A nurse is planning care for a client who is preoperative for a surgical procedure. The nurse should identify that which of the following tasks is outside of their scope of practice?

Rationale:

• Ask the client for a list of close contacts: The client exhibits classic symptoms of active tuberculosis (TB), including weight loss, night sweats, hemoptysis (bloody cough), and chest tightness. Identifying close contacts is crucial for contact tracing and limiting disease spread.
• Obtain a sputum culture: A sputum culture is essential for diagnosing pulmonary TB. This test confirms the presence of Mycobacterium tuberculosis and guides further treatment decisions.
• Place the client in a negative-pressure room: Clients suspected of having TB should be placed in a negative-pressure isolation room to prevent airborne transmission to others, especially in healthcare settings.
• Use airborne precautions: Airborne precautions, including the use of an N95 respirator, are required for suspected or confirmed TB due to its airborne transmission risk.
• Obtain blood cultures: Blood cultures are not the priority in TB diagnosis unless sepsis is suspected. TB is primarily diagnosed through respiratory samples, not blood.
• Recommend ABGs be drawn: Arterial blood gases (ABGs) are typically unnecessary in TB unless there is respiratory compromise requiring ventilatory support or oxygenation monitoring, which is not indicated here.
• Request a glucocorticoid prescription from the provider: Glucocorticoids are not standard treatment for TB and may suppress immune response. They may be used in specific TB complications like meningitis or pericarditis, but not in general pulmonary TB management.

Rationale:

A. Evaluate the client's coping skills: Secondary prevention focuses on early identification and prompt intervention to prevent worsening of a condition. Assessing the client’s coping skills helps the nurse identify maladaptive behaviors or psychological distress early, allowing for timely referral or intervention.

B. Explore the client's desired goals: Exploring future goals is tertiary prevention, which aims at restoring function and promoting long-term adaptation after a life event. While important, it does not address immediate detection or intervention needs during an acute phase.

C. Discuss available support systems with the client: This is a supportive and therapeutic action, but it is part of tertiary prevention, which promotes recovery and prevents further decline. It is not as immediate or diagnostic as evaluating current coping abilities.

D. Ensure the safety of the client: Ensuring client safety is always a priority if there is any indication of harm or suicidal ideation. However, if no imminent safety risk is present, it does not serve as the main focus of secondary prevention, which emphasizes early detection and screening.