A nurse is caring for a client who has shingles with multiple skin lesions. Which of the following actions by the nurse require intervention nurse's supervisor?
The nurse wears gloves when providing direct care to the patient.
The nurse admits another client who has shingles to the client’s double room.
The nurse wears a gown when bathing the client.
The nurse wears an N95 respirator mask
The Correct Answer is B
Choice A rationale: Wearing gloves is appropriate when providing direct care to a client with shingles to prevent the spread of the virus.
Choice B rationale: Shingles is caused by the varicella-zoster virus, and it is highly contagious. Placing a client with shingles in a double room increases the risk of spreading the virus to other clients, especially those with compromised immune systems.
Choice C rationale: Wearing a gown is appropriate when there is a risk of contact with the client's lesions to prevent the spread of the virus.
Choice D rationale: While wearing a mask may be indicated for certain respiratory conditions, it is not typically required when caring for a client with shingles.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale: The nurse should not include any opinions, judgments, or blame in the incident report, as this could be used as evidence in a legal case. Therefore, the nurse should not question the charge nurse about care deficits.
Choice B rationale: The nurse should not include any opinions, judgments, or blame in the incident report, as this could be used as evidence in a legal case. Therefore, the nurse should not document what the nurse believes was the cause of ulcer development.
Choice C rationale: This is important because it provides factual information about the client's condition and perception of the event, which could help in identifying the factors that contributed to the ulcer development and preventing further complications.
Choice D rationale: Documenting in the client's medical record that the nurse completed an incident report is not the primary purpose of the incident report itself. Incident reports are internal documents used by the healthcare facility to track and investigate events. The documentation in the client's medical record should focus on the client's clinical condition, care provided, and response to treatment.
Correct Answer is B
Explanation
Choice A rationale: While age can influence the overall prognosis and response to treatment, the location of the burn is more critical in the immediate assessment of severity.
Choice B rationale: The priority when assessing the severity of burns is the location of the burn. Burns to certain areas, such as the face, neck, or major joints, can be more critical due to the potential for complications, including impairment of breathing, vision, or mobility. Burns to these areas may require prompt intervention and closer monitoring to ensure early mitigation of the above complications
Choice C rationale: While understanding the cause is important for prevention and future education, it is not the immediate priority in assessing the severity of the current burn.
Choice D rationale: While medical history may impact the overall treatment plan, it is not the primary factor in the initial assessment of burn severity.
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