A charge nurse has four new clients arriving on the unit for admission. Which of the following clients should the nurse place in airborne precautions?
A client who has tuberculosis.
A client who has pneumonia.
A client who has shigella.
A client who has strep throat.
The Correct Answer is A
Choice A Reason:
Tuberculosis (TB) is a highly contagious bacterial infection that primarily affects the lungs and is spread through airborne particles. When a person with active TB coughs, sneezes, or talks, they release tiny droplets containing the bacteria into the air, which can be inhaled by others1. Therefore, placing a client with TB in airborne precautions is essential to prevent the spread of the infection. This involves using a negative pressure room and requiring healthcare workers to wear N95 respirators or higher-level protection.
Choice B Reason:
Pneumonia is an infection that inflames the air sacs in one or both lungs, which can fill with fluid or pus. While pneumonia can be caused by bacteria, viruses, or fungi, it is typically spread through respiratory droplets rather than airborne particles. Therefore, droplet precautions, rather than airborne precautions, are usually sufficient for managing clients with pneumonia. This includes wearing masks and maintaining a safe distance from the infected person.
Choice C Reason:
Shigella is a bacterial infection that primarily affects the intestines and is spread through the fecal-oral route. It is not transmitted through the air, so airborne precautions are not necessary. Instead, contact precautions are recommended to prevent the spread of Shigella, which involves wearing gloves and gowns when handling the patient or their environment and practicing good hand hygiene.
Choice D Reason:
Strep throat is a bacterial infection caused by group A Streptococcus. It is spread through respiratory droplets when an infected person coughs or sneezes. Similar to pneumonia, droplet precautions are sufficient for managing clients with strep throat. This includes wearing masks and maintaining a safe distance from the infected person to prevent the spread of the bacteria.
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View Related questions
Correct Answer is A
Explanation
Choice A: I will walk three times per week.
Walking is a weight-bearing exercise, which is crucial for maintaining bone density and reducing the risk of osteoporosis. Regular physical activity, especially weight-bearing exercises like walking, helps stimulate bone formation and slows down bone loss. The National Osteoporosis Foundation recommends at least 30 minutes of weight-bearing exercise on most days of the week to help prevent osteoporosis.
Choice B: I will avoid exposure to the sun.
Avoiding sun exposure is not advisable for reducing the risk of osteoporosis. Sunlight is a natural source of vitamin D, which is essential for calcium absorption and bone health. While excessive sun exposure can be harmful, moderate exposure helps the body produce sufficient vitamin D. Therefore, avoiding sun exposure entirely can lead to vitamin D deficiency, increasing the risk of osteoporosis.
Choice C: I will take 250 milligrams of calcium once per day.
The recommended daily intake of calcium for older adults is significantly higher than 250 milligrams. For adults aged 51 and older, the National Institutes of Health recommends 1,200 milligrams of calcium per day. Adequate calcium intake is vital for maintaining bone health and preventing osteoporosis. Therefore, taking only 250 milligrams of calcium per day is insufficient to meet the body’s needs.
Choice D: I will decrease my intake of dairy products.
Dairy products are a primary source of calcium, which is essential for bone health. Reducing the intake of dairy products can lead to inadequate calcium intake, increasing the risk of osteoporosis. Instead, older adults should ensure they consume enough dairy or other calcium-rich foods to meet their daily calcium requirements.
Correct Answer is A
Explanation
Choice A Reason:
Cranial nerve VII, also known as the facial nerve, is responsible for controlling the muscles of facial expression. When assessing this nerve, a nurse would expect to see symmetrical facial movements, such as a symmetrical smile. This indicates that the facial nerve is functioning properly on both sides of the face. Any asymmetry could suggest a problem with the facial nerve, such as Bell’s palsy or a stroke.
Choice B Reason:
The position of the tongue is controlled by cranial nerve XII, the hypoglossal nerve, not cranial nerve VII. The hypoglossal nerve is responsible for the movements of the tongue, and a midline position indicates normal function of this nerve. Therefore, this response is not relevant to the assessment of cranial nerve VII.
Choice C Reason:
Turning the head against resistance is a test for cranial nerve XI, the accessory nerve. This nerve controls the sternocleidomastoid and trapezius muscles, which are involved in head and shoulder movements. Assessing the ability to turn the head against resistance helps evaluate the function of the accessory nerve, not the facial nerve.
Choice D Reason:
Pupillary constriction in response to light is a function of cranial nerve III, the oculomotor nerve. This nerve controls the muscles that constrict the pupil in response to light, a reflex known as the pupillary light reflex. This response is not related to the function of cranial nerve VII.
