Nokea
When planning to perform a sterile dressing change for a client, which of the following actions should a healthcare professional take?
- A. Wear sterile gloves to remove the old dressing.
- B. Cleanse the wound with an antiseptic solution.
- C. Use clean gloves to apply the new dressing.
- D. Open sterile supplies before donning sterile gloves.
Correct Answer: D
Rationale: Opening sterile supplies before donning sterile gloves is a critical step in maintaining the sterility of the supplies during a dressing change procedure. By doing so, the healthcare professional ensures that they do not touch non-sterile surfaces with their hands once sterile gloves are worn, reducing the risk of introducing pathogens to the wound and minimizing the potential for contamination.
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During tracheostomy care, what action should a healthcare professional take?
- A. Use clean technique to remove the inner cannula.
- B. Remove the outer cannula for cleaning.
- C. Soak the inner cannula in normal saline.
- D. Change tracheostomy ties if they are wet.
Correct Answer: D
Rationale: Changing tracheostomy ties if they are wet is essential to prevent infection and maintain skin integrity. Wet ties can harbor bacteria, increasing the risk of skin breakdown and other complications. Regularly changing wet ties promotes cleanliness, reduces the likelihood of complications, and ensures optimal care for the client with a tracheostomy.
A healthcare professional is preparing to administer an intramuscular (IM) injection to a client. Which of the following actions should the healthcare professional take?
- A. Use a 1-inch needle.
- B. Insert the needle at a 45-degree angle.
- C. Aspirate before injecting the medication.
- D. Administer the injection in the deltoid muscle.
Correct Answer: C
Rationale: Aspirating before injecting the medication is a crucial step in IM injections to check for blood return, ensuring that the needle is not in a blood vessel. This technique helps prevent accidental intravascular injection of the medication, reducing the risk of complications such as inadvertent intravenous administration of the substance.
A client has a pressure ulcer. Which of the following findings indicates healing of the ulcer?
- A. Increase in drainage.
- B. Decrease in size.
- C. Presence of foul odor.
- D. Reddened wound edges.
Correct Answer: B
Rationale: When a pressure ulcer is healing, there is a decrease in its size as the tissue repair progresses. This reduction in size is a positive indication of the healing process. An increase in drainage, presence of foul odor, or reddened wound edges are typically signs of infection or lack of improvement. Therefore, the correct answer is a decrease in size.
A healthcare professional is assessing a client who has fluid volume overload. Which of the following findings should the healthcare professional expect?
- A. Hypotension.
- B. Bradycardia.
- C. Crackles in the lungs.
- D. Flat neck veins.
Correct Answer: C
Rationale: Crackles in the lungs are a classic sign of fluid volume overload. When there is an excess of fluid in the lungs, it can manifest as crackling sounds upon auscultation. This finding indicates the accumulation of fluid in the alveoli and interstitial spaces of the lungs, which is a common manifestation of fluid volume overload.
Which of the following statements indicates the client understands the colostomy care instructions?
- A. I will change the colostomy bag once a week.
- B. I will avoid eating high-fiber foods.
- C. I will clean around the stoma with mild soap and water.
- D. I will apply lotion to the skin around the stoma.
Correct Answer: C
Rationale: The correct answer is C. Cleaning around the stoma with mild soap and water is crucial for colostomy care as it helps prevent infection and skin irritation. Changing the colostomy bag frequency, dietary modifications, or applying lotion are not primary aspects of stoma care. Proper cleaning around the stoma helps maintain hygiene and prevents complications, making it a key component of caring for a colostomy.