A nurse on a medical unit is teaching a group of assistive personnel about handling clients’ bed linens safely. Which of the following instructions should the nurse include?

Return any fresh linen not used for a client to the linen supply:

Tie linen bags securely at the top.

Fili linen bags with as much soiled linen as possible:

Use double bagging to remove soiled linen from the client's room.

Answer and Explanation

The Correct Answer is B

A) Return any fresh linen not used for a client to the linen supply: Fresh linen that has been placed on a client’s bed but not used should not be returned to the linen supply. This is to prevent cross-contamination. Once linen is brought into a patient’s room, it should be considered contaminated, even if it was not used, and should be discarded properly.

B) Tie linen bags securely at the top: This is the correct action. When disposing of soiled linens, tying the linen bag securely helps to prevent the spread of pathogens and minimizes the risk of contamination. It also keeps the environment clean and safe for both staff and patients.

C) Fill linen bags with as much soiled linen as possible: Linen bags should not be overfilled. Overfilling bags can make them difficult to handle and can increase the risk of exposure to contaminants. Bags should be filled to a safe and manageable level to ensure proper handling and safety when transporting soiled linens.

D) Use double bagging to remove soiled linen from the client's room: Double bagging is typically not necessary unless there is a significant risk of contamination, such as with highly infectious material. Standard practice is to use a single, securely tied bag. Double bagging can create unnecessary waste and complicate disposal procedures unless specifically indicated by the situation or facility protocols.

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Correct Answer is A

Explanation

A) Reach around the pack and open the top flap away from the body: The nurse should open the top flap of the sterile pack first by pulling it away from the body. This ensures that the sterile contents of the pack are not contaminated by touching the body or clothing. It is important to open the flap away from the body and face to maintain the sterility of the field and prevent any potential contamination.

B) Move to the opposite side of the pack to open the fourth flap: Moving to the opposite side of the pack to open the fourth flap is not necessary. The nurse should open the pack from the side where it is placed, and typically the sterile pack has a specific order for opening the flaps to maintain a sterile field. Opening the fourth flap from the opposite side would not be the most efficient or safest practice.

C) Place the pack on a sterile work surface: While placing the sterile pack on a sterile work surface is important, this step is not directly related to opening the sterile pack. Ensuring the work surface is sterile is crucial, but the question specifically addresses the proper way to open the pack, which involves how to handle the flaps safely.

D) Open the right flap with the left hand: It is essential to avoid crossing over sterile areas or using non-dominant hands for opening the pack's flaps in a manner that could risk contamination. Each flap should be opened in a controlled way, usually with the dominant hand, and this action must follow the correct sequence to prevent any potential contamination, especially when handling the pack’s sterile contents.

A. The client pushes downward on the handgrips B. The client stands in a tripod position prior to walking C. The Client places partial weight on the affected leg D. The client keeps the elbows in a fixed position

Correct Answer is D

Explanation

A) The client pushes downward on the handgrips: Pushing downward on the handgrips of the crutches helps the client maintain balance and support, which is crucial for safely using crutches. This action aids in transferring weight and can provide stability during movement. As long as the client does not push too forcefully, this action is appropriate and not a safety risk.

B) The client stands in a tripod position prior to walking: The tripod position is a standard stance for crutch walking, where the crutches are placed slightly ahead and wider than the feet to provide a stable base of support. This position helps prevent the client from losing balance before starting to walk and is essential for maintaining safety while ambulating.

C) The client places partial weight on the affected leg: In a three-point gait, placing partial weight on the affected leg is a proper and necessary action to maintain the correct gait. This allows for proper distribution of weight between the crutches and the unaffected leg. The partial weight-bearing is often part of the rehabilitation process for clients with an injured or weakened leg.

D) The client keeps the elbows in a fixed position: Keeping the elbows in a fixed position during crutch walking can be dangerous, as it limits the client’s ability to adjust their posture or support properly. Flexing the elbows to about 20 to 30 degrees is ideal for balance, shock absorption, and mobility. A fixed elbow position restricts these movements, making it a safety concern because it could lead to muscle strain or decreased control over crutch placement.

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A nurse on a medical unit is teaching a group of assistive personnel about handling clients’ bed linens safely. Which of the following instructions should the nurse include?

Nursing Test Bank

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Explanation

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Correct Answer is D

Explanation

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