When performing dressing changes in an older client, what should the nurse assess for?
Signs of infection
Skin color changes
Decreased pain levels
Changes in blood pressure
The Correct Answer is A
A. Signs of infection: Older adults may have compromised immune systems and are more susceptible to infections. During dressing changes, the nurse should assess for signs of infection such as increased redness, swelling, warmth, drainage, or foul odor, which could indicate an infection at the wound site.
B. Skin color changes: While changes in skin color can be indicative of various skin conditions or circulation problems, assessing for signs of infection is more pertinent during dressing changes to prevent and manage complications.
C. Decreased pain levels: Older adults may have altered pain perception due to age-related changes or comorbidities. However, assessing for signs of infection takes priority during dressing changes to ensure timely intervention if infection is present.
D. Changes in blood pressure: Changes in blood pressure may be relevant in certain clinical contexts but are not specifically related to performing dressing changes in older clients.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Alcohol and cotton swabs: When a patient undergoes skin testing for allergies, it's important to have alcohol and cotton swabs readily available to clean the skin before applying allergens. This helps ensure that the test results are accurate and not influenced by any contaminants on the skin.
B. Resuscitation equipment: While resuscitation equipment is essential in any medical setting, it is not directly related to skin testing for allergies.
C. Flashlight: A flashlight may be helpful for visualizing the skin during the procedure, but it is not as crucial as alcohol and cotton swabs for skin preparation.
D. Measuring guide: A measuring guide may be used for other types of assessments or procedures but is not specifically necessary for skin testing for allergies.
Correct Answer is B
Explanation
A. Place a N95 mask on the patient: Tuberculosis (TB) is an airborne infectious disease, and N95 masks are specifically designed to filter out airborne particles, including those that may carry TB bacteria. Therefore, placing an N95 mask on the patient helps prevent the spread of TB to others during transportation.
B. Place a surgical mask on the patient: While a surgical mask may provide some level of
protection, it is not as effective as an N95 mask in filtering out airborne particles, particularly those associated with TB transmission.
C. Be sure the patient is wearing a protective gown: Protective gowns are typically used to
prevent the transmission of infection through contact with body fluids or contaminated surfaces. However, in the case of TB, airborne precautions, including respiratory protection with masks, are more crucial.
D. Instruct the patient to wear gloves to radiology: Gloves are not necessary for respiratory protection against TB during transportation to radiology.
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