When preparing to apply a dry dressing, the first step that the ...

[cagreen833]

When preparing to apply a dry dressing, the first step that the nurse should take is to:
 
  A. Cleanse the wound
  B. Prepare the sterile field
  C. Palpate the wound edges
  D. Assess the wound integrity

Question 2

The nurse is caring for a patient with a continuous intravenous infusion of 0.9 normal saline with 40 mEq of potassium chloride added to each liter.
 
  During a routine hourly check of the infusion, the nurse discovers that 4 hours of fluid has infused in the past 1 hour. The nurse's first action should be to: a. notify the primary care provider.
  b. assess the patient.
  c. reduce the infusion rate.
  d. notify the charge nurse.

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Answer to Question 1

B
B. Open sterile dressing tray or individually wrapped sterile supplies. Place on bedside table Sterile dressings remain sterile while on or within sterile surface. Preparation of all supplies prevents break in technique during dressing change.
A. The wound is cleansed after the sterile field is prepared.
C and D. The wound is assessed before procedure to apply dry dressing.

Answer to Question 2

C
If the intravenous fluid is infusing 4 times faster than ordered, the first intervention should be to reduce the rate. Notification of the primary care provider and the charge nurse would occur after the flow rate is reduced and an assessment of the patient is performed. Although assessing the patient is vitally important, you do not want to allow the fluid to continue infusing at a rapid rate while you are performing the assessment.

[cagreen833]

TYSM

[zacnyjessica]

Gracias!