An unlicensed assistive personnel (UAP) who is working on a skilled nursing unit is diagnosed with hepatitis A (HVA). Two weeks later, a nurse complains of headache, nausea, anorexia, arthralgia, and low-grade fever. Which action should the nurse-manager take next?

Observe the nurse for jaundice and icterus sclera.

Review the immunization status of all unit employees.

Refer the nurse to employee health for serological testing.

Post an employee notice of the outbreak of HVA on the unit.

Answer and Explanation

The Correct Answer is C

Choice A reason: Observing the nurse for jaundice and icterus sclera is not the best action for the nurse-manager to take. These are signs of liver damage that may occur in the later stages of HVA infection. The nurse-manager should not rely on the physical appearance of the nurse to diagnose or rule out HVA. The nurse-manager should also respect the privacy and dignity of the nurse and not make any assumptions based on the skin or eye color.

Choice B reason: Reviewing the immunization status of all unit employees is an important action for the nurse-manager to take, but not the best one. The nurse-manager should ensure that all the staff are vaccinated against HVA or have received immune globulin if exposed. However, this action does not address the immediate needs and concerns of the nurse who is symptomatic and may be infected. The nurse-manager should also consider the possibility of other causes of the nurse's symptoms besides HVA.

Choice C reason: Referring the nurse to employee health for serological testing is the best action for the nurse-manager to take. The nurse-manager should facilitate the prompt and accurate diagnosis and treatment of the nurse who is symptomatic and may have HVA. The nurse-manager should also follow the infection control and reporting protocols of the facility and the health department. The nurse-manager should also provide support and counseling to the nurse and the staff.

Choice D reason: Posting an employee notice of the outbreak of HVA on the unit is not the best action for the nurse-manager to take. The nurse-manager should inform and educate the staff about the risk and prevention of HVA, but not in a way that may cause panic or stigma. The nurse-manager should also protect the confidentiality and rights of the nurse and the UAP who are diagnosed with HVA. The nurse-manager should also consult with the infection control and quality improvement teams before posting any notice.

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Correct Answer is B

Explanation

Choice A reason: This is not a relevant information to complete the report. The police department may want to interview the client about the MVC, but this is not a priority for the nurse or the healthcare provider.

Choice B reason: This is a relevant information to complete the report. The neurovascular assessments below the fracture are important to monitor the blood flow and nerve function of the affected limb. Normal findings indicate that the fracture and the surgery did not cause any complications or impairments.

Choice C reason: This is not a relevant information to complete the report. The absence of nausea or vomiting during the PACU recovery stay is a positive outcome, but it does not affect the current pain management or the postoperative care of the client.

Choice D reason: This is not a relevant information to complete the report. The family's request for a private room is a matter of preference and availability, but it does not influence the clinical status or the treatment plan of the client.

A. Discuss why visitors should not lie in the bed with the client. B. Notify the charge nurse that the visitor is lying on the client's bed. C. Explain that the client has the right to have a visitor lie on the bed. D. Instruct the UAP to ask the visitor to get off the client's bed. E. Instruct the UAP to ask the visitor to get off the client's bed.

Correct Answer is D

Explanation

Choice A reason: Discussing why visitors should not lie in the bed with the client is not the best action for the nurse to implement. The nurse should not waste time explaining the rationale to the visitor, as this may cause conflict or resentment. The nurse should focus on the immediate safety and comfort of the client and the visitor.

Choice B reason: Notifying the charge nurse that the visitor is lying on the client's bed is not the best action for the nurse to implement. The nurse should not escalate the situation to the charge nurse, as this may imply that the nurse is unable to handle the problem. The nurse should use his or her own authority and judgment to resolve the issue.

Choice C reason: Explaining that the client has the right to have a visitor lie on the bed is not the best action for the nurse to implement. The nurse should not condone or encourage the visitor's behavior, as this may compromise the client's health and hygiene. The nurse should respect the client's wishes, but also uphold the standards of care and infection control.

Choice D reason: Instructing the UAP to ask the visitor to get off the client's bed is the best action for the nurse to implement. The nurse should delegate the task to the UAP, who has already established rapport with the visitor and the client. The nurse should also monitor the situation and ensure that the UAP is polite and respectful to the visitor and the client.

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An unlicensed assistive personnel (UAP) who is working on a skilled nursing unit is diagnosed with hepatitis A (HVA). Two weeks later, a nurse complains of headache, nausea, anorexia, arthralgia, and low-grade fever. Which action should the nurse-manager take next?

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Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

Several family members are visiting a client who had a myocardial infarction 4 days ago. The unlicensed assistive personnel (UAP) informs the nurse that one of the visitors is lying on the client's bed. Which action should the nurse implement?

Correct Answer is D

Explanation

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