The nurse and the student nurse are caring for two different patients on the medical-surgical unit. One patient is in airborne precautions, and one is in contact precautions. The nurse explains to the student different interventions for care. Which information will the nurse include in the teaching session? (Select all that apply.)

Apply the knowledge the nurse has of the disease process to prevent the spread of microorganisms.

Dispose of supplies to prevent the spread of microorganisms.

Check the working order of the negative-pressure room for the airborne precaution patient on admission and at discharge.

Wash hands before entering and leaving both of the patients' rooms.

Be consistent in nursing interventions since there is only one difference in the precautions.

Have patients in airborne precautions wear a mask during transportation to other departments.

Answer and Explanation

Correct Answer : A,B,C,D,F

A. Applying knowledge of disease processes is essential in preventing the spread of infections and understanding transmission routes.

B. Proper disposal of supplies is crucial in minimizing the risk of cross-contamination and infection spread.

C. Checking the negative-pressure system is critical to ensure it functions properly to contain airborne pathogens.

D. Hand hygiene is a key practice in preventing infection and should be performed before and after patient contact in both scenarios.

E. This statement is misleading; while some precautions may overlap, there are specific differences that must be addressed in interventions for airborne versus contact precautions.

F. It is important for patients in airborne precautions to wear a mask during transportation to prevent the spread of infectious particles.

Nursing Test Bank

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Naxlex Comprehensive Predictor Exams

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Free Nursing Study Resources

Correct Answer is B

Explanation

A. Increasing activity level may be unrealistic for a patient on strict bed rest due to a pelvic fracture.
B. Repositioning every 2 hours is a realistic and achievable goal for a patient on bed rest to prevent complications such as pressure ulcers and maintain circulation.
C. Using a walker for ambulation may not be feasible immediately after a pelvic fracture.
D. Transferring with a sliding board may not be safe or appropriate in the early stages post-injury, especially if bed rest is required.

A. 15 degree B. 90 degree C. 30 degree D. 45 degree

Correct Answer is A

Explanation

A. The tuberculin test is administered intradermally, and the needle should be inserted at a 15-degree angle to ensure the medication is delivered just under the surface of the skin.
B. A 90-degree angle is used for intramuscular injections, not for intradermal tests like the tuberculin test.
C. A 30-degree angle is commonly used for subcutaneous injections and is too deep for an intradermal injection.
D. A 45-degree angle is also used for subcutaneous injections but is not suitable for intradermal injections.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is developing a care plan for a patient prescribed bed rest as a result of a pelvic fracture. Which goal statement is realistic for the nurse to assign to this patient?

Correct Answer is B

Explanation

The nurse is planning to administer a tuberculin test with a 27-gauge, 5/8-inch needle. At which angle will the nurse insert the needle?

Correct Answer is A

Explanation

A nurse develops a nursing diagnostic statement for a patient with a medical diagnosis of pneumonia with chest x-ray results of lower lobe infiltrates. Which nursing diagnosis did the nurse write?

The nurse is assessing a new patient admitted to home health. Which questions will be most appropriate for the nurse to ask to determine the risk of infection? (Select all that apply.)

A nurse is caring for a 5-year-old patient whose temperature is 101.2° F. The nurse expects this patient to hyperventilate. Which factor does the nurse remember when planning care for this type of hyperventilation?

While the nurse is taking a patient history, the nurse discovers the patient has a type of diabetes that results from a head injury and does not require insulin. Which dietary change should the nurse share with the patient?

A terminally ill patient is experiencing constipation secondary to pain medication. Which is the best method for the nurse to improve the patient's constipation problem?

A patient has been diagnosed with heart failure and cardiac output is decreased. Which formula can the nurse use to calculate cardiac output?

A patient has experienced a myocardial infarction. On which primary blood vessel will the nurse focus care to reduce ischemia?