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 D
Explanation
A. The statement "You can resume sexual activity 2 days after you complete your antiviral treatment" is incorrect. Chlamydia is a bacterial infection, and the standard treatment is with antibiotics, not antivirals. Additionally, the client should wait until they have completed the full course of antibiotics and have been re-evaluated by their healthcare provider before resuming sexual activity to prevent the spread of the infection.
B. The statement "Your sexual partners can receive a chlamydia vaccine to protect against infection" is incorrect. As of my last knowledge update in January 2022, there is no chlamydia vaccine available. Chlamydia is typically treated with antibiotics, and preventing transmission involves safe sexual practices and partner notification.
C. The statement "Chlamydia is an incurable infection that causes a thick, curd-like discharge" is incorrect. Chlamydia is a curable bacterial infection, and it may or may not cause symptoms. It does not typically cause a thick, curd-like discharge; that description is more characteristic of a yeast infection.
D. The statement "The law requires a report of each case of chlamydia to the local health department" is correct. Chlamydia is a notifiable disease, meaning healthcare providers are legally required to report cases to the local health department. This reporting is essential for public health surveillance, tracking the prevalence of the infection, and implementing measures to control its spread.
Correct Answer is A
Explanation
A. In team nursing, an RN assumes the role of a team leader or coordinator. The RN oversees and coordinates the care provided by other team members, which may include licensed practical nurses (LPNs), nursing assistants, and other healthcare professionals. The team collaborates to meet the needs of a group of clients.
B. Caring for the same clients throughout their hospitalization is more characteristic of primary nursing, where an RN takes primary responsibility for the care of a specific group of clients.
C. Linking community resources with clients to ensure quality care is more aligned with case management or community health nursing, where the focus is on coordinating services across healthcare settings and connecting clients with appropriate resources.
D. Providing every aspect of care for a group of clients during a shift is not consistent with team nursing. In team nursing, the workload is distributed among team members, and an RN typically coordinates and oversees the care provided by the team.
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