.
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