A client presents to the emergency department with muscle aches, headache, fever, and describes a recent loss of taste and smell.
The nurse obtains a nasal swab for COVID-19 testing. Which action is most important for the nurse to take?

The correct answer is choiceb. Identify the client using 2 client identifiers,c. Perform hand hygiene,e. Don gloves,f. Check the skin around the face, andg. Assess respiratory function.

Choice A rationale:

Determining if the client needs to go to the bathroom is not directly related to the immediate preparation for oxygen administration. However, it can be considered as part of overall patient comfort and care.

Choice B rationale:

Identifying the client using 2 client identifiers is crucial to ensure the correct patient is receiving the correct treatment, which is a standard safety protocol in healthcare settings.

Choice C rationale:

Performing hand hygiene is essential to prevent the spread of infection and maintain a sterile environment.

Choice D rationale:

Brushing the client’s teeth is not a necessary step before applying a simple face mask for oxygen administration. It is more related to general oral hygiene.

Choice E rationale:

Donning gloves is important to protect both the nurse and the patient from potential contamination and infection.

Choice F rationale:

Checking the skin around the face is important to ensure there are no existing sores or irritations that could be exacerbated by the mask.

Choice G rationale:

Assessing respiratory function is critical to determine the patient’s baseline respiratory status and to monitor the effectiveness of the oxygen therapy.

Choice A rationale:

Famotidine is a histamine-2 receptor antagonist (H2RA) that decreases gastric acid secretion. It is often used to treat conditions such as ulcers, gastroesophageal reflux disease (GERD), and heartburn.

Bismuth subsalicylate, metronidazole, tetracycline, and pantoprazole are all medications used in the treatment of H. pylori infection. However, these medications can interact with famotidine, potentially leading to decreased efficacy or increased side effects.

Therefore, it is important for the nurse to review the client's electronic medical record for any current or recent use of famotidine before administering the H. pylori treatment regimen. This will help to ensure the safety and effectiveness of the treatment.

Choice B rationale:

Loperamide is an antidiarrheal medication. It is not typically used in the treatment of H. pylori infection and is not known to interact with the medications used in this regimen.

Choice C rationale:

Aspirin is a salicylate medication that is often used to treat pain, fever, and inflammation. It can also be used to prevent blood clots. However, aspirin can interact with bismuth subsalicylate, potentially leading to increased risk of bleeding.

Therefore, it is important for the nurse to assess the client's risk of bleeding before administering the H. pylori treatment regimen if they are also taking aspirin.

Choice D rationale:

Ipratropium is a bronchodilator medication that is used to treat asthma and chronic obstructive pulmonary disease (COPD). It is not typically used in the treatment of H. pylori infection and is not known to interact with the medications used in this regimen.