A nurse caring for a client who requires isolation has just finished a care procedure. Which of the following pieces of personal protective equipment (PPE) should the nurse remove last?

Choice A reason: Moderate fatigue typically encourages sleep as the body naturally seeks rest to recover. However, if fatigue is excessive, it might lead to an overtired state where the patient finds it difficult to relax and fall asleep. Normal ranges of physical activity and resulting fatigue can actually promote better sleep patterns by helping to regulate the body's natural sleep-wake cycle.

Choice B reason: The ability to talk about the day's events can be therapeutic and help in reducing stress levels. It allows the patient to process emotions and experiences, potentially leading to a calmer state of mind which is conducive to sleep. This is particularly true if the conversation is positive or neutral rather than rehashing stressful or traumatic events.

Choice C reason: The presence of pain is a significant factor that can disrupt sleep. Pain can make it difficult for a person to find a comfortable position for sleep, and it can cause frequent awakenings or prevent the patient from falling asleep altogether. Pain management should be a priority in patient care, especially at night, to facilitate better sleep. For instance, arthritis pain can be particularly disruptive due to joint discomfort, and addressing this with appropriate pain relief can greatly improve sleep quality.

Choice D reason: While unfamiliar stimuli can disrupt sleep, their absence is not typically a factor that would negatively affect sleep patterns. In fact, a lack of unfamiliar stimuli, meaning a quiet and consistent environment, is generally beneficial for sleep as it reduces the chances of disturbances.

Choice A reason: Placing a client with active pulmonary TB in a room with positive airflow is not recommended, as positive airflow would push potentially contaminated air into general circulation, risking the spread of TB. Instead, a room with negative airflow is appropriate to contain and remove contaminated air.

Choice B reason: Determining whether the client lives alone or with others is important for public health and contact tracing purposes. If the client lives with others, those individuals may need to be tested and monitored for TB as well.

Choice C reason: Using an alcohol-based hand cleaner is a standard practice unless hands are visibly soiled. If hands are visibly soiled, handwashing with soap and water is necessary.

Choice D reason: Reminding the client to cover their mouth with a tissue when coughing is a key measure to prevent the spread of TB, which is transmitted through airborne particles from coughs or sneezes.

Choice E reason: Antifungal medications are not used to treat TB, which is caused by a bacterium, not a fungus. The client should be instructed about taking anti-tuberculosis medications, not antifungals.