The nurse is providing safety instructions to a client who is being discharged home with oxygen therapy. Which information provided by the client indicates understanding?

Remove tubing while eating.

Keep the tank in a cool place.

Avoid direct skin contact.

Place a pad around the tank.

Answer and Explanation

The Correct Answer is C

C. Oxygen is a highly combustible gas, and direct contact with oil or grease can increase the risk of fire. Therefore, avoiding direct skin contact helps minimize this risk.

A. Clients should not remove the oxygen tubing while eating. It’s essential to continue oxygen

therapy during meals to maintain adequate oxygen levels.

B. Oxygen tanks should be stored in a well-ventilated area but not in a confined space. Avoid extreme temperatures (both hot and cold) and direct sunlight.

D. Although it’s essential to secure oxygen tanks to prevent tipping, placing a pad around the

tank is not a standard safety practice.

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Correct Answer is D

Explanation

A. Erythema (redness) and serosanguineous exudate (clear to blood-tinged fluid) are typical findings in the early stages of wound healing, especially within the first few days post-surgery. However, one week post-surgery, these signs should begin to decrease as the wound progresses through the inflammatory phase of healing.

B. Eschar (dry, black, or brown necrotic tissue) and slough (yellow or white soft tissue) are indicative of non-viable tissue and delayed wound healing.

C. Beefy red granulation tissue is a positive sign of healing. It indicates new tissue formation, which is essential for the healing process. Granulation tissue is typically moist, and its presence suggests that the wound is progressing well towards healing.

D.This indicates that the edges of the incision are properly closed and healing as expected.

A. Uses an oral airway to keep the teeth apart. B. Places the client in a supine position. C. Tests for a gag reflex before performing oral care. D. Suctions secretions from the posterior pharynx.

Correct Answer is B

Explanation

A. Using an oral airway can be appropriate in some situations to keep the mouth open and facilitate oral care, especially in an unconscious client. This helps prevent biting and allows for easier access to the oral cavity. Therefore, this action does not indicate a need for additional training.

B. Placing an unconscious client in a supine position for oral care can be inappropriate, as it increases the risk of aspiration, especially if there are secretions in the mouth. It is generally safer to position the client in a lateral position to minimize this risk. This action may indicate a need for additional training.

C. Testing for a gag reflex before performing oral care is a standard precaution, especially for unconscious clients. This helps prevent aspiration and ensures the safety of the client during the procedure.

D. Suctioning secretions from the posterior pharynx is an appropriate action to maintain airway patency and prevent aspiration, especially for unconscious clients who may have difficulty managing their secretions.

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The nurse is providing safety instructions to a client who is being discharged home with oxygen therapy. Which information provided by the client indicates understanding?

Nursing Test Bank

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