The nurse is instructing the parents of a child who underwent a surgical repair of a myelomeningocele on how to change an occlusive dressing on the child’s back.
Which parental statement indicates understanding of the procedure?
The skin incision should be kept moist by periodically wetting the dressing.
When changing the dressing, the tape should be removed rapidly from the edges.
The incision should be protected from fecal contamination by an intact dressing.
To ensure easy removal of the sutures, the dressing should be kept dry.
To ensure easy removal of the sutures, the dressing should be kept dry.
The Correct Answer is C
Choice A rationale
Keeping the skin incision moist by periodically wetting the dressing is not the recommended care for a myelomeningocele surgical repair. The dressing needs to be kept dry to prevent infection and promote healing.
Choice B rationale
Removing the tape rapidly from the edges of the dressing during a change is not advised. This could potentially damage the skin and disrupt the healing process.
Choice C rationale
An intact dressing protects the incision from fecal contamination, which is crucial in preventing infection. This statement indicates an understanding of the procedure.
Choice D rationale
While it’s important to keep the dressing dry to ensure easy removal of sutures, it’s not the primary concern. The main goal is to protect the incision from contamination.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"C"}
Explanation
A. Croup
- Rationale: Croup is a condition characterized by a barking cough and stridor (a high-pitched breathing sound), often accompanied by noisy breathing. It is a common cause of respiratory distress in children and can present with symptoms similar to those described.
B. Asthma
- Rationale: Asthma can present in young children with symptoms such as wheezing, shortness of breath, and rapid breathing. However, diagnosing asthma in very young children can be challenging due to the variability of symptoms and the overlap with other respiratory conditions.
C. Bronchiolitis
- Rationale: The child’s symptoms of “fast and noisy breathing” could be indicative of bronchiolitis, a common lung infection in young children. This condition is often preceded by symptoms of a common cold, such as sneezing and a runny nose, which the child had the previous week.
D. Foreign Body Aspiration
- Rationale: Foreign body aspiration should be considered in young children who present with sudden onset of respiratory symptoms, including noisy or rapid breathing, particularly if there is a history of coughing or choking.
Correct Answer is D
Explanation
The correct answer is **d. Monitor the infant for response to auditory stimuli**.
Choice A rationale:
Drawing an antibiotic trough level within 3 days is not a necessary action after a 14-day antibiotic treatment for bacterial meningitis in an infant. Trough levels are typically monitored during the course of treatment to ensure appropriate dosing, not after completion of therapy.
Choice B rationale:
Administering antipyretic medication continuously is not recommended after the completion of antibiotic treatment for bacterial meningitis. Fever is a common symptom during the acute phase of the illness, and the need for antipyretics should decrease as the infection is resolved.
Choice C rationale:
Continuing strict monitoring of daily wet diapers for 1 week is not a necessary action after the completion of antibiotic treatment for bacterial meningitis. Monitoring fluid intake and output is important during the acute phase of the illness, but not necessarily after the infant has completed the full course of antibiotics.
Choice D rationale:
Monitoring the infant for response to auditory stimuli is an important action to include when preparing the family for discharge after a 14-day antibiotic treatment for bacterial meningitis. Hearing loss is a potential complication of bacterial meningitis, and the infant should be evaluated for any hearing impairment before being discharged from the hospital.
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