When changing the client's dressing for a vacuum-assisted closure (VAC) wound therapy system, the nurse observes foul, purulent drainage.
Which intervention(s) should the nurse implement? Select all that apply.

Choice A rationale

A client with a positive Mantoux test and sputum cultures positive for acid-fast bacillus (AFB) requires a negative airflow room and airborne precautions. This is to prevent the spread of tuberculosis (TB), an infectious disease that can be transmitted through airborne particles. The use of a particulate respirator mask by healthcare personnel is essential in protecting themselves from inhaling infectious aerosols. Implementing these precautions is critical in controlling the spread of TB within healthcare settings and ensuring patient and staff safety.

Choice B rationale

A client with genital herpes simplex II lesions does not require a negative airflow room or airborne precautions. Herpes simplex virus (HSV) is primarily transmitted through direct contact with infected lesions or body fluids. Standard precautions, including contact precautions when dealing with lesions, are adequate to prevent the spread of HSV. Negative airflow rooms and airborne precautions are not necessary for managing this condition.

Choice C rationale

Scarlet fever, complicated with pneumonia, primarily requires standard and droplet precautions rather than airborne precautions. Scarlet fever is caused by group A Streptococcus, which is spread through respiratory droplets. While pneumonia can increase the severity of the infection, negative airflow rooms and particulate respirators are not typically required. Droplet precautions, such as wearing masks and maintaining distance, are sufficient to prevent transmission.

Choice D rationale

Scabies is a parasitic infestation that spreads through direct skin-to-skin contact or contact with contaminated items such as bedding and clothing. Negative airflow rooms and airborne precautions are not necessary for managing scabies. Standard and contact precautions, including wearing gloves and gowns and thoroughly cleaning and disinfecting contaminated items, are adequate to prevent the spread of the mites causing scabies. The use of a particulate respirator mask is not required.

Choice A rationale

Explaining that every client will receive the same high level of care does not address the client's specific concerns about receiving care in accordance with their religion. It is important to recognize and respect individual preferences and beliefs in healthcare.

Choice B rationale

Asking the client about individual care preferences is the best action as it allows the nurse to understand and accommodate the client's specific religious needs and preferences. This approach demonstrates respect for the client's beliefs and promotes patient-centered care.

Choice C rationale

Consulting with a nurse who shares the same religious beliefs might provide some insight, but it is not the best approach. The client may have unique personal preferences that differ from general practices of their religion, so direct communication with the client is more effective.

Choice D rationale

Researching the religion on social media platforms is not a reliable or appropriate way to gather information about a client's care preferences. Social media may not provide accurate or comprehensive information, and personal preferences should be discussed directly with the client. .