A nurse is preparing to admit a client who has a new diagnosis of methicillin-resistant Staphylococcus aureus (MRSA). The nurse should plan to place the client in which of the following types of transmission-based precautions?

Choice A Reason: Light sensitivity

Light sensitivity, also known as photophobia, is a common symptom of a ruptured cerebral aneurysm. When an aneurysm ruptures, it can cause bleeding in the brain, leading to increased intracranial pressure and irritation of the meninges, which can result in sensitivity to light.

Choice B Reason: Loss of consciousness

Loss of consciousness is a critical symptom of a ruptured cerebral aneurysm. The sudden increase in intracranial pressure from the bleeding can lead to a rapid decline in the patient’s level of consciousness. This symptom is a medical emergency and requires immediate attention.

Choice C Reason: A dilated pupil

A dilated pupil can indicate increased intracranial pressure or direct pressure on the cranial nerves due to the bleeding from a ruptured aneurysm. This symptom is often associated with severe neurological impairment and requires urgent medical intervention.

Choice D Reason: Visual disturbances

Visual disturbances, such as blurred or double vision, can occur due to the pressure exerted by the bleeding on the optic nerves or other parts of the visual pathway. These disturbances are significant indicators of neurological compromise.

Choice E Reason: Nausea and vomiting

Nausea and vomiting are common symptoms of increased intracranial pressure, which can result from a ruptured cerebral aneurysm. The irritation of the brain’s vomiting center due to the bleeding can lead to these symptoms.

Choice F: Numbness on one side of the face

Numbness on one side of the face is not typically a direct symptom of a ruptured cerebral aneurysm. While neurological deficits can occur, numbness is more commonly associated with other types of strokes or localized nerve damage rather than the acute presentation of a ruptured aneurysm.

Choice A Reason: Try to defecate at different times of the day

This statement is not advisable for clients with constipation. Regularity is key in managing constipation. Encouraging the client to try to defecate at the same time each day can help establish a routine and improve bowel regularity. The body’s natural circadian rhythms can aid in this process, making it easier to have a bowel movement at a consistent time.

Choice B Reason: Consume a low-fiber diet

A low-fiber diet is not recommended for clients with constipation. Fiber adds bulk to the stool and helps it pass more easily through the intestines. Foods high in fiber include fruits, vegetables, whole grains, and legumes. Increasing dietary fiber intake is a common and effective strategy for managing constipation. The recommended daily intake of fiber is 25 grams for women and 38 grams for men.

Choice C Reason: Reduce your daily activity

Reducing daily activity is not beneficial for managing constipation. Physical activity helps stimulate intestinal function and can promote regular bowel movements. Encouraging clients to engage in regular exercise, such as walking, swimming, or yoga, can help alleviate constipation. The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic activity per week.

Choice D Reason: Increase your daily fluid intake

Increasing daily fluid intake is a key recommendation for managing constipation. Fluids help soften the stool, making it easier to pass. Water is the best choice, but other fluids like herbal teas and clear soups can also be beneficial. It is generally recommended to drink at least 8 cups (64 ounces) of water per day, though individual needs may vary based on factors such as age, sex, and activity level.