A nurse is planning care for a child who has mumps. Which of the following instructions should the nurse include in the plan?
Initiate contact precautions.
Initiate standard precautions.
Initiate airborne precautions.
Initiate droplet precautions.
The Correct Answer is D
Choice A: Contact precautions are not necessary for a child who has mumps, as mumps is not transmitted by direct or indirect contact with the infected person or their environment. Contact precautions are used for infections that are spread by contact with skin, wounds, body fluids, or contaminated surfaces.
Choice B: Standard precautions are always used for any patient care, regardless of their diagnosis or infection status. Standard precautions include hand hygiene, use of personal protective equipment (PPE), safe injection practices, and proper disposal of waste and sharps. However, standard precautions alone are not sufficient for a child who has mumps, as mumps are transmitted by respiratory droplets.
Choice C: Airborne precautions are not necessary for a child who has mumps, as mumps are not transmitted by small particles that remain suspended in the air and can be inhaled by others. Airborne precautions are used for infections that are spread by airborne transmission, such as tuberculosis, measles, or chickenpox.
Choice D: Droplet precautions are required for a child who has mumps, as mumps are transmitted by large respiratory droplets that are expelled when the infected person coughs, sneezes, or talks. Droplet precautions include wearing a surgical mask when within 3 feet of the patient, placing the patient in a private room or cohorts with other patients with the same infection, and limiting visitors and staff who are susceptible to the infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A: This statement indicates an understanding of the teaching, as washing all recently used clothing, bedding, and towels in hot water can help eliminate lice and nits (eggs). Lice and nits can survive on fabrics for up to two days and can spread from one person to another through direct or indirect contact. Washing items in hot water can kill lice and nits by exposing them to high temperatures.
Choice B: This statement indicates a lack of understanding of the teaching, as nits will not always be present after treatment. Nits are tiny white or yellow oval-shaped eggs that are attached to the hair shaft near the scalp. Nits can hatch into nymphs (young lice) within seven to ten days and mature into adult lice within nine to twelve days. Nits can be removed by using a fine-toothed comb or by applying products that loosen their grip on the hair.
Choice C: This statement indicates a lack of understanding of the teaching, as treating all family members may not be necessary or effective. Treating all family members can expose them to unnecessary chemicals or medications that may have side effects or cause resistance. Treating all family members may also not prevent reinfestation if there are other sources of exposure such as school or daycare. Only family members who have evidence of lice or nits should be treated.
Choice D: This statement indicates a lack of understanding of the teaching, as throwing out toys that can't be dry cleaned or washed may not be required or practical. Throwing out toys can cause emotional distress or financial burden for the child or the parents. Throwing out toys may also not prevent reinfestation if there are other sources of exposure such as clothing or bedding. Toys that can't be dry cleaned or washed can be sealed in plastic bags for two weeks to suffocate the lice and nits.
Correct Answer is A
Explanation
Choice A reason: This choice is correct because providing a latex-free environment is an essential intervention for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac. Spina bifida is a congenital defect in which the spinal cord and its coverings do not close properly, resulting in a protrusion of the meninges (meningocele) or the meninges and spinal cord (myelomeningocele). Children who have spina bifida are at a high risk of developing a latex allergy, which can cause severe reactions such as anaphylaxis or death. Therefore, avoiding exposure to latex products such as gloves, catheters, balloons, or bandages is crucial to prevent complications.
Choice B reason: This choice is incorrect because initiating contact precautions is not necessary for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac. Contact precautions are infection control measures that prevent the transmission of microorganisms that can be spread by direct or indirect contact with the client or their environment. They may be indicated for clients who have multidrug-resistant organisms, clostridium difficile, or scabies, but they are not required for clients who have spina bifida unless they have a concurrent infection.
Choice C reason: This choice is incorrect because limiting visitors to immediate family members is not indicated for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac. Limiting visitors may be indicated for clients who have immunosuppression, isolation, or terminal illness, but it may not be beneficial for clients who have spina bifida. Allowing visitors may provide emotional and social support for the client and their family, as long as they follow standard precautions and do not pose any risk of infection or injury.
Choice D reason: This choice is incorrect because maintaining the infant in the supine position is not an appropriate intervention for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac.
Maintaining the infant in the supine position may cause pressure or trauma to the sac, which can lead to rupture, infection, or nerve damage. Therefore, positioning the infant in a prone or side-lying position with the hips flexed and knees abducted can help to protect the sac and prevent complications.
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