A charge nurse is observing a newly licensed nurse who is caring for a client who has pulmonary tuberculosis. The charge nurse should expect the newly licensed nurse to take which of the following actions?
Place the client on droplet precautions.
Place the client in a room with positive-pressure airflow.
Wear a surgical mask when taking the client out of the room.
Wear an N95 respirator mask when in the client's room.
The Correct Answer is D
Answer is: Wear an N95 respirator mask when in the client’s room.
Explanation: Pulmonary tuberculosis (TB) is a contagious disease caused by bacteria that can spread through the air. The most common way of transmission is through respiratory droplets that are expelled when a person with active TB coughs, sneezes, or speaks1. Therefore, the charge nurse should expect the newly licensed nurse to take precautions to protect themselves and the client from exposure to TB. One of these precautions is to wear an N95 respirator mask when in the client’s room2. An N95 respirator mask is a type of personal protective equipment (PPE) that filters out at least 95% of airborne particles, including bacteria and viruses3. It can prevent the nurse from inhaling or spreading TB to others.
The other options are incorrect because:
Place the client on droplet precautions: Droplet precautions are not enough to prevent transmission of TB, as they only protect against respiratory droplets that are less than 5 micrometers in diameter1. However, TB bacteria can be found in larger droplets that can travel farther and infect people who are not in direct contact with the source1.
Place the client in a room with positive-pressure airflow: Positive-pressure airflow is not effective against TB, as it does not reduce the concentration of airborne particles or prevent them from escaping through cracks and gaps in doors and windows. Moreover, positive-pressure airflow can create negative pressure in other areas of the facility, which can increase the risk of cross-contamination.
Wear a surgical mask when taking the client out of the room: A surgical mask is not sufficient to protect against TB, as it only filters out particles that are larger than 5 micrometers in diameter3. It also does not fit properly on the face and may allow some particles to pass through3.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Request crutches from a medical equipment provider. This choice is not appropriate for a client with left-sided weakness due to a stroke. Crutches are primarily used for lower extremity support and would not address the client's mobility and safety needs related to their left-sided weakness.
Choice B rationale:
Advise the client to install grab bars in the bathroom at home. This is the correct choice. Installing grab bars in the bathroom will enhance the client's safety and independence. Left-sided weakness can result in balance issues, and having grab bars near the toilet and in the shower can help prevent falls and provide the client with support while using these facilities. This intervention promotes the client's functional autonomy and reduces the risk of injury.
Choice C rationale:
Encourage the client to allow a home care aide to perform ADLs for them. While it might be necessary for a client with severe disability to receive assistance with Activities of Daily Living (ADLs), the question does not provide enough information to suggest that the client's condition warrants this level of intervention. Encouraging independence is generally preferred to maintain the client's self-esteem and engagement in daily life activities.
Choice D rationale:
Contact hospice to provide follow-up care for the client. Hospice care is intended for clients with terminal illnesses who are in the final stages of life. A client who has had a stroke and is experiencing left-sided weakness does not automatically qualify for hospice care. The client's condition can be managed with rehabilitation and support, and hospice care is not appropriate in this context.
Correct Answer is A
Explanation
The correct answer is choice A: Provide information about alternate birth control methods.
Choice A rationale:
The nurse should prioritize providing information about alternate birth control methods to the client who is uncertain about undergoing a tubal ligation. This approach aligns with the principle of informed consent and patient autonomy. By presenting different options, the client can make a well-informed decision about their reproductive health. This ensures that the client's choice is based on a comprehensive understanding of all available alternatives.
Choice B rationale:
While involving the client's partner in the decision-making process can be important, the primary responsibility of decision-making lies with the client. Therefore, asking if the client has discussed the decision with their partner (Choice B) may not directly address the client's uncertainty and need for information about alternative birth control methods.
Choice C rationale:
Emphasizing the benefits of having the procedure (Choice C) might not be appropriate if the client is uncertain about whether it's the right choice for them. This approach may come across as biased and not respectful of the client's ambivalence. Providing unbiased information about all options is a more balanced approach.
Choice D rationale:
Discussing the client's feelings about the procedure (Choice D) is essential but should be done in conjunction with providing information about alternate birth control methods. Addressing the client's emotions without offering alternatives may not fully support the client's decision-making process.
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