A nurse is assisting with the care of a client who is at 30 weeks of gestation and has tuberculosis. Which of the following actions should the nurse take?

Provide a surgical mask for the client's partner during visits

Initiate airborne precautions for the client.

Tell the client that a cesarean birth is necessary.

Administer penicillin G to the client immediately

Answer and Explanation

The Correct Answer is B

A. Provide a surgical mask for the client's partner during visits: While it is important to protect visitors, providing only a surgical mask is insufficient for tuberculosis precautions. Airborne infections like TB require specialized respirators (such as N95 masks), not just standard surgical masks.

B. Initiate airborne precautions for the client: Tuberculosis is an airborne disease, meaning the client must be placed on airborne precautions. This includes placing the client in a negative pressure room and requiring anyone entering to wear an N95 respirator to prevent transmission.

C. Tell the client that a cesarean birth is necessary: Having tuberculosis does not automatically necessitate a cesarean delivery. If the TB is well controlled and the client is noninfectious by the time of labor, vaginal birth is typically safe.

D. Administer penicillin G to the client immediately: Penicillin G is used to treat infections such as syphilis, not tuberculosis. TB requires a specific antibiotic regimen (such as isoniazid, rifampin, ethambutol, and pyrazinamide), not penicillin.

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Correct Answer is C

Explanation

A. "I do not need to sign a consent form before this procedure.": A signed informed consent form is required before an intravenous pyelogram (IVP) because it involves the injection of contrast dye, which carries risks such as allergic reactions and kidney injury.

B. "I should limit my fluid intake for 2 days after the procedure.": Clients are encouraged to increase fluid intake after an IVP to help flush the contrast dye from their system and reduce the risk of kidney complications, not limit fluids.

C. "I will feel a warming sensation after the injection of the dye.": This statement shows understanding. It is common to feel a warm, flushing sensation or a metallic taste in the mouth shortly after the contrast dye is injected during an IVP. These effects are usually brief and harmless.

D. "I can have a meal up to 2 hours before the procedure.": Clients are typically instructed to be NPO (nothing by mouth) for a certain period, often after midnight, before the procedure to reduce the risk of aspiration and to ensure clear imaging. Eating close to the procedure time is not recommended.

A. "Your baby is at a higher risk because they were born with congenital dermal melanocytosis.” B. "This is because your baby is breastfed. You should start supplementing with formula." C. "Your baby is at a higher risk because they have had four bowel movements in the first day of life.” D. "This is because your baby's liver is not yet efficient at breaking down red blood cells."

Correct Answer is D

Explanation

A. "Your baby is at a higher risk because they were born with congenital dermal melanocytosis.": Congenital dermal melanocytosis, also known as Mongolian spots, are harmless pigmented birthmarks and are unrelated to bilirubin levels or jaundice risk in newborns.

B. "This is because your baby is breastfed. You should start supplementing with formula.": Breastfeeding itself is not a reason to stop or supplement with formula unless medically necessary. Breastfeeding jaundice can occur, but proper feeding techniques and frequency usually manage it without needing supplementation.

C. "Your baby is at a higher risk because they have had four bowel movements in the first day of life.": Frequent bowel movements actually help lower bilirubin levels by aiding in the excretion of bilirubin through stool, so this would not increase jaundice risk.

D. "This is because your baby's liver is not yet efficient at breaking down red blood cells.": Newborns often experience physiological jaundice because their immature livers cannot efficiently process the breakdown products of red blood cells, leading to elevated bilirubin levels in the blood.

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A nurse is assisting with the care of a client who is at 30 weeks of gestation and has tuberculosis. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is D

Explanation

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