Level: Clinical
Difficulty: Medium
Subtopic: Trauma-informed care
NCLEX: A 42-year-old client in a crisis stabilization unit is being evaluated for history of intimate partner violence….
Psychiatric / mental health nursing Psychosocial Integrity
Case Study
A 42-year-old client in a crisis stabilization unit is being evaluated for history of intimate partner violence. Assessment data include the client is withdrawn, flat affect, and refusing meals for 2 days. Which infection-prevention action is essential?
Question
A. Perform hand hygiene and apply the transmission-based precautions indicated by the client's diagnosis.
B. Wear gloves only and skip hand hygiene when leaving the room.
C. Use sterile technique for all routine hygiene regardless of diagnosis.
D. Skip precautions if the client has no fever.
B. Wear gloves only and skip hand hygiene when leaving the room.
C. Use sterile technique for all routine hygiene regardless of diagnosis.
D. Skip precautions if the client has no fever.
Rationale
Correct answer: A. Perform hand hygiene and apply the transmission-based precautions indicated by the client's diagnosis.
Rationale: Infection control matches the pathogen route: hand hygiene plus appropriate precautions for contact, droplet, or airborne transmission.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.
Rationale: Infection control matches the pathogen route: hand hygiene plus appropriate precautions for contact, droplet, or airborne transmission.
Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.