A nurse is preparing to perform a wet-to-dry dressing change for a client who has an infected abdominal wound.
Which of the following techniques should the nurse use when performing this dressing change?
Remove the tape by pulling from the center of the dressing
Wear sterile gloves to remove the dressing
Clean the wound from the center to the outer edges
Moisten the dressing before removal
The Correct Answer is C
When removing the dressing and cleaning the wound, it is important to start from the center of the wound and work towards the outer edges. This technique helps prevent contamination of the wound by minimizing the risk of dragging bacteria or debris from the surrounding skin into the wound.
The other options listed are not recommended for this specific procedure:
When removing the tape, it is generally recommended to pull it parallel to the skin surface rather than pulling from the center of the dressing. This technique reduces the risk of causing trauma or disrupting the wound.
While it is important to maintain aseptic technique during dressing changes, wearing sterile gloves is not necessary for a wet-to-dry dressing change. Clean, non-sterile gloves are typically sufficient for this procedure, as the dressing material itself is not sterile.
In a wet-to-dry dressing change, the dressing is typically applied moist and allowed to dry over time. Therefore, moistening the dressing before removal is not necessary. The primary goal is to remove the dry dressing, which may adhere to the wound bed, and then clean the wound before applying a fresh dressing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Explanation B.Triiodothyronine
Levothyroxine is a synthetic form of the thyroid hormone thyroxine (T4). It is converted to triiodothyronine (T3), the active form of the thyroid hormone, in the body. Monitoring the levels of triiodothyronine (T3) can help assess the effectiveness of levothyroxine therapy and ensure that the client's thyroid hormone levels are within the desired therapeutic range.
Serum potassium levels in (option A) should not be monitored because they are not directly affected by levothyroxine. However, imbalances in electrolytes can occur in some individuals with thyroid disorders. Electrolyte levels may be monitored, but it is not the primary focus of monitoring for levothyroxine therapy.
Blood urea nitrogen (BUN) in (option C) should not be monitored because it is a test used to assess kidney function and is not directly related to monitoring levothyroxine therapy.
Prothrombin time (PT) in (option D) should not be monitored because it is a test used to evaluate the clotting function of the blood and is not specifically related to monitoring levothyroxine therapy.
Correct Answer is A
Explanation
Explanation
A. Chadwick’s sign
Chadwick's sign is a characteristic change that occurs during pregnancy, specifically in the cervix, vagina, and vulva. It is characterized by a bluish or purplish discoloration of these areas.
Chloasma in (option B) is incorrect because it is a condition characterized by the development of dark patches on the skin, commonly referred to as "mask of pregnancy." Chloasma typically affects the face, particularly the cheeks, forehead, and upper lip. It is not associated with a change in colour in the vaginal or vulvar area.
Hegar's sign in (option C) is incorrect because it is a softening of the lower uterine segment that can be felt during a pelvic examination. It is not related to the colour changes in the vaginal or vulvar area.
Ballottement in (option D) is incorrect because it is a palpation technique used during a prenatal examination to assess the position of the foetus. It involves the examiner gently pushing against the uterus and feeling a rebound or "floating" movement of the foetus. It does not involve changes in the colour of the vaginal or vulvar area.
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