A nurse in an assisted-living facility reinforcing teaching with staff members about preparing for an external chemical disaster. Which of the following instructions should the nurse include?

"Open the fireplace dampers day room."

"Move clients to a room above ground with few windows."

"Turn on fans in the facility to circulate air."

"Cover the electrical outlets with wet towels."

Answer and Explanation

The Correct Answer is B

A) Open the fireplace dampers in the day room:
Opening the fireplace dampers in the event of an external chemical disaster would not be appropriate. In fact, this could allow toxic air or chemicals to enter the facility. It is important to seal off ventilation points that might allow the chemicals to enter, such as windows, doors, and any other openings, rather than opening the dampers.

B) Move clients to a room above ground with few windows:
In the event of an external chemical disaster, moving clients to a room above ground with few windows is a key safety measure. Rooms that are above ground level tend to be safer in such situations because chemicals may settle at ground level, increasing exposure risks to those below ground. A room with few windows is also important because it minimizes potential entry points for toxic substances from outside. The focus is on containing the air supply and limiting exposure to harmful agents.

C) Turn on fans in the facility to circulate air:
Turning on fans in the facility during a chemical disaster could worsen the situation by spreading toxic air or chemicals throughout the building. Fans are generally used to circulate air, but in this context, they would not be helpful and could potentially increase exposure to harmful substances. Instead, the focus should be on reducing airflow from the outside and sealing off the building.

D) Cover the electrical outlets with wet towels:
Covering electrical outlets with wet towels is not an effective response to an external chemical disaster. While wet towels can be useful in some scenarios for filtering or protecting from certain substances, in a chemical disaster, the priority is to ensure proper ventilation control and to protect from airborne chemicals by sealing the room. Electrical outlets should be covered for safety only when there is a risk of electrical hazards, but not necessarily in the case of a chemical disaster unless there is specific concern about sparks or fire.

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Correct Answer is B

Explanation

A) Arterial blood gases: Arterial blood gas (ABG) tests are typically used to assess respiratory and metabolic function, including the balance of oxygen and carbon dioxide in the blood. While important in many clinical situations, ABGs are not specifically relevant for monitoring a client on levothyroxine, as it does not directly affect gas exchange or acid-base balance.

B) Thyroid stimulating hormone (TSH): TSH is the most important laboratory test to monitor in a client taking levothyroxine, as this medication is used to replace or supplement thyroid hormone levels. Levothyroxine directly affects thyroid hormone levels in the body, so monitoring TSH levels is essential for determining whether the medication dosage needs to be adjusted. Elevated TSH levels may indicate that the dose is too low, while low levels may suggest an overdose.

C) Prothrombin time: Prothrombin time (PT) is used to assess blood clotting and coagulation status. While certain thyroid conditions can influence coagulation, PT is not a routine test to monitor in clients on levothyroxine therapy unless there are specific concerns related to bleeding or clotting. It is not the most relevant test for monitoring thyroid function in this context.

D) Blood urea nitrogen (BUN): Blood urea nitrogen (BUN) levels reflect kidney function and hydration status. While kidney function is always important to monitor, BUN is not specifically used to assess the effects of levothyroxine therapy. It would not provide direct information regarding the effectiveness of the medication or the thyroid status of the client.

A. Administer granulocyte colony stimulating factor. B. Monitor the infant's lymphocyte count. C. Initiate droplet precautions. D. Educate the infant's guardians about exchange transfusions.

Correct Answer is B

Explanation

A) Administer granulocyte colony stimulating factor: Granulocyte colony-stimulating factor (G-CSF) is used to stimulate white blood cell production in certain conditions like neutropenia. However, in an infant with HIV, the primary concern is the HIV progression and monitoring for complications rather than administering G-CSF. It is not routinely used for infants with HIV unless there is a specific indication such as neutropenia.

B) Monitor the infant's lymphocyte count: Monitoring the infant’s lymphocyte count is an appropriate and essential intervention. HIV affects the immune system by targeting CD4+ T lymphocytes, so tracking the lymphocyte count will help gauge the progression of the disease and the effectiveness of the treatment. It is vital to assess the infant’s immune status, as HIV can lead to a weakened immune system and increase susceptibility to infections.

C) Initiate droplet precautions: Droplet precautions are typically required for infections like influenza or certain respiratory illnesses. HIV is not transmitted via droplets; it is primarily transmitted through blood, sexual contact, and from mother to child during childbirth or breastfeeding. Therefore, droplet precautions are not necessary for this infant.

D) Educate the infant's guardians about exchange transfusions: Exchange transfusions are generally not a routine intervention for infants with HIV unless there is a specific complication like severe hyperbilirubinemia or other hematologic conditions. The focus for infants with HIV is on managing antiretroviral therapy (ART) and preventing infections, rather than performing exchange transfusions. Educating the guardians about ART and infection prevention would be more appropriate.

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