A nurse is participating in a biological disaster simulation where citizens are exposed to pneumonic plague. Which of the following interventions should the nurse plan to use while caring for these clients?
Initiate droplet precautions.
Administer an antitoxin.
Initiate airborne precautions.
Destroy the linens after use.
The Correct Answer is C
Choice A Reason: This is incorrect because droplet precautions are not sufficient to prevent the transmission of pneumonic plague. Droplet precautions are used to prevent the spread of infectious agents that are expelled through coughing, sneezing, or talking and travel only a short distance in the air. Droplet precautions include wearing a surgical mask, gown, and gloves, and placing the client in a private room or with a roommate who has the same infection.
Choice B Reason: This is incorrect because administering an antitoxin is not an intervention for pneumonic plague. An antitoxin is a substance that neutralizes the effects of a toxin produced by a microorganism. Pneumonic plague is not caused by a toxin, but by a bacterial infection.
Choice C Reason: This is correct because initiating airborne precautions is an intervention for pneumonic plague. Airborne precautions are used to prevent the spread of infectious agents that can remain suspended in the air and travel over long distances. Pneumonic plague is a severe and potentially fatal infection caused by the bacterium Yersinia pestis, which can be transmited through respiratory droplets or aerosols. Airborne precautions are used to prevent the spread of infectious agents that can remain suspended in the air and travel over long distances. Airborne precautions include wearing a respirator or N95 mask, placing the client in a negative-pressure room with an air filtration system, and limiting visitors and staff contact.
Choice D Reason: This is incorrect because destroying the linens after use is not an intervention for pneumonic plague. Linens that are contaminated with body fluids or secretions should be handled with gloves and placed in leak-proof bags for laundering or disposal, but they do not need to be destroyed.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is: C. Continue the rate at 125 mL/hr.
Choice A: Slow the rate to 50 mL/hr
Slowing the IV fluid rate to 50 mL/hr is not appropriate for a patient with a head injury. Adequate fluid management is crucial to maintain cerebral perfusion pressure and prevent secondary brain injury. Reducing the rate to 50 mL/hr could lead to hypovolemia, which might decrease cerebral perfusion and worsen the patient’s condition.
Choice B: Slow the rate to 20 mL/hr
Slowing the IV fluid rate to 20 mL/hr is even less appropriate. Such a low rate would likely result in significant hypovolemia, severely compromising cerebral perfusion pressure. This could exacerbate the patient’s head injury by reducing the blood flow to the brain, leading to further damage.
Choice C: Continue the rate at 125 mL/hr
Continuing the rate at 125 mL/hr is appropriate. This rate helps maintain euvolemia, which is essential for ensuring adequate cerebral perfusion pressure in patients with head injuries. Maintaining a stable fluid rate helps prevent both hypovolemia and hypervolemia, both of which can negatively impact intracranial pressure and cerebral perfusion.
Choice D: Increase the rate to 250 mL/hr
Increasing the IV fluid rate to 250 mL/hr is not recommended. Overhydration can lead to increased intracranial pressure, which can be detrimental to a patient with a head injury. Excessive fluid administration can cause cerebral edema, worsening the patient’s condition.
Correct Answer is D
Explanation
Choice a) is incorrect because elevating the client’s feet is not the priority action for a hypotensive client. Elevating the client’s feet may help increase the venous return to the heart, but it may also compromise the respiratory status of a client who has esophageal varices and is at risk of aspiration.
Choice b) is incorrect because administering a unit of packed RBCs is not the priority action for a hypotensive client. Administering a unit of packed RBCs may help increase the oxygen-carrying capacity of the blood, but it may also increase the blood viscosity and pressure, which can worsen the bleeding from the esophageal varices.
Choice c) is incorrect because initiating a dopamine IV infusion for the client is not the priority action for a hypotensive client. Initiating a dopamine IV infusion may help increase the blood pressure and cardiac output, but it may also cause vasoconstriction and tachycardia, which can increase the risk of hemorrhage and arrhythmias.
Choice d) is correct because increasing the client’s IV fluid rate is the priority action for a hypotensive client. Increasing the client’s IV fluid rate may help restore the intravascular volume and perfusion, which can prevent shock and organ damage. Increasing the client’s IV fluid rate may also dilute the blood and reduce its viscosity and pressure, which can decrease the bleeding from the esophageal varices.
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