Which is the best approach to change nasogastric tube tape that has become crusted with secretions?

Soak the crusted areas of tape with adhesive remover.

Saturate the tape with a denatured alcohol solution.

Use blunt-edged scissors to loosen the tape from the skin.

Soften the secretions using a warm moist washcloth.

Answer and Explanation

The Correct Answer is D

Choice A reason: This is an incorrect choice because soaking the crusted areas of tape with adhesive remover is not the best approach to change nasogastric tube tape that has become crusted with secretions. Adhesive remover is a solvent that can dissolve the glue that holds the tape to the skin. However, it can also irritate the skin and cause redness, burning, or allergic reactions. The nurse should avoid using adhesive remover on the patient's face, especially near the eyes, nose, or mouth.

Choice B reason: This is an incorrect choice because saturating the tape with a denatured alcohol solution is not the best approach to change nasogastric tube tape that has become crusted with secretions. Denatured alcohol is a mixture of ethanol and other chemicals that can dissolve the glue that holds the tape to the skin. However, it can also dry out the skin and cause cracking, peeling, or bleeding. The nurse should avoid using denatured alcohol on the patient's face, especially near the eyes, nose, or mouth.

Choice C reason: This is an incorrect choice because using blunt-edged scissors to loosen the tape from the skin is not the best approach to change nasogastric tube tape that has become crusted with secretions. Blunt-edged scissors are scissors that have rounded tips instead of sharp points. They can be used to cut the tape without injuring the skin. However, they can also pull or tug on the skin and cause pain, discomfort, or damage. The nurse should avoid using scissors on the patient's face, especially near the eyes, nose, or mouth.

Choice D reason: This is the correct choice because softening the secretions using a warm moist washcloth is the best approach to change nasogastric tube tape that has become crusted with secretions. A warm moist washcloth is a cloth that is soaked in warm water and wrung out. It can be applied gently to the crusted areas of tape to soften the secretions and loosen the tape from the skin. It can also soothe the skin and prevent irritation or infection. The nurse should use a clean washcloth for each application and discard it after use.

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Correct Answer is A

Explanation

Choice A reason: This is the correct choice because melatonin is the safest sleep aid for the elderly patient with insomnia. Melatonin is a natural hormone that regulates the sleep-wake cycle. It has few side effects and interactions, and does not cause dependence or withdrawal. Melatonin can improve the quality and duration of sleep, and reduce the time to fall asleep.

Choice B reason: This is an incorrect choice because temazepam is not the safest sleep aid for the elderly patient with insomnia. Temazepam is a benzodiazepine that enhances the activity of GABA, a neurotransmitter that inhibits brain activity. It has many side effects and interactions, and can cause dependence, tolerance, or withdrawal. Temazepam can also impair cognitive and motor functions, and increase the risk of falls, fractures, and delirium.

Choice C reason: This is an incorrect choice because trazodone is not the safest sleep aid for the elderly patient with insomnia. Trazodone is an antidepressant that blocks the reuptake of serotonin, a neurotransmitter that regulates mood and sleep. It has many side effects and interactions, and can cause orthostatic hypotension, cardiac arrhythmias, priapism, or serotonin syndrome. Trazodone can also impair cognitive and motor functions, and increase the risk of falls, fractures, and delirium.

Choice D reason: This is an incorrect choice because triazolam is not the safest sleep aid for the elderly patient with insomnia. Triazolam is a benzodiazepine that enhances the activity of GABA, a neurotransmitter that inhibits brain activity. It has many side effects and interactions, and can cause dependence, tolerance, or withdrawal. Triazolam can also impair cognitive and motor functions, and increase the risk of falls, fractures, and delirium.

A. Presence of pedal pulses and intact sensation B. Presence of fingernail clubbing C. Presence of abdominal rebound tenderness D. Presence of any petechiae or bruises

Correct Answer is A

Explanation

Choice A reason: This is the correct choice because presence of pedal pulses and intact sensation is the most important bath time assessment of the diabetic patient. Pedal pulses are the pulses that can be felt on the top or side of the foot, and they indicate the blood flow to the lower extremities. Intact sensation is the ability to feel touch, pain, temperature, and vibration on the skin, and it indicates the nerve function of the lower extremities. Diabetic patients are at risk of developing peripheral vascular disease and peripheral neuropathy, which can impair the blood flow and nerve function of the lower extremities, and lead to ulcers, infections, or amputations. The nurse should assess the pedal pulses and intact sensation of the diabetic patient regularly, especially before and after bathing, to monitor for any signs of complications or deterioration.

Choice B reason: This is an incorrect choice because presence of fingernail clubbing is not the most important bath time assessment of the diabetic patient. Fingernail clubbing is a condition where the nails become curved and enlarged, and the nail bed becomes soft and spongy. It is a sign of chronic hypoxia or low oxygen levels in the blood, and it can be associated with various diseases such as lung cancer, cystic fibrosis, or congenital heart defects. However, it is not a common or specific complication of diabetes, and it does not pose an immediate risk of harm or injury to the diabetic patient.

Choice C reason: This is an incorrect choice because presence of abdominal rebound tenderness is not the most important bath time assessment of the diabetic patient. Abdominal rebound tenderness is a sign of peritoneal inflammation, which is the inflammation of the membrane that lines the abdominal cavity and organs. It is elicited by pressing and releasing the abdomen quickly, and it causes pain when the pressure is released. It can be caused by various conditions such as appendicitis, diverticulitis, or peritonitis. However, it is not a common or specific complication of diabetes, and it does not pose an immediate risk of harm or injury to the diabetic patient.

Choice D reason: This is an incorrect choice because presence of any petechiae or bruises is not the most important bath time assessment of the diabetic patient. Petechiae are small, red, or purple spots on the skin that are caused by bleeding under the skin. Bruises are larger, blue, or purple areas on the skin that are caused by bleeding under the skin. They can be caused by various factors such as trauma, infection, medication, or blood disorders. However, they are not a common or specific complication of diabetes, and they do not pose an immediate risk of harm or injury to the diabetic patient.

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Which is the best approach to change nasogastric tube tape that has become crusted with secretions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which is the safest sleep aid for the elderly patient with insomnia?

Correct Answer is A

Explanation

Which bath time assessment of the diabetic patient is most important?

Correct Answer is A

Explanation

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