A nurse is caring for a client who has a wound infection that contains vancomycin-resistant Enterococcus (VRE). Which of the following types of precautions should the nurse plan to take while caring for this client?
Airborne
Droplet
Protective environment
Contact
The Correct Answer is D
Choice A reason: Airborne precautions are used for diseases that are spread through the air over long distances, such as tuberculosis, measles, or chickenpox. VRE is not typically spread through the air.
Choice B reason: Droplet precautions are used for diseases that are spread through large droplets in the air, such as influenza or pertussis. VRE is not spread through droplets but through contact with contaminated surfaces or equipment.
Choice C reason: A protective environment is designed to protect immunocompromised patients from infection and is not typically used for patients with VRE. This type of precaution includes the use of HEPA filters, laminar air flow, and other strategies to maintain a sterile environment.
Choice D reason: Contact precautions are the appropriate measures for a patient with a VRE infection. VRE can be spread from one person to another through contact with contaminated surfaces or equipment or through person-to-person spread, often via contaminated hands. It is not spread through the air by coughing or sneezing. Therefore, contact precautions, including the use of gloves and gowns, are necessary when caring for patients with VRE to prevent the spread of the bacteria.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Decreased energy is a common symptom of OSA due to disrupted sleep patterns and the body's struggle to maintain adequate oxygen levels during apneic episodes. This can lead to excessive daytime sleepiness and fatigue.
Choice B reason: While thyroid disease can be associated with sleep disorders, it is not a direct finding of OSA. However, hypothyroidism can contribute to the development of OSA due to myxedematous changes leading to airway obstruction.
Choice C reason: Pneumonia is not a direct finding of OSA. However, individuals with OSA may be at increased risk for respiratory infections due to repeated episodes of upper airway collapse during sleep, which can lead to aspiration.
Choice D reason: Hypotension is generally not associated with OSA. In fact, OSA is more commonly linked with hypertension due to the sympathetic nervous system activation that occurs with each apneic episode.
Correct Answer is ["A","B","C","E"]
Explanation
Choice A reason: Restlessness can be a sign of discomfort or pain, especially in a postoperative client. It may manifest as constant shifting or an inability to remain still, indicating that the client is trying to find a position that alleviates the pain.
Choice B reason: Clenching, such as tightly gripping the handrails of the bed or making fists, can indicate that the client is trying to manage pain or discomfort through tension in the muscles.
Choice C reason: Grimacing, or making a pained facial expression, is a clear nonverbal cue of pain. It often involves furrowing the brow, closing the eyes tightly, or contorting the mouth.
Choice D reason: Drowsiness is not typically a direct indicator of pain. It may be related to medication effects, fatigue, or the body's response to healing post-surgery. However, it does not specifically signal pain.
Choice E reason: Moaning, groaning, or making other vocal sounds can be a response to pain, particularly in clients who are unable to articulate their pain verbally due to sedation or other factors.
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