A nurse is reinforcing teaching with a client who is 12 hr postpartum and has an episiotomy.
Which of the following instructions should the nurse include?

Cleanse the perineal area from back to front.

Wash the perineal area with povidone-iodine twice daily.

Change the perineal pad with each void.

Wipe the perineal area with a soft towel.

Answer and Explanation

The Correct Answer is C

A.   Cleansing the perineal area from back to front can introduce bacteria from the rectum to the urinary tract, increasing the risk of infection. Front to back is the recommended direction for cleansing.
B.   Washing the perineal area with povidone-iodine twice daily may be too frequent and could potentially irritate the area. Gentle cleansing with warm water is typically recommended.
C.   Changing the perineal pad with each void helps to maintain cleanliness and prevent infection by reducing the buildup of moisture and bacteria.
D.   Wiping the perineal area with a soft towel is appropriate for gentle cleansing but does not address the importance of changing the perineal pad regularly.

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Correct Answer is A

Explanation

A. Providing a tour of the perioperative area prior to surgery helps familiarize the adolescent with the environment, reducing anxiety and promoting a sense of control over the situation.
B. Explaining that anesthesia is a special type of sleep is oversimplifying and may not provide the adolescent with a clear understanding of the procedure. It's important to provide accurate information at a developmentally appropriate level.
C. Waiting until after surgery to explain the importance of coughing and deep breathing misses an opportunity for preoperative education. Teaching about postoperative care beforehand allows the adolescent to understand and participate in their own recovery process.
D. Keeping medical equipment out of the client's sight may reduce anxiety, but it does not address the adolescent's need for preparation and education about the surgical experience.

A. The adolescent brother criticizes the parents' plan to have a funeral service. B. The school-age sister views death as being a type of temporary sleep. C. The adolescent brother fears the terminal illness is contagious. D. The school-age sister is concerned about the impact of her sibling's death on herself

Correct Answer is D

Explanation

A. The adolescent brother criticizing the parents' plan for a funeral service might indicate a coping mechanism or emotional response but is not a typical response.
B. The school-age sister viewing death as a type of temporary sleep demonstrates a common misconception about death in children but is not necessarily the most likely response from siblings.
C. The adolescent brother fearing the terminal illness is contagious might occur due to a lack of understanding or misinformation but is not a common response among siblings.
D. The school-age sister being concerned about the impact of her sibling's death on herself is a common response. Siblings often have concerns about their own feelings and the changes that will occur within the family dynamic after the loss of a sibling.

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A nurse is reinforcing teaching with a client who is 12 hr postpartum and has an episiotomy. Which of the following instructions should the nurse include?

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A nurse is reinforcing teaching with a client who is 12 hr postpartum and has an episiotomy.
Which of the following instructions should the nurse include?