A healthcare worker is caring for a group of clients in an infectious disease unit. The worker should wear an OSHA-approved N95 respirator mask when caring for a client with which of the following infectious diseases?

Correct Answer: C

Rationale: The correct answer is C: Tuberculosis. Healthcare workers should wear an N95 respirator mask when caring for clients with airborne infectious diseases like tuberculosis. The N95 mask is designed to filter out at least 95% of airborne particles, including those that may carry the tuberculosis bacteria. This level of protection is necessary to prevent the healthcare worker from inhaling the infectious agent. Pertussis (A), Mycoplasma pneumonia (B), and Respiratory syncytial virus (D) are not typically transmitted through the air and therefore do not require the use of an N95 respirator mask for standard care. These diseases are usually spread through respiratory droplets or direct contact, so standard precautions such as wearing a surgical mask and gloves are sufficient.

Correct Answer: A

Rationale: The correct answer is A: Fluctuation of the fluid level within the water seal chamber. This indicates proper chest tube function as it shows that the system is maintaining the desired pressure and allowing for adequate drainage without obstruction. When the patient breathes in and out, the fluid level fluctuates due to changes in intrathoracic pressure. Explanation of other choices: B: Absence of fluid in the drainage tubing - This would indicate a problem with drainage, possibly due to a blockage in the tubing. C: Continuous bubbling within the water seal chamber - This would suggest an air leak in the system, which is not ideal as it can lead to lung collapse. D: Equal amounts of fluid drainage in each collection chamber - While equal drainage is good, it does not specifically indicate proper chest tube function like the fluctuation of the fluid level does.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Provide straws and offer fluids between meals, which is suitable for delegation to a nursing assistant. This task involves assisting the client with fluid intake through a simple method that does not require clinical judgment or specialized training. Providing straws and offering fluids between meals can help the client increase their fluid intake, which is essential for addressing Deficient Fluid Volume. Option A) Administer IV fluids requires specialized training and the ability to assess the client's condition for any potential complications. This task falls under the scope of practice for licensed nurses and should not be delegated to a nursing assistant. Option C) Developing a plan for added fluid intake over 24 hours involves critical thinking and consideration of the client's specific needs, medical history, and overall condition. This task requires nursing judgment and should be performed by a licensed nurse. Option D) Teaching family members to assist the client with fluid intake involves providing education on the client's specific condition, signs of dehydration, and appropriate methods for encouraging fluid intake. This task requires healthcare knowledge and should be carried out by a healthcare provider with expertise in patient education. Educationally, understanding the principles of delegation in nursing practice is crucial for ensuring safe and effective patient care. Delegating tasks appropriately based on the complexity of the task, the competence of the individual, and the client's needs is essential in healthcare settings to optimize outcomes and promote quality care delivery.

Correct Answer: C

Rationale: In the case of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH), it is crucial to monitor for hyponatremia (Option C). SIADH is a condition where the body retains water excessively, leading to dilutional hyponatremia due to low sodium levels in the blood. This electrolyte abnormality can result in serious neurological symptoms such as confusion, seizures, and coma if not managed appropriately. Option A (Hypokalemia) and Option B (Hyperkalemia) are unlikely in SIADH unless there are additional underlying conditions or medications affecting potassium levels. Monitoring potassium levels is important in other conditions like renal failure. Option D (Hypernatremia) is also incorrect as SIADH typically leads to low sodium levels, not high. Hypernatremia is more commonly seen in conditions where there is excessive water loss or reduced water intake. Educationally, understanding the electrolyte imbalances associated with specific conditions like SIADH is crucial for nurses and healthcare providers to provide safe and effective care. Monitoring electrolyte levels and recognizing early signs of imbalance are key components of managing patients with conditions affecting fluid and electrolyte balance.

Correct Answer: B

Rationale: The correct answer is B) A 72-year-old client with COPD and normal arterial blood gases (ABGs) who is ventilator-dependent. This client is the most appropriate to assign to the step-down unit nurse because they have stable ABGs despite being ventilator-dependent, indicating better overall respiratory function compared to the other options. Option A is incorrect because a client on a ventilator with acute respiratory failure and respiratory acidosis requires intensive care and close monitoring of their respiratory status, making them unsuitable for the step-down unit. Option C is incorrect because a new admission client with diabetic ketoacidosis on an insulin drip needs specialized care to manage their metabolic condition, which is beyond the scope of a step-down unit nurse. Option D is incorrect because a client on a ventilator with narcotic overdose and respiratory alkalosis may still require close monitoring and intervention for their overdose, making them more appropriate for the intensive care unit. In an educational context, understanding the rationale behind assigning patients based on their condition and level of care needed is crucial for nurses to prioritize patient safety and optimize outcomes. This scenario highlights the importance of matching patient acuity with nursing expertise and resources available in different units to provide appropriate care.