A nurse is contributing to the plan of care for a client who has developed an infectious wound with foul-smelling drainage. Which of the following actions should the nurse include in the plan of care?
Discard soiled wound care supplies in a trash receptacle outside the client's room.
Administer antibiotic therapy before culturing the client's wound.
Instruct visitors to perform hand hygiene for 15 seconds after leaving the client's room.
Place the client in a private room with a private bathroom.
The Correct Answer is D
Choice A reason: Discarding soiled wound care supplies in a trash receptacle outside the client's room is not an appropriate action. The nurse should dispose of contaminated materials in a biohazard container inside the client's room to prevent the spread of infection.
Choice B reason: Administering antibiotic therapy before culturing the client's wound is not an appropriate action. The nurse should obtain a wound culture before starting antibiotic therapy to ensure accurate results and avoid altering the microorganisms present in the wound.
Choice C reason: Instructing visitors to perform hand hygiene for 15 seconds after leaving the client's room is not an appropriate action. The nurse should instruct visitors to perform hand hygiene for at least 20 seconds before and after entering the client's room to reduce the risk of transmitting infection.
Choice D reason: Placing the client in a private room with a private bathroom is an appropriate action. The nurse should implement contact precautions for a client who has an infectious wound with foul-smelling drainage to prevent cross-contamination and protect other clients and staff from exposure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A: This is correct because aligning the client's joints with the joints on the frame can ensure proper functioning and comfort of the CPM device. The nurse should adjust the length and width of the device to fit the client's leg and secure it with straps.
Choice B: This is incorrect because padding the CPM device with a thick pillow can interfere with its movement and cause pressure on the leg. The nurse should use only thin padding or no padding at all for the CPM device.
Choice C: This is incorrect because placing the client in high-Fowler's position can cause flexion contractures and impair circulation in the leg. The nurse should place the client in supine or semi-Fowler's position with the leg elevated on pillows.
Choice D: This is incorrect because setting the degree of flexion and extension as tolerated by client can cause excessive pain and damage to the joint. The nurse should set the degree of flexion and extension according to the provider's prescription and gradually increase it as ordered.
Correct Answer is A
Explanation
Choice A reason: Urinating before and after sexual intercourse can help flush out any bacteria that may have entered the urinary tract during sexual activity, and prevent them from causing an infection.
Choice B reason: Increasing milk consumption to make the urine more alkaline is not a recommended instruction, as it may increase the risk of developing kidney stones or calcium deposits in the urinary tract.
Choice C reason: Emptying the bladder at least every 4 hours is a good practice, but not sufficient to prevent urinary tract infections. The nurse should also advise the client to drink plenty of fluids, especially water, to dilute the urine and flush out bacteria.
Choice D reason: Using vaginal douche once a week is not a recommended instruction, as it may alter the normal flora of the vagina and increase the risk of infection. The nurse should advise the client to avoid using any products that may irritate the genital area, such as perfumed soaps, sprays, or powders.
Choice E reason: Drinking cranberry juice daily is not a proven method to prevent urinary tract infections, although some studies suggest that it may have some benefits. The nurse should inform the client that cranberry juice may interact with some medications, such as warfarin, and that it may also increase the acidity of the urine, which can cause discomfort or burning sensation.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today