When cleansing a wound with a drain, which technique should the practical nurse (PN) use?
Start at the most inflamed area to protect the tissue and promote healing.
Start at the area with the most drainage to avoid infecting other areas.
Start at the drain site to avoid bringing skin bacteria toward the wound.
Start at the clean area several inches away from the drain to avoid contaminating the drain.
The Correct Answer is C
A. Start at the most inflamed area to protect the tissue and promote healing:
Cleansing should progress from least contaminated to most contaminated area.
B. Start at the area with the most drainage to avoid infecting other areas:
This would spread bacteria to cleaner tissue.
C. Start at the drain site to avoid bringing skin bacteria toward the wound:
Drain site is most contaminated; clean outward to prevent contamination of wound.
D. Start at the clean area several inches away from the drain to avoid contaminating the drain:
Would push bacteria toward the more vulnerable drain site.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Preferred activities or tokens for each compliance:
Positive reinforcement, such as rewarding desired behavior with activities or tokens, is effective in behavior modification for intellectually disabled clients.
B. Unit tasks for each omission of teeth brushing:
This is a form of punishment and is not as effective in promoting long-term behavioral change as positive reinforcement.
C. Candy for each successful hygiene task, like brushing his teeth:
While it is a form of positive reinforcement, candy is not ideal due to the dental health focus of the task and potential nutritional concerns.
D. Privilege restriction or fines for refusals to complete a hygienic task:
Punitive measures are less effective and can increase resistance.
Correct Answer is A
Explanation
A. Obtain a specimen of urethral drainage for culture:
Symptoms suggest possible gonorrhea or chlamydia; culture needed for diagnosis and treatment guidance.
B. Identify all sexual partners in the last four days:
Partner notification is important but follows confirmed diagnosis.
C. Observe the perineal area for a chancroid-like lesion:
Chancroid presents differently; symptoms point to urethritis.
D. Assess for perineal itching, erythema, and excoriation:
These are signs of fungal infection or dermatitis, not primary concern here.
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