A nurse is caring for a 2-year-old child who has Clostridium difficile.
Which of the following actions should the nurse take?
Instruct the parents to avoid bringing fresh flowers into the room.
Initiate contact precautions.
Place the child in a room that has a HEPA filtration system.
Use an N95 respirator.
The Correct Answer is B
Choice A rationale:
Instructing parents to avoid bringing fresh flowers into the room is not the primary intervention for a child with Clostridium difficile. While it is essential to maintain a clean environment, the most critical action is to implement proper infection control measures.
Choice B rationale:
This is the correct answer. Initiating contact precautions is crucial when caring for a child with Clostridium difficile. This includes using gloves and gowns to prevent the spread of the bacteria to others.
Choice C rationale:
Using a HEPA filtration system in the room is not the first-line intervention for managing Clostridium difficile. While it can help maintain air quality, it does not directly address the transmission of the bacteria.
Choice D rationale:
Using an N95 respirator is not the primary action in caring for a child with Clostridium difficile. Contact precautions, such as gloves and gowns, are more critical to prevent the spread of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Rigid abdomen. A rigid abdomen is not typically associated with placenta previa. Placenta previa is a condition in which the placenta partially or completely covers the cervix, and it is more likely to present with painless vaginal bleeding rather than abdominal rigidity.
Choice B rationale:
Persistent uterine contractions. Persistent uterine contractions are not a characteristic finding in placenta previa. In fact, uterine contractions can be concerning in the presence of placenta previa as they may increase the risk of bleeding.
Choice C rationale:
Bright red vaginal bleeding. Bright red vaginal bleeding is a common and hallmark symptom of placenta previa. This bleeding typically occurs without pain and can be intermittent or continuous. It is essential to recognize this symptom promptly because it can lead to significant maternal and fetal complications.
Choice D rationale:
Increased fetal movement. Increased fetal movement is not a typical finding in placenta previa. The presence or absence of fetal movement should always be monitored during pregnancy, but it is not a specific indicator of placenta previa.
Correct Answer is D
Explanation
Choice A rationale:
Identification is a defense mechanism where an individual associates themselves with another person or group. It does not apply to the situation described in the question.
Choice B rationale:
Reaction formation involves expressing the opposite of one's true feelings or desires. It is not the most suitable defense mechanism for the situation where the adolescent blames the teacher for their failure.
Choice C rationale:
Regression refers to reverting to an earlier stage of development in response to stress or conflict. It does not align with the adolescent's statement about their teacher disliking athletes.
Choice D rationale:
Rationalization is the defense mechanism in which a person provides logical or socially acceptable reasons for their behavior, even if these reasons are not accurate. In this case, the adolescent is rationalizing their poor performance by blaming the teacher's bias against athletes. This choice best fits the situation described.
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