As seen in the picture, the practical nurse (PN) begins to remove a pair of sterile gloves after changing a client's dressing. Which action should the PN take next?
Move away from the overbed table.
Pull glove down, keeping inside out.
Loosen the glove from the fingers.
Raise the hands above waist level.
The Correct Answer is B
A. Move away from the overbed table: This action can be done after the gloves are completely removed and disposed of. Moving away too early increases the risk of bumping into something and contaminating the gloves.
B. Sterile gloves are contaminated on the outside after performing a procedure like a dressing change. Pulling the glove down and everting it (turning it inside out) confines the contamination to the inside of the glove, reducing the risk of transferring germs to the hands or surrounding surfaces. This maintains a sterile field and minimizes the risk of healthcare-associated infections (HAIs).
C. Loosen the glove from the fingers: This might be the initial step while grasping the glove for removal, but the key is to maintain aseptic technique by keeping the outside of the glove contained throughout removal.
D. Raise the hands above waist level: Raising hands above the waist level increases the risk of contaminating the sterile field or nearby surfaces if the glove integrity is compromised.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Lifting the skin is a common technique used to assess skin turgor, which is the elasticity of the skin.By letting go, the nurse can observe how quickly the skin snaps back into place, indicating good or poor elasticity.
B. recording palpated temperature might be done during a focused assessment, but it wouldn't necessarily be the next step after lifting the skin.
C. measuring indentation depth might be relevant for assessing edema (swelling), but it's not the primary focus after lifting for turgor.
D. observing swelling could be assessed visually without lifting the skin, and while it's important, assessing elasticity comes first in this scenario.
Correct Answer is D
Explanation
A. C-reactive protein level is a general marker for inflammation and can indicate infection, but it does not provide specific information about the wound infection.
B. Serum albumin is important for assessing nutritional status and wound healing potential, but it does not directly address the acute issue of a possible wound infection.
C. Serum blood glucose level is significant, especially in clients with diabetes, as high glucose can impair healing and increase infection risk. However, it does not directly provide information about the infection itself.
D. Culture for sensitive organisms is the most relevant lab value to evaluate before reporting to the healthcare provider. It identifies the specific pathogens causing the infection and guides appropriate antibiotic treatment.
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