A nurse is serving on a committee that is developing infectious disease protocols. Which of the following instructions should the nurse include in the protocol for clients who have Clostridium difficile?

Disinfect hands using an alcohol-based waterless antiseptic.

Wear an N95 respirator when caring for the client.

Use diluted bleach to clean solled equipment.

Provide a room with negative-pressure airflow.

Answer and Explanation

The Correct Answer is C

A. Disinfecting hands using an alcohol-based waterless antiseptic is not effective against Clostridium difficile spores. C. difficile is a bacterium that forms spores, which are resistant to alcohol-based hand sanitizers. Handwashing with soap and water is recommended for effective removal of the spores.

B. Wearing an N95 respirator is not specifically indicated for caring for clients with Clostridium difficile. The primary mode of transmission for C. difficile is fecal-oral, and standard precautions, including gloves and gowns, are usually sufficient. N95 respirators are more commonly used for airborne precautions.

C. Using diluted bleach to clean soiled equipment is the correct instruction. Clostridium difficile spores are resistant to many disinfectants, but bleach (sodium hypochlorite) is effective in killing C. difficile spores. Diluted bleach solutions are recommended for cleaning surfaces and equipment that may be contaminated with C. difficile.

D. Providing a room with negative-pressure airflow is not typically necessary for clients with Clostridium difficile. Standard precautions, including appropriate cleaning and disinfection, are generally sufficient to prevent the spread of C. difficile in healthcare settings.

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Correct Answer is C

Explanation

A. Report the fire details to the facility emergency extension:

While reporting the fire details is important, activating the fire alarm takes precedence. The alarm initiates a quicker and broader response to the emergency.

B. Close the door to the client's room:

Closing the door may be a subsequent action to contain smoke and fire, but it is not the immediate priority. Activating the fire alarm ensures a faster response and is crucial for alerting others.

C. Activate the fire alarm.

Activating the fire alarm is the most immediate action to take in the event of a fire. The fire alarm alerts others in the facility, including staff and emergency services, about the potential danger. This rapid notification initiates the emergency response, ensuring a quick and coordinated effort to address the fire situation and safeguard everyone in the vicinity.

D. Turn off electrical equipment:

Turning off electrical equipment is a valid action to prevent further hazards, but it is not the immediate priority. Activating the fire alarm comes first to ensure the safety of everyone in the facility.

A. Provide the client's breakfast. B. Obtain the client's capillary blood glucose level. C. Check the calibration of the glucometer. D. Administer prescribed insulin.

Correct Answer is C

Explanation

A. Providing the client's breakfast is an essential aspect of diabetes care, but obtaining information about the client's blood glucose level is a priority before administering insulin or making decisions about meal planning.

B. Obtaining the client's capillary blood glucose level is a critical first step. Knowing the current blood glucose level guides the nurse in determining the appropriate insulin dosage, assessing the need for any adjustments in the treatment plan, and planning the client's breakfast based on their current glucose level.

C. Checking the calibration of the glucometer is the first action to ensure the accuracy of the blood glucose measurement. Regular calibration checks help maintain the precision of the glucometer and ensure reliable results.

D. Administering prescribed insulin is an important step in managing type 1 diabetes, but the dosage should be determined based on the client's current blood glucose level. Administering insulin without knowing the current glucose level could lead to inappropriate dosage and potential complications.

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A nurse is serving on a committee that is developing infectious disease protocols. Which of the following instructions should the nurse include in the protocol for clients who have Clostridium difficile?

Nursing Test Bank

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