The practical nurse (PN) is reinforcing the instructions to the parents of a child who had a surgical repair of a myelomeningocele about changing an occlusive dressing on the child's back.
Which statement by the parents indicates that they understand this procedure?
"The purpose of the dressing is to protect the incision from fecal contamination.”.
"The dressing will help dry the sutures for ease of removal.”.
"We should rapidly remove the tape from the edges of the dressing when changing it.”.
"The dressing should be dampened periodically to keep the skin incision moist.”.
The Correct Answer is A
Choice A rationale
Protecting the myelomeningocele surgical incision from fecal contamination is paramount to prevent infection, as the defect is often located in the lumbosacral area. Fecal matter contains a high concentration of microorganisms, and any contamination could lead to serious central nervous system infections like meningitis.
Choice B rationale
The statement that the dressing will help dry the sutures for ease of removal is incorrect. Occlusive dressings are designed to maintain a moist wound environment, which promotes optimal wound healing and reduces scar formation, rather than drying sutures for removal.
Choice C rationale
Rapidly removing tape from the edges of the dressing is an incorrect technique. This can cause skin trauma, including stripping or tearing, especially in infants whose skin is delicate. Tape should be removed slowly and parallel to the skin to minimize epidermal injury.
Choice D rationale
The statement that the dressing should be dampened periodically to keep the skin incision moist is generally incorrect for surgical incisions once an occlusive dressing is applied. The occlusive dressing itself maintains a moist environment underneath, and external dampening could introduce pathogens and compromise the sterile field.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Gravida refers to the total number of pregnancies a woman has had, regardless of outcome. The client has had a pregnancy that resulted in a miscarriage at 16 weeks, a pregnancy that resulted in fetal demise at 31 weeks, and the current pregnancy at 39 weeks. Therefore, the total number of pregnancies is 3. The gravida is 3.
Correct Answer is D
Explanation
Choice A rationale
Collecting a urine specimen for electrolytes and protein would not directly address the client's acute symptoms of restlessness and apprehension. While important for general assessment, these lab parameters are not the primary indicators of fetal distress or immediate maternal physiological deterioration in this context. Normal electrolyte ranges: sodium 135-145 mEq/L, potassium 3.5-5.0 mEq/L. Protein in urine is usually negative.
Choice B rationale
Moving the client into a dorsal recumbent position can actually exacerbate vena caval compression in a laboring client at 42-weeks gestation, potentially leading to supine hypotensive syndrome, which would worsen rather than alleviate restlessness and apprehension due to decreased cardiac output and uteroplacental perfusion.
Choice C rationale
Encouraging the client to push with the next contraction is inappropriate given her symptoms of restlessness and apprehension. These symptoms could indicate evolving complications, such as hypoxemia or even early stages of hypovolemic shock, requiring immediate assessment of vital signs and fetal well-being before encouraging active labor efforts.
Choice D rationale
Providing information about the baby's status can help alleviate the client's apprehension, especially if her symptoms are related to anxiety about the labor process or fetal well-being, which is common in intrapartum fever. Scientific rationale supports addressing psychological distress to improve coping mechanisms.
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