A nurse is caring for a client who has pneumonia caused by Haemophilus influenzae type B. Which of the following types of isolation precautions should the nurse implement?
Protective environment
Droplet
Airborne
Contact
The Correct Answer is B
Rationale:
A. Protective environment: Protective environment precautions are used for clients with compromised immune systems (e.g., transplant patients), not for those with bacterial pneumonia caused by Haemophilus influenzae type B.
B. Droplet: Haemophilus influenzae type B is spread through respiratory droplets, so droplet precautions are appropriate. The nurse should wear a mask when within 3 feet of the client to prevent transmission.
C. Airborne: Airborne precautions are used for diseases transmitted through small particles in the air, such as tuberculosis or measles, but are not necessary for Haemophilus influenzae type B, which is droplet-transmitted.
D. Contact: Contact precautions are used for infections spread by direct or indirect contact with the patient or their environment, such as Clostridium difficile or MRSA, but not for Haemophilus influenzae type B pneumonia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Rationale:
A. Chronic Kidney Disease (CKD): The elevated BUN and creatinine levels, along with the client's decreased urine output and fluid retention, suggest impaired kidney function, increasing the risk for chronic kidney disease, especially with underlying comorbidities.
B. Hyperglycemia: There are no signs or symptoms indicating hyperglycemia, so hyperglycemia is unlikely to be a concern in this case based on the presented findings.
C. Uremia: Uremia occurs when waste products accumulate in the blood due to renal dysfunction, and the elevated BUN and creatinine, combined with symptoms like fatigue and dyspnea, indicate this condition in the client.
D. Hyperkalemia: Impaired kidney function limits potassium excretion, increasing the risk for hyperkalemia. Given the client’s kidney impairment, this can lead to elevated potassium levels and potentially cause life-threatening arrhythmias.
E. Polycystic Kidney Disease: Polycystic kidney disease typically presents with a gradual onset of symptoms like kidney enlargement and a family history, which the client’s acute presentation does not support, making PKD an unlikely diagnosis.
Correct Answer is B
Explanation
Rationale:
A. Pulse oximeter: A pulse oximeter is useful for monitoring oxygen saturation during suctioning, but it is not required for the procedure itself. The primary equipment needed is related to suctioning and maintaining airway patency.
B. Sterile water: Sterile water is essential for tracheostomy suctioning to keep the suction catheter sterile and to irrigate the catheter as needed. It helps to prevent infection and maintain hygiene during the procedure.
C. Nasal cannula: A nasal cannula is used for oxygen delivery, but it is not required for the suctioning procedure itself. Suctioning may be performed independently of oxygen therapy, although oxygen may be administered after suctioning if needed.
D. Yankauer catheter: A Yankauer catheter is used for oral suctioning, not for tracheostomy suctioning. For tracheostomy suctioning, a specific tracheal suction catheter is required to fit the airway.
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