A nurse is admitting a client who requires droplet precautions due to influenza. Which of the following actions should the nurse take?
Place the client in a room with negative airflow.
Wear a gown when providing care to the client.
Ensure the client's room has HEPA filtration.
Wear a mask when providing care to the client.
The Correct Answer is D
A. Inspection is usually done first to observe any obvious abnormalities, but it is not the immediate action when the client reports pain.
B. Palpation should be done last, as it can cause discomfort or alter the findings of other assessment techniques.
C. Auscultating the abdomen should be done second after inspection. This is recommended because bowel sounds should be assessed before palpation, as palpation may alter the sounds.
D. Percussion can follow auscultation, but it is not the immediate action.
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Related Questions
Correct Answer is B
Explanation
A. Filing nails in a rounded shape may lead to ingrown nails, so a straight-across filing is recommended for safety and proper nail care.
B. An orange stick is commonly used to clean under the nails, as it is gentle and reduces the risk of injury to the nail bed.
C. Pushing the cuticles back with a metal nail file can cause injury and infection. A soft tool like an orangewood stick is preferred.
D. Trimming the nails at the lateral corners is not recommended as it can cause the nails to become ingrown. Nails should be trimmed straight across.
Correct Answer is B
Explanation
A. Contact precautions are used for infections that are spread through direct contact with contaminated surfaces or items.
B. Droplet precautions are used for infections spread through respiratory droplets, such as influenza.
C. Protective isolation is used for clients with weakened immune systems, but TB requires airborne precautions, not protective isolation.
D. Tuberculosis (TB) is transmitted via airborne particles, so the nurse should initiate airborne precautions, including the use of an N95 respirator, negative pressure rooms, and other measures to prevent the spread of TB.
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