Which information provided by the patient would help distinguish a hemorrhagic stroke from a thrombotic stroke?

Choice A rationale

Active tuberculosis is primarily transmitted via airborne particles containing Mycobacterium tuberculosis. Therefore, isolating the client in a private room equipped with negative pressure ventilation is crucial. This system ensures that air from the room is exhausted directly outside or through a high-efficiency particulate air (HEPA) filter, preventing the dissemination of airborne pathogens to other areas and protecting healthcare workers and other clients from exposure.

Choice B rationale

Assigning a client with active tuberculosis to a room with clients requiring droplet precautions is inappropriate. Droplet precautions are for larger respiratory droplets that typically travel short distances, whereas tuberculosis involves smaller airborne nuclei that can remain suspended in the air and travel greater distances. This placement would significantly increase the risk of cross-contamination and disease transmission to other susceptible individuals within the healthcare environment.

Choice C rationale

While masks are essential for airborne precautions, routine use of gowns and gloves for staff and visitors is generally not required for tuberculosis unless direct contact with respiratory secretions or contaminated items is anticipated. The primary mode of transmission is airborne, making respiratory protection the paramount intervention. Over-gowning and gloving unnecessarily consume resources and do not significantly enhance protection against airborne transmission.

Choice D rationale

Modifying the protocol for donning and removing personal protective equipment (PPE) before entering or leaving the client's room is unsafe and increases the risk of contamination. Strict adherence to established PPE protocols, including proper hand hygiene and the correct sequence for donning and doffing, is critical to prevent self-contamination and the spread of pathogens. Any deviation from these protocols compromises safety and infection control efficacy.

Choice A rationale

Obtaining a prescription for an indwelling urinary catheter in a client with a T4 spinal cord injury who is at risk for urinary tract infections (UTIs) is generally discouraged for long-term management. Indwelling catheters significantly increase the risk of UTIs due to biofilm formation and the introduction of bacteria into the sterile urinary tract. Intermittent catheterization or other bladder management strategies are preferred to minimize this risk.

Choice B rationale

Encouraging fluid intake at and between meals is a critical intervention for preventing urinary tract infections in clients with spinal cord injuries. Increased fluid intake promotes frequent bladder emptying, which helps to flush bacteria from the urinary tract, reducing bacterial stasis and colonization. Adequate hydration maintains urine flow and dilutes bacterial concentrations, thereby lowering the risk of ascending infections.

Choice C rationale

Offering the client the bedpan every 2 hours might not be an effective strategy for preventing UTIs in a client with a T4 spinal cord injury. This injury level often results in a neurogenic bladder, where the client may not have normal sensation or control over bladder emptying. Regular, scheduled emptying, often through intermittent catheterization, is more effective in preventing overdistention and residual urine, which are risk factors for UTIs.

Choice D rationale

Cleansing the perineum from back to front is an incorrect technique and significantly increases the risk of urinary tract infections. This method can introduce fecal bacteria, such as Escherichia coli, from the anal area into the urethra, leading to ascending UTIs. The correct and scientifically sound method for perineal cleansing is from front to back, which prevents the migration of enteric microorganisms to the urinary meatus.