Author Question: The nurse is preparing to obtain a throat culture. Which statement indicates that the nurse has ... (Read 127 times)

tatyanajohnson · **on:** Jun 25, 2018

The nurse is preparing to obtain a throat culture. Which statement indicates that the nurse has performed this skill before?

1. The nurse allows the client to insert the swab in the mouth.
2. The nurse removes the swab while making sure to touch the sides of the tonsils.
3. The nurse has the client tilt the head back and say ah to relax the tongue to avoid the gagging reflex.
4. The nurse asks the client to blow the nose to clear the nasal passageway and then checks with penlight for patency.

Question 2

The nurse is assisting with a thoracentesis. Place the steps of the procedure for assisting the client in the correct order.

Click on the down arrow for each response in the right column and select the correct choice from the list.
Response 1. Help position the client and cover the client as needed with a bath blanket.
Response 2. Observe the client for signs of distress, such as dyspnea, pallor, and coughing.
Response 3. Support the client verbally and describe the steps as needed.
Response 4. Support the client throughout the procedure.
Response 5. Collect drainage and laboratory specimens. Then apply small sterile dressing over the site.

CourtneyCNorton · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Correct Answer: 3

Having the client tilt the head back and say ah helps to relax the throat and prevent gagging. Allowing the client to insert the swab in the mouth is inappropriate and will result in the need to re-swab. Touching the sides of the tonsils will contaminate the swab. Asking the client to blow the nose to clear the nasal passageways and then checking with a penlight for patency is the procedure for a nasal specimen.

Answer to Question 2

Correct Answer: 1,4,3,2,5

Positioning and properly covering the client with a bath blanket is the first step. Supporting the client throughout the procedure is the second step. Supporting the client verbally and describing the steps as needed is the third step. Observing the client for signs of distress, such as dyspnea, pallor, and coughing, is the fourth step. Collecting the drainage and laboratory specimens and covering the site with a small, sterile dressing is the last step of the procedure.