The nurse is preparing a client placed on droplet precautions for transport from the client's room to another department. The client wears eyeglasses and refuses to remove them while being transported. Which action should the nurse take?

Obtain permission from the nursing supervisor to transport the client without protective equipment.

Place protective goggles over the client's eyeglasses after first positioning the face mask.

Instruct the client about the need to wear a fitted respirator-style mask when leaving the room.

Secure a surgical face mask over the bridge of the client's nose just below the eyeglasses.

Answer and Explanation

The Correct Answer is D

A. Transporting the client without protective equipment would not comply with droplet precaution protocols and could pose a risk of infection to others.
B. Placing goggles over the eyeglasses is not necessary if a surgical mask can be properly fitted, as the mask itself provides the needed protection for droplet precautions.
C. A fitted respirator-style mask is typically not required for droplet precautions; a surgical mask is sufficient.
D. Securing a surgical face mask over the bridge of the client's nose just below the eyeglasses ensures that the mask is properly fitted, providing adequate protection while allowing the client to wear their eyeglasses comfortably. This approach adheres to droplet precaution protocols.

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Correct Answer is C

Explanation

A. Adjusting the hand grips is necessary to ensure that the client can bear weight comfortably through the arms without placing stress on the wrists or shoulders, so avoiding this adjustment is incorrect.
B. Holding the crutch 6 inches to the side is a common guideline, but it is not as crucial as ensuring the correct fit of the crutches to avoid axillary nerve damage and ensure proper posture.
C. The crutch should fit 2 finger widths below the axilla to prevent pressure on the brachial plexus nerves, which can lead to nerve damage. This demonstrates an understanding of proper crutch fit and use.
D. Walking with the arms fully extended is incorrect; the arms should be slightly bent at the elbows to allow for proper weight distribution and movement.

A. Elevate the area and apply light pressure over the site. B. Apply a cold pack to the area for twenty minutes. C. Document the site where the medication was given. D. Notify the healthcare provider of the allergic response.

Correct Answer is C

Explanation

A. Elevating the area and applying light pressure is not appropriate for a small raised area from an intradermal injection, which is usually a normal reaction and not an indication for elevation or pressure.
B. Applying a cold pack is unnecessary and may not be appropriate unless there is significant discomfort or an allergic reaction, which is not suggested by the description of a small, raised area.
C. Documenting the site where the medication was given is important for record-keeping and monitoring the reaction to the intradermal test. This helps in assessing normal reactions versus abnormal ones later.
D. Notifying the healthcare provider of an allergic response should be done if the reaction is severe or unexpected, but a small, round raised area is typically a normal response to an intradermal injection.

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The nurse is preparing a client placed on droplet precautions for transport from the client's room to another department. The client wears eyeglasses and refuses to remove them while being transported. Which action should the nurse take?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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