Share This Link

Placing the client in a room with another client who has pharyngitis is not recommended. Pharyngitis can be caused by various different pathogens, not just streptococci. Co-housing clients with different infections can lead to cross-infection, complicating both clients’ conditions. Therefore, this choice is not the best option.

Limiting the client’s visitors to visitations of 30 minutes is not necessarily beneficial. The duration of the visit does not significantly impact the risk of transmission as much as the precautions taken during the visit, such as hand hygiene and wearing a mask. Therefore, while limiting visitation time might reduce exposure, it is not the most effective measure to prevent the spread of infection.

Providing the client a room with negative pressure airflow of six air exchanges per hour is not necessary for a client with a streptococcal infection. Negative pressure rooms are typically used for clients with airborne diseases, such as tuberculosis. A streptococcal infection is spread through droplets, not airborne transmission, so a negative pressure room would not provide any additional benefit.

Leaning on the crutches for support while standing still is not the correct way to use crutches. It can lead to discomfort and instability.

Standing 5 cm (2 in) from the front of a chair before sitting is not directly related to the use of crutches.

Bearing weight on the axilla while standing in the tripod position is not the correct way to use crutches. The tripod position is used for resting, not weight bearing.

Ensuring a client can use crutches before discharge requires clinical judgment and skilled assessment, so it should not be delegated to assistive personnel.

Checking a client's ability to swallow following a stroke involves assessing the client's airway and potential risk of aspiration, which is a complex nursing task and should not be delegated to assistive personnel.

Obtaining a client's pain rating prior to physical therapy requires understanding the client's pain and its management, which should not be delegated to assistive personnel.

Incorrect. Leaning on the crutches for support while standing still is not the correct way to use crutches. It can lead to discomfort and instability.

Incorrect. Standing 5 cm (2 in) from the front of a chair before sitting is not directly related to the use of crutches.

Incorrect. Bearing weight on the axilla while standing in the tripod position is not the correct way to use crutches. The tripod position is used for resting, not weight bearing.

Incorrect. Monitoring the circulation in all four extremities requires clinical judgment and skilled assessment, and it should not be delegated to assistive personnel.

Incorrect. Recording the condition of the client's skin requires observation and assessment, which should not be delegated to assistive personnel.

Incorrect. Testicular examinations are important for young adult males, but they should be performed monthly as part of testicular self-examination, not every 5 years.

Incorrect. Young adult females should have a routine physical examination annually, not every 4 years, to monitor their overall health and address any potential health concerns.

Incorrect. While tuberculosis screening is essential in certain populations, such as healthcare workers or individuals at high risk of exposure, a tuberculosis skin test every 3 years is not a standard recommendation for all young adults.

While volunteering at a local food pantry can be a meaningful activity, it is not the priority when considering Maslow's hierarchy of needs. Physiological needs, such as nutrition and exercise, take precedence.

Finding an enjoyable hobby addresses the client's need for self-fulfillment and self-esteem, which comes at a higher level in Maslow's hierarchy. It is not the immediate priority during discharge planning.

Supporting environmental conservation aligns with self-actualization, which is a higher-level need in Maslow's hierarchy. It is not the priority during discharge planning.

Allowing the client to continue taking medications as they did at home without verifying the prescriptions can be unsafe and is not within the scope of nursing practice.

Taking the medications from the client and discarding them is inappropriate. The nurse should not dispose of the client's medications without proper assessment and verification.

Placing the medications in the medication cart and administering them without verification is unsafe and against best practices for medication administration.

Discontinued medications should be documented in the client's medical records and communicated during the transfer report, but it is not the priority information to include in the report.

Correct. The frequency of vital sign collection is essential for monitoring the client's health status and any changes in their condition. This information helps the receiving facility to continue appropriate monitoring and interventions.

Completed nursing interventions are important but may not be as urgent as the frequency of vital sign collection. Information about ongoing nursing care and interventions should also be included in the transfer report.