The client has protective precautions (reverse isolation) in place due to a severely depressed neutrophil count. Which statement by the client demonstrates a good understanding of the precautions?
“The precautions will protect me and help my blood count recover faster."
"Persons entering the room with colds should stay at least 3 feet from me."
"My family plans to bring flowers from my garden to help me feel better."
"Persons entering my room should perform hand hygiene before entering."
The Correct Answer is D
A. “The precautions will protect me and help my blood count recover faster.”: While protective precautions are meant to safeguard the client from infections, this statement does not specifically address the necessary actions or behaviors that need to be followed to maintain reverse isolation. Recovery of blood counts is a complex process that depends on multiple factors, including the underlying condition and treatment.
B. "Persons entering the room with colds should stay at least 3 feet from me.": This statement is not sufficient for reverse isolation. Individuals entering the room should be free of any respiratory illnesses, and maintaining a distance may not be adequate protection. Ideally, anyone entering the room should be healthy and ideally wearing appropriate protective gear, such as masks, to reduce the risk of transmitting infections.
C. "My family plans to bring flowers from my garden to help me feel better.": Bringing flowers from outside can introduce pathogens and compromise the sterile environment necessary for a client in reverse isolation. This statement demonstrates a lack of understanding of the precautions required to maintain a safe environment.
D. "Persons entering my room should perform hand hygiene before entering.": This statement accurately reflects an understanding of the precautions needed in reverse isolation. Hand hygiene is critical in preventing the introduction of pathogens into the sterile environment of a client with a severely depressed neutrophil count. It helps to minimize the risk of infections, which is the primary goal of reverse isolation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Twist at the waist when she moves an object to one side: Twisting at the waist can place excessive strain on the lower back and increase the risk of injury. Instead, the client should pivot her whole body to move an object, which helps maintain spinal alignment and reduces strain.
B. Bend at the knees when picking up an object: This instruction is crucial for preventing back strain. Bending at the knees allows the client to use her legs' strength to lift the object rather than putting pressure on the back. This technique helps protect the spine and promotes safe lifting practices.
C. Hold an object away from her body as she lifts it: Holding an object away from the body increases leverage and strain on the back muscles. The client should keep the object close to her body while lifting to maintain better balance and reduce the risk of injury.
D. Relax her abdominal muscles when she lifts an object: Engaging the abdominal muscles provides support to the spine during lifting. Relaxing the abdominal muscles can lead to a lack of core stability, increasing the risk of back injury. The client should be encouraged to engage her core muscles while lifting.
Correct Answer is D
Explanation
A. A nurse gives a client the choice to take a pain medication via intramuscular or oral route: This action exemplifies the ethical principle of autonomy, as it respects the client’s right to make decisions regarding their own treatment options.
B. A nurse administers scheduled pain medication for a client who is having pain: This action reflects the principle of beneficence, which emphasizes the obligation to act in the best interest of the client and alleviate suffering. Administering pain medication according to the schedule supports the client's well-being.
C. A nurse fulfills a promise to a client that they will return with their pain medication: This action demonstrates fidelity, which involves keeping promises and commitments made to clients. It ensures trust and accountability in the nurse-client relationship.
D. A nurse provides nonpharmacological pain interventions to each client equally: This action represents the principle of justice, which emphasizes fairness and equality in the distribution of resources and treatment among clients. Providing equal access to pain interventions ensures that all clients receive appropriate care regardless of their individual circumstances, aligning with the ethical principle of justice.
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