Which practice is recommended to prevent human immune deficiency virus (HIV) transmission by health care workers?

Correct Answer: B

Rationale: The correct answer is B) Using standard precautions. This practice is recommended to prevent HIV transmission by healthcare workers because standard precautions are a set of infection control practices that are designed to prevent transmission of infectious diseases. Standard precautions include practices such as hand hygiene, the use of personal protective equipment (e.g., gloves, gowns, masks), safe injection practices, and safe handling of potentially contaminated equipment or surfaces. These precautions are essential in preventing the spread of HIV and other bloodborne pathogens in healthcare settings. Option A) Wearing a mask within three feet of the client is not specifically targeted at preventing HIV transmission. Masks are typically used to prevent respiratory droplet transmission of diseases like COVID-19 or influenza. Option C) Applying hand sanitizer to gloves during cares is not an effective practice for preventing HIV transmission. Hand sanitizer is meant for cleaning hands, not gloves, and does not provide a sufficient barrier against bloodborne pathogens. Option D) Double gloving may provide an extra layer of protection, but it is not a standard practice recommended for preventing HIV transmission. Standard precautions emphasize using appropriate personal protective equipment based on the type of exposure risk, and double gloving may not always be necessary or practical in every situation. In an educational context, it is crucial for healthcare workers to understand and follow standard precautions to protect themselves and their patients from potential infections, including HIV. By adhering to these practices consistently, healthcare workers can create a safe environment for both themselves and those under their care. Regular training, reinforcement, and compliance monitoring are essential components of maintaining a culture of infection control in healthcare settings.

Correct Answer: B

Rationale: In caring for a client with AIDS and PCP, the nurse's priority assessment should be lung sounds (Option B). PCP is a type of pneumonia that primarily affects the lungs, causing symptoms like cough, shortness of breath, and chest pain. Monitoring lung sounds is crucial to assess the severity of respiratory distress and the effectiveness of oxygenation. Skin turgor (Option A) is more indicative of hydration status and would be important in other situations like dehydration, but it is not the priority in a client with PCP. Radial pulses (Option C) and capillary refill (Option D) are important assessments for circulatory status, but in this case, respiratory assessment takes precedence due to the nature of PCP affecting the lungs directly. In an educational context, understanding the rationale behind prioritizing assessments helps nurses provide timely and appropriate care to clients with complex conditions. By focusing on the most critical assessment first, nurses can intervene promptly and potentially prevent further complications in clients with AIDS and PCP.

Correct Answer: B

Rationale: The correct answer is B) Compartment syndrome. In this scenario, the client's symptoms indicate a potential compartment syndrome, a serious condition caused by increased pressure within a muscle compartment. The acute pain greater than the severity of the fracture, 'pins and needles' sensation distal to the injury, and weak/thready pulse but bounding on unaffected extremities are classic signs of compartment syndrome due to compromised blood flow and nerve function. Option A) Ischial tuberosity is incorrect as it pertains to a bony structure in the pelvis and is not related to the symptoms described. Option C) Broken arm syndrome is not a recognized medical condition, making it an incorrect distractor. Option D) Pulmonary embolism involves a blockage in the pulmonary artery, typically presenting with symptoms like chest pain, shortness of breath, and cough, which are not evident in the client's case. Educationally, understanding the signs and symptoms of compartment syndrome is crucial for nurses to recognize and intervene promptly to prevent permanent damage to muscles and nerves. This case highlights the importance of thorough assessment, critical thinking, and swift action in emergency situations to provide optimal patient care.

Correct Answer: A

Rationale: The correct answer is A) Mental state, which will NOT be utilized in a Braden Scale Assessment. The Braden Scale is a tool used to assess a patient's risk of developing pressure ulcers. The scale considers six parameters: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. In the context of long-term care, it is crucial to assess a patient's risk of developing pressure ulcers due to their decreased mobility and prolonged periods of immobility. Sensory perception is included in the Braden Scale because patients who have impaired sensation are at a higher risk of developing pressure ulcers as they may not be able to feel discomfort or pain from prolonged pressure on their skin. While mental state is essential for overall patient assessment and care, it is not a specific factor considered in the Braden Scale for assessing pressure ulcer risk. This is because mental state does not directly impact a patient's susceptibility to developing pressure ulcers, unlike the other factors included in the scale. Educationally, understanding the components of assessment tools like the Braden Scale is vital for nurses to provide comprehensive care to patients in long-term care settings. It ensures that nurses can accurately identify patients at risk for pressure ulcers and implement appropriate preventive measures to maintain their skin integrity and overall well-being.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Maintaining the integrity of a portal of entry. By providing measures to reduce skin breakdown, such as keeping the skin clean, dry, and intact, the nurse is effectively preventing pathogens from entering the body through breaks in the skin. This action disrupts the chain of infection at the portal of entry stage, thereby reducing the risk of infection transmission. Option A) Sterilizing the area to reduce the reservoir risk is incorrect because sterilizing the area would target eliminating pathogens at the reservoir stage, not necessarily at the portal of entry. The focus should be on preventing entry rather than reducing reservoir risk. Option C) Creating a reservoir to decrease the risk of infection is incorrect because creating a reservoir would actually increase the risk of infection by providing a source for pathogens to multiply and spread. Option D) Creating a susceptible host is incorrect because the goal is to prevent infection by reducing the opportunity for pathogens to enter the body, not by making the host more susceptible to infection. In an educational context, understanding how infection control measures work to break the chain of infection is crucial for healthcare professionals to provide effective care and prevent the spread of infections in healthcare settings. By emphasizing the importance of maintaining skin integrity and implementing proper infection prevention protocols, nurses can play a significant role in reducing the risk of healthcare-associated infections.