A nurse is planning care for a client who has rheumatoid arthritis. Which of the following interventions should the nurse include in the plan?

Choice A rationale:

Protective environment isolation precautions are used for immunocompromised patients to protect them from infections in the environment. It is not the appropriate precaution for a patient with bacterial meningitis, which is spread through respiratory droplets.

Choice B rationale:

Airborne precautions are used for diseases that are spread through the air and require a negative pressure room. Examples include tuberculosis and chickenpox. Bacterial meningitis is spread through respiratory droplets, not airborne transmission.

Choice C rationale:

Contact precautions are used for diseases that are spread by direct or indirect contact. Examples include MRSA and Clostridium difficile. Bacterial meningitis is primarily spread through respiratory droplets, not direct contact.

Choice D rationale:

Droplet precautions are used for diseases that are spread by respiratory droplets, such as influenza and bacterial meningitis. Patients with bacterial meningitis should be placed in a private room and wear a mask, and healthcare providers should wear a mask and eye protection when within 3 feet of the patient. This precaution helps prevent the spread of respiratory droplets containing the bacteria.

The four findings that require follow-up are B, C, E, and F.

Rationale:

1. Blood pressure: A normal blood pressure for an adolescent is 110/70 mm Hg. The question does not provide the adolescent's blood pressure, so it cannot be determined if it requires followup or not.
2. Capillary refill: A normal capillary refill time is less than 2 seconds. A prolonged capillary refill time indicates impaired blood flow to the extremity, which could be due to vascular injury, compartment syndrome, or shock.
3. Pedal pulse: A normal pedal pulse is +2 or +3. A weak pedal pulse (+1) indicates reduced blood flow to the extremity, which could be due to vascular injury, compartment syndrome, or shock.
4. Heart rate: A normal heart rate for an adolescent is 60 to 100 beats per minute. The question does not provide the adolescent's heart rate, so it cannot be determined if it requires follow-up or not.
5. Skin temperature: A normal skin temperature is warm and dry. A cool skin temperature indicates reduced blood flow to the extremity, which could be due to vascular injury, compartment syndrome, or shock.
6. Pain: A pain level of 10 on a scale of 0 to 10 indicates severe pain that needs to be managed with appropriate analgesics and nonpharmacological interventions.