A nurse is admitting a client who has active tuberculosis. Which of the following nursing interventions is appropriate?

Place the client in a room that is ventilated to the outside.

Wear a gown when delivering the client's food tray.

Prohibit visitors while the client's infection is active.

Administer a tuberculin skin test prior to discharge.

Answer and Explanation

The Correct Answer is A

A.   Place the client in a room that is ventilated to the outside: Clients with active tuberculosis should be placed in negative pressure rooms with air exhausted directly to the outside to prevent the spread of airborne pathogens.
B.   Wear a gown when delivering the client's food tray: Gowns are not typically necessary for routine care of clients with tuberculosis unless there is potential for contact with respiratory secretions.
C.   Prohibit visitors while the client's infection is active: Visitors should be educated about tuberculosis precautions and provided with appropriate personal protective equipment if necessary, but prohibiting visitors may not be necessary.
D.   Administer a tuberculin skin test prior to discharge: Tuberculin skin testing is used for screening and diagnosis of tuberculosis infection, not for management of active tuberculosis.

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Correct Answer is D

Explanation

A. Washing the newborn's head under a stream of running water is not recommended, as it could startle the newborn or lead to water entering the ears or eyes. Instead, the head should be washed gently using a damp cloth or sponge.

B. Bathing the newborn within 30 minutes after a feeding is not advisable. This could increase the risk of regurgitation or discomfort during the bath. It is better to bathe the newborn when they are calm and not immediately after feeding.

C. Starting the bath by washing the diaper area first is incorrect. The newborn’s face and head should be washed first to avoid spreading bacteria from the diaper area to other parts of the body.

D. The bath water should be 100 to 103 degrees Fahrenheit, as this is a safe and comfortable temperature for the newborn. It prevents chilling or burns and ensures the bath is soothing for the baby.

A. Pallor in the exposed portion of the left foot B. Inability to move the left foot C. Increased warmth of the exposed portion of the left foot D. Ecchymosis in the exposed portion of the left foot E. Paresthesia in the left foot

Correct Answer is ["A","B","D","E"]

Explanation

A. Pallor in the exposed portion of the left foot indicates a possible reduction in blood flow, which is a symptom of compartment syndrome.
B. Inability to move the left foot could suggest nerve damage or significant muscle dysfunction, which are potential consequences of compartment syndrome.
C. Increased warmth of the exposed portion of the left foot is not typically a symptom of compartment syndrome. This condition is more commonly associated with coolness due to impaired blood flow rather than increased warmth.
D. Ecchymosis in the exposed portion of the left foot may be indicative of underlying bleeding or bruising, which can increase compartmental pressure and is a symptom of compartment syndrome.
E. Paresthesia in the left foot, such as tingling or a burning sensation, can be a sign of nerve compression or damage, which is consistent with compartment syndrome.

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A nurse is admitting a client who has active tuberculosis. Which of the following nursing interventions is appropriate?

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Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a postpartum client about bathing her newborn. Which of the following statements should the nurse include?

Correct Answer is D

Explanation

A nurse is collecting data from a client who has a long-leg cast on his left leg and reports severe pain. Which of the following findings should the nurse identify as an indication that the client might have compartment syndrome? (Select all that apply.)

Correct Answer is ["A","B","D","E"]

Explanation

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