A nurse is contributing to the plan of care for a client who has influenza. Which of the following interventions should the nurse include in the plan?
Have the client wear a surgical mask during transport.
Wear an N95 mask while providing care to the client.
Administer an influenza immunization to the client.
Place the client in a negative airflow room.
Correct Answer : A
a. Have the client wear a surgical mask during transport. This is the appropriate intervention to prevent the spread of the influenza virus when the client needs to be transported within the healthcare facility. Influenza is primarily spread through respiratory droplets, so wearing a surgical mask helps to contain these droplets.
b. Wear an N95 mask while providing care to the client. An N95 mask is generally not required for influenza. Standard precautions, including wearing a surgical mask when within close proximity to the client, are usually sufficient.
c. Administer an influenza immunization to the client. It is not appropriate to administer the influenza vaccine to a client who is already infected with the influenza virus.
d. Place the client in a negative airflow room. Negative airflow rooms are typically reserved for airborne diseases such as tuberculosis. Influenza, which spreads via droplets, does not require this level of isolation.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Administering a prescribed oral dose of trazodone to the client is correct. Trazodone is sometimes used to manage agitation in patients with Alzheimer's disease, as it has calming effects and can help reduce agitation and anxiety. However, the use of any medication should be based on the client's individualized treatment plan and prescribed by a healthcare provider.
Choice B Reason:
Encouraging ambulation might not be suitable if the client is agitated, as it could potentially escalate the situation or increase the risk of falls or injury. Safety should be a priority, and ambulation might not be advisable during a state of agitation.
Choice C Reason:
Isolating the client in their room is incorrect. Isolating the client might increase feelings of confusion, fear, or distress, potentially worsening the agitation. It's important to engage and support the client rather than isolate them, which can be distressing for someone with Alzheimer's disease.
Choice D Reason:
Applying bilateral wrist restraints to the client is incorrect. The use of restraints should only be considered as a last resort when all other measures have failed and when there's an immediate risk of harm to the client or others. Restraints can be physically and psychologically harmful, leading to increased agitation, anxiety, and potential injury. They should be used only under strict guidelines and with proper authorization when all other interventions have been exhausted.
Correct Answer is D
Explanation
Choice A Reason:
Setting the degree of flexion and extension as tolerated by the client is generally appropriate in a CPM device, but this should be done within the prescribed range recommended by the healthcare provider. Simply allowing the client to adjust the degree of flexion and extension without guidance might lead to overextension or inadequate movement, potentially causing discomfort or hindering recovery.
Choice B Reason:
Padding the CPM device with a thick pillow isn't the recommended approach. CPM devices typically come with appropriate padding to ensure comfort and proper positioning. Using a thick pillow might alter the device's mechanics or cause uneven support, affecting the intended movement of the knee.
Choice C Reason:
Placing the client in high-Fowler's position (sitting upright at a 90-degree angle) isn't a standard or necessary position for using a CPM device after a knee arthroplasty. The client can typically use the CPM device while lying in a comfortable and relaxed position, following the healthcare provider's instructions regarding positioning during CPM therapy.
Choice D Reason:
Aligning the client's joints with the joints on the frame is essential for the correct function of the CPM device. This alignment helps in providing the intended range of motion without causing unnecessary stress or strain on the knee joint.

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