The nurse observes an unlicensed assistive personnel (UAP) who is preparing to provide personal care for a client who requires contact precautions. The UAP has applied a gown and gloves and secured the tops of the gloves over the gown sleeves. Which action should the nurse take?

Confirm that the gown is tied securely at the neck and waist.

Help the UAP reposition the gown sleeve over the glove edges.

Remind the UAP to wash hands frequently while in the room.

Assist the UAP with the application of a face mask or face shield.

None

Answer and Explanation

The Correct Answer is A

A. Confirming that the gown is tied securely at the neck and waist is correct. Properly securing the gown ensures full coverage and prevents gaps where contamination could occur. This step is crucial for maintaining effective contact precautions.
B. Helping the UAP reposition the gown sleeve over the glove edges is incorrect. Standard PPE protocol requires that gloves be worn over the gown sleeves to prevent exposure when the hands are raised or moved.
C. Reminding the UAP to wash hands frequently while in the room is incorrect. While hand hygiene is always important, ensuring proper PPE use is the immediate priority in this scenario.
D. Assisting the UAP with the application of a face mask or face shield is incorrect. Contact precautions do not require a mask or face shield unless there is a risk of splashes or sprays of infectious material.

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Correct Answer is C

Explanation

A. Phobia.
A phobia is an irrational fear of a specific object, situation, or activity that leads to a desire to avoid it. The client's behavior is more characteristic of a compulsion rather than a phobia.

B. Obsession.
An obsession is an intrusive, unwanted thought, image, or urge that causes significant anxiety.
While the client's fear of contamination could be an obsession, the handwashing itself is a compulsion.

C. Compulsion.
This is the correct answer because a compulsion is a repetitive behavior or mental act that a person feels driven to perform in response to an obsession. The client's excessive handwashing ritual is a classic example of a compulsion.

D. Addiction.
Addiction involves a compulsive need for and use of a habit-forming substance or behavior, typically involving a sense of euphoria or pleasure, which is not applicable to the client's behavior.

A. Ensure that the infant's crib mattress is firm. B. Prop the infant with a pillow when in a side-lying position. C. Place the infant in a prone position whenever possible. D. Swaddle the infant in a blanket for sleeping.

Correct Answer is A

Explanation

A. Ensure that the infant's crib mattress is firm. A firm mattress reduces the risk of SIDS by preventing the infant from sinking into a soft surface, which can obstruct breathing.

B. Prop the infant with a pillow when in a side-lying position. Propping with a pillow is not recommended as it can increase the risk of suffocation and is not a recommended SIDS prevention measure.
C. Place the infant in a prone position whenever possible. Placing an infant in a prone (stomach) position is a significant risk factor for SIDS. Infants should be placed on their backs to sleep.
D. Swaddle the infant in a blanket for sleeping. While swaddling can be safe if done correctly, it is not as critical as ensuring a firm mattress. Additionally, improper swaddling can pose risks if the blanket becomes loose.

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The nurse observes an unlicensed assistive personnel (UAP) who is preparing to provide personal care for a client who requires contact precautions. The UAP has applied a gown and gloves and secured the tops of the gloves over the gown sleeves. Which action should the nurse take?

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

The nurse is planning to teach infant care and preventive measures for sudden infant death syndrome (SIDS) to a group of new parents. Which information is most important for the nurse to include?

Correct Answer is A

Explanation

While the nurse is conducting an admission assessment of a female client with bipolar disorder, the client suddenly begins to take off her clothes and throw them about the room. Which action should the nurse take first?

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