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 D
Explanation
Choice A rationale:
A blood glucose level of 110 mg/dL is within the normal range and is an expected finding.
Choice B rationale:
A weight gain of 0.91 kg (2 lb) in 2 days could be expected in a client receiving enteral feeding due to fluid intake. However, it's important to monitor for signs of fluid overload.
Choice C rationale:
Diarrhea one time in a 24-hour period can occur in some clients but should be monitored for any patterns or changes.
Choice D rationale:
A gastric residual of 300 mL at the end of the shift is higher than expected and may indicate delayed gastric emptying or intolerance to enteral feeding. This finding should be reported.
Correct Answer is B
Explanation
Choice A rationale:
Scheduling a support session for the client is important for emotional support but is not the priority before addressing the client's immediate communication needs.
Choice B rationale:
Reviewing the use of an artificial larynx with the client is the priority. Total laryngectomy involves the removal of the larynx, affecting speech. Providing information on alternative methods of communication, such as an artificial larynx, is crucial before the surgery.
Choice C rationale:
Determining the client's reading ability is relevant but does not take precedence over preparing the client for immediate postoperative communication.
Choice D rationale:
Explaining the techniques of esophageal speech can be part of the client education but is not the priority before addressing the immediate need for communication.
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