A nurse is preparing to obtain a blood specimen from a client's central venous access device. Prior to collecting the specimen, the nurse should clean the connection thoroughly with which of the following antiseptics?
Povidone-iodine
Hydrogen peroxide
2% chlorhexidine
70% alcohol solution
The Correct Answer is C
A. Povidone-iodine: Although effective for skin disinfection, povidone-iodine requires a long drying time and is not the preferred agent for disinfecting the access port of central lines. It is more commonly used for preparing the skin before catheter insertion, not for port access.
B. Hydrogen peroxide: Hydrogen peroxide is not recommended for disinfecting central venous access devices due to its cytotoxic properties and potential to damage catheter materials. It can also irritate tissue and is not effective against all organisms.
C. 2% chlorhexidine: Chlorhexidine is the preferred antiseptic for disinfecting central venous catheter ports. It offers rapid, broad-spectrum antimicrobial action and prolonged residual activity, making it ideal for preventing catheter-related bloodstream infections.
D. 70% alcohol solution: Alcohol is commonly used but lacks the persistent antimicrobial activity of chlorhexidine. While it can reduce surface microbes, it is less effective at preventing infection over time compared to 2% chlorhexidine.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Scaly plaques on skin: Scaly plaques are more characteristic of chronic conditions like psoriasis, not Stevens-Johnson syndrome. SJS is an acute, severe mucocutaneous reaction involving widespread epidermal necrosis, not thick, scaly lesions.
B. Pearly papules with a central crater: This describes basal cell carcinoma, a form of skin cancer. It is not consistent with the acute, inflammatory, and blistering nature of Stevens-Johnson syndrome, which typically involves mucous membranes and skin detachment.
C. Weeping skin surfaces: Stevens-Johnson syndrome leads to widespread skin blistering, sloughing, and erosion, often resulting in moist, weeping lesions. This breakdown of the epidermis resembles a severe burn and is a hallmark of the condition.
D. Irregularly shaped, pigmented papules: These are often associated with melanoma or other pigmented skin disorders. They do not match the blistering, painful rash and mucosal involvement seen in SJS.
Correct Answer is B
Explanation
A. Have the client drink 360 mL (12 oz) of plain water: While rehydration is important, plain water alone may not be sufficient to replace lost electrolytes in heat exhaustion. Oral rehydration with electrolyte-containing fluids is usually preferred.
B. Place the client in a cool environment: Moving the client to a shaded or air-conditioned environment is essential to reduce core body temperature and prevent progression to heat stroke. This is a priority action in treating heat exhaustion.
C. Immerse the client in ice water: Ice water immersion is used in severe heat stroke, not heat exhaustion. It may cause vasoconstriction and shivering, which can worsen the condition if used prematurely.
D. Give the client salt tablets: Salt tablets are not recommended due to the risk of gastrointestinal irritation and potential for sodium overload. Balanced electrolyte fluids are a safer and more effective way to restore electrolyte balance.
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