The nurse is instructing the parents of a child who underwent a surgical repair of a myelomeningocele on how to change an occlusive dressing on the child’s back.
Which parental statement indicates understanding of the procedure?
The skin incision should be kept moist by periodically wetting the dressing.
When changing the dressing, the tape should be removed rapidly from the edges.
The incision should be protected from fecal contamination by an intact dressing.
To ensure easy removal of the sutures, the dressing should be kept dry.
To ensure easy removal of the sutures, the dressing should be kept dry.
The Correct Answer is C
Choice A rationale
Keeping the skin incision moist by periodically wetting the dressing is not the recommended care for a myelomeningocele surgical repair. The dressing needs to be kept dry to prevent infection and promote healing.
Choice B rationale
Removing the tape rapidly from the edges of the dressing during a change is not advised. This could potentially damage the skin and disrupt the healing process.
Choice C rationale
An intact dressing protects the incision from fecal contamination, which is crucial in preventing infection. This statement indicates an understanding of the procedure.
Choice D rationale
While it’s important to keep the dressing dry to ensure easy removal of sutures, it’s not the primary concern. The main goal is to protect the incision from contamination.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choice B: Thick, muffled voice.
Choice B rationale: A thick, muffled voice is a characteristic symptom of epiglottitis. The inflammation and swelling of the epiglottis cause an obstruction in the airway, leading to changes in the child's voice quality.
Choice A rationale: High-pitched wheezing is typically associated with conditions affecting the lower airways, such as asthma or bronchiolitis. Epiglottitis primarily affects the upper airway, causing stridor (a high-pitched, harsh sound during inhalation) rather than wheezing.
Choice C rationale: Purulent nasal discharge is not a typical symptom of epiglottitis. Epiglottitis usually presents with minimal or no secretions, while purulent discharge is more commonly seen in bacterial infections like sinusitis or pneumonia.
Choice D rationale: A productive cough is not a common symptom of epiglottitis. Coughing is associated with conditions affecting the lower respiratory tract, such as bronchitis or pneumonia. Epiglottitis primarily affects the upper airway, causing difficulty breathing and a characteristic "thick, muffled voice."
Correct Answer is D
Explanation
Choice A rationale
While inspecting the infant’s ears daily can help detect signs of an ear infection early, it does not prevent recurrent otitis media.
Choice B rationale
Positioning the infant prone after feeding does not prevent recurrent otitis media and can actually increase the risk of sudden infant death syndrome.
Choice C rationale
While breastfeeding frequently can provide numerous health benefits for the infant, it does not specifically prevent recurrent otitis media.
Choice D rationale
Avoiding exposure to smoke can help prevent recurrent otitis media in infants. Smoke can irritate the Eustachian tubes, which can lead to fluid buildup and increase the risk of ear infections.
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