A nurse is assisting with the care of several clients. The nurse should identify that which of the following client conditions requires contact precautions?
Hemophilus influenzae
Streptococcal pharyngitis
Clostridium difficile
Mycoplasma pneumoniae
The Correct Answer is C
A. Hemophilus influenzae, which causes respiratory infections, generally requires droplet precautions, not contact precautions.
B. Streptococcal pharyngitis is also typically managed with droplet precautions, not contact precautions.
C. Clostridium difficile (C. diff) is a bacterial infection that causes severe diarrhea and gastrointestinal symptoms. It is spread through direct contact with contaminated surfaces or equipment, so contact precautions are necessary to prevent transmission.
D. Mycoplasma pneumoniae, which causes respiratory infections, requires droplet precautions, not contact precautions.
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Related Questions
Correct Answer is D
Explanation
A. While it is important to maintain confidentiality, the nurse must follow mandatory reporting laws for suspected abuse, which may require informing appropriate authorities.
B. While it may be important to acknowledge the harm done, directly labeling the parent's behavior as "wrong" could potentially escalate the situation and may not be helpful in building rapport with the adolescent.
C. Making assumptions about the behavior of another parent can be seen as judgmental and may not be helpful in addressing the adolescent’s concerns or in facilitating a safe environment for disclosure.
D. This response provides reassurance to the adolescent that they are not responsible for the abuse and helps to create a nonjudgmental, supportive environment, allowing the adolescent to feel safe and heard.
Correct Answer is A
Explanation
A. The new onset of lethargy in a child with endocarditis is a significant concern, as it can indicate worsening infection or complications such as embolism. This child requires urgent assessment to prevent further deterioration.
B. Erythema of the lips in a child with Kawasaki disease is concerning, but this symptom is expected as part of the disease process. However, other signs like fever and conjunctivitis would be more concerning.
C. An increased erythrocyte sedimentation rate (ESR) in a child with rheumatic fever suggests inflammation, but it is not an immediate life-threatening concern like the lethargy in endocarditis.
D. Weak pedal pulses in a toddler with coarctation of the aorta indicate circulatory compromise, but this child may not be in immediate danger as the condition is often diagnosed and managed with interventions like surgery or medication.
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