A nurse is teaching a newly licensed nurse about the care of a client who has a methicillin-resistant Staphylococcus aureus (MP of the following statements by the newly licensed nurse indicates an understanding of the teaching?
"I will tell the client's visitors to wear a mask when they are within 3 feet of the client."
"I will place the client in a private room."
"I will wear an N95 respirator mask when caring for the client."
"I will remove my gown before my gloves after providing client care."
The Correct Answer is B
Choice A rationale:
Telling the client's visitors to wear a mask within 3 feet is not a standard precaution for MRSA. Standard precautions, including hand hygiene, are generally sufficient.
Choice B rationale:
Placing the client in a private room is appropriate to prevent the spread of MRSA to other clients.
Choice C rationale:
Wearing an N95 respirator mask is not necessary for routine care of a client with MRSA. Standard precautions are usually adequate.
Choice D rationale:
Removing the gown before gloves is not consistent with standard precautions. The gown should be removed after gloves to minimize the risk of contamination.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
- A. Calcium 9.6 mg/dL: This value is within the normal range for calcium, which is typically between 8.7 to 10.2 mg/dL. Therefore, this value does not need to be reported to the provider.
- B. Potassium 5.8 mEq/L: This value is above the normal range for potassium, which is generally between 3.5 to 5.0 mEq/L. Elevated potassium levels can be dangerous and may indicate hyperkalemia, which requires prompt medical attention.
- C. Magnesium 1.9 mEq/L: This value falls within the normal range for magnesium, which is usually between 1.6 to 2.2 mg/dL. Thus, this is not a value that would typically be reported to the provider.
- D. Sodium 140 mEq/L: This value is within the normal range for sodium, which is commonly between 135 to 145 mEq/L. As such, it does not need to be reported to the provider.
Correct Answer is D
Explanation
Choice A rationale:
Assessing comfort level is important, but assessing peripheral pulses takes precedence to ensure the client's safety and prevent complications.
Choice B rationale:
Assessing skin integrity is relevant but secondary to assessing peripheral pulses. Skin integrity can be addressed after ensuring adequate circulation.
Choice C rationale:
Assessing elimination needs is not the priority in this context. While it's important to address overall care needs, assessing peripheral pulses is more critical in preventing complications related to restraints.
Choice D rationale:
Assessing peripheral pulses is the priority when caring for a client with restraints to each extremity. Monitoring circulation ensures that blood flow is maintained, and complications related to impaired circulation are promptly identified.
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