A nurse is admitting a client who has measles and a persistent cough. Which of the following actions is a priority for the nurse to take?

Place the client in airborne isolation.

Advise the family members not to bring flowers into the room.

Obtain a sputum sample for culture.

Place the client on contact precaution.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Placing the client in airborne isolation is a priority because measles is highly contagious and spread through airborne droplets. Airborne precautions are necessary to prevent the transmission of pathogens that can remain suspended in the air for longer periods. Measles is known for its high infectivity, and isolating the client in a negative pressure room equipped with HEPA filtration can help prevent the spread of the virus to other patients and healthcare workers.

Choice B rationale:

While advising family members not to bring flowers into the room is a reasonable infection control measure, it is not the priority action in this scenario. The immediate concern is to prevent the spread of the highly contagious measles virus through airborne transmission.

Choice C rationale:

Obtaining a sputum sample for culture is not the priority action in this situation. Measles is a viral infection, and sputum cultures are typically used to identify bacterial infections. Additionally, the primary mode of transmission for measles is through airborne droplets, so preventing its spread takes precedence over obtaining a sputum sample.

Choice D rationale:

Placing the client on contact precaution is not the correct choice for managing measles. Measles is primarily transmitted through the airborne route, so airborne precautions, not contact precautions, are necessary to prevent its transmission.

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Correct Answer is A

Explanation

Choice A rationale:

This choice is correct. Hepatitis B is primarily transmitted through contact with infected blood and bodily fluids. Contact precautions are designed to prevent the spread of infections that are transmitted through direct or indirect contact. These precautions include wearing gloves and gowns when in contact with the client or their environment.

Choice B rationale:

Droplet precautions are not appropriate for hepatitis B. Droplet precautions are used for infections that are spread through respiratory droplets, like coughing or sneezing. Hepatitis B is not primarily transmitted through respiratory droplets.

Choice C rationale:

Standard precautions involve the use of protective barriers such as gloves, gowns, masks, and eye protection to prevent the transmission of infections. While these precautions should always be practiced, they are not specifically tailored to hepatitis B, which has its own set of precautions.

Choice D rationale:

Airborne precautions are used for infections that are spread through small respiratory particles that remain suspended in the air for longer periods. Hepatitis B is not transmitted through airborne routes, so airborne precautions are not necessary.

A. Intramuscular. B. Subcutaneous. C. Oral. D. Intravenous.

Correct Answer is D

Explanation

Choice A rationale:

Intramuscular administration involves injecting medication into muscle tissue, which may result in slower and variable absorption rates. It is not the optimal route for providing fast and complete absorption of Furosemide.

Choice B rationale:

Subcutaneous administration delivers medication into the fatty tissue beneath the skin. While it can be used for some medications, it generally results in slower absorption compared to intravenous administration, and it may not be suitable for Furosemide, which requires rapid action in a severe heart failure situation.

Choice C rationale:

Oral administration involves taking medication by mouth, and the absorption process can be influenced by factors such as gastric emptying and gastrointestinal transit time. In an urgent scenario of severe heart failure, oral administration might be too slow and unpredictable.

Choice D rationale:

Intravenous administration allows for the fastest and most complete absorption of Furosemide. By directly delivering the medication into the bloodstream, it bypasses the absorption barriers of the gastrointestinal tract, leading to rapid onset of action and predictable effects, which is crucial in managing acute heart failure. This route is commonly used in critical situations where immediate therapeutic effects are needed.

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A nurse is admitting a client who has measles and a persistent cough. Which of the following actions is a priority for the nurse to take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who has hepatitis

Correct Answer is A

Explanation

A Medical-Surgical nurse is preparing to administer Furosemide to a patient who is having severe heart failure. Which route of administration should the nurse use to provide the fastest and most complete absorption of Furosemide?

Correct Answer is D

Explanation

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