A nurse is caring for a client who is placed on droplet precautions. Which of the following actions should the nurse take?

Wear a surgical mask when within 0.6 m (2 ft) of the client.

Move the client to a positive airﬂow room.

Place a surgical mask on the client when they leave their room.

Remove fresh ﬂowers from the client’s room.

Answer and Explanation

The Correct Answer is C

Answer: C. Place a surgical mask on the client when they leave their room.

Rationale:

A) Wear a surgical mask when within 0.6 m (2 ft) of the client.
While it is necessary to wear a surgical mask when in close proximity to a client on droplet precautions, the distance specified (0.6 m or 2 ft) is less than the standard recommended distance of 1 meter (3 feet). Therefore, this option is not fully aligned with best practices.

B) Move the client to a positive airflow room.
Positive airflow rooms are typically used for clients with immunosuppression or those who need protection from airborne pathogens, not for those on droplet precautions. This action is not appropriate for a client requiring droplet precautions.

C) Place a surgical mask on the client when they leave their room.
This action is appropriate and essential to minimize the risk of transmission of infectious agents to others when the client is moving outside their isolation area. The client wearing a mask is a key part of droplet precautions.

D) Remove fresh flowers from the client’s room.
While it may be necessary to remove fresh flowers in certain cases (such as for neutropenic clients), this is not specifically related to droplet precautions. Droplet precautions focus primarily on respiratory secretions and do not directly involve the presence of flowers.

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Correct Answer is C

Explanation

The nurse should expect to find an increased heart rate in a client with a fever. An elevated body temperature can cause an increase in metabolic rate, which can lead to an increase in heart rate. This is a normal physiological response to fever and helps the body to generate heat and fight oﬀ infection.

A. Apply corn-starch to the client’s skin. B. Allow the client’s skin to air-dry after cleaning. C. Clean the client’s skin with a pH-balanced cleanser. D. Use hot water to clean the client’s skin.

Correct Answer is C

Explanation

Urinary incontinence can lead to skin irritation and breakdown if the skin is not properly cleaned 1. Using a pH-balanced cleanser can help maintain the skin’s natural acidity and prevent irritation.

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