A nurse is contributing to the plan of care for a client who has a positive throat culture for streptococci. Which of the following interventions should the nurse recommend to be included in the plan of care?

Place the client in a room with another client who has pharyngitis.

Ensure that the client wears a surgical mask during transportation throughout the facility.

Limit the client's visitors to visitations of 30 minutes.

Provide the client a room with negative pressure airflow of six air exchanges per hour.

Answer and Explanation

The Correct Answer is B

The correct answer is Choice B.

Choice A rationale: Placing the client in a room with another client who has pharyngitis is not recommended. Pharyngitis can be caused by various different pathogens, not just streptococci. Co-housing clients with different infections can lead to cross-infection, complicating both clients’ conditions. Therefore, this choice is not the best option.

Choice B rationale: Ensuring that the client wears a surgical mask during transportation throughout the facility is the correct choice. Streptococcal infections are spread through respiratory droplets. A surgical mask can help prevent the spread of these droplets, protecting other clients and healthcare workers in the facility. This is a standard precaution in infection control.

Choice C rationale: Limiting the client’s visitors to visitations of 30 minutes is not necessarily beneficial. The duration of the visit does not significantly impact the risk of transmission as much as the precautions taken during the visit, such as hand hygiene and wearing a mask. Therefore, while limiting visitation time might reduce exposure, it is not the most effective measure to prevent the spread of infection.

Choice D rationale: Providing the client a room with negative pressure airflow of six air exchanges per hour is not necessary for a client with a streptococcal infection. Negative pressure rooms are typically used for clients with airborne diseases, such as tuberculosis. A streptococcal infection is spread through droplets, not airborne transmission, so a negative pressure room would not provide any additional benefit.

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Correct Answer is C

Explanation

A. Remove dentures:

Removing dentures is a step often performed during post-mortem care but may not necessarily need to be completed before family viewing, especially if the dentures are normally worn by the deceased.

B. Apply a shroud around the body with a visible identification tag:

Applying a shroud with a visible identification tag is an important step for dignified covering and identification but might be more appropriate after the family has viewed the body.

C. Clean soiled areas of the body:

This is the most appropriate action to ensure the body appears as dignified and comfortable as possible for family viewing. It involves cleaning any visible soiled areas to provide a respectful presentation to the family.

D. Place the client's head in a dependent position:

Placing the client's head in a dependent position is not typically necessary or recommended in this context. The goal is to ensure the body appears as natural and dignified as possible.

A. Place the client's medication record on the bedside table while ambulating the client. B. Give a report about the client's status while standing at the nurses' station. C. Speak with the client about their condition after visitors have left. D. Place a message board in the client's room to post dietary information.

Correct Answer is C

Explanation

A. Place the client's medication record on the bedside table while ambulating the client: This action does not relate to protecting the client's privacy. It might actually compromise confidentiality by leaving sensitive information exposed.

B. Give a report about the client's status while standing at the nurses' station: This action does not protect the client's privacy. Discussing sensitive information in a public area can lead to breaches of confidentiality.

C. Speak with the client about their condition after visitors have left: Correct. Protecting the client's privacy is essential, and discussing personal health information in private with the client respects their right to confidentiality.

D. Place a message board in the client's room to post dietary information: This action does not relate to protecting the client's privacy. Posting dietary information may be helpful for staff, but it doesn't address the client's privacy concerns.

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A nurse is contributing to the plan of care for a client who has a positive throat culture for streptococci. Which of the following interventions should the nurse recommend to be included in the plan of care?

Nursing Test Bank

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