A nurse is demonstrating the use of a transparent film dressing over a client's superficial wound. Which of the following information about a transparent dressing should the nurse include? - correct answer The dressing allows the wound bed to breathe. (A transparent dressing is applied to allow oxygen to pass through the dressing. This is referred to as "breathing" and promotes healing of the wound.) A nurse is collecting data from a client following a lumbar puncture. The nurse should identify which of the following findings as a potential adverse effect of this procedure? - correct answer Headache. (The nurse should identify that a headache can be an adverse effect following a lumbar puncture. To minimize the client's discomfort, the nurse should administer analgesics, offer fluids, and maintain the client in a dorsal recumbent position for the length of time prescribed by the provider.) A nurse is evaluating the crutch-walking technique of a client who is required to keep weight off their right leg. Which of the following is the proper crutch gait for this client? - correct answer Three point. (The nurse should identify that the client needs to be able to bear weight on the unaffected leg; therefore, a three point gait provides at least points of support.) A nurse is assisting with the admission of a client to a medical-surgical unit. Which of the following findings should the nurse identify as an indication that the client is malnourished? - correct answer Pallor with scaly skin. (The nurse should identify that pallor along with scaly skin can indicate malnutrition. The skin should be smooth and have the same hue as other areas of the sun-exposed skin in clients who are well-nourished.) A nurse is assisting with the care of a client who has a prescription for IV therapy. The client tells the nurse that they have numerous allergies. Which of the following allergies should the nurse bring to attention of the charge nurse prior to the initiation of the therapy? - correct answer Latex. (Nurses use products containing latex, including gloves, tourniquets, and IV tubing, to deliver IV therapy. Clients who have an allergic reaction to latex can have a wide range of manifestations, such as itching and hives, or a more serious reaction, such as dyspnea or laryngospasm.) A nurse is caring for a client who has an indwelling urinary catheter. Which of the following actions should the nurse take? - correct answer Clean the perineal area at least once a day. (The nurse
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