A nurse is caring for an older adult client who wears hearing aids with detachable ear molds.
Which of the following actions should the nurse take when caring for the hearing aids?

Choice A rationale:

Soft bowel sounds at a rate of 1 per minute describe hypoactive bowel sounds, which indicate decreased motility. This choice does not describe hyperactive bowel sounds.

Choice B rationale:

High-pitched bowel sounds are characteristic of hyperactive bowel sounds. These sounds are associated with increased motility and can indicate conditions such as diarrhea or early bowel obstruction. This choice correctly describes hyperactive bowel sounds.

Choice C rationale:

The absence of bowel sounds after listening for 3 to 5 minutes is indicative of absent or hypoactive bowel sounds, not hyperactive bowel sounds.

The correct answer is **d. Initiate contact precautions for the client**.

Choice a rationale: Varicella zoster does not require airborne precautions, as it is primarily transmitted through direct contact and respiratory droplets. Assigning the client to a negative pressure airflow room is not necessary for this specific infection.

Choice b rationale: Aspirin should not be administered to clients with varicella zoster, as it has been associated with the development of Reye's syndrome, a rare but serious condition that can cause liver and brain damage. Instead, acetaminophen or ibuprofen may be used to manage fever and discomfort.

Choice c rationale: While maintaining a distance of at least 0.91 m (3 feet) from the client can help reduce the risk of respiratory droplet transmission, it is not sufficient as the sole intervention. Contact precautions, which include the use of PPE and proper hand hygiene, are essential to prevent the spread of varicella zoster.

Choice d rationale: Varicella zoster, also known as chickenpox, is a highly contagious viral infection that spreads through direct contact with the rash, respiratory droplets, or aerosolized particles from the skin lesions. To prevent the transmission of the virus, contact precautions should be implemented for clients with varicella zoster. This includes using personal protective equipment (PPE) such as gowns and gloves when in direct contact with the client or their environment, and ensuring proper hand hygiene before and after contact. Additionally, the client should be placed in a private room or cohorted with other clients with the same infection.