A nurse is assisting in the review of infection control precautions implemented by staff in a facility.
Select 2 client situations that require follow-up by the infection control nurse.
Client 1
Client 2
Client 3
Client 4
Client 5
Correct Answer : A,D
A. Client 1: The client with Pertussis should have individuals wear surgical masks when within 3 feet of the client, not 1 foot. Pertussis is highly contagious, and proper precautions are necessary to prevent transmission
B. Client 2: The client with Clostridium difficile is placed in a private room, and nurses wear gowns and gloves during direct care. These are appropriate contact precautions for preventing the spread of C. difficile.
C. Client 3: The client with Herpes simplex is managed with nurses wearing gowns and gloves during direct care, which is appropriate for preventing the spread of the virus through direct contact.
D. Client 4: The client with Mycobacterium tuberculosis should be placed in a negative airflow room, not a positive airflow room. Negative airflow rooms help contain airborne pathogens and prevent them from spreading to other areas.
E. Client 5: The client with Streptococcal pharyngitis is placed in a private room, and the client wears a surgical mask when transported outside their room. These are appropriate droplet precautions to prevent the spread of infection.
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Related Questions
Correct Answer is C
Explanation
A. While the nurse's notes may include observations about the client's condition, recording that an incident report was filed does not provide pertinent details regarding the client's care and is not appropriate.
B. Incident reports are confidential documents and should not be shared with the client's family, so providing a copy of the report is inappropriate.
C. Documenting the facts about the incident in the medical record is essential to provide a complete account of the client's care and any resulting changes or observations. This documentation is important for continuity of care and legal purposes.
D. Incident reports should not be placed in the medical record, as they are separate documents intended for internal review and quality assurance purposes.
Correct Answer is A
Explanation
A. Raisin toast is a bland carbohydrate that is generally well-tolerated and can help settle the stomach, making it a suitable choice for clients experiencing chemotherapy-induced nausea.
B. Soft-serve ice cream may be too rich and can upset the stomach for some clients undergoing chemotherapy, leading to increased nausea.
C. String cheese is high in fat and protein, which might not be well-tolerated during episodes of nausea, as heavy foods can exacerbate discomfort.
D. Hot tea may be soothing for some clients; however, certain herbal teas can sometimes provoke nausea or have an adverse effect, making it less ideal than bland carbohydrates.
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