Nursing Elites

1. A nurse is preparing for the hospital admission of a client who is suspected to have active tuberculosis (TB). Which of the following precautions should the nurse plan to implement to safely care for this client?

• A. Staff and visitors should wear gowns, masks, and gloves while in the client's room.
• B. The client should be placed in a private room with a special ventilation system.
• C. The client may be placed in a room with other clients who require droplet isolation precautions.
• D. The protocol for donning and removing personal protective equipment before entering or leaving the room of a client with TB is different than for clients who are in other types of isolation.

Correct answer: B

Rationale: When caring for a client suspected of having active tuberculosis (TB), it is essential to place the client in a private room with a special ventilation system to prevent the spread of TB bacteria to others. Choice A is incorrect because staff and visitors should wear respiratory protection, not just gowns, masks, and gloves. Choice C is incorrect as clients with TB should not be placed in a room with other clients, as they need to be isolated to prevent transmission. Choice D is incorrect because the protocol for donning and removing personal protective equipment for clients with TB is similar to other types of isolation, focusing on proper infection control measures.

2. A nurse is caring for a client who has active pulmonary tuberculosis (TB). The client is on airborne precautions and is being treated with multidrug therapy. A chest x-ray is scheduled for the client. Which of the following is not a precaution the nurse should take to safely transport the client to x-ray?

• A. Ask the x-ray technician to come to the client's room to perform a portable x-ray.
• B. Have the client wear a mask.
• C. Notify the x-ray department that the client is on airborne precautions.
• D. Wear a filtration mask and gloves for protection against the client's microorganisms.

Correct answer: A

Rationale: The correct answer is to ask the x-ray technician to come to the client's room to perform a portable x-ray. This option minimizes the risk of exposing other individuals to the client's infectious microorganisms during transport. Having the client wear a mask (Choice B) and notifying the x-ray department about airborne precautions (Choice C) are crucial precautions to prevent the spread of infection. Additionally, wearing a filtration mask and gloves (Choice D) is essential for the nurse's protection when in direct contact with the client, but it is not directly related to transporting the client to the x-ray department.

3. A nurse at a provider's office receives a phone call from a client who reports unrelieved chest pain after taking a nitroglycerin (Nitrostat) tablet 5 minutes ago. Which of the following is an appropriate response by the nurse?

• A. Tell the client to take an aspirin.
• B. Instruct the client to call 911.
• C. Have the client take another nitroglycerin tablet in 15 minutes.
• D. Advise the client to come to the office.

Correct answer: B

Rationale: In this scenario, the client reporting unrelieved chest pain after taking a nitroglycerin tablet could be indicative of a serious cardiac event. Instructing the client to call 911 is the most appropriate response because immediate medical attention is necessary for chest pain that is not relieved by nitroglycerin. Telling the client to take an aspirin (Choice A) may not address the urgency of the situation, and aspirin might not be appropriate depending on the client's medical history. Having the client take another nitroglycerin tablet (Choice C) without relief could lead to overdosage. Advising the client to come to the office (Choice D) is not the best course of action when dealing with a potential cardiac emergency that requires immediate intervention.

4. A client who is HIV-positive, has pneumonia and is not responding to antibiotic therapy may have active pulmonary tuberculosis (TB) due to exposure history and symptoms of night sweats and hemoptysis. Which test is the most reliable to confirm the diagnosis of active pulmonary TB?

• A. Chest x-ray
• B. Presence of bronchophony
• C. Mantoux test
• D. Sputum culture for acid-fast bacillus

Correct answer: D

Rationale: The correct answer is D: Sputum culture for acid-fast bacillus. The most reliable test to confirm the diagnosis of active pulmonary TB is the sputum culture for acid-fast bacillus. This test helps identify the presence of Mycobacterium tuberculosis, the causative agent of TB, in the sputum. Chest x-rays can show characteristic findings of TB but are not as reliable as sputum cultures for confirmation. Bronchophony is a test for assessing vocal resonance and is not specific for TB diagnosis. The Mantoux test is a screening test for TB exposure but cannot confirm active disease.

5. A client hospitalized with deep vein thrombosis has been on IV heparin for 5 days. The provider prescribes oral warfarin (Coumadin) without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response?

• A. The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level.
• B. I will call the provider to get a prescription for discontinuing the IV heparin today
• C. Both heparin and Coumadin work together to dissolve the clots.
• D. The IV heparin increases the effects of the Coumadin and decreases the length of your hospital stay.

Correct answer: A

Rationale: The correct answer is, 'The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level.' Warfarin (Coumadin) is an oral anticoagulant that takes time to reach its full effect, typically a few days. In the meantime, IV heparin is used to provide immediate anticoagulation until the Coumadin levels become therapeutic. Option B is incorrect because discontinuing the IV heparin abruptly without reaching a therapeutic level with Coumadin can increase the risk of clot formation. Option C is incorrect because heparin and Coumadin do not work together to dissolve clots; they both have anticoagulant effects but work differently. Option D is incorrect because IV heparin does not directly increase the effects of Coumadin; they have different mechanisms of action.

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