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Which of the following clients should be placed in isolation for airborne precautions?

A client with an unknown skin infection

A client that recently traveled and developed a fever with cough

A high school wrestling champion with a rash

A client with heart palpitations

Answer and Explanation

The Correct Answer is B

Choice A reason: This is not the correct answer because a skin infection is not transmitted by airborne droplets. A skin infection is usually caused by bacteria, fungi, or parasites that invade the skin and cause inflammation, redness, itching, or pus. A skin infection can be contagious by direct contact with the infected area or by sharing personal items, such as towels, clothing, or razors. The client with a skin infection should be placed in isolation for contact precautions, which involve wearing gloves and gowns and using disposable equipment.

Choice B reason: This is the correct answer because a fever with cough can be a sign of a respiratory infection that is transmitted by airborne droplets. A respiratory infection is caused by viruses, bacteria, or fungi that infect the lungs, throat, or nose and cause symptoms such as fever, cough, sore throat, or difficulty breathing. A respiratory infection can be contagious by inhaling the tiny droplets that are released when the infected person coughs, sneezes, or talks. The client with a respiratory infection should be placed in isolation for airborne precautions, which involve wearing a respirator mask and placing the client in a negative pressure room.

Choice C reason: This is not the correct answer because a rash is not transmitted by airborne droplets. A rash is a change in the color, texture, or appearance of the skin that can be caused by various factors, such as allergies, infections, medications, or injuries. A rash can be contagious by direct contact with the affected skin or by sharing personal items, such as clothing, bedding, or sports equipment. The client with a rash should be placed in isolation for contact precautions, which involve wearing gloves and gowns and using disposable equipment.

Choice D reason: This is not the correct answer because heart palpitations are not transmitted by airborne droplets. Heart palpitations are the sensation of having a fast, irregular, or pounding heartbeat that can be caused by various factors, such as stress, anxiety, caffeine, nicotine, or heart conditions. Heart palpitations are not contagious and do not require isolation. The client with heart palpitations should be evaluated for the underlying cause and treated accordingly.

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Correct Answer is A

Explanation

Choice A reason: Blanching is the term that the nurse documents for this finding, because it describes the temporary whitening of the skin when pressure is applied. Blanching indicates that the blood vessels in the skin are constricted or compressed, and that the blood flow is reduced or interrupted. Blanching can be a normal response to cold, stress, or pressure, or it can be a sign of a problem, such as ischemia, infection, or inflammation.

Choice B reason: Warmth is not the term that the nurse documents for this finding, because it describes the increased temperature of the skin, not the color change. Warmth indicates that the blood vessels in the skin are dilated or expanded, and that the blood flow is increased or enhanced. Warmth can be a normal response to heat, exercise, or emotion, or it can be a sign of a problem, such as infection, inflammation, or allergy.

Choice C reason: Redness is not the term that the nurse documents for this finding, because it describes the original color of the skin, not the color change. Redness indicates that the blood vessels in the skin are dilated or expanded, and that the blood flow is increased or enhanced, as explained above. Redness can be a normal response to heat, exercise, or emotion, or it can be a sign of a problem, such as infection, inflammation, or allergy.

Choice D reason: Nonblanching is not the term that the nurse documents for this finding, because it describes the opposite of what the nurse observed. Nonblanching means that the skin does not turn white when pressure is applied, but rather remains red or purple. Nonblanching indicates that the blood vessels in the skin are damaged or ruptured, and that the blood has leaked into the surrounding tissues. Nonblanching can be a sign of a serious problem, such as bruising, bleeding, or necrosis.

A. Obtain a PAPR mask B. Do not turn away from the sterile field C. Add items to the sterile field by dropping them gently D. Cover the sterile field once it is set up E. Prepare the client before setting up the sterile field

Correct Answer is ["B","C","E"]

Explanation

Choice A reason: Obtaining a PAPR mask is not a step in preparing a sterile field. A PAPR mask is a powered airpurifying respirator that protects the wearer from airborne contaminants. It is not required for setting up a sterile field, unless the client has a highly infectious disease.

Choice B reason: Do not turn away from the sterile field is a step in preparing a sterile field. Turning away from the sterile field can contaminate the field or the items on it. The nurse should always face the sterile field and keep it in view.

Choice C reason: Add items to the sterile field by dropping them gently is a step in preparing a sterile field. Dropping items gently onto the sterile field prevents splashing or touching the field or the items. The nurse should open the sterile packages away from the field and drop the items close to the edge of the field.

Choice D reason: Covering the sterile field once it is set up is not a step in preparing a sterile field. Covering the sterile field can compromise its sterility and create moisture that can harbor microorganisms. The nurse should not cover the sterile field unless it is necessary to move it or store it for later use.

Choice E reason: Preparing the client before setting up the sterile field is a step in preparing a sterile field. Preparing the client involves explaining the procedure, obtaining consent, providing privacy, and positioning the client. The nurse should prepare the client before setting up the sterile field to avoid leaving the field unattended or exposing it to the client's body fluids.

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This is the edited text:Which of the following clients should be placed in isolation for airborne precautions?

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This is the edited text:

Which of the following clients should be placed in isolation for airborne precautions?