The nurse is assessing a newly admitted client whose chief complaint is "coughing up blood" and whose recent history includes a productive cough and night sweats. What is the nurse's priority intervention?
Initiate droplet precautions
Initiate airborne precautions
Place the client in a positive pressure room
Initiate neutropenic precautions
The Correct Answer is B
B. Airborne precautions are used for diseases that can be transmitted through tiny respiratory droplets that remain in the air for extended periods. Examples include tuberculosis and measles. Given the symptom of coughing up blood and the possibility of an infectious respiratory disease, initiating airborne precautions could be warranted.
A. Droplet precautions are typically implemented for diseases that spread through respiratory droplets, such as influenza or pertussis. However, coughing up blood suggests a more serious condition that may not be adequately addressed by droplet precautions alone.
C. Positive pressure rooms are typically used in healthcare settings to prevent outside air from entering the room, thus reducing the risk of airborne contaminants. While this measure can be beneficial for certain conditions, such as those requiring airborne precautions, it may not be the priority intervention.
D. Neutropenic precautions are implemented for patients with compromised immune systems, particularly those with low white blood cell counts (neutropenia). While this precaution is important for protecting immunocompromised patients from infections, it may not be the priority intervention.
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Related Questions
Correct Answer is D
Explanation
D. Conveying an accepting attitude involves demonstrating empathy, respect, and non-judgmental acceptance of the client as they are. Clients with BPD often have a fear of rejection and abandonment, so feeling accepted and understood by the nurse is critical for building trust.
A. In the early stages of group intervention, clients may not yet feel comfortable engaging in deep self-reflection without first establishing trust in the nurse and the group.
B. Identifying community resources is important for comprehensive care, but it may not be the most essential aspect initially for establishing trust.
C. Providing positive feedback can help reinforce positive behaviors and build rapport with clients, but it may not be the most essential aspect initially for establishing trust.
Correct Answer is D
Explanation
D. Histrionic personality disorder (HPD) is characterized by a pattern of excessive emotionality and attention-seeking behavior. Individuals with HPD often display dramatic, flamboyant, or exaggerated emotions and may use seductive or provocative behavior to capture the attention of others.
A. Histrionic personality disorder (HPD) is characterized by attention-seeking behavior, emotional instability, and a strong desire for excitement and novelty. They are less likely to be preoccupied with minute details or exhibit perfectionistic traits, which are more commonly associated with obsessive- compulsive personality disorder (OCPD).
B. Grandiosity, self-importance, and a sense of entitlement are characteristic features of narcissistic personality disorder (NPD), not histrionic personality disorder (HPD).
C. Difficulty being alone, indecisiveness, and submissiveness are more commonly associated with dependent personality disorder (DPD), not histrionic personality disorder (HPD).
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