The nurse is caring for a patient on contact precautions. Which action will be most appropriate to prevent the spread of disease?

Transport the patient safely and quickly when going to the radiology department.

Use a dedicated blood pressure cuff that stays in the room and is used for that patient only.

Place the patient in a room with negative airflow.

Wear a gown, gloves, face mask, and goggles for interactions with the patient.

Answer and Explanation

The Correct Answer is B

A) Transport the patient safely and quickly when going to the radiology department: While it's important to transport patients safely and efficiently, this action does not directly address the prevention of disease spread associated with contact precautions. Contact precautions primarily involve preventing direct or indirect contact with the patient's bodily fluids or contaminated surfaces.

B) Use a dedicated blood pressure cuff that stays in the room and is used for that patient only: This is the most appropriate action for preventing the spread of disease on contact precautions. Using dedicated equipment for the patient reduces the risk of cross-contamination between patients. It helps prevent the transmission of pathogens from one patient to another through contaminated equipment.

C) Place the patient in a room with negative airflow: Negative airflow rooms are typically used for patients on airborne precautions to prevent the spread of airborne pathogens. While maintaining appropriate airflow is important for infection control, it is not specific to contact precautions.

D) Wear a gown, gloves, face mask, and goggles for interactions with the patient: This option describes the appropriate personal protective equipment (PPE) to wear when caring for a patient on contact precautions. While it's important to wear PPE, using dedicated equipment for the patient is more directly related to preventing disease spread in this scenario

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Free Nursing Study Resources

Correct Answer is ["A","B","D"]

Explanation

A) Calcium gluconate 1.5 grams IV now: Calcium gluconate is administered to counteract the effects of hyperkalemia by stabilizing the myocardial cell membrane. It does not lower potassium levels but helps protect the heart from potential dysrhythmias associated with high potassium levels.

B) Dextrose 50% injection (50ml) IV push now: Dextrose 50% injection, also known as D50W, is administered to temporarily shift potassium from the extracellular space into the intracellular space, thereby lowering serum potassium levels. It is commonly used in combination with insulin to facilitate the movement of potassium into cells.

C) Colace 100 mg PO now: Colace is a stool softener and does not affect serum potassium levels. It is not indicated for the treatment of hyperkalemia.

D) Regular insulin 10 units IV now: Regular insulin is administered with dextrose to facilitate the movement of potassium from the extracellular space into the intracellular space. Insulin stimulates the cellular uptake of glucose, which in turn drives potassium into cells along with glucose.

E) Potassium chloride 20 mEq orally now: Potassium chloride is contraindicated in the treatment of hyperkalemia as it would further increase serum potassium levels. It is typically used to supplement potassium in clients with hypokalemia, not hyperkalemia.

A. Cheyne-Stokes respirations B. Kussmaul respirations C. Apneustic respirations D. Stridor

Correct Answer is A

Explanation

A) Cheyne-Stokes respirations:
Cheyne-Stokes respirations are characterized by a cycle of gradually increasing and then decreasing respirations followed by a period of apnea. This pattern repeats in a regular cycle. It is commonly observed in clients with conditions affecting the central nervous system, such as traumatic brain injury, stroke, or brain tumors. Cheyne-Stokes respirations can also occur during the dying process. The alternating periods of hyperventilation and apnea result from fluctuations in oxygen and carbon dioxide levels in the blood.

B) Kussmaul respirations:
Kussmaul respirations are deep, rapid, and labored breathing patterns often observed in clients with metabolic acidosis, particularly diabetic ketoacidosis. Unlike Cheyne-Stokes respirations, Kussmaul respirations do not involve periods of apnea.

C) Apneustic respirations:
Apneustic respirations are characterized by prolonged inspiratory gasps followed by insufficient expiration. This irregular breathing pattern typically indicates damage to the pons, a part of the brainstem involved in regulating breathing. Apneustic respirations are different from the pattern described in the scenario.

D) Stridor:
Stridor is a high-pitched, noisy respiratory sound heard on inspiration that indicates upper airway obstruction, such as from swelling, foreign body aspiration, or tumors. It is not associated with the alternating pattern of hyperventilation and apnea described in Cheyne-Stokes respirations.

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The nurse is caring for a patient on contact precautions. Which action will be most appropriate to prevent the spread of disease?

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Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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