A charge nurse is evaluating a newly licensed nurse's understanding of infection control procedures. Which of the following actions demonstrates that the nurse is following the appropriate protocol for a client who has streptococcal pharyngitis?
Placing the client in a positive-airflow room with 12 air exchanges per hour
Explaining to the client that he cannot have visitors until his manifestations resolve
Donning sterile gloves when performing routine oral care
Wearing a mask when within 1 m (3.3 ft) of the client
The Correct Answer is D
A. A positive-airflow room with 12 air exchanges per hour is used for protective environments (e.g., neutropenic clients), not for those with droplet infections like streptococcal pharyngitis.
B. Visitors are not prohibited for clients with streptococcal pharyngitis. Visitors should follow droplet precautions, such as wearing a mask if close to the client.
C. Sterile gloves are not required for routine oral care; clean gloves are sufficient unless performing a sterile procedure.
D. Streptococcal pharyngitis is spread via droplet transmission. A mask should be worn when within 3 feet (1 meter) of the client to prevent the spread of infection.
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Related Questions
Correct Answer is B
Explanation
A.Setting up in-home physical therapycan support long-term function but is not the most immediate concern.
B. Since the client has a new diagnosis of COPDand lives alone, ensuring their home environment is safeis the priorityto reduce fall risk, ensure access to oxygen if needed, and prevent complications.
C.Providing printed materialsis important for education but not the highest priority for safety.
D.Suggesting a support grouphelps with emotional needs but is a lower priority than ensuring the client’s immediate physical safety at home.
Correct Answer is D
Explanation
A.Nurses do not presentthe informed consent details; it is the provider’s responsibility to explain the procedure, risks, benefits, and alternatives. Nurses do notneed to collaborate on presenting this information.
B.While it can be helpful for a nurse to be present when the provider explains the procedure, it is not requiredfor informed consent and does not demonstrate full understanding of the legal requirement.
C.Any licensed nurse—not necessarily a supervisor—can witness a client’s signature on the consent form, as long as the nurse verifies that the client signed voluntarily and appeared competent.
D.This demonstrates an understanding of informed consent. The client must be mentally competent, understand the information provided, and voluntarily agree to the procedure.
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