You are admitting a client from a long-term care facility with a new diagnosis of Hepatitis A. He has a history of a cerebral vascular accident (CVA) that has left him incontinent of both urine and stool. Which of the following is the most appropriate level of precautions?
Droplet precautions
Contact precautions
Standard precautions are only necessary as there is no risk of transmission.
Airborne precautions
The Correct Answer is B
Choice A reason (precautions): Droplet precautions are not the primary recommendation for Hepatitis A, as it is not primarily spread through droplets.
Choice B reason (precautions): Contact precautions are recommended for patients with Hepatitis A due to the risk of fecal-oral transmission, especially in a patient with incontinence.
Choice C reason (precautions): While standard precautions are always necessary, they are not sufficient alone for Hepatitis A, which requires additional precautions due to its mode of transmission.
Choice D reason (precautions): Airborne precautions are not required for Hepatitis A, as it is not spread through the air.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: A PR interval of 0.04-0.20 seconds is too broad and includes values that are both below and above the normal range.
Choice B reason: A PR interval of 0.12-0.20 seconds is the established normal range for adults, reflecting proper conduction through the AV node.
Choice C reason: The PR interval being less than half the R-to-R ratio is not a standard measurement for PR intervals and does not provide a specific range.
Choice D reason: A PR interval of 0.08-0.10 seconds is below the normal range and may suggest pre-excitation or an AV nodal (junctional) rhythm.
Correct Answer is C
Explanation
Choice A reason: Recording the client's intake and output is important but not the highest priority in an unconscious patient following a cerebral hemorrhage.
Choice B reason: Performing passive range of motion exercises is a lower priority compared to maintaining a patent airway.
Choice C reason: Suctioning saliva from the client's mouth is the highest priority to maintain airway patency and prevent aspiration, which is critical for an unconscious patient.
Choice D reason: Monitoring the client's electrolyte levels is important but secondary to immediate life-saving interventions such as maintaining airway patency.
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