A nurse is reinforcing discharge teaching with a client who has heart failure. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

Rationale for Correct Choices:

• N95 respirator. The client’s presentation of a cough, fatigue, night sweats, weight loss, and positive sputum culture for M. tuberculosis strongly suggests active tuberculosis (TB). Tuberculosis is transmitted through airborne particles, and an N95 respirator is required to protect healthcare workers from inhaling these particles. The N95 mask is specifically designed to filter out small particles, including the Mycobacterium tuberculosis bacteria.
• Gloves. Gloves should be worn when caring for patients with suspected or confirmed TB to prevent contact transmission. While TB is primarily transmitted via airborne particles, gloves are still necessary to protect healthcare workers from coming into contact with bodily fluids such as sputum or any other potentially contaminated materials.

Rationale for Incorrect Options:

• Face shield. A face shield is not required as primary protection for TB. While face shields can protect against splashes and droplets, TB is primarily transmitted via airborne particles, for which an N95 respirator is more appropriate.
• Surgical mask. A surgical mask is not sufficient for protecting healthcare workers against tuberculosis because it does not filter out small airborne particles like the N95 respirator does. Surgical masks are primarily intended for droplet precautions, but tuberculosis is spread through airborne transmission, necessitating an N95 mask for adequate protection.

• Gown. A gown is not required in this situation unless the patient has other symptoms or conditions that increase the risk of contamination, such as excessive wound drainage or the potential for body fluid splashes. For TB transmission, the primary concern is airborne transmission, and appropriate PPE focuses on respiratory protection (N95) and gloves for contact precautions.

A. "I can stop giving my child this medication if he is taking a steroid." Montelukast is a leukotriene receptor antagonist used for long-term asthma management and should not be discontinued without consulting a provider. It can be used alongside inhaled corticosteroids for better asthma control.
B. "I will give this medication to my child once daily in the evening." Montelukast is typically administered once daily in the evening because leukotrienes contribute to airway inflammation and bronchoconstriction, which can be more pronounced at night. Evening administration maximizes its effectiveness in preventing asthma symptoms.
C. "It takes 2 months of scheduled use before this medication is effective." Montelukast begins to show effects within a few days to a few weeks of consistent use, not two months. However, it is not a rescue medication and should be taken regularly for long-term asthma control.
D. "I will give this medication to my child every 2 hours if he is wheezing." Montelukast is not a rescue medication and does not provide immediate relief for acute bronchospasms. A short-acting beta-agonist, such as albuterol, should be used for rapid symptom relief during wheezing episodes.