A nurse is caring for a client who has active tuberculosis. Which of the following actions should the nurse take?
Remain 1 m (3 feet) away from the client when providing care.
Apply a surgical mask before entering the client’s room.
Ensure the door to the client’s room is closed at all times.
Place a “no visitors” sign on the client’s door.
The Correct Answer is C
Choice A Reason:
Remaining 1 meter (3 feet) away from the client when providing care is not sufficient to prevent the spread of tuberculosis (TB). TB is an airborne disease, and the bacteria can remain suspended in the air for several hours. Therefore, maintaining a distance alone does not provide adequate protection against inhaling the bacteria.
Choice B Reason:
Applying a surgical mask before entering the client’s room is not the most effective measure. Surgical masks are designed to protect against large droplets and splashes, but they do not provide adequate protection against airborne particles like TB bacteria. Instead, healthcare workers should use N95 respirators, which are specifically designed to filter out airborne particles.
Choice C Reason:
Ensuring the door to the client’s room is closed at all times is a critical measure in preventing the spread of TB. This action helps to contain the airborne bacteria within the room, reducing the risk of transmission to others in the healthcare facility. This is part of airborne precautions, which are essential for managing patients with active TB.
Choice D Reason:
Placing a “no visitors” sign on the client’s door can help limit the number of people exposed to the TB bacteria, but it is not the most critical action. While it is important to restrict visitors, ensuring the door is closed and using appropriate personal protective equipment (PPE) are more effective measures in controlling the spread of TB.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
Choice A Reason:
Using an electric shaver is recommended for clients who have received chemotherapy because it reduces the risk of cuts and bleeding. Chemotherapy can lower platelet counts, leading to an increased risk of bleeding. Traditional razors can cause nicks and cuts, which can be problematic for clients with low platelet counts.
Choice B Reason:
Avoiding crowds is crucial for clients who have received chemotherapy because their immune systems are often weakened, making them more susceptible to infections. Crowded places increase the risk of exposure to pathogens, which can lead to serious infections in immunocompromised individuals.
Choice C Reason:
Taking temperature weekly is not sufficient for clients who have received chemotherapy. These clients are at a higher risk of infections, and any sign of fever should be monitored closely. It is generally recommended to take the temperature daily or more frequently if the client feels unwell.
Choice D Reason:
Consuming a low-residue diet is not typically necessary for clients who have received chemotherapy unless they are experiencing specific gastrointestinal issues. A balanced diet with adequate nutrients is usually recommended to support overall health and recovery.
Choice E Reason:
Monitoring for bruising is important for clients who have received chemotherapy because it can indicate low platelet counts or other bleeding disorders. Early detection of bruising can help in managing and preventing more serious bleeding complications.
Correct Answer is D
Explanation
Choice A Reason:
Respiratory therapy is not typically required for clients with chronic kidney disease unless they have concurrent respiratory issues. CKD primarily affects the kidneys and related systems, so respiratory therapy is not a standard referral for these patients.
Choice B Reason:
Hospice care is generally reserved for clients with terminal illnesses who are nearing the end of life. While CKD can be a serious condition, many clients manage it with appropriate treatment and lifestyle changes. Therefore, hospice care is not a standard referral for newly diagnosed CKD patients.
Choice C Reason:
Occupational therapy may be beneficial for clients with CKD who experience difficulties with daily activities due to fatigue or other symptoms. However, it is not the most immediate or essential referral upon initial diagnosis.
Choice D Reason:
Dietary services are crucial for clients with chronic kidney disease. Proper nutrition can help manage symptoms, slow disease progression, and improve overall health. A dietitian can provide personalized dietary plans to ensure the client avoids foods that may exacerbate their condition and includes those that support kidney health.
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