A nurse is admitting a client who has active tuberculosis. Which of the following nursing interventions is appropriate?
Place the client in a room that is ventilated to the outside.
Wear a gown when delivering the client's food tray.
Prohibit visitors while the client's infection is active.
Administer a tuberculin skin test prior to discharge.
The Correct Answer is A
A. Place the client in a room that is ventilated to the outside: Clients with active tuberculosis should be placed in negative pressure rooms with air exhausted directly to the outside to prevent the spread of airborne pathogens.
B. Wear a gown when delivering the client's food tray: Gowns are not typically necessary for routine care of clients with tuberculosis unless there is potential for contact with respiratory secretions.
C. Prohibit visitors while the client's infection is active: Visitors should be educated about tuberculosis precautions and provided with appropriate personal protective equipment if necessary, but prohibiting visitors may not be necessary.
D. Administer a tuberculin skin test prior to discharge: Tuberculin skin testing is used for screening and diagnosis of tuberculosis infection, not for management of active tuberculosis.
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Related Questions
Correct Answer is C
Explanation
A. Suggest the family persuade the client to take the medication: This option involves coercion, which is not ethically appropriate. Clients have the right to refuse medication, and persuasion from family members should not be used to override this right.
B. Recommend that the medication be delivered intramuscularly: Administering medication against a client's will through an invasive route like intramuscular injection is not appropriate and may constitute assault.
C. Remind the newly licensed nurse that the client has a right to refuse medication: This response upholds the client's autonomy and right to refuse treatment. Nurses must respect a client's decision to decline medication, provided they are competent to make that decision.
D. Suggest the newly licensed nurse contact the pharmacy to inquire about compatible foods: This response does not address the ethical issue of respecting the client's autonomy and right to refuse medication.
Correct Answer is ["A","B","C","E"]
Explanation
A. Documenting urine color is essential after a transurethral resection of the prostate to monitor for bleeding and ensure that the bladder irrigation is effective in clearing out blood clots.
B. Monitoring for bladder spasms is important as they can indicate the presence of blood clots or other complications, and they can be very painful for the client.
C. Checking the drainage tubing for obstructions is crucial to maintain the patency of the catheter and ensure continuous irrigation. Obstructions can lead to complications such as bladder distention or increased bleeding.
D. Maintaining the client in a left side-lying position is not specifically required for continuous bladder irrigation and is not typically part of postoperative care for a client who had a transurethral resection of the prostate.
E. Using clean technique for intermittent irrigation is important to prevent infection. While sterile technique is ideal, clean technique can be used for the client's own catheter care at home or in settings where sterile technique is not feasible. However, in a clinical setting, sterile technique is usually preferred to minimize infection risk.
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