An assistive personnel (AP) asks a nurse what precautions he should take when measuring the vital signs of a client who has pneumonia. Which of the following responses should the nurse make?

"Wear a mask when entering the client's room."

"Gloves are not necessary if you wash your hands well."

"Place a mask on the client when you check her vital signs."

"Wear a gown whenever you come in close contact with the client."

Answer and Explanation

The Correct Answer is A

A.   Wearing a mask helps prevent the spread of respiratory droplets that may contain infectious pathogens, such as those causing pneumonia. It protects both the client from potential pathogens carried by the AP and the AP from potential exposure to the client's respiratory secretions.

B.   Gloves should be worn when there is a risk of contact with the client's body fluids, including respiratory secretions, to prevent transmission of infectious agents. Hand hygiene (washing hands well) is important but does not replace the need for gloves in situations where there is a risk of exposure to bodily fluids.
C.   Placing a mask on the client would not typically be required unless the client is coughing excessively and the mask is intended to contain respiratory droplets. However, the focus of precautions should primarily be on protecting the AP.
D.   Wearing a gown may be necessary if there is a risk of contamination with respiratory secretions or if the AP anticipates contact with the client's body fluids. However, it is not specifically required for routine vital sign measurement unless there is visible contamination or extensive contact with the client's secretions.

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Correct Answer is D

Explanation

A. This response may come across as judgmental or directive, which can be perceived as dismissive of the client's struggle. It does not acknowledge the complexity of the disorder or the client's feelings of helplessness, potentially hindering open communication and trust.
B. While this question encourages exploration of the underlying reasons for the behavior, it might feel probing or intrusive to the client. It could be interpreted as focusing solely on the behavior itself rather than acknowledging the client's recognition of its abnormality or their feelings of helplessness.
C. This response acknowledges and validates the client's awareness of the problem, which can be empowering. It reinforces the client's self-awareness and readiness to address their behavior, promoting a therapeutic alliance based on mutual understanding and respect.
D. This response demonstrates empathy and understanding of the client's feelings. It acknowledges the emotional struggle the client is experiencing and opens the door for further exploration of their feelings and thoughts. It encourages the client to express their emotions and concerns, which is essential in building a supportive therapeutic relationship.

A. Gelatin B. Shellfish C. Yeast D. Eggs

Correct Answer is B

Explanation

A. Gelatin is derived from collagen obtained from various animal body parts. It is commonly used in medications, including some capsules and intravenous (IV) preparations. It has no association with cardiac catheterization procedure.
B. This is because the contrast dye used during the procedure typically contains iodine, which can cause an allergic reaction in susceptible individuals.
C. Yeast allergies are reactions to proteins found in yeast, commonly used in baking and brewing and sometimes present in vaccines and medications. However, it has no association with cardiac catheterization procedure.
D. Egg allergies involve reactions to proteins found in eggs and can be present in vaccines, some medications, and some foods. However, it has no association with cardiac catheterization procedure.

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An assistive personnel (AP) asks a nurse what precautions he should take when measuring the vital signs of a client who has pneumonia. Which of the following responses should the nurse make?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Explanation

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