A nurse is admitting a client who has tuberculosis and a productive cough. Which of the following types of isolation precautions should the nurse initiate for the client?

Choice A reason: Performing CPT immediately after the child eats is not a good action for the nurse to plan to take for a child who has cystic fibrosis and a prescription to receive CPT. CPT involves techniques such as percussion, vibration, and postural drainage that help to loosen and remove mucus from the lungs. Performing CPT right after eating can cause nausea, vomiting, or aspiration, especially if the child has gastroesophageal reflux disease (GERD), which is common in cystic fibrosis. The nurse should plan to perform CPT at least 1 hour before or after meals.

Choice B reason: Percussing each lung segment for 15 min is not a necessary action for the nurse to plan to take for a child who has cystic fibrosis and a prescription to receive CPT. Percussion is a technique that involves clapping the chest with a cupped hand to create vibrations that loosen the mucus in the airways. Percussion can be done manually or with a mechanical device. The duration of percussion depends on the amount and location of the mucus, but it is usually done for 3 to 5 min per lung segment. Percussing for 15 min per segment can be excessive and cause bruising, pain, or fatigue.

Choice C reason: Administering albuterol prior to CPT is a beneficial action for the nurse to plan to take for a child who has cystic fibrosis and a prescription to receive CPT. Albuterol is a bronchodilator that helps to relax the smooth muscles of the airways and improve airflow. Administering albuterol before CPT can enhance the effectiveness of the airway clearance techniques by opening up the airways and making it easier to cough up the mucus.

Choice D reason: Performing vibration during the client’s inspirations is not a correct action for the nurse to plan to take for a child who has cystic fibrosis and a prescription to receive CPT. Vibration is a technique that involves applying pressure and shaking the chest wall during exhalation to help move the mucus out of the lungs. Vibration can be done manually or with a mechanical device. Performing vibration during inspiration can interfere with the inhalation of air and oxygen, and reduce the effectiveness of the technique.

Choice A reason: Administering the medication 2 hr before exercise is a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast is a leukotriene modifier that helps to prevent asthma attacks and exercise induced bronchoconstriction. It is taken once a day in oral form and may cause side effects such as stomach pain, diarrhea, or mood changes. For children who have exercise induced asthma, an additional dose of montelukast may be taken 2 hr before exercise.

Choice B reason: Giving the medication at the onset of wheezing is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast is not a fast acting rescue medicine for asthma attacks and needs to be taken daily. It does not work quickly enough to relieve the symptoms of an acute asthma attack, such as wheezing, coughing, or shortness of breath. For an asthma attack, the child should use a short acting beta agonist inhaler, such as albuterol, as prescribed by the provider.

Choice C reason: Administering the granules mixed with 20 oz of water is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast granules come in a sachet with 4 mg of granules inside (one dose). They can be placed directly on the child's tongue or mixed with a spoonful of cold or room temperature soft food, such as applesauce, mashed carrots, rice, or ice cream. They can also be mixed with 1 teaspoonful (5 mL) of cold or room temperature baby formula or breast milk. They should not be mixed with any other liquid drink other than baby formula or breast milk. The mixture should be taken within 15 minutes after opening the packet.

Choice D reason: Giving the medication in the morning daily is not a correct instruction for the parent of a child who has asthma and a prescription for montelukast granules. Montelukast works best when taken in the evening, as it can improve the symptoms of asthma and allergic rhinitis that occur at night or early in the morning. Taking it at the same time every day can also help to maintain a steady level of the drug in the body and prevent missed doses.