A nurse is assessing a client who reports a severe headache and stiff neck. The nurse's assessment reveals positive Kernig's and Brudzinski's signs. Which of the following actions should the nurse perform first?
Decrease bright lights.
Initiate IV access.
Administer antibiotics.
Implement droplet precautions.
The Correct Answer is D
Choice A reason: Decreasing bright lights is an appropriate action for a nurse to take when caring for a client who has signs of meningitis, as it helps to reduce the photophobia (sensitivity to light) and headache that are common symptoms of the condition. However, this action is not the first priority, as it does not prevent the transmission of the infection or treat the underlying cause.
Choice B reason: Initiating IV access is an appropriate action for a nurse to take when caring for a client who has signs of meningitis, as it facilitates the administration of fluids, medications, and blood products that may be needed to manage the condition. However, this action is not the first priority, as it does not prevent the transmission of the infection or treat the underlying cause.
Choice C reason: Administering antibiotics is an appropriate action for a nurse to take when caring for a client who has signs of meningitis, as it helps to treat the bacterial infection that is the most common cause of the condition. However, this action is not the first priority, as it requires a prescription from the health care provider and confirmation of the diagnosis by laboratory tests such as blood culture or cerebrospinal fluid analysis.
Choice D reason: Implementing droplet precautions is the first priority action for a nurse to take when caring for a client who has signs of meningitis, as it helps to prevent the spread of the infection to other clients and staff members. Droplet precautions are a type of isolation precautions that are used for infections that are transmitted by respiratory droplets, such as meningitis, influenza, and pertussis. Droplet precautions involve wearing a surgical mask when entering the client's room, placing the client in a private room or cohorting with other clients who have the same infection, and limiting visitors and staff contact with the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A: Collaborate with a physical therapist to develop programs for injured employees to return to work. This is incorrect because this is a tertiary prevention strategy, not a secondary prevention strategy. Tertiary prevention aims to restore function and prevent disability or complications after an injury or illness has occurred.
Choice B: Help plant workers identify signs of carpal tunnel syndrome. This is correct because this is a secondary prevention strategy. Secondary prevention aims to detect and treat health problems early before they become more serious or chronic. Carpal tunnel syndrome is a common occupational health problem that can cause pain, numbness, and weakness in the hand and wrist. Early identification and treatment can prevent permanent nerve damage and disability.
Choice C: Organize an influenza immunization campaign. This is incorrect because this is a primary prevention strategy, not a secondary prevention strategy. Primary prevention aims to prevent disease or injury from occurring in the first place, by reducing exposure or risk factors. Influenza immunization can protect plant workers from getting infected by the flu virus and reduce the spread of the disease.
Choice D: Teach plant workers about proper lifting techniques. This is incorrect because this is also a primary prevention strategy, not a secondary prevention strategy. Proper lifting techniques can prevent musculoskeletal injuries such as sprains, strains, and herniated discs, by avoiding excessive stress on the spine and joints.
Correct Answer is D
Explanation
Choice A: Encourage community members to practice fire drills. This is incorrect because fire drills are a part of the preparedness phase, not the prevention/mitigation phase. The prevention/mitigation phase aims to reduce the risk and impact of disasters, while the preparedness phase aims to enhance the readiness and response capacity of individuals and communities.
Choice B: Identify community members who have disabilities. This is incorrect because identifying community members who have disabilities is also a part of the preparedness phase, not the prevention/mitigation phase. The prevention/mitigation phase focuses on actions that can prevent or minimize the occurrence or effects of disasters, such as installing smoke detectors, reinforcing buildings, or creating evacuation routes.
Choice C: Provide first aid to community members affected by a tornado. This is incorrect because providing first aid to community members affected by a tornado is a part of the response phase, not the prevention/mitigation phase. The response phase involves immediate actions to save lives, protect property, and meet basic needs after a disaster occurs.
Choice D: Assist community members in developing a disaster plan. This is correct because assisting community members in developing a disaster plan is a part of the prevention/mitigation phase. A disaster plan can help identify potential hazards, assess vulnerabilities, establish goals and objectives, and implement strategies to reduce the risk and impact of disasters.
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