A nurse is instructing an assistive personnel (AP) in caring for a client who has vancomycin-resistant enterococci (VRE). Which of the following types of isolation precautions should the nurse instruct the AP to use?

A. Obtain a radial pulse.: Assessing the radial pulse does not help control active bleeding and does not address the immediate risk associated with hemophilia. Circulatory checks may be useful later, but they do not stop hemorrhage. The priority is to control bleeding before moving to assessment tasks.

B. Maintain direct pressure over the site.: Clients with hemophilia have impaired clotting and require sustained direct pressure to help slow bleeding. Continuous pressure supports platelet plug formation and reduces blood loss from even minor injuries. This action directly targets the immediate threat and is the most effective next step.

C. Reinforce the dressing over the site.: Adding more dressing does not exert the pressure needed to stop bleeding in hemophilia. Reinforcement may absorb more blood but will not help form a clot or reduce active bleeding. This delays the correct intervention and can allow further blood loss.

D. Check whether the bleeding has stopped.: Checking too soon interrupts clot formation, which is especially fragile in clients with clotting disorders. Lifting the dressing to inspect can dislodge early clots and worsen hemorrhage. Bleeding must be controlled first through sustained, uninterrupted pressure.

A. Temperature: The client’s temperature is within normal limits at 36° C (96.8° F) and does not indicate infection or systemic complications at this time. No immediate follow-up is required for temperature.

B. Findings of right lower extremity assessment: Swelling, ecchymosis, visible bone, and displacement indicate a severe open fracture. These findings require urgent follow-up to prevent further tissue injury, infection, and neurovascular compromise.

C. X-ray results: The X-ray confirms an open spiral tibial shaft fracture, which is a serious orthopedic injury requiring surgical intervention. Prompt reporting and coordination with orthopedic surgery are necessary for definitive management.

D. Pain level: The client reports severe pain (10/10), which may indicate ongoing tissue damage or inadequate analgesia. Pain management and continuous monitoring are essential to prevent complications and improve comfort.

E. Level of consciousness: The client is alert and oriented to person, place, and time. No follow-up is required regarding mental status at this time.

F. Right pedal pulses: The weak right pedal pulse, cool foot, minimal movement, and reduced sensation indicate compromised perfusion and potential neurovascular injury. Immediate follow-up is required to prevent ischemic complications.

G. Oxygen saturation: Oxygen saturation is within normal limits at 97% on room air, indicating adequate oxygenation. No immediate follow-up is required.