How it Works
Try Naxlex NCLEX-RN (Free-Trial)

Exhibits

The practical nurse (PN) is preparing to change the turban dressing.

For each intervention, click to indicate whether it is indicated or not indicated for the dressing change. Each row must have one

A.

Clean the site using sterile gauze and sterile water.

B.

Place client in a private room.

C.

Avoid hand sanitizer after the procedure.

D.

Place the soiled dressing in a red biohazard bag.

E.

Use sterile gloves to remove

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}

  1. Clean the site using sterile gauze and sterile water.
    • Indicated: The turban dressing should be changed using sterile techniques to prevent infection and ensure proper wound care.
  2. Place client in a private room.
    • Not Indicated: The client is already on contact precautions for MRSA, so the private room is a general requirement and not a specific intervention for the dressing change.
  3. Avoid hand sanitizer after the procedure.
    • Not Indicated: Hand sanitizer is typically used before and after procedures. For MRSA contact precautions, hand hygiene is critical, and proper hand washing or using hand sanitizer is recommended after the procedure.
  4. Place the soiled dressing in a red biohazard bag.
    • Indicated: The soiled dressing is considered contaminated and should be disposed of in a red biohazard bag to prevent the spread of infection.
  5. Use sterile gloves to remove the old dressing.
    • Indicated: Sterile gloves are required for removing and replacing the dressing to maintain a sterile field and prevent infection.


Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Free Nursing Study Resources

Related Questions

Correct Answer is {"dropdown-group-1":"E","dropdown-group-2":"E","dropdown-group-3":"D"}

Explanation

  1. Dark Room Lighting
    Consistent with Elder Mistreatment: A dark, uninviting environment can indicate neglect or lack of proper care. It may reflect poor living conditions or neglect of the client's environment, which can be a sign of mistreatment.
  2. Malnutrition
    Consistent with Elder Mistreatment: The client’s low weight (98 lb) relative to her height (5 ft 4 in) suggests potential malnutrition. Malnutrition can be a sign of neglect, as the client might not be receiving adequate food or nutrition, which is a form of mistreatment.
  3. Pressure Injuries
    Consistent with Elder Mistreatment: Although the pressure injuries have closed, the presence of Stage II pressure ulcers in the past indicates a lack of proper care and attention to the client’s needs. Pressure ulcers are a common sign of neglect in care settings.

Not Consistent with Elder Mistreatment

  • Poor Hygiene
    Not Consistent: The client appears clean and healthy with no issues in skin condition or oral hygiene, so this is not a sign of mistreatment.
  • Bilateral Leg Edema
    Not Consistent: While edema might be a concern in heart failure management, it is not specifically indicative of elder mistreatment.
  • Short Term Memory Loss
    Not Consistent: Short-term memory loss is not necessarily a sign of mistreatment; it could be related to aging or medical conditions.

Correct Answer is ["C","D"]

Explanation

A. Teaching the client with fluid restrictions how to measure urine output requires specialized knowledge and skills. This task should be performed by a licensed nurse to ensure accurate instruction and patient understanding.
B. Irrigating an indwelling urinary catheter involves sterile technique and specialized knowledge, which should be performed by a licensed nurse. This task requires specific training to prevent complications.
C. Transporting a urine culture sample to the laboratory can be safely assigned to a UAP. It involves routine tasks that do not require advanced clinical skills and is essential for timely processing of specimens.
D. Emptying the bedside drainage unit for a client with an indwelling urinary catheter can be performed by a UAP. This task involves basic care procedures that support patient hygiene and comfort.
E. Obtaining a post-voided residual (PVR) volume requires a specific clinical skill and understanding of the procedure, which should be performed by a licensed nurse rather than a UAP.

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Register