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    Hesi RN exit proctored exam

    While caring for a client after a small bowel resection, the nurse is informed that the client has a history of methicillin-resistant Staphylococcus aureus (MRSA). To reduce the risk of recurrence of the MRSA in the postoperative wound, which intervention is most important for the nurse to implement?

    Explanation & Rationale

    A. Report any increase in the white blood cell count: While monitoring for signs of infection is important, an increase in WBC count alone does not address the risk of MRSA recurrence in the wound. Early intervention with infection control measures is more important. B. Change the surgical dressing readily when soiled: A soiled dressing acts as a wick, pulling moisture and bacteria toward the incision. In a postoperative client with a history of MRSA, any drainage or moisture trapped against the skin provides a medium for the staphylococcus bacteria to multiply and invade the surgical site. Changing the dressing readily when soiled ensures that the wound environment remains unfavorable for bacterial growth, directly reducing the risk of a localized recurrence or surgical site infection (SSI). C. Instruct the family to adhere to contact precautions: Instructing the family on contact precautions is essential for preventing the spread of MRSA to others (the nurse, other patients, or the family members themselves), but it does not directly reduce the risk of the client's own MRSA recurring in their new surgical wound. D. Wear a face mask while performing wound care: Wearing a face mask is not necessary for preventing MRSA transmission in the wound care setting. Contact precautions, including proper hand hygiene and wearing gloves, are more effective for MRSA prevention.

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