Q&A: PEDS/ RESPIRATORY

CYSTIC FIBROSIS

CYSTIC FIBROSIS

The nurse is teaching parents of a child with croup on home treatments. Which of the following does the nurse recommend? Select all that apply. A. A cool bath for fever reduction B. Sleep with cool humidified air C. Place the child near a steamy shower D. Placement in a whirlpool bath E. Expose the child to cool, night air

Place the child near a steamy shower A steamy shower helps reduce swelling in the airway of a child with croup. Additional home behaviors include keeping the child calm, giving acetaminophen or ibuprofen for pain, and keeping the child hydrated. Expose the child to cool, night air Cool night air is beneficial for a child with croup. Sleep with cool humidified air Humidified air will reduce irritation to the airways. A cool bath for fever reduction The parents should avoid placing the child in the supine position, because this aggravates the airways. Placement in a whirlpool bath A child will be supine for a bath, so this is contraindicated. A child in the supine position has more difficulty breathing than when sitting up.

PNEUMONIA

Pneumonia (PNA)

RSV (respiratory syncytial virus)

RSV

The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions should the nurse include in the plan of care? Select all that apply. 1.Place the infant in a private room. 2.Ensure that the infant's head is in a flexed position. 3.Wear a mask, gown, and gloves when in contact with the infant. 4.Place the infant in a tent that delivers warm humidified air. 5.Position the infant on the side, with the head lower than the chest. 6.Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

1.Place the infant in a private room. 3.Wear a mask, gown, and gloves when in contact with the infant. 6.Ensure that nurses caring for the infant with RSV do not care for other high-risk children. RSV is a highly communicable disorder and is transmitted via droplets or contact with respiratory secretions. Use of contact, droplet, and standard precautions during care (wearing gloves, mask, and a gown) reduces nosocomial transmission of RSV. In addition, it is important to ensure that nurses caring for a child with RSV do not care for other high-risk children to prevent the transmission of the infection. An infant with RSV should be placed in a private room. The infant should be positioned with the head and chest at a 30- to 40-degree angle and the neck slightly extended to maintain an open airway and decrease pressure on the diaphragm. Cool humidified oxygen is delivered to relieve dyspnea, hypoxemia, and insensible water loss from tachypnea. Test-Taking Strategy(ies):Focus on the subject, care of the child with bronchiolitis and RSV. Recalling the mode of transmission of RSV will assist in answering correctly. Remember that RSV is highly communicable and is transmitted via droplets or direct contact with respiratory secretions.

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriatenursing action? 1. Initiate strict enteric precautions. 2. Move the infant to a private room. 3. Leave the infant in the present room, because RSV is not contagious. 4. Inform the staff that using standard precautions is all that is necessary when caring for the child.

2. Move the infant to a private room. RSV is a highly communicable disorder and is transmitted via droplets and direct contact with respiratory secretions. Use of contact, droplet, and standard precautions during care is necessary. Using good hand-washing technique and wearing gloves, gown, and a mask should be done to prevent transmission. An infant with RSV should be placed in a private room to prevent transmission. Enteric precautions are unnecessary. Test-Taking Strategy(ies):Note the strategic words, most appropriate.Focus on the subject, the method of transmission of RSV. Remember that the virus is transmitted via droplets and direct contact with respiratory secretions. An infant with RSV is contagious and should be placed in a private room.

The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriatenursing action 1.Initiate strict enteric precautions. 2.Move the infant to a room with another child with RSV. 3.Leave the infant in the present room because RSV is not contagious. 4.Inform the staff that they must wear a mask, gloves, and a gown when caring for the child.

2.Move the infant to a room with another child with RSV. Rationale: RSV is a highly communicable disorder and is not transmitted via the airborne route. The virus usually is transferred by the hands. Use of contact and standard precautions during care is necessary. Using good hand-washing technique and wearing gloves and gowns are also necessary. Masks are not required. An infant with RSV is isolated in a single room or placed in a room with another child with RSV. Enteric precautions are unnecessary. Test-Taking Strategy(ies):Note the strategic words, most appropriate.Focus on the subject, the method of transmission of RSV. Remember that the virus is not transmitted via the airborne route and is usually transferred by the hands. An infant with RSV is isolated in a single room or placed in a room with another child with RSV.

The nurse is caring for a hospitalized infant with a diagnosis of bronchiolitis. In which position should the nurse place the infant? 1.Supine, side-lying position with the arms elevated 2.Prone with the head of the bed elevated 15 degrees 3.Trendelenburg's, at a 60-degree angle with pelvis higher than head 4.Head and chest at a 30-degree angle with the neck slightly extended

4.Head and chest at a 30-degree angle with the neck slightly extended Rationale: The nurse should position the infant with the head and the chest at a 30- to 40-degree angle with the neck slightly extended to maintain an open airway and to decrease pressure of the diaphragm. The positions noted in the remaining options do not achieve these goals. Test-Taking Strategy(ies):Focus on the subject, positioning for the infant with bronchiolitis. Visualize each of the positions identified in the options. Keeping in mind that the goal is to maintain an open airway will assist in directing you to the correct option.

A nurse is caring for a 7-year-old who has recently been diagnosed with asthma and is providing education on the importance of avoiding triggers that can cause an asthma exacerbation. Which of the following would be a trigger for asthma? Select all that apply. A. Allergens B. Anxiety C. Exercise D. Cold weather E. Infections

A, B, C, D, E Allergens Allergens are a common stimuli that can initiate the inflammatory response, triggering an asthma exacerbation. Anxiety Anxiety is a trigger that can trigger an asthma exacerbation. Exercise Exercise can trigger an asthma attack. Cold weather Infections are stimuli that can trigger an asthma exacerbation. Infections Infections are stimuli that can trigger an asthma exacerbation.

The nurse caring for a newborn who has just been diagnosed with cystic fibrosis knows that which of the following statements would best explain this diagnosis to the parents? A. "It is an inherited disease that causes your child's mucus to be very thick, which affects their breathing and digestion" B. "It is an inherited disease that causes bronchospasms secondary to exposure to allergens" C. "It is an acquired disease that causes fluid to move into the alveoli secondary to severe hypertension" D. "It is an inherited disease that causes digestive problems and bronchospasms which affects breathing"

A. "It is an inherited disease that causes your child's mucus to be very thick, which affects their breathing and digestion" Cystic fibrosis is an autosomal recessive trait that causes a mutation in the CFTR gene which causes an increase in the viscosity of mucus that causes an obstruction in pulmonary and gastrointestinal systems.

The nurse is caring for a client who has been brought to the emergency department for an asthma exacerbation. Which of the following would NOT be an expected finding when completing a comprehensive respiratory assessment of this client? A. Cheyne-Stokes respirations B. Wheezes C. Diminished breath sounds D. Tachypnea

A. Cheyne-Stokes respirations This is an abnormal respiratory pattern with periods of apnea. It is not an expected clinical finding in a client experiencing an acute asthma exacerbation. All other assessment findings would be expected with this clinical picture. Tachypnea Tachypnea, or rapid breathing, is an expected finding with a client who is experiencing an asthma exacerbation. Wheezes Wheezes are an expected finding with this condition. Diminished breath sounds It is expected that the client experiencing an asthma exacerbation has diminished breath sounds.

The nurse caring for a 4-year-old who has been admitted with the diagnosis of epiglottitis asks the mother about which of the following childhood immunizations? A. Haemophilus Influenzae type B B. Diphtheria, Tetanus and Pertussis C. Pneumococcal D. Measles, Mumps & Rubella

A. Haemophilus Influenzae type B Epiglottitis is often caused by Haemophilus Influenza type B. Diphtheria, Tetanus and Pertussis Epiglottitis is often caused by Haemophilus Influenza type B. Pneumococcal Epiglottitis is often caused by Haemophilus Influenza type B. Measles, Mumps & Rubella Epiglottitis is often caused by Haemophilus Influenza type B.

A nurse is working as part of a multidisciplinary team to help a 16-year-old client with cystic fibrosis. In addition to physical care, which activity is most important for a client of this age with cystic fibrosis? A. Helping the teen to transition to adult care services by promoting independence in decision making B. Reminding the teen that despite the condition, he or she will still be able to stay in school C. Assisting the client to play games with peers of the same age D. Explaining and educating the client on facts surrounding the condition

A. Helping the teen to transition to adult care services by promoting independence in decision making A teen client with cystic fibrosis faces many challenges in association with a changing body and feelings as well as with physical health. The nurse who works with an adolescent who has a chronic disease such as cystic fibrosis can help the teen with physical needs but can also help as the client learns to make independent health decisions. A client this age will soon be transitioning to adult care and can learn to make more choices about what is best. Reminding the teen that despite the condition, he or she will still be able to stay in school This is true, but it is not the most important item for the nurse to discuss with this client. Assisting the client to play games with peers of the same age At this age, the client typically no longer needs assistance with socialization. Explaining and educating the client on facts surrounding the condition The client should have had many opportunities for education regarding the condition of cystic fibrosis, so this would not be the most important action the nurse could take.

The nurse admitting a client with cystic fibrosis that has a cough, fever and is tachypneic knows that which of the following medication orders should you give top priority? A. IV antibiotics B. Vitamins ADEK C. Nebulized hypertonic saline D. Pancreatic enzymes

A. IV antibiotics The client has presented with signs of a respiratory infection that needs to be treated promptly and IV antibiotics should be given top priority. Pancreatic enzymes The client has presented with signs of a respiratory infection that needs to be treated promptly. Therefore IV antibiotics should be given top priority. Vitamins ADEK The client has presented with signs of a respiratory infection that needs to be treated promptly. Therefore IV antibiotics should be given top priority. Nebulized hypertonic saline The client has presented with signs of a respiratory infection that needs to be treated promptly. Therefore IV antibiotics should be given top priority.

The nurse providing care for a 3-year-old diagnosed with epiglottitis expects orders for which of the following medications? Select all that apply. A. IV corticosteroids B. Nebulized bronchodilators C. IV antibiotics D. IV diuretics E. Nebulized epinephrine

A. IV corticosteroids Corticosteroids may be used to decrease inflammation in the airway. C. IV antibiotics Antibiotics will treat the bacterial cause of epiglottitis. IV diuretics The respiratory distress noted in the client is not caused by fluid overload. Nebulized bronchodilators Research shows that bronchodilators and nebulized epinephrine are not effective in treating epiglottitis. Nebulized epinephrine Research shows that bronchodilators and nebulized epinephrine are not effective in treating epiglottitis.

A nurse caring for a 10-year-old with pneumonia, that will be discharged home with oral antibiotics, knows that which of the following should be included in the discharge instructions? A. Increase fluid intake to prevent dehydration B. How to properly apply a warm compress C. How to use a bulb suction syringe D. Properly administration of nebulized medications at home

A. Increase fluid intake to prevent dehydration Dehydration is a common problem associated with pneumonia that could complicate the child's recovery. Properly administration of nebulized medications at home Nebulized medications are more likely to be used with a client diagnosed with asthma. How to use a bulb suction syringe Bulb syringes are used in infants to help them clear secretions. A 10 year old child should be able to manage secretions on their own without suction. How to properly apply a warm compress This topic would be appropriate for a client with an ear infection being sent home with antibiotics but does not apply to a child with pneumonia.

The nurse caring for a 2-year-old who presented to an urgent care center with stridor and excessive drooling knows that which of the following interventions should be given top priority? A. Keep the child calm until emergency airway equipment is available B. Assess the throat for signs of a cherry red epiglottis C. Place an IV in preparation for giving IV antibiotics D. Place the child on 2L via NC and prepare for intubation

A. Keep the child calm until emergency airway equipment is available If the child becomes upset or cries it could cause the airway to spasm more resulting in complete airway obstruction. Children with possible epiglottis should only be examined in a setting that has emergency airway equipment readily available. Place an IV in preparation for giving IV antibiotics This child may have epiglottitis, all interventions should wait until emergency airway equipment is close by. This is because upsetting the child could cause the airway to spasm and result in complete airway obstruction. Assess the throat for signs of a cherry red epiglottis This child may have epiglottitis, all interventions should wait until emergency airway equipment is close by. This is because upsetting the child could cause the airway to spasm and result in complete airway obstruction. Place the child on 2L via NC and prepare for intubation This child may have epiglottitis, all interventions should wait until emergency airway equipment is close by. This is because upsetting the child could cause the airway to spasm and result in complete airway obstruction. While they may need to be intubated it may be avoided by keeping the child calm and comfortable.

A nurse is expecting an 18-month-old with bronchiolitis from the emergency department, Which of the following protective gear should be worn when entering the child's room? Select all that apply. A. Mask B. Gown C. Shoe covers D. Gloves E. Respirator Mask

A. Mask B. Gown D. Gloves Gown A bronchiolitis is most commonly caused by a respiratory syncytial virus which is spread through droplets that can live on surfaces, therefore droplet and contact precautions are required. Gloves A bronchiolitis is most commonly caused by a respiratory syncytial virus which is spread through droplets that can live on surfaces, therefore droplet and contact precautions are required. Mask A bronchiolitis is most commonly caused by a respiratory syncytial virus which is spread through droplets that can live on surfaces, therefore droplet and contact precautions are required. Respirator Mask Respirator Masks are used when the infection can be spread through an airborne pathogen. Shoe covers Although shoe covers may be indicated with some contact precautions they are primarily used in situations where blood or infected materials are going to be coming into contact with the floor. A child with RSV is unlikely to be spreading the pathogens to the floor.

The nurse is caring for a client who has been taking erythromycin. For which of the following side effects should the nurse monitor? A. Nausea and vomiting B. Rash C. Increased urinary output D. Constipation

A. Nausea and vomiting Erythromycin is a macrolide antibiotic that carries the common side effects of nausea and vomiting, abdominal pain, and cramps. Increased urinary output This is not a side effect associated with macrolide antibiotics. Rash This is not a side effect associated with macrolide antibiotics. Constipation This is not a side effect associated with macrolide antibiotics.

A patient with asthma has started a new prescription for albuterol (Proventil HFA). What side effects are associated with use of this drug? Select all that apply. A. Pounding heart rate B. Depression C. Vomiting D. Restlessness E. Tremor in the extremities

A. Pounding heart rate D. Restlessness E. Tremor in the extremities Pounding heart rate It may also have negative side effect that causes a pounding heart rate. Restlessness Shakiness, and restlessness are also the side effects of Albuterol. Tremor in the extremities Albuterol is a drug used to open the airways and facilitate easier breathing. It may also have negative side effects that causes tremor in the extremities. Depression The incidence of depression was not reported as side effect with Albuterol use. Vomiting This is not also reported as a side effect of Albuterol.

The nurse caring for a 6-month-old diagnosed with bronchiolitis knows which of the following is most likely the cause? A. Respiratory Syncytial Virus B. Varicella zoster virus C. Haemophilus influenzae type B D. Rotavirus

A. Respiratory Syncytial Virus RSV is the most common cause of bronchiolitis in children. Haemophilus influenzae type B Haemophilus influenzae type B is a common cause of epiglottitis Rotavirus Rotavirus is a common cause of diarrhea and vomiting in children. Varicella zoster virus This is the virus that causes chickenpox in children.

A three month old infant needs an IM injection of palivizumab for prevention of RSV. Which site is mostappropriate for the nurse to administer this medication? A. Vastus lateralis site B. Ventrogluteal site C. Dorsogluteal site D. Deltoid site

A. Vastus lateralis site The vastus lateralis site is the most common site for intramuscular injection in infants. This site is easy to access and typically has a large enough muscle that medication can be injected into the area. The nurse should avoid using the deltoid site on a 3-month old because the infant will not have enough muscle in this area. Ventrogluteal site This site does not have adequate muscle mass on an infant. Deltoid site This site on a three month old do not typically have an adequate amount of muscle mass and fat, and the delivery of medication could be compromised. The needle could also hit bone and be extremely painful for the child. Dorsogluteal site This site does not have adequate muscle mass on an infant.

ASTHMA

ASTHMA

The nursing providing care to a 5-year-old admitted for treatment of bacterial pneumonia knows that which of the following complications are associated with pneumonia? Select all that apply. A. Tension Pneumothorax B. Acute otitis media C. Nasal Polyps D. Pleural effusion E. Splenomegaly

Acute otitis media Acute otitis media (AOM) AOM is a complication commonly seen with pneumococcal pneumonia. Pleural effusion occurs as the pleural space fills with fluid. Pleural effusion Acute otitis media (AOM) AOM is a complication commonly seen with pneumococcal pneumonia. Pleural effusion occurs as the pleural space fills with fluid. Tension Pneumothorax Tension pneumothorax is a complication often seen in clients with staphylococcal pneumonia. Nasal Polyps Nasal polyps can occur as a result of chronic inflammation. They are often seen in clients with cystic fibrosis. Splenomegaly Splenomegaly can occur with infectious mononucleosis.

A nurse is demonstrating how to use a metered-dose inhaler to a client with asthma. Which of the following elements should the nurse include as part of this teaching? Select all that apply. A. Do not use the inhaler again for at least 5 minutes after the first dose B. Shake the inhaler well before using Immediately breath out after inhaling the medication C. Avoid putting the mouthpiece in the mouth without a spacer, if possible D. Press the canister while taking a deep breath

B, C, D B. Shake the inhaler well before using This is important to ensure the medication is evenly distributed in the canister. C. Avoid putting the mouthpiece in the mouth without a spacer, if possible The client should not put the mouthpiece in his mouth without using a spacer, unless the spacer is unavailable. D. Press the canister while taking a deep breath When using a metered-dose inhaler, the client must coordinate expelling the medication and breathing it in. Immediately breath out after inhaling the medication In order for the medication to have an effect, it must be dispersed in the respiratory tract, so the client should hold their breath for 10-15 seconds. Do not use the inhaler again for at least 5 minutes after the first dose If the client needs another dose, they may administer one after waiting one or two minutes.

An 8-year-old who has just been diagnosed with asthma wants to know why it is important to take the medication fluticasone on a daily basis. Which of the following statements by the nurse should be included? A. "Fluticasone is an inhaled B-Adrenergic agonist that is a rescue medication for when you can't breath" B. "Fluticasone is an inhaled steroid that helps prevent inflammation in your lungs" C. "Fluticasone is a steroid that provides quick relief for when you are having bronchospasms" D. "Fluticasone is a pill that you need to take daily to help alleviate allergies"

B. "Fluticasone is an inhaled steroid that helps prevent inflammation in your lungs" Fluticasone is a steroid given via inhalation. They are used to help prevent inflammation in the lungs with helps prevent asthma exacerbations. "Fluticasone is an inhaled B-Adrenergic agonist that is a rescue medication for when you can't breath" Fluticasone is used for long-term management of asthma and is does not work as a rescue medication in acute exacerbations. "Fluticasone is a pill that you need to take daily to help alleviate allergies" Fluticasone is a corticosteroid given via inhalation. "Fluticasone is a steroid that provides quick relief for when you are having bronchospasms" Fluticasone is given to help prevent inflammation in the lungs. It does not help treat bronchospasms. B-Adrenergic agonists like albuterol relax smooth muscle and are given to treat bronchospasms.

The nurse caring for a client diagnosed with cystic fibrosis knows that which of the following is a clinical manifestation of long term respiratory problems? Select all that apply. A. Epistaxis B. Barrel-shaped chest C. Retractions D. Clubbing of fingers and toes E. Nasal polyps

B. Barrel-shaped chest D. Clubbing of fingers and toes E. Nasal polyps Barrel-shaped chest Chronic overinflation of the lungs causes the development of a barrel-shaped chest. Clubbing of fingers and toes Clubbing is a physical deformity of the nails that occurs secondary to chronic hypoxia. Nasal polyps Nasal polyps are caused by chronic inflammation that occurs in clients with cystic fibrosis. Retractions Retractions are associated with an acute presentation of respiratory distress and would not be a sign of chronic respiratory problems with cystic fibrosis. Epistaxis Nosebleeds are not a symptom associated with long term respiratory problems.

The nurse is assessing a client and recognizes that this client is having a bronchospasm. Which treatments should the nurse anticipate? Select all that apply. A. Suctioning B. Bronchodilators C. Chest tube D. Diuretics E. Steroids

B. Bronchodilators When a client is having a bronchospasm, treatment will include steroids and bronchodilators to relax the smooth muscle and open up the airway. E. Steroids This is a treatment for bronchospasm, usually given with a bronchodilator. Diuretics This is helpful if there were fluids or mucus in the lungs, but is not necessary for a bronchospasm. Suctioning This is helpful if there were fluids or mucus in the lungs, but is not necessary for a bronchospasm. Chest tube A chest tube would be helpful for a collapsed lung but would do nothing for a bronchospasm.

The nurse is caring for a client with cystic fibrosis. Which of the following is an appropriate nursing intervention? Select all that apply. A. Avoid carbohydrates in the diet B. Feed a high protein diet C. Feed a low calorie diet D. Give pancreatic enzyme replacement E. Provide a high calorie diet

B. Feed a high protein diet D. Give pancreatic enzyme replacement E. Provide a high calorie diet Feed a high protein diet High protein is necessary for the client with CF. These clients use more calories than persons without cystic fibrosis, and have trouble keeping muscle mass and a normal weight. Give pancreatic enzyme replacement The client with cystic fibrosis must be provided adequate nutrition for growth, because they have a defective amino acid which causes obstructions throughout the body due to the build-up of thick, sticky mucus. The obstructions occur primarily in the lungs, GI system, and other organs. Provide a high calorie diet These clients use more calories than persons without cystic fibrosis, and have trouble keeping muscle mass and a normal weight. Feed a low calorie diet The client must take in plenty of calories for growth, since aborption is inhibited with this condition. Avoid carbohydrates in the diet A low-carbohydrate diet is not necessary with this condition.

The nurse caring for a 6-year-old with atypical community acquired pneumonia knows that which of the following pathogens is the most common cause of this? A. H. influenzae B. M. pneumoniae C. C. trachomatis D. S. pneumoniae

B. M. pneumoniae M. pneumoniae is the most common cause of community acquired pneumonia. S. pneumoniae S. pneumoniae is a very common bacterial cause of pneumonia and the use of the word "atypical" indicates that it is caused by pathogens other than the most common. C. trachomatis C. trachomatis is the pathogen that causes chlamydial pneumonia that can occur in infants. H. influenzae H. influenzae is a common cause of pneumonia in children.

The nurse caring for a newborn knows that which of the following is often the earliest clinical manifestation of cystic fibrosis? A. Pneumonia B. Meconium Ileus C. Azotorrhea D. Steatorrhea

B. Meconium Ileus The increased viscosity of mucus can cause the small intestine to be blocked with very thick meconium that the newborn is unable to pass in the expected 24 hours. This is the earliest clinical manifestation in about 10% of newborns. Steatorrhea Steatorrhea is the medical term used to describe bulky stools that are frothy from an inability to properly digest fat. While clients with cystic fibrosis (CF) may have steatorrhea it is not likely to be the earliest clinical manifestation. Azotorrhea Azotorrhea is the medical term used to describe foul smelling stool that occurs from putrefied protein in the stool. While a client with CF may have azotorrhea, it is not likely to be the earliest clinical manifestation. Pneumonia While clients with CF are likely to have frequent respiratory infections it is not likely to be the earliest clinical manifestation.

A nurse is caring for a newborn infant who needs a chest tube. What is the mostcommon reason why a newborn infant would need a chest tube? A. Post-op thoracotomy B. Respiratory distress syndrome C. Pertussis D. Cystic fibrosis

B. Respiratory distress syndrome A chest tube, whether placed in an infant, child or adult, is usually positioned for correction of a pneumothorax, which occurs as a hole in the lining of the pleural sac covering the lung. As air accumulates in the space, it presses against the lung tissue so that it cannot inflate normally, which is why some people call the condition a collapsed lung. A newborn infant may need a chest tube if he develops a respiratory condition, such as meconium aspiration. However, the most common reason why an infant would need a chest tube is because of respiratory distress syndrome. Cystic fibrosis Since cystic fibrosis (CF) is a condition in which there is excess mucus in the lungs that is viscous and thicker than normal, a chest tube is not used for treatment. Pertussis Pertussis is treated with antibiotics. A chest tube is not used, as this condition does not affect the lining between the pleural sac and the lung. Post-op thoracotomy While a chest tube may be placed following a thoracotomy, it is not the most common reason for a chest tube in an infant.

The nurse knows that which of the following medications is commonly used to help prevent Exercise-induced bronchospasm? A. Ipratropium B. Salmeterol C. Omalizumab D. Montelukast sodium

B. Salmeterol Salmeterol is a long acting bronchodilator is used to help prevent asthma exacerbations caused by exercise. Ipratropium Ipratropium is an anticholinergic that is given to help relieve bronchospasms and is usually given in combination with albuterol. Omalizumab Omalizumab is a monoclonal antibody given to treat persistent, severe, atopic asthma. Montelukast sodium Montelukast sodium is given to reduce inflammatory responses to allergens.

A nurse is caring for a 5-day-old child with respiratory distress and pneumonia who requires a mechanical ventilator. The provider has ordered nitric oxide to be administered with the ventilator breaths. Which bestdescribes the purpose of nitric oxide in this situation? A. The nitric oxide prevents atelectasis B. The nitric oxide works as a vasodilator C. The nitric oxide reduces the risk of hemorrhage D. The nitric oxide will make the child more comfortable

B. The nitric oxide works as a vasodilator Nitric oxide is a pulmonary vasodilator. When combined with use of a mechanical ventilator, nitric oxide can improve oxygenation by increasing the size of blood vessels and promoting the flow of oxygenated blood. Nitric oxide is typically inhaled as part of the mechanical ventilatory system so that the client receives the gas at the same time as the breaths from the ventilator. The nitric oxide will make the child more comfortable This is not a use for nitric oxide. The nitric oxide prevents atelectasis This is not a use for nitric oxide. The nitric oxide reduces the risk of hemorrhage This is not a use for nitric oxide.

A three-year-old child has been brought in to the hospital with a diagnosis of Haemophilus influenza B. After testing, the provider determines that the child has epiglottitis and treatment is started. Which information would the nurse provide to the parents of this child about caring for this condition? Select all that apply. A. Gently use a tongue depressor to keep the mouth open B. Use a cool mist humidifier in the room C. Encourage the child to eat plenty of cold foods D. The child should not lie flat E. Encourage the child not to cry

B. Use a cool mist humidifier in the room D. The child should not lie flat E. Encourage the child not to cry Use a cool mist humidifier in the room The nurse should place a cool mist humidifier in the room to help decrease swelling. The child should not lie flat Epiglottitis is a life-threatening condition because the client's epiglottis becomes swollen and can obstruct the airway. It occurs most often in children ages two to eight, often from Haemophilus influenzae type b or streptococcus pneumoniae. Treatment is centered on maintaining airway patency and administration of antibiotics. The child should be kept calm, because agitation can lead to further airway compromise. The head of the bed should be raised because when the child lies flat, it affects respiratory status. Encourage the child not to cry The child should be kept calm, because agitation can lead to further airway compromise. Encourage the child to eat plenty of cold foods The child should be kept NPO status. Gently use a tongue depressor to keep the mouth open Nothing should be placed in the child's mouth.

An infant in the pediatrics unit has been diagnosed with respiratory syncytial virus (RSV). The nurse should include which of the following precautions in caring for this infant? Select all that apply. A. Ensure the client's room has negative-pressure ventilation B. Wear goggles if there is potential for splashing of body fluids C. Keep the client in a private room D. Have staff wear an N95 respirator when providing care for the client E. Wear a surgical mask for close contact with the client

B. Wear goggles if there is potential for splashing of body fluids Respiratory syncytial virus is an infectious condition that affects infants and young children. Standard plus contact precautions should be used, which includes wearing personal protective equipment whenever there is potential for contact with blood or body fluids. This includes keeping the client in a private room and wearing a gown, gloves, and goggles when providing care, and a surgical mask for close contact if the client is coughing or sneezing. C. Keep the client in a private room Respiratory syncytial virus is an infectious condition that affects infants and young children. Standard plus contact precautions should be used, which includes wearing personal protective equipment whenever there is potential for contact with blood or body fluids. This includes keeping the client in a private room and wearing a gown, gloves, and goggles when providing care, and a surgical mask for close contact if the client is coughing or sneezing. E. Wear a surgical mask for close contact with the client Respiratory syncytial virus is an infectious condition that affects infants and young children. Standard plus contact precautions should be used, which includes wearing personal protective equipment whenever there is potential for contact with blood or body fluids. This includes keeping the client in a private room and wearing a gown, gloves, and goggles when providing care, and a surgical mask for close contact if the client is coughing or sneezing. Ensure the client's room has negative-pressure ventilation These are a part of airborne precautions. Since RSV is not transmitted by the airborne route, these precautions are not necessary. Have staff wear an N95 respirator when providing care for the client These are a part of airborne precautions. Since RSV is not transmitted by the airborne route, these precautions are not necessary.

The nurse receives the following client assignment. Which client should the nurse see first? 1) A 50-year-old with chest pain 2) A 13-year-old with an asthma attack 3) A 2-month-old that is fussy 4) A 90-year-old with cyclical vomiting A. A 90-year-old with cyclical vomiting B. A 50-year-old with chest pain C. A 13-year-old with an asthma attack D. A 2-month-old that is fussy

C. A 13-year-old with an asthma attack Using the ABC's (airway, breathing, circulation), the nurse should see the asthma attack first as this involves the client's airway and breathing. Next, the nurse should see the client with chest pain, followed by the client with cyclical vomiting, and last see the fussy baby. A 50-year-old with chest pain This client should be seen second. A 90-year-old with cyclical vomiting This client should be seen third. A 2-month-old that is fussy This client should be seen last.

The nurse is caring for a client with cystic fibrosis (CF). Which diagnosis is the most concerning for them? A. UTI B. Blood clots C. Sinusitis D. Cellulitis

C. Sinusitis Cystic fibrosis is a disorder in which a genetic mutation causes thickening of mucous and affects the lungs, GI system, and endocrine system. These clients are at a high risk for pulmonary infections. A goal of management of this client is to prevent pulmonary infections, because these lead to complications and are difficult to treat. UTI CF does not affect pathways in the genitourinary system, so a UTI would be treated normally as in a client without CF. Cellulitis A client with cystic fibrosis does not have a lowered immune system. Cellulitis and other infections that are not within the body systems affected by CF are treated with the same protocol as clients without CF. Blood clots A client with CF will experience the same complications from a blood clot as a client without CF.

The nurse is caring for a client admitted with pneumonia. The nurse notices the client is diaphoretic. After reviewing the client's vital signs, what should the nurse do next? A. Administer an antipyretic B.Encourage relaxation techniques C. Assess work of breathing D. Check a blood sugar

C. Assess work of breathing This client's heart rate and respiratory rate have increased. This combined with diaphoresis may indicate the client is working harder to breathe than previously. They may require incentive spirometry or a breathing treatment. *note* you should also be auscultating lung sounds at this point. Check a blood sugar The airway takes priority. It is possible that these symptoms are caused by hypoglycemia or by anxiety/restlessness, but knowing that the client has pneumonia, it's more important to evaluate their respiratory status first. Encourage relaxation techniques The airway takes priority. It is possible that these symptoms are caused by hypoglycemia or by anxiety/restlessness, but knowing that the client has pneumonia, it's more important to evaluate their respiratory status first. Administer an antipyretic The airway takes priority. The temperature is likely not high enough to trigger a PRN medication. Knowing the client has pneumonia, it's more important to make sure their respiratory status is intact first before moving on to other interventions. Labored breathing can make a temperature rise. If their respiratory status is acceptable, and the blood sugar is normal, at that point you should consider other causes, such as the fever.

The nurse caring for a 5-year-old assesses the following assessment findings: stridor, drooling, high fever, toxic appearance, increased heart rate, and respiratory rate. Which of the following should be avoided during the assessment? A. Auscultating the lung sounds B. Checking the child's capillary refill time C. Assessing the throat D. Applying a continuous pulse ox monitor

C. Assessing the throat This could upset the child and cause spasms in the airway leading to complete airway obstruction. Applying a continuous pulse ox monitor It is a relatively non-invasive procedure that can be carried out without upsetting the child. Auscultating the lung sounds It is a relatively non-invasive procedure that can be carried out without upsetting the child. Checking the child's capillary refill time It is a relatively non-invasive procedure that can be carried out without upsetting the child.

The nurse is assessing a 10-month-old child who was brought to the ER by parents because is having a difficult time breathing. Upon examination, the child is in no distress, airway is intact and skin is pink, warm, dry. The provider orders a breathing treatment and some steroids. When the nurse enters the room to administer the medications, the child is drooling and red in the face. What is the first action the nurse should take? A. Tell the child to stop drooling B. Reposition the child by sitting the child up C. Call a rapid response D. Give the breathing treatment

C. Call a rapid response When a child is drooling and having breathing problems, they are having symptoms of epiglottitis. This is a medical emergency and the nurse should activate the rapid response team, call for emergency airway equipment, and administer oxygen. The nurse should not leave the child. Give the breathing treatment A breathing treatment will not be helpful for epiglottitis. Reposition the child by sitting the child up This child needs emergency airway management. Sitting the child up will not be enough to to open the child's airway. Tell the child to stop drooling This child is drooling because of an inability to swallow. This is a medical emergency, and the nurse would not tell this child to stop drooling.

The nurse is caring for a client in status asthmaticus. Which of the following is a priority nursing action? A. Administer aminophylline IV per provider order B. Provide emotional support C. Give inhaled bronchodilator therapy as ordered D. Monitor the client's respiratory status for signs of hypoxia

C. Give inhaled bronchodilator therapy as ordered While all the options are appropriate actions for a client in status asthmaticus, inhaled bronchodilators work the fastest and should always be given first in this client scenario. Administer aminophylline IV per provider order While administering IV theophylline is appropriate to prevent and treat shortness of breath, it is secondary to administering an inhaled bronchodilator. Monitor the client's respiratory status for signs of hypoxia Monitoring is important at all times. However, monitoring is a passive activity, and this client needs medication actively administered as soon as possible. Provide emotional support Yes, the nurse will provide emotional support, but action is needed with this client in the form of administering an inhaled bronchodilator.

The nurse is caring for a client who is experiencing an acute asthma attack. The nurse understand that a bronchodilator is given because it produces which of the following actions on the bronchial tree? A. It decreases the levels of leukotrienes in the bronchial tree B. It decreases the amount of mucus in the bronchial tree C. It promotes the production of cAMP, causing bronchodilation D. It causes the client to cough up mucus more effectively

C. It promotes the production of cAMP, causing bronchodilation cAMP is a substance that helps dilate smooth muscle of the bronchiole tree, allowing airflow. It decreases the amount of mucus in the bronchial tree This is not an action of cAMP. It causes the client to cough up mucus more effectively While cAMP Does have an effect on cilial movement, this is not the reason to give a bronchodilator during an acute attack. It decreases the levels of leukotrienes in the bronchial tree Leukotrienes are associated with contraction of airway smooth muscles, but bronchodilators do not affect these levels.

A community health nurse provides screening for a family whose child has a likelihood of developing cystic fibrosis because of their genetic background. Which of the following community health interventions does this describe? A. Health screening B. Community consultation C. Risk identification D. Health system referral

C. Risk identification Risk identification describes a community-based intervention that identifies those individuals who are at higher risk of developing a health condition. Risk identification looks at the factors that put the affected person at higher risk of the health problem. It differs from screening in that it is more specific, whereas screening is testing of larger populations with the idea that it can identify potential health problems if they exist. Health system referral This nurse is simply attempting to identify a client at risk of a certain condition, not a referral to a provider or services. Health screening This describes testing a large number of people to identify potential problems. Community consultation This involves reporting health needs to officials or the public.

The nurse is caring for a pregnant client. After genetic testing, the fetus is found to have cystic fibrosis(CF). Which of the following is accurate information for the nurse to tell the client about the disorder? A. This disorder is an autosomal dominant disorder B. Males are more often affected than females C. The couple has a 1 in 4 chance of having another child with CF D. Children with cystic fibrosis rarely live past seven years of age

C. The couple has a 1 in 4 chance of having another child with CF Cystic fibrosis is a condition marked by the production of thick mucus which clogs the lungs and digestive tract. It is an autosomal recessive disorder, which means that one out of every four children born to a parent with the gene are affected. Males and females are equally affected. Due to advances in medical treatment, a person with CF lives to adulthood in most cases. Children with cystic fibrosis rarely live past seven years of age Most people living with cystic fibrosis now live productive lives into adulthood. This disorder is an autosomal dominant disorder The disorder is autosomal recessive, meaning that the child needs two of the genes to express the condition. Males are more often affected than females Males and females are equally affected by CF.

A 5-year-old diagnosed with viral pneumonia is being discharged home with a prescription for acetaminophen to help manage the fever. Which of the following would be important for the nurse to cover prior to discharge? A. "Administer the acetaminophen every 4 hours regardless of the child's fever" B. "Give acetaminophen with over the counter cold medicine to help manage the cough and other symptoms." C. "Give acetaminophen with ibuprofen to achieve the best effect" D. "Be cautious using over-the-counter cold medicines because they often include acetaminophen"

D. "Be cautious using over-the-counter cold medicines because they often include acetaminophen" Over-the-counter cold medicine often contains acetaminophen and there is a high risk for overdosing if parents give acetaminophen and cold medicines at the same time. "Administer the acetaminophen every 4 hours regardless of the child's fever" Acetaminophen should not be given more than 4 doses a day. "Give acetaminophen with ibuprofen to achieve the best effect" While it is appropriate to alternate ibuprofen with acetaminophen to help manage a fever, it is not necessary. "Give acetaminophen with over the counter cold medicine to help manage the cough and other symptoms."

The nurse providing care to a 9-month-old admitted with bacterial pneumonia is counting the client's respiratory rate and charts which of the following breaths per minute as normal? A. 18 B. 70 C. 20 D. 45

D. 45 The normal range for respirations for infants 1 month - 12 months of age is 30-60 breaths per minute. 18 The normal range for respirations for infants 1 month - 12 months of age is 30-60 breaths per minute. 70 The normal range for respirations for infants 1 month - 12 months of age is 30-60 breaths per minute. 20 The normal range for respirations for infants 1 month - 12 months of age is 30-60 breaths per minute.

The nurse caring for a client diagnosed with asthma knows that spirometry is not a reliable treatment option until a child reaches which of the following ages? A. 3-4 years B. 9-10 years C. 7-8 years D. 5-6 years

D. 5-6 years Children who are ages 5-6 are developmentally capable of following instructions for spirometry.

The nurse providing care to a 10-year-old that presented to the ER with an asthma exacerbation knows to be most concerned by which of the following assessment findings? A. A hacking, non-productive cough B. Hyperresonance on percussion C. Prolonged expiration D. A silent chest

D. A silent chest This indicates that air movement in the chest is so restricted that there are no breath sounds. This is an ominous sign that indicates respiratory failure. A hacking, non-productive cough This is a symptom commonly associated with asthma and does not necessarily an indication of severity. Hyperresonance on percussion This is a symptom commonly associated with asthma and does not necessarily an indication of severity. Prolonged expiration This is a symptom commonly associated with asthma and does not necessarily an indication of severity.

The nurse is caring for a client who has a sudden asthma attack. Which inhaler does the nurse know to give first? A. Cromolyn B. Azmacort C. Flucotasone D. Albuterol

D. Albuterol This is a beta-2 agonist, which is an acute bronchodilator and should be given first. Azmacort Azmacort is an inhaled steroid which should be given after albuterol. Flucotasone Flucotasone is an inhaled steroid which should be given after albuterol. Cromolyn This does not treat acute asthma attacks, but is used to prevent asthma attacks. It should not be given in the event of an acute attack.

A client who is newly diagnosed with asthma is learning about how to use a metered dose inhaler. Which information from the nurse is correct to use the inhaler correctly and to avoid medication errors? A. Hold the medication in the mouth for 10 seconds after taking it in through the inhaler B. The metered-dose inhaler can only be used with a spacer in place C. Prime the inhaler 10 times before using it to ensure the medication reaches the client D. Breathe out before administering the medication and then breathe in to inhale the drug

D. Breathe out before administering the medication and then breathe in to inhale the drug A metered-dose inhaler may be used to deliver medication to a client who needs an inhaled dose of a drug. A metered-dose inhaler delivers a set amount of the medication and is designed to hold a specific number of doses per canister. It diminishes the potential for error because the amount is well controlled. The nurse can teach the client to breathe out before using the inhaler, then take a big breath in to pull the medication into the lungs. Prime the inhaler 10 times before using it to ensure the medication reaches the client A metered-dose inhaler is precise enough that it does not need priming. The metered-dose inhaler can only be used with a spacer in place A spacer is attached to the inhaler as a holding chamber for the drug until the client breathes it in. A metered-dose inhaler can be used with or without a spacer. Hold the medication in the mouth for 10 seconds after taking it in through the inhaler The medication should be immediately breathed down into the lungs, not held in the mouth.

The nurse caring for a 4-month-old with bronchiolitis knows that which of the following complications commonly occurs with this respiratory illness? A. Malnutrition B. Retinopathy C. Peritonsillar abscess D. Dehydration

D. Dehydration Bronchiolitis is associated with copious nasal secretions and tachypnea which can make it difficult for infants to feed. Retinopathy Retinopathy is a complication associated with premature babies who have been administered high flow oxygen over a long period of time. Malnutrition While infants with bronchiolitis may have difficulty feeding bronchiolitis is an acute illness that will not affect the child's feeding long enough to cause malnutrition. Peritonsillar abscess A peritonsillar abscess is when an abscess or pus pocket forms near the tonsils. This is a complication associated with tonsillitis, not bronchiolitis.

A nurse is triaging a 5-year-old that has difficulty breathing and is rapidly getting worse. On assessment, loud croaking sounds on inspiration are noted. The nurse also assesses drooling and a preference to sit in a tripod position. Which of the following diagnoses do you suspect? A. Acute laryngotracheobronchitis B. Bronchiolitis C. Acute Nasopharyngitis D. Epiglottitis

D. Epiglottitis These are the signs and symptoms associated with the diagnosis epiglottis where the epiglottis becomes inflamed and can cause airway obstruction. It is usually caused by the bacteria Haemophilus influenza type B. Acute laryngotracheobronchitis While ALTB (Croup) does share some symptoms with epiglottitis one major difference is that croup does not have a rapid onset. It progresses slowly over several days and the child usually has an upper respiratory infection. Bronchiolitis Bronchiolitis is an infection of the lower respiratory system and would not cause symptoms like stridor and drooling. Acute Nasopharyngitis Acute Nasopharyngitis is a common cold and symptoms associated with this are fever, nasal discharge, headache, sneezing and coughing.

A client with a cough is has been ordered a cough suppressant. The nurse knows that which of the following medications is appropriate for this client's condition? A. Gentamicin B. Glipizide C. Gabapentin D. Guaifenesin

D. Guaifenesin Guaifenesin (Robitussin) is an expectorant, which works by thinning and loosening mucus in the airways. Gentamicin This drug is an anti-infective used for gram negative bacteria when penicillins are ineffective. Glipizide This is an anti-diabetic medication the stimulates the release of insulin from the pancreas. Gabapentin This is an analgesic that treats seizures, neuropathy pain, peripheral neuropathy and prevents headaches.

A nurse is talking to the parents of a child who has just been diagnosed with cystic fibrosis. Which intervention would be most appropriate in helping this family to cope with their child's diagnosis and treatment management? A. Have the family verbalize to the child that they are just as frustrated with the diagnosis as the child B. Have the family undergo further testing to ensure that they cannot pass the condition on to other children C. Protect the child's health by minimizing outside activities D. Instruct the family to instill treatments into the routine of daily activities

D. Instruct the family to instill treatments into the routine of daily activities Parents of a child with cystic fibrosis may feel many negative emotions because of their child's condition. It is important for the nurse to provide help and support for families of children with cystic fibrosis in addition to regular client care. The nurse can teach parents that it is important not to single out their child with CF and instead have him participate in regular activities as with any other child. The family should strive to make treatments and procedures as much a part of everyday life as possible.< Have the family verbalize to the child that they are just as frustrated with the diagnosis as the child The child with CF looks to the family for support and emotional strength, and while it is healthy for the family to discuss feelings openly, it is not healthy to continue to verbalize negative emotions toward the illness."Protect the child's health by minimizing outside activities" is incorrect, because it is better for the child to be encouraged to stay active and healthy. Protect the child's health by minimizing outside activities It is better for the child to be encouraged to stay active and healthy. Have the family undergo further testing to ensure that they cannot pass the condition on to other children If a child is born with CF, this means the parents of the child are both CF carriers. The gene is recessive, which means that two parents who are both carriers of the mutated gene have a 25% chance of passing CF to their child with each pregnancy.

The nurse is caring for a 17-year-old client admitted for complications of cystic fibrosis. The nurse knows that teaching is needed when the client states which of the following? A. I'm different from my friends because I cannot do all the same things that they can do. This upset me this week. I was really sad B. I try to drink as much as possible during the school day, because I know that getting dehydrated will lead to lots of problems since I have cystic fibrosis C. My PE teacher makes me stay back for activities that she thinks I can't handle. I've been managing this condition my whole life, and I know what I can and cannot do physically D. My friend and I are planning a hiking trip in the mountains when I get better. I am determined to be as normal as possible, I won't let this CF hold me back

D. My friend and I are planning a hiking trip in the mountains when I get better. I am determined to be as normal as possible, I won't let this CF hold me back The adolescent with a chronic disease often feels invincible. They may not comprehend the impact of a poorly managed illness. Exposure to high altitude can lead to hypoxia when a person with cystic fibrosis is in a lower atmospheric pressure. When a client has chronic hypoxemia, it can lead to pulmonary hypertension and cor pulmonale, so the client must be careful to avoid situations where hypoxia could occur. My PE teacher makes me stay back for activities that she thinks I can't handle. I've been managing this condition my whole life, and I know what I can and cannot do physically This statement demonstrates that the client has a realistic idea of this chronic condition. I try to drink as much as possible during the school day, because I know that getting dehydrated will lead to lots of problems since I have cystic fibrosis This statement reflects appropriate understanding of CF management. I'm different from my friends because I cannot do all the same things that they can do. This upset me this week. I was really sad This statement shows that the client is aware of lifestyle differences due to cystic fibrosis, and is exploring some negative feelings with the nurse, which is healthy.

As the nurse caring for a 9-month-old with bronchiolitis, which of the following do you expect to be a part of their care while in hospital? Select all that apply. A. Chest percussion and postural drainage B. Antibiotics C. Continuous pulse oximetry monitoring D. Regular nasal suctioning E. Oxygen administration

D. Regular nasal suctioning Infants with bronchiolitis are likely to have copious amounts of nasal secretions. Regular nasal suctioning helps keep their airway open. Suctioning prior to feeding is particularly beneficial as it helps them to feed. C. Continuous pulse oximetry monitoring The infected lower airways cause altered gas exchange and hypoxia. Therefore, these children need to have their oxygenation levels monitored closely. E. Oxygen administration Hypoxia is a common symptom of bronchiolitis and children with this diagnosis will often need supplemental oxygen. Chest percussion and postural drainage It is not shown to be beneficial in the treatment of bronchiolitis Antibiotics There is no research supporting the use of antibiotics in bronchiolitis.

A nurse has been assigned to float to the pediatrics unit for a shift. The nurse has been assigned three clients, including an infant with rotavirus, a child recovering from an appendectomy, and a baby with respiratory syncytial virus. Which practices should be implemented that would best protect the nurse from contracting an infectious disease? Select all that apply. A. The nurse keeps one set of vital sign equipment in each client room to avoid cross-contamination B. The nurse practices hand hygiene before and after providing client care C. The nurse does not recap needles after use D. The nurse asks for a different assignment than the infant because the nurse has not been vaccinated against rotavirus E. The nurse considers every client to be infected with transmittable disease whether their diagnosis is known or not

The nurse considers every client to be infected with transmittable disease whether their diagnosis is known or not When working with clients who have infectious diseases, the nurse can best protect him or herself and other clients by using items carefully and not sharing items between clients. The nurse should wash hands before and after every client contact, and immediately discard used needles in a sharps container. Recapping needles is dangerous for the nurse, due to the risk for needlestick injury. Standard precautions should always be followed, which includes protecting self against exposure to blood and body fluids from every client, as if each client has an infectious condition. The nurse does not recap needles after use When working with clients who have infectious diseases, the nurse can best protect him or herself and other clients by using items carefully and not sharing items between clients. The nurse should wash hands before and after every client contact, and immediately discard used needles in a sharps container. Recapping needles is dangerous for the nurse, due to the risk for needlestick injury. Standard precautions should always be followed, which includes protecting self against exposure to blood and body fluids from every client as if each client has an infectious condition. The nurse practices hand hygiene before and after providing client care When working with clients who have infectious diseases, the nurse can best protect him or herself and other clients by using items carefully and not sharing items between clients. The nurse should wash hands before and after every client contact, and immediately discard used needles in a sharps container. Recapping needles is dangerous for the nurse, due to the risk for needlestick injury. Standard precautions should always be followed, which includes protecting self against exposure to blood and body fluids from every client as if each client has an infectious condition. The nurse keeps one set of vital sign equipment in each client room to avoid cross-contamination When working with clients who have infectious diseases, the nurse can best protect him or herself and other clients by using items carefully and not sharing items between clients. The nurse should wash hands before and after every client contact, and immediately discard used needles in a sharps container. Recapping needles is dangerous for the nurse, due to the risk for needlestick injury. Standard precautions should always be followed, which includes protecting self against exposure to blood and body fluids from every client as if each client has an infectious condition. The nurse asks for a different assignment than the infant because the nurse has not been vaccinated against rotavirus The nurse should practice standard AND contact precautions with this infant to prevent transmission of rotavirus.