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Difficulty: HardStandard and Transmission-Based Precautions

A practical nurse (PN) is assigned to care for a client admitted with suspected active pulmonary tuberculosis and an infected surgical wound with cultured Methicillin-resistant Staphylococcus aureus (MRSA). Which actions should the PN include in the client's plan of care? Select all that apply.

  1. Ensure the client is placed in a negative-pressure airflow room with the door kept closed.Answer
  2. Apply a fit-tested N95 respirator, fluid-resistant gown, and gloves before entering the client's room.Answer
  3. C
    Administer the initial dose of intravenous (IV) vancomycin as prescribed for the MRSA infection.
  4. D
    Remove the N95 respirator, gown, and gloves inside the client's room immediately after providing care.
  5. Place a standard surgical mask on the client during essential transport to the radiology department.Answer
  6. F
    Post an isolation sign on the door specifying the diagnoses of tuberculosis and MRSA to alert visitors.

Answer

The correct interventions are to place the client in a negative-pressure room with the door closed, wear an N95 respirator along with a gown and gloves upon entry, and place a standard surgical mask on the client during transport.
The client requires both airborne and contact precautions. This necessitates a negative-pressure airflow room with the door closed to contain airborne pathogens. Healthcare personnel must wear an N95 respirator, fluid-resistant gown, and gloves to protect against both transmission routes. Finally, placing a surgical mask on the client during transport acts as source control to prevent the spread of respiratory secretions.

Step-by-Step Solution

1
Analyze the client's diagnoses to determine the required transmission-based precautions.
Suspected active pulmonary tuberculosis requires airborne precautions. A wound infected with MRSA requires contact precautions.
Identifying the transmission route dictates the necessary environmental controls and personal protective equipment (PPE).
2
Determine the appropriate room assignment and PPE for combined airborne and contact precautions.
A negative-pressure room is required. Staff must wear an N95 respirator (airborne), plus a gown and gloves (contact).
This prevents the inhalation of aerosolized droplet nuclei and avoids direct contact with drug-resistant organisms.
3
Evaluate the proposed nursing interventions against the PN scope of practice, safety protocols, and privacy standards.
Administering an initial IV antibiotic dose and writing diagnoses on a public door must be excluded. The N95 respirator must be removed outside the room.
To maintain client safety, adhere to legal scope of practice limitations, prevent infection transmission, and protect client privacy.

Key Concept

Standard and Transmission-Based Precautions
Estimated Time:1m 30s
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Topics

Standard and Transmission-Based Precautions

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