A nurse manager is reviewing isolation guidelines with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding of isolation guidelines?
"I will instruct visitors to wear a mask when visiting a client who is on contact precautions."
"I will place a client who has compromised immunity in a negative-pressure airflow room."
"I will have a client who is on airborne precautions wear a mask when out of her room."
"I will wear an N95 respirator mask when caring for a client who is on droplet precautions"
The Correct Answer is C
A. Contact precautions typically involve wearing gloves and a gown to prevent the spread of infectious agents through direct contact. Masks are not generally required for visitors unless the client is also on droplet or airborne precautions. Therefore, this statement reflects a misunderstanding of the specific requirements for contact precautions.
B. A client with compromised immunity should be placed in a positive-pressure airflow room, not a negative-pressure room. Positive-pressure rooms help prevent outside contaminants from entering the room, thereby protecting the immunocompromised client.
C. Clients on airborne precautions (e.g., for tuberculosis, varicella, or measles) should wear a mask if they need to leave their room to prevent the spread of airborne pathogens to others. This helps to contain infectious particles and protect others from exposure.
D. An N95 respirator mask is required for airborne precautions, not droplet precautions. For droplet precautions (e.g., for influenza, pertussis), a standard surgical mask is sufficient to protect against respiratory droplets.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Accompanying a client to physical therapy is a task that can be appropriately delegated to an AP, as it does not require clinical judgment or advanced nursing knowledge. This task does not require the skills of an LPN.
B. Reinforcing dietary teaching with a client who has heart disease is within the scope of practice for an LPN. LPNs can reinforce teaching that has already been initiated by the registered nurse (RN). This task involves some level of knowledge and skill but does not require independent clinical judgment, making it suitable for the LPN.
C. Obtaining a urine specimen from an older adult client is a task that can be delegated to an AP, as it is a routine procedure that does not require nursing assessment or decision-making. This task does not require the skills of an LPN.
D. Providing postmortem care for a client who has just died is a task that can be appropriately delegated to an AP. This task involves following established protocols and does not require clinical judgment or advanced nursing skills. It is not necessary to assign this task to an LPN.
Correct Answer is B
Explanation
A. A client who has peripheral vascular disease and has an absent pedal pulse in the right foot is not the highest priority because this is a chronic condition that does not pose an
immediate threat to the client's health. The nurse should monitor the client's circulation, provide education on foot care, and encourage smoking cessation if applicable.
B. This client is at risk for urinary retention, which can lead to bladder distension,
infection, and renal damage. The nurse should assess the client's bladder, perform a
bladder scan, and notify the provider if indicated. This is the most urgent situation that requires immediate intervention.
C. A client who is newly diagnosed with pancreatic cancer and is scheduled to begin IV chemotherapy is not the highest priority because this is a planned procedure that does not require immediate action. The nurse should prepare the client for chemotherapy, provide emotional support, and teach the client about potential side effects and complications.
D. A client who has methicillin-resistant Staphylococcus aureus (MRSA) and has an
axillary temperature of 38° C (101° F) is not the highest priority because this is a sign of infection that can be managed with antibiotics and infection control measures. The nurse should administer the prescribed antibiotics, monitor the client's vital signs, and
implement contact precautions.
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