A nurse is caring for a client who has a wound infection. Wound cultures identify the infecting organism as vancomycin-resistant enterococci (VRE). Which type of precautions should the health care team initiate?
droplet precautions
neutropenic precautions
airborne precautions
contact precautions
The Correct Answer is D
A. Droplet precautions are used for diseases transmitted via respiratory droplets, such as influenza or pertussis.
B. Neutropenic precautions are implemented to protect clients with compromised immune systems from exposure to pathogens, typically in the environment.
C. Airborne precautions are used for diseases transmitted via small droplet nuclei that remain suspended in the air, such as tuberculosis or measles.
D. Contact precautions are appropriate for clients infected or colonized with multidrug-resistant organisms like VRE, requiring the use of gloves and gowns when providing care to prevent transmission.
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Related Questions
Correct Answer is A
Explanation
A. Standard precautions include the use of gloves, gowns, masks, eye protection, or face shields, depending on the anticipated exposure. Wearing gloves and a gown is appropriate when there is a risk of exposure to bodily fluids, which can occur when bathing a client with open skin lesions. This approach helps prevent the transmission of infections.
B. The UAP does not need to wear gloves when taking blood pressures on all clients unless there is a risk of exposure to blood or body fluids.
C. While wearing gloves, a gown, and an N95 mask may be appropriate for certain situations involving airborne precautions (e.g., tuberculosis), it is not necessary for standard precautions when caring for a client with diarrhea.
D. This is an overuse of gloves and does not align with standard precautions, which recommend using gloves only when there is or may be contact with blood, bodily fluids, secretions, excretions, contaminated items, or mucous membranes.
Correct Answer is ["A","B","C","F"]
Explanation
A. The client's signs and symptoms, including crackles on auscultation and difficulty breathing, warrant a chest x-ray to assess for possible pneumonia or other respiratory conditions.
B. Obtaining a sputum culture can help identify the causative organism and guide antibiotic therapy for respiratory infection.
C. Antibiotic therapy is indicated for the treatment of respiratory infection, especially if the sputum culture indicates bacterial involvement.
D. There is no indication for inserting a Foley catheter based on the client's signs and symptoms.
E. Nasogastric tube insertion for decompression is not indicated based on the client's respiratory symptoms.
F. Oxygen therapy is indicated for the client's low oxygen saturation level and respiratory distress. Applying oxygen at 2L per nasal cannula can help improve oxygenation.
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