A nurse is reinforcing teaching with a client who has herpes simplex virus type 2. Which of the following statements by the client indicates an understanding of the teaching?

"The virus cannot spread to areas other than the genital area."

"The lesions may reoccur in times of stress."

"I am only contagious while the lesions are present."

"I can have unprotected sex as long as I am taking acyclovir."

Answer and Explanation

The Correct Answer is B

"The lesions may reoccur in times of stress." This statement indicates that the client understands that the virus can reactivate and cause new outbreaks during times of stress.

Choice A is not correct because the virus can spread to other areas through skin-to-skin contact.

Choice C is not correct because the virus can still be contagious even when no lesions are present.

Choice D is not correct because having unprotected sex can still transmit the virus even while taking acyclovir.

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Correct Answer is C

Explanation

The correct answer is c. Apply a moist saline dressing to the area.

Choice A reason: Obtaining a set of vital signs is important, but it is not the immediate priority in this situation. The vital signs will not address the protruding organs directly.

Choice B reason: Flexing the client’s knees and hips may provide comfort but does not directly address the issue of the open incision and protruding organs.

Choice C reason: Applying a moist saline dressing to the area is the correct action. It helps to protect the protruding organs by keeping them moist and reduces the risk of organ damage or infection. This is the priority action to keep the organs moist and reduce the risk of tissue damage until surgical repair can be done.

Choice D reason: Elevating the head of the client’s bed 20° may be part of the overall care plan, but it is not the immediate priority when dealing with protruding organs from an open abdominal incision.

A. Apply moist heat to the incision while in bed. B. Sit in a straight-backed chair. C. Perform range of motion exercises by adducting the hip.

Correct Answer is B

Explanation

Sit in a straight-backed chair. After a total hiparthroplasty, the client should avoid sitting in chairs that are too low or too soft, as they can be difficult to rise from and can risk dislocating the new hip. The clientshould apply ice to the incision site, not moist heat, in the first few dayspostoperatively. The client should avoid adducting the hip as this can also riskdislocation of the new hip joint. Hydrogen peroxide should not be used to cleanthe surgical incision, as it can delay wound healing.

Choice A: The client shouldapply ice to the incision site, not moist heat, in the first few days postoperatively.

Choice C: The client should avoid adducting the hip as this can risk dislocation ofthe new hip joint.

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A nurse is reinforcing teaching with a client who has herpes simplex virus type 2. Which of the following statements by the client indicates an understanding of the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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