A nurse is reinforcing teaching about activities of daily living with a client who had a stroke. Which of the following statements should the nurse include?

Rationale:

• Ask the client for a list of close contacts: The client exhibits classic symptoms of active tuberculosis (TB), including weight loss, night sweats, hemoptysis (bloody cough), and chest tightness. Identifying close contacts is crucial for contact tracing and limiting disease spread.
• Obtain a sputum culture: A sputum culture is essential for diagnosing pulmonary TB. This test confirms the presence of Mycobacterium tuberculosis and guides further treatment decisions.
• Place the client in a negative-pressure room: Clients suspected of having TB should be placed in a negative-pressure isolation room to prevent airborne transmission to others, especially in healthcare settings.
• Use airborne precautions: Airborne precautions, including the use of an N95 respirator, are required for suspected or confirmed TB due to its airborne transmission risk.
• Obtain blood cultures: Blood cultures are not the priority in TB diagnosis unless sepsis is suspected. TB is primarily diagnosed through respiratory samples, not blood.
• Recommend ABGs be drawn: Arterial blood gases (ABGs) are typically unnecessary in TB unless there is respiratory compromise requiring ventilatory support or oxygenation monitoring, which is not indicated here.
• Request a glucocorticoid prescription from the provider: Glucocorticoids are not standard treatment for TB and may suppress immune response. They may be used in specific TB complications like meningitis or pericarditis, but not in general pulmonary TB management.

Rationale:

A. Ensure the client is aware of the scheduled time for the procedure: While knowing the time of surgery is helpful for preparation, it is not a requirement for informed consent. The key issue is whether the client understands the procedure itself and its implications.

B. Make sure the client has been informed about the risks of the procedure: Before witnessing informed consent, the nurse must confirm that the client has received complete information from the provider about the procedure, including its purpose, risks, benefits, and alternatives. This ensures the client is making an informed decision.

C. Ensure the client receives opioid medication prior to giving consent for the procedure: Administering opioids before consent can impair the client's cognitive ability to understand and voluntarily agree. Consent must be obtained while the client is alert and oriented, prior to any sedating medications.

D. Make sure the client's family agrees to the procedure: Consent is only valid when given by the competent client. Family agreement is not legally required unless the client is unable to consent and a legal surrogate is designated.