A nurse is teaching a group of assistive personnel about airborne precautions. Which of the following statements should the nurse make when caring for a client who has the measles?
A mask is not required when more than 3 feet from a client who requires airborne precautions.
A client who has varicella should be placed in a positive pressure room.
A respirator should be worn when entering the client's room.
A gown and gloves should be worn when providing direct care to the client.
The Correct Answer is C
Choice A reason: A mask is not sufficient to protect against airborne pathogens, such as the measles virus. A mask only filters out large droplets, but not the small particles that can remain suspended in the air. A mask should be worn when caring for a client who requires droplet precautions, such as influenza or pertussis.
Choice B reason: A client who has varicella should be placed in a negative pressure room, not a positive pressure room. A negative pressure room prevents the contaminated air from escaping the room and infecting others. A positive pressure room does the opposite: it prevents the outside air from entering the room and contaminating the client. A positive pressure room is used for clients who require protective isolation, such as those who are immunocompromised.
Choice C reason: A respirator should be worn when entering the client's room who has the measles. A respirator is a special type of mask that filters out both large and small particles, and provides a tight seal around the face. A respirator is required for clients who require airborne precautions, such as tuberculosis, varicella, or measles.
Choice D reason: A gown and gloves should be worn when providing direct care to the client who has the measles, but they are not specific to airborne precautions. A gown and gloves are part of standard precautions, which apply to all clients regardless of their diagnosis or infection status. A gown and gloves protect the nurse from contact with the client's blood, body fluids, secretions, and excretions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Collecting the client's urine output every 24 hours is a task that the nurse can delegate to an AP. This task is within the AP's scope of practice and does not require clinical judgment or assessment. The nurse should provide clear instructions and expectations to the AP, and monitor and evaluate the client's fluid status and renal function.
Choice B reason: Administering the client's scheduled antitubercular medications is a task that the nurse cannot delegate to an AP. This task is outside the AP's scope of practice and requires clinical judgment and assessment. The nurse should follow the five rights of medication administration and monitor the client for adverse effects and therapeutic outcomes.
Choice C reason: Assisting the client with speech therapy exercises is a task that the nurse cannot delegate to an AP. This task is outside the AP's scope of practice and requires specialized knowledge and skills. The nurse should collaborate with the speech therapist and follow the prescribed plan of care for the client.
Choice D reason: Placing the client on airborne precautions is a task that the nurse cannot delegate to an AP. This task is outside the AP's scope of practice and requires clinical judgment and assessment. The nurse should implement the infection control measures and educate the client and the AP about the rationale and the procedures.
Correct Answer is D
Explanation
Choice A reason: Respecting the client's decision and informing the provider is an appropriate action, but not the first one that the nurse should take. The nurse should first assess the client's understanding of the condition and the treatment options, and provide education and support as needed.
Choice B reason: Explaining the benefits and risks of the procedure is an appropriate action, but not the first one that the nurse should take. The nurse should first assess the client's understanding of the condition and the treatment options, and provide education and support as needed.
Choice C reason: Suggesting alternative treatments for the condition is an appropriate action, but not the first one that the nurse should take. The nurse should first assess the client's understanding of the condition and the treatment options, and provide education and support as needed.
Choice D reason: Assessing the client's understanding of the consequences of uterine prolapse and the need for surgery is the first and most appropriate action that the nurse should take. The nurse should determine the client's knowledge, beliefs, and preferences regarding the condition and the surgery, and address any gaps, misconceptions, or concerns. The nurse should also respect the client's autonomy and right to make informed decisions about their health care.
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