A nurse is placing a patient on isolation precautions. The patient’s diagnostic results at 1400 are given.
Which of the following actions should the nurse take?
Wear an N95 mask when caring for the patient.
Place a container for soiled linens inside the patient’s room.
Wear a sterile, water-resistant gown if within 3 feet of the patient.
Ensure the patient’s room is well-ventilated.
Correct Answer : A,B
Choice A rationale
When a patient is placed on isolation precautions, the nurse should wear an N95 mask when caring for the patient. This is to protect the nurse from airborne particles that may be present in the patient’s environment.
Choice B rationale
Another important action the nurse should take is to place a container for soiled linens inside the patient’s room. This is to prevent the spread of infection from the patient’s room to other areas of the healthcare facility.
Choice C rationale
Wearing a sterile, water-resistant gown if within 3 feet of the patient is not necessary unless the patient has a condition that requires contact precautions, such as MRSA or VRE. In general, isolation precautions do not require the use of a sterile gown unless performing a sterile procedure.
Choice D rationale
Ensuring the patient’s room is well-ventilated is important for certain types of isolation precautions, such as airborne precautions for tuberculosis. However, it is not a standard action for all isolation precautions.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale
While showering frequency can vary depending on the specific isolation precautions, it does not indicate understanding of the protective isolation precautions.
Choice B rationale
Informing friends and family to visit when feeling well does not indicate understanding of protective isolation precautions. Protective isolation precautions are designed to protect the patient from infections, not based on how the patient is feeling.
Choice C rationale
Taking a plane to visit grandchildren does not indicate understanding of protective isolation precautions. Travel restrictions would depend on the specific condition and doctor’s advice.
Choice D rationale
Wearing a face mask when leaving the hospital room is a common requirement in protective isolation precautions to prevent the spread of infections.
Correct Answer is A
Explanation
Choice A rationale
After drawing up the medication, the nurse should ask another nurse to observe the medication wastage. This is a standard procedure for controlled substances like opioids. The second nurse acts as a witness to ensure that the unused portion of the medication is disposed of properly and not diverted for inappropriate use.
Choice B rationale
Notifying the pharmacy when wasting the medication is not the immediate next step after drawing up the medication. While some institutions may require notification of the pharmacy for controlled substance wastage, the immediate next step is typically to have another nurse witness the wastage.
Choice C rationale
Locking the remaining medication in the controlled substances cabinet is not the immediate next step after drawing up the medication. The remaining medication should be wasted with a witness present.
Choice D rationale
Disposing of the vial with the remaining medication in a sharps container is not the immediate next step after drawing up the medication. The remaining medication should be wasted with a witness present.
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