A nurse is preparing for the admission of client who has suspected active tuberculosis. Which of the following precautions should the nurse plan to implement to safely care for this client?
Assign the client to a room with other clients who require droplet precautions.
Modify the protocol for donning and removing personal protective equipment before entering or leaving the client's room.
Have staff and visitors wear gowns, masks, and gloves while in the client's room.
Place the client in a private room with a special ventilation system.
The Correct Answer is D
Rationale:
A. Clients with active tuberculosis should not be placed in a room with other clients, even if they require droplet precautions, as TB requires airborne precautions.
B. While PPE protocols are important, the most critical precaution for TB is ensuring the client is in the correct environment to prevent airborne transmission.
C. Wearing gowns, masks, and gloves is important, but the most essential measure is the room's ventilation system.
D. Active tuberculosis is an airborne infectious disease, so the client should be placed in a private room with a negative pressure ventilation system to prevent the spread of the bacteria through the air.
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Correct Answer is C
Explanation
Rationale:
A. Denial involves refusing to accept reality but is not as characteristic of borderline personality disorder as splitting.
B. Reaction formation involves behaving in a manner opposite to one's true feelings, which is not the primary defense mechanism in borderline personality disorder.
C. Splitting is a common defense mechanism in borderline personality disorder where the client views people or situations as all good or all bad, potentially causing conflict within the healthcare team.
D. Regression involves reverting to earlier developmental stages but does not typically cause division among healthcare providers.
Correct Answer is C
Explanation
Rationale:
A. Amphetamines can cause agitation and psychosis but are less commonly associated with delirium.
B. Antihistamines, particularly those with sedative properties, can contribute to delirium, but they are not the primary culprit.
C. Benzodiazepines, especially when used in high doses or in older adults, can cause delirium. They have sedative effects and can impair cognitive function, leading to confusion and delirium, particularly in vulnerable populations.
D. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is generally not associated with causing delirium, though any medication can contribute to altered mental status depending on the patient’s overall health.