A nurse assesses an older client who is scratching and rubbing ...

[futuristic]

A nurse assesses an older client who is scratching and rubbing white ridges on the skin between the fingers and on the wrists. Which action should the nurse take?
 
  a. Place the client in a single room.
  b. Administer an antihistamine.
  c. Assess the client's airway.
  d. Apply gloves to minimize friction.

Question 2

A nurse assesses a client who has a chronic wound. The client states, I do not clean the wound and change the dressing every day because it costs too much for supplies. How should the nurse respond?
 
  a. You can use tap water instead of sterile saline to clean your wound.
  b. If you don't clean the wound properly, you could end up in the hospital.
  c. Sterile procedure is necessary to keep this wound from getting infected.
  d. Good hand hygiene is the only thing that really matters with wound care.

[Chou]

Answer to Question 1

ANS: A
The client's presentation is most likely to be scabies, a contagious mite infestation. The client needs to be admitted to a single room and treated for the infestation. Secondary interventions may include medication to decrease the itching. This is not an allergic manifestation; therefore, antihistamine and airway assessments are not indicated. Gloves may decrease skin breakdown but would not address the client's infectious disorder.

Answer to Question 2

ANS: A
For chronic wounds in the home, clean tap water and nonsterile supplies are acceptable and serve as cheaper alternatives to sterile supplies. Of course, if the wound becomes grossly infected, the client may end up in the hospital, but this response does not provide any helpful information. Good handwashing is important, but it is not the only consideration.

[futuristic]

Thank you

[Chou]

No problemo