The charge nurse on a medical unit is preparing to admit several clients who have possible pandemic flu during a preparedness drill.
What action by the nurse is best?

Choice A rationale

Wrapping the infant too snugly, especially around the head, can lead to overheating, which is a known risk factor for SIDS. Overheating can interfere with an infant's ability to arouse from sleep, a protective mechanism against SIDS, and disrupt thermal regulation.

Choice B rationale

Positioning the infant prone (on their stomach) for sleep significantly increases the risk of SIDS. The prone position is associated with rebreathing of exhaled air, leading to carbon dioxide accumulation and oxygen depletion. It also increases the risk of airway obstruction and overheating, both contributing factors to SIDS.

Choice C rationale

Sitting an infant up in an infant seat for sleep is not recommended as a primary sleep position for preventing SIDS. While useful for transport, prolonged sleep in an infant seat can lead to airway compression, head entrapment, and an increased risk of positional asphyxiation, especially if the infant's head slumps forward.

Choice D rationale

Placing infants on their backs or sides for sleep significantly reduces the risk of SIDS. The supine (back) position prevents airway obstruction from rebreathing exhaled air and allows for optimal oxygenation. The side position, while acceptable, is less stable than the back position and is not as strongly recommended.

Choice A rationale

A sputum culture for acid-fast bacillus (AFB) is considered the gold standard for confirming the diagnosis of active pulmonary tuberculosis. This test directly identifies the presence of Mycobacterium tuberculosis in respiratory secretions, providing definitive evidence of infection and allowing for drug susceptibility testing, which is crucial for guiding treatment.

Choice B rationale

A chest X-ray can show abnormalities suggestive of pulmonary tuberculosis, such as infiltrates, cavitations, or effusions, but it is not definitive. Other respiratory conditions can present similarly, and a chest X-ray alone cannot confirm the presence of active Mycobacterium tuberculosis. It serves as a supportive diagnostic tool.

Choice C rationale

A sputum smear for acid-fast bacilli provides rapid presumptive evidence of active tuberculosis by visualizing AFB under a microscope. While helpful for early detection and isolation precautions, it does not confirm the species of mycobacteria and has lower sensitivity than culture. A positive smear needs confirmation with culture.

Choice D rationale

The Mantoux test, or tuberculin skin test, indicates exposure to Mycobacterium tuberculosis and the development of a cell-mediated immune response. A positive test signifies either latent TB infection or active disease but cannot differentiate between the two. It does not confirm active pulmonary tuberculosis and is not reliable for confirming active disease.