The nurse is working on an infectious disease unit. Which client should be assigned to a room with negative airflow, while requiring personnel to use a particulate respirator mask, and requiring staff to observe airborne, as well as standard precautions?
A female adolescent admitted with multiple genital Herpes simplex II lesions.
Twin siblings admitted with scarlet fever that is complicated with pneumonia.
An older client with scabies who is admitted from an extended care facility.
A client with a positive Mantoux and sputum cultures results positive for acid-fast bacillus (AFB).
The Correct Answer is D
Rationale
A. Herpes simplex virus type II (HSV-II) primarily spreads through direct contact with the lesions and is not airborne. Airborne precautions and negative airflow rooms are not necessary for this condition.
B. Scarlet fever is caused by Group A Streptococcus bacteria and typically spreads through respiratory droplets. However, scarlet fever itself does not require airborne precautions. If complicated with pneumonia, respiratory droplets could potentially spread the infection, but specific airborne precautions are generally not required unless there are other pathogens involved that require it.
C. Scabies is caused by the Sarcoptes scabiei mite and spreads through direct skin-to-skin contact. It does not require airborne precautions or negative airflow rooms.
D. A positive Mantoux test and sputum cultures positive for acid-fast bacillus (AFB) suggest tuberculosis (TB) infection. TB is spread through airborne droplets (e.g., coughing, sneezing), and therefore, requires airborne precautions including negative airflow rooms to prevent transmission to others.A
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale
A. A. lung biopsy involves obtaining a tissue sample from the lung for microscopic examination. It is typically performed to diagnose conditions such as lung cancer or to investigate unusual findings seen on imaging studies. However, for a client with COPD experiencing increased shortness of breath, a lung biopsy is not typically indicated as a first-line investigation. It is more invasive and usually reserved for specific diagnostic purposes other than routine evaluation of COPD symptoms.
B. Antibody testing is used to detect antibodies specific to certain infections or autoimmune conditions. It is not typically used in the routine evaluation of COPD symptoms unless there is suspicion of a specific autoimmune or infectious cause contributing to exacerbations, which is less common in COPD compared to other conditions.
C. A. sweat test is used to diagnose cystic fibrosis (CF), a genetic disorder that affects the lungs and digestive system. It measures the amount of chloride in sweat, which is elevated in individuals with CF. Since COPD and CF are distinct conditions with different underlying causes and diagnostic criteria, a sweat test is not appropriate for evaluating COPD symptoms.
D. Spirometry is the most appropriate test to schedule for evaluating a client with COPD who reports increased shortness of breath with activity. Spirometry measures lung function by assessing how much and how quickly a person can move air into and out of their lungs. It provides valuable information about the severity of airflow limitation, which is characteristic of COPD.
Correct Answer is B
Explanation
Rationale
A. Applying ice or a warm compress without assessing the site could potentially worsen any underlying issue.
B. The appropriate intervention would be to discontinue the IV site after ensuring a new access is established. This is because continuing to use a painful IV site can lead to complications such as infiltration or phlebitis.
C. Redressing the site without assessment does not address the client's complaint of pain.
D. Checking the medical record provides information about when the IV was inserted, which can be important for assessing the site's viability and expected duration. However, it doesn't address the immediate concern of the client's pain at the site or refusal of a flush.
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