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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Elevate the head of the client's bed for 1 hr after the feeding:Elevating the head of the bed helps prevent aspiration and promotes proper digestion by using gravity to keep the feeding solution in the stomach or jejunum.
B. Administer the feeding solution at a cold temperature: Feeding solutions should be administered at room temperature to prevent gastrointestinal discomfort or cramping.
C. Rotate the jejunostomy tube once per day:
Rotation of the jejunostomy tube is not a standard practice. Jejunostomy tubes are typically secured in place, and rotation is not necessary.
D. Flush the tube with 90mL of sterile water before and after the feeding:
Typically, the tube is flushed with about 30 mL of water before and after feedings to ensure patency and prevent clogging, not 90 mL.
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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