A client is brought to the clinic with symptoms of measles. Which precaution should the nurse implement to prevent transmission to others?
Standard precautions.
Droplet precautions.
Contact precautions.
Airborne precautions.
The Correct Answer is D
The correct answer is choice d. Airborne precautions.
Choice A rationale:
Standard precautions are the basic level of infection control that should be used in the care of all patients all of the time. These precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources. However, they are not sufficient to prevent the transmission of measles, which is an airborne virus.
Choice B rationale:
Droplet precautions are used for diseases that are transmitted by large droplets that are expelled into the air and travel 3 to 6 feet from the patient. Measles is not primarily transmitted by large droplets and therefore, droplet precautions are not the most effective measure for preventing measles transmission.
Choice C rationale:
Contact precautions are used for infections, diseases, or germs that are spread by touching the patient or items in the patient’s room. Measles is highly contagious and can be spread through the air by breathing, coughing, or sneezing, so contact precautions alone would not prevent the spread of measles.
Choice D rationale:
Airborne precautions are required for diseases that are transmitted by smaller droplets, which remain in the air for long periods of time and can be spread over long distances when the infected person breathes, coughs, or sneezes. Measles is known to be highly contagious and can remain airborne for up to two hours in an airspace after the infected person leaves an area. Therefore, airborne precautions, which include the use of a high-efficiency particulate air (HEPA) filter and special respiratory protection, are necessary to prevent the spread of measles.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Chest X-ray is not a diagnostic test for measles. It may be used to assess for complications like pneumonia.
Choice B rationale:
Throat swab culture is not used to diagnose measles. It is more commonly used to detect bacterial infections such as strep throat.
Choice C rationale:
Blood glucose level is not relevant to the diagnosis of measles.
Choice D rationale:
Measles-specific IgM antibodies test is the definitive diagnostic test for measles. It detects the presence of specific antibodies produced by the immune system in response to the measles virus.
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale:
The prodrome stage of measles infection is characterized by symptoms that precede the rash. One of the characteristic features of this stage is a high fever, typically greater than 38.5°C. This fever is a result of the immune response to the viral infection.
Choice B rationale:
Another characteristic of the prodrome stage is malaise and anorexia. Malaise refers to a general feeling of discomfort or unease, while anorexia is a loss of appetite. These symptoms are common during the early stages of many viral infections, including measles.
Choice C rationale:
Koplik spots are small white or bluish-white spots with a red base that appear on the buccal mucosa (inner lining of the cheeks) during the prodrome stage of measles. They are considered pathognomonic for measles, meaning they are highly characteristic of the disease and help differentiate it from other viral rashes.
Choice D rationale:
Maculopapular rash is not characteristic of the prodrome stage but appears during the next stage of measles called the exanthematous stage. This rash consists of flat, red spots (macules) that later develop into raised bumps (papules) It typically starts on the face and spreads downward to the trunk and extremities.
Choice E rationale:
Hyperpigmentation of the skin is not a characteristic of the prodrome or any stage of measles. Hyperpigmentation refers to the darkening of the skin, which is not associated with measles infection.
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