A nurse is performing wound care for a client who has an abdominal incision. Which of the following techniques should the nurse implement?

Cleanse the insertion site of the drain using a circular motion toward the center.

Irrigate the wound with a low-pressure flow of solution.

Irrigate the wound using a 10-mL syringe.

Cleanse the wound starting at the bottom and moving upward.

Answer and Explanation

The Correct Answer is B

A. Cleanse the insertion site of the drain using a circular motion toward the center: Proper technique involves cleaning from the least contaminated area (the center) outward to the surrounding skin, not toward the center, to prevent introducing pathogens into the wound.

B. Irrigate the wound with a low-pressure flow of solution: Low-pressure irrigation helps remove debris and exudate without damaging tissue or disrupting healing. It is a safe and effective method for cleansing an abdominal incision.

C. Irrigate the wound using a 10-mL syringe: Using a small syringe can create high-pressure flow, which may traumatize tissue. Larger volume syringes (e.g., 30–60 mL) with controlled, low-pressure flow are recommended for wound irrigation.

D. Cleanse the wound starting at the bottom and moving upward: Wound cleaning should proceed from the least contaminated area (top or center of the incision) toward more contaminated areas (periphery) to reduce the risk of introducing bacteria into the wound.

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Correct Answer is ["A","D","E"]

Explanation

Rationale:

A. Limit visitors to 30 min per day: Time restrictions help reduce others’ exposure to radiation from the sealed implant. Limiting duration minimizes cumulative exposure for visitors while still allowing social interaction for the client.

B. Place the client in a semi-private room: Clients with internal radiation implants require a private room to protect others from unnecessary radiation exposure. A semi-private room increases the risk of radiation exposure to other patients and is inappropriate.

C. Instruct visitors who are pregnant to remain 3 feet from the client: Pregnant visitors should avoid contact with clients receiving internal radiation entirely, as even minimal exposure could harm the fetus. The safest recommendation is to avoid visiting during treatment.

D. Wear a lead apron when providing care: A lead apron shields the nurse from radiation exposure, especially when working close to the client. This is part of the time, distance, and shielding principles for radiation safety.

E. Close the door to the client's room: Keeping the door closed helps contain radiation within the client’s room, reducing exposure to staff and visitors in nearby areas. This is a standard precaution in caring for clients with sealed implants.

A. Food exchange lists for meal planning from the American Diabetes Association B. Food label recommendations from the Institute of Medicine C. Diabetes medication information from the Physicians' Desk Reference D. Personal blogs about managing the adverse effects of diabetes medications

Correct Answer is A

Explanation

Rationale:

A. Food exchange lists for meal planning from the American Diabetes Association: The ADA provides evidence-based, reliable resources for meal planning that help clients manage blood glucose levels and make informed dietary choices. These lists are tailored for diabetes management.

B. Food label recommendations from the Institute of Medicine: While the IOM provides general nutrition guidelines, they are not specifically designed for diabetes management and may not address individualized meal planning needs for blood glucose control.

C. Diabetes medication information from the Physicians' Desk Reference: The PDR contains medication details but is intended for healthcare professionals, not clients. It may be too technical for patient education purposes.

D. Personal blogs about managing the adverse effects of diabetes medications: Blogs may provide anecdotal information that is not evidence-based and could be inaccurate or misleading, making them an unreliable resource for client education.

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A nurse is performing wound care for a client who has an abdominal incision. Which of the following techniques should the nurse implement?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is ["A","D","E"]

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Correct Answer is A

Explanation

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