A nurse is obtaining an aerobic wound culture for a client. Which of the following actions should the nurse take first?
Swab the wound bed with a sterile cotton-tipped swab
Cleanse the area around the wound with sterile saline.
Don sterile gloves
Place the collection tube in a specimen bag.
The Correct Answer is C
- A: Swabbing the wound bed is an essential step in obtaining a wound culture, but it is not the first action that should be taken. This step is performed after the wound has been cleansed to ensure that the sample is not contaminated with debris or bacteria from the surrounding skin.
- B: Cleansing the area around the wound with sterile saline is the correct first step. This action helps to remove any contaminants or debris from the wound surface, ensuring that the culture obtained is from the wound itself and not from the surrounding skin, which could lead to inaccurate results.
- C: Donning sterile gloves is a crucial step to maintain sterility during the procedure. However, it is not the first action because the nurse must first cleanse the wound area to prevent contamination of the culture specimen.
- D: Placing the collection tube in a specimen bag is done after obtaining the wound culture to transport the specimen to the laboratory. This is one of the final steps in the process, not the first.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: A superficial wound with no exudate (fluid drainage) can benefit from a film dressing. Film dressings are transparent, adhesive, and provide a protective barrier while allowing visualization of the wound. They are suitable for wounds with minimal or no drainage.
Choice B rationale: Foam dressings are often used for wounds with moderate to heavy exudate. They provide absorption and insulation but may not be the best choice for a wound with no exudate.
Choice C rationale: Alginate dressings are absorbent and suitable for wounds with moderate to heavy exudate. They may not be necessary for a superficial wound with no drainage.
Choice D rationale: Hydrofiber dressings are absorbent and can handle moderate to heavy exudate. Like alginate dressings, they may not be the most appropriate choice for a wound with no exudate.
Correct Answer is D
Explanation
Choice A rationale: This describes a full-thickness burn with eschar formation, not a deep partial-thickness burn.
Choice B rationale: This may indicate a deeper burn involving the subcutaneous tissue, but the absence of blisters makes it less characteristic of a deep partial-thickness burn.
Choice C rationale: This suggests a full-thickness burn with damage to nerve endings, not a deep partial-thickness burn.
Choice D rationale: A deep partial-thickness burn is characterized by a pink or mottled appearance with the presence of blisters. This type of burn involves damage to the epidermis and portions of the dermis, causing pain and sensitivity to touch.
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