The nurse is preparing to change the linens on the bed of a client who has a draining sacral wound infected by MRSA. Which PPE items should the nurse plan to use? (Select all that apply.)

Shoe covers

Gown

N95 respirator

Surgical mask

Gloves

Answer and Explanation

Correct Answer : B,D,E

A reason:

Shoe covers are not typically required for standard precautions when dealing with MRSA-infected wounds. They are used in specific scenarios to prevent environmental contamination.

B reason:

Wearing a gown is essential to protect the nurse's clothing and skin from potential contamination with MRSA.

C reason:

An N95 respirator is not necessary unless there is a concern about airborne transmission, which is not the case with MRSA in a draining wound.

D reason:

A surgical mask may be used to protect the nurse from any potential splashes or to prevent respiratory droplets from contaminating the wound area.

E reason:

Gloves are essential to protect the nurse's hands from contamination and prevent the spread of MRSA. They should be worn during any contact with the wound or contaminated linens.

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

Explanation

A reason:

Shaving the client's hair in the direction of hair growth is correct. This technique helps to reduce the risk of skin irritation and cuts.

B reason:

Washing the client's extremities from proximal to distal is incorrect. The correct technique is to wash from distal to proximal to promote circulation and prevent the spread of contamination.

C reason:

Checking for personal items when changing the bed linens is correct. This prevents accidental loss or damage to the client's belongings and ensures a thorough and respectful care process.

D reason:

Keeping the bath water temperature between 43.3°C (110°F) and 46.1°C (115°F) is correct. This range is warm enough to be comfortable and effective for cleaning without risking burns or discomfort.

E reason:

Placing a clean gown on the strongest arm first is incorrect. The gown should be placed on the weakest arm first to reduce the difficulty and discomfort during the dressing process.

A. I will have a cup of hot cocoa immediately before bedtime B. I will walk briskly for 30 minutes before bedtime C. I will do my muscle relaxation techniques each afternoon D. I will no longer have a glass of wine before bedtime

Correct Answer is D

Explanation

A reason:

Having a cup of hot cocoa immediately before bedtime is not advisable as it contains caffeine, which can interfere with sleep. Herbal teas or warm milk are better alternatives to promote relaxation and sleep.

B reason:

Walking briskly for 30 minutes before bedtime can be stimulating rather than relaxing. While regular exercise is beneficial for sleep, it is best performed earlier in the day. Exercise close to bedtime can increase alertness and make it harder to fall asleep.

C reason:

Doing muscle relaxation techniques each afternoon is beneficial, but the focus should be on practicing these techniques before bedtime to help wind down and prepare for sleep. Afternoon relaxation is good but not directly related to sleep promotion.

D reason:

Avoiding alcohol before bedtime is correct. Although alcohol may initially make one feel drowsy, it can disrupt sleep patterns and reduce sleep quality. Abstaining from alcohol before bed is a positive step toward improving sleep.

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The nurse is preparing to change the linens on the bed of a client who has a draining sacral wound infected by MRSA. Which PPE items should the nurse plan to use? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing hygiene care for a client who is immobile. Which of the following actions should the nurse take? (Select all that apply.)

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

Explanation

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Correct Answer is D

Explanation

The nurse is preparing to change the linens on the bed of a client who has a draining sacral wound infected by MRSA. Which PPE items should the nurse plan to use? (Select all that apply.)

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