Which of the following is an appropriate nursing action for skin irritation around the Gastrostomy tube site?
Providing a skin barrier for any drainage at the site
Turn the client to the side
Apply adhesive bandage directly to the skin
Keep the head of bed 25 degrees
The Correct Answer is A
a) Providing a skin barrier for any drainage at the site: Protecting the skin from moisture or drainage prevents further irritation or breakdown. Skin barriers help maintain skin integrity.
b) Turn the client to the side: Positioning may help with aspiration prevention but does not address skin irritation around the G-tube site.
c) Apply adhesive bandage directly to the skin: Adhesive bandages can further irritate or damage already sensitive skin and are not recommended for irritated or moist areas.
d) Keep the head of bed 25 degrees: While semi-Fowler’s positioning (30–45°) is good for preventing aspiration, this is unrelated to treating skin irritation directly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["250"]
Explanation
Rate (ml/hr)= Volume ÷Time
=125ml ÷ 0.5
=250 ml/hr
Correct Answer is A
Explanation
a) Clear Liquid Diet: A clear liquid diet consists of liquids that are clear at room temperature, such as broth, tea, and clear juices. It requires minimal digestion and leaves minimal residue, making it ideal for clients with gastrointestinal issues, post-surgery, or before certain diagnostic tests.
b) Renal Diet: A renal diet is designed for patients with kidney disease and focuses on limiting protein, sodium, potassium, and phosphorus intake. It is not composed solely of clear liquids.
c) Mechanically Altered Diet: A mechanically altered diet involves foods that are chopped, pureed, or ground to aid in chewing or swallowing, not just clear liquids.
d) Pureed Diet: A pureed diet consists of foods that are blended or mashed into a smooth consistency, not clear liquids that become fluid at body temperature.
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