Module 4 EAQs

According to Maslow's hierarchy, which example belongs to the third level of needs? (Select all that apply) A. A client is depressed because the client's significant other passed away." B. "A client is constipated due to excess loss of fluids from the body." C. "A client wants to reconnect with old friends after being diagnosed with cancer." D. "A client has to live in a rat-infested apartment due to a lack of financial resources." E. "A client never goes to family gatherings because the family members do not accept the client."

A. A client is depressed because the client's significant other passed away." C. "A client wants to reconnect with old friends after being diagnosed with cancer." E. "A client never goes to family gatherings because the family members do not accept the client." Rationale: According to Maslow's hierarchy of needs, the third level of needs is love and belonging. This includes friendship, social relationships, sexual love, and so on. If the client is depressed due to the death of the spouse, this is an example of the third level of needs not being met. If the client feels the urge to reconnect with old friends after being diagnosed with a terminal illness, the client is in need of emotional support and love. If the client refuses to retain social relationships with family members, this is an example of a failure to meet love and belonging needs. If the client is losing body fluids leading to constipation, this indicates a deficit in the first level of needs, which are physiological. If the client lives in a rat-infested apartment, there is an increased the risk of infections and disease, which indicates a lack of physical safety, and this is an example of the second level of needs not being met.

Which type of immunity would a 4-year-old child develop during the course of an infection with varicella? A. Active natural immunity B. Active artificial immunity C. Passive natural immunity D. Passive artificial immunity

A. Active natural immunity Rationale: In active natural immunity, the infected child's immune system responds to the invading organism (varicella) by producing antibodies specific to the antigen. Active artificial immunity is acquired by the injection of antigens; after this, the child develops antibodies. Passive natural immunity is acquired by the fetus from the mother. Passive artificial immunity is acquired through the injection of antibodies

Which strategies would the nurse apply when vaccinating a child to decrease pain and anxiety? (Select all that apply) A. Applying a topical anesthetic B. Injecting the most painful vaccine last C. Holding the child upright during the vaccination D. Administering intramuscular injections rapidly without prior aspiration E. Administering acetaminophen or ibuprofen after vaccination

A. Applying a topical anesthetic B. Injecting the most painful vaccine last C. Holding the child upright during the vaccination D. Administering intramuscular injections rapidly without prior aspiration

When assessing risk factors, which question would the nurse ask a client who has developed pneumonia? A. "Are you diabetic?" B. "Have you ever had pneumonia?" C. "What do you use for contraception?" D. "Do you have a history of intravenous [IV] drug abuse?"

A. Are you diabetic? Rationale: Chronic diseases such as diabetes are a risk factor for developing infections such as pneumonia. Inquiring about the client's pneumonia history provides additional information regarding the client's knowledge but does not let the nurse understand the client's risk factors. Contraception would be explored in sexual barrier devices for sexually transmitted infections. IV drug abuse would be explored to assess risk of exposure to blood-borne pathogens such as Hepatitis B.

The nurse is changing the dressing of a postoperative client. Another client has fallen near the nursing station and is unconscious. Which is the priority nursing action in this situation? A. Attend to the client who lost consciousness. B. Delegate the dressing change to the nursing assistant. C. Delegate the care of the unconscious client to the nursing assistant. D. Complete the dressing, because the open wound may increase infection risk.

A. Attend to the client who lost consciousness. Rationale: Loss of consciousness may pose a threat to the client's safety and survival and is a high-priority need. The nurse would attend to the unconscious client. The nursing assistant may not have the required knowledge and skills to perform a dressing change. The care of an unconscious client may need critical nursing assessments and clinical decision-making and should not be delegated to the nursing assistant. Risk of infection is not a threat to survival and is considered an intermediate need.

The nurse is interviewing a client who was diagnosed with systemic lupus erythematosus (SLE). Which clinical findings to this disease would the nurse expect the client to exhibit? (Select all that apply) A. Butterfly facial rash B. Firm skin fixed to tissue C. Inflammation of the joints D. Muscle mass degeneration E. Inflammation of small arteries

A. Butterfly facial rash C. Inflammation of the joints Rationale: The connective tissue degeneration of SLE leads to involvement of the basal cell layer, producing a butterfly rash over the bridge of the nose and in the cheek region. Polyarthritis occurs in most clients, with joint changes similar to those seen in rheumatoid arthritis. Firm skin fixed to tissue occurs in scleroderma; in an advanced stage the client has the appearance of a living mummy. Muscle mass degeneration occurs in muscular dystrophy; it is characterized by muscle wasting and weakness. Inflammation of small arteries occurs in polyarteritis nodosa, a collagen disease affecting the arteries and nervous system.

Which information will the nurse consider when planning care for a client with human immunodeficiency virus (HIV) who has been diagnosed with class 3 tuberculosis? (Select all that apply) A. Class 3 tuberculosis is a clinically active disease, which is contagious. B. Tuberculosis is the leading cause of mortality in clients infected with HIV. C. HIV-positive clients are more likely to have multidrug resistant tuberculosis. D. Individuals with HIV usually have high fevers with active tuberculosis infection. E. Persons with active tuberculosis are usually treated on an outpatient basis.

A. Class 3 tuberculosis is a clinically active disease, which is contagious. B. Tuberculosis is the leading cause of mortality in clients infected with HIV. E. Persons with active tuberculosis are usually treated on an outpatient basis. Rationale: Class 3 tuberculosis is a clinically active and contagious disease; it is diagnosed either with positive bacteriological studies, or with both a significant reaction to a tuberculin skin test and clinical or x-ray evidence of current disease. Tuberculosis is the leading cause of mortality in clients with HIV infection. Persons with active tuberculosis are Class 3 tuberculosis is a clinically active disease, which is contagious. Tuberculosis is the leading cause of mortality in clients infected with HIV. HIV-positive clients are more likely to have multidrug resistant tuberculosis. Individuals with HIV usually have high fevers with active tuberculosis infection. Persons with active tuberculosis are usually treated on an outpatient basis. usually treated on an outpatient basis, and this does not change based on the client's HIV status. Although clients with HIV are more likely to develop active tuberculosis, they are not more likely to develop multidrug resistant tuberculosis. Immune-compromised clients, such as individuals who are HIV positive, are less likely to have high fever because of a diminished inflammatory and immune response to infection.

The nurse would include which instruction to the parents of a child being treated with oral ampicillin for otitis media? A. Complete the entire course of antibiotic therapy. B. Herbal fever remedies are highly discouraged. C. Administer the medication with meals. D. Stop the antibiotic therapy when the child no longer has a fever.

A. Complete the entire course of antibiotic therapy. Rationale: Once antibiotic therapy is initiated, the antibiotics start to destroy specific bacterial infections that the health care provider is trying to treat. Antibiotic therapy takes a specific dose and number of days to completely eliminate the bacteria. If the caregivers start a dose and stop it before the course is complete, the remaining bacteria have a chance to grow again, become resistant to antibiotic treatment, and multiply. The nurse would not discourage use of herbal fever remedies; however, the herbal treatment would be reviewed to see if it is contraindicated. Ampicillin would be taken 1 to 2 hours after meals. Antibiotic therapy would be completed as prescribed.

Which function of leukocytes is involved in the inflammation process? (SATA) A. Destruction of bacteria and cellular debris B. Selective attack and destruction of non-self cells C. Release of vasoactive amines during allergic reactions D. Secretion of immunoglobulins in response to a specific antigen E. Enhancement of immune activity through secretion of various factors, cytokines, and lymphokines

A. Destruction of bacteria and cellular debris C. Release of vasoactive amines during allergic reactions E. Enhancement of immune activity through secretion of various factors, cytokines, and lymphokines Rationale: Leukocytes such as monocytes and eosinophils are involved in inflammation. Their functions include the destruction of bacteria and cellular debris and the release of vasoactive amines to limit allergic reactions. Helper/inducer T-cells and cytotoxic cells selectively attack and destroy non-self cells and secrete immunoglobulins in response to the presence of a specific antigen. B-lymphocytes, or plasma cells, secrete immunoglobulins in response to the presence of a specific antigen. Helper/inducer T-cells are involved in cell-mediated immunity, enhancing immune activity through the secretion of various factors, cytokines, and lymphokines.

The nurse is teaching unlicensed assistant personnel about ways to prevent the spread of infection. The nurse decides to emphasize the need to break the cycle of infection. Which teaching would be priority? A. Hand washing before and after providing client care B. Cleaning all equipment with an approved disinfectant after use C. Wearing personal protective equipment (PPE) when providing client care D. Using medical and surgical aseptic techniques at all times

A. Hand washing before and after providing client care Rationale: Hand washing before and after providing care is the single most effective means of preventing the spread of infection by breaking the cycle of infection. Although all the other interventions are acceptable procedures and may assist in preventing the spread of infection, none are as effective as hand washing.

Which disease process places a client at increased risk for infection? (Select all that apply) A. Leukemia B. Lymphoma C. Emphysema D. Schizophrenia E. Osteoarthritis

A. Leukemia B. Lymphoma C. Emphysema Rationale: Disease processes that increase the client's risk for infection include leukemia, lymphoma, and emphysema, which lead to a diminished immune system. Schizophrenia and osteoarthritis do not impair a person's immune system.

Which information is appropriate for the nurse to include in the education for a group of nursing students regarding near-miss events? (Select all that apply) A. No actual harm is caused to the clients. B. Moderate-harm may be caused. C. They are caused by a variation in standard care. D. They are caused by impaired immune functioning E. The cause may be analyzed by a failure modes effects analysis (FMEA)

A. No actual harm is caused to the clients. C. They are caused by a variation in standard care E. They are caused by impaired immune functioning Rationale: The medical errors that cause no harm to the client are described as near-miss events. These events do not reach the client and do not cause severe complications because the interventions to avoid them or correct the damage are instituted. They are caused by a variation in standard care. The nurse can analyze the cause of these events by the failure mode effective analysis (FMEA) system while reporting them. Adverse events cause moderate harm to the client. Such events are caused by the fault of the system or health care professionals. Near-miss events are not caused by impaired functioning of the immune system.

Which action would the nurse instruct an older client to implement to ensure antibody-mediated immunity? (Select all that apply) A. Obtain a shingles vaccination. B. Receive a tetanus booster injection. C. Obtain the pneumococcal vaccination. D. Receive annual testing for tuberculosis. E. Receive an annual influenza vaccination. F. Avoid obtaining the pertussis vaccination.

A. Obtain a shingles vaccination. B. Receive a tetanus booster injection. C. Obtain the pneumococcal vaccination. E. Receive an annual influenza vaccination. Rationale: Because older adults are less able to make new antibodies in response to the presence of new antigens, they should receive the shingles vaccination. Because older adults may not have sufficient antibodies present to provide protection when they are reexposed to microorganisms they have already generated antibodies against, booster shots are encouraged. The pneumococcal and influenza vaccinations help create antibodies in response to new antigens. Testing for tuberculosis addresses cell-mediated immunity for the older client. Avoiding the pertussis vaccine would not ensure antibody-mediated immunity.

Identify the clinical manifestation associated with the release of histamine during a type I rapid hypersensitivity reaction. (Select all that apply) A. Pruritus B. Erythema C. Fibrotic changes D. Nasal mucus secretion E. Conjunctival mucus secretion F. Hematuria

A. Pruritus B. Erythema D. Nasal mucus secretion E. Conjunctival mucus secretion Rationale: Histamine causes itching or pruritus, erythema, and nasal and conjunctival mucus secretion. Fibrotic changes occur with type III immune complex reactions. Hematuria is a complication from a type III hypersensitivity reaction such as systemic lupus erythematosus.

Which option is an example of actively acquired specific immunity? (Select all that apply) A. Recovery from measles B. Recovery from chickenpox C. Maternal immunoglobulin in the neonate D. Immunization with live or killed vaccines E. Injection of human gamma immunoglobulin

A. Recovery from measles B. Recovery from chickenpox D. Immunization with live or killed vaccines Rationale: Clients who recovered from measles or chickenpox or those immunized with a live- or killed-virus vaccine have naturally acquired active-type immunity. Maternal immunoglobulin in a neonate and an injection of human gamma immunoglobulin into a client are examples of passively acquired specific immunity.

Which tasks should the nurse perform to comply with public health laws? (Select all that apply) A. Report cases of communicable diseases. B. Report incidents of domestic violence. C. Provide emergency assistance at an accident scene D. Notify the primary health care provider of any client-related problems. E. Ensure that clients in a community have received necessary immunizations.

A. Report cases of communicable diseases. B. Report incidents of domestic violence. E. Ensure that clients in a community have received necessary immunizations. Rationale: To comply with public health laws, the nurse is required to report cases of communicable diseases. The nurse must also report cases of suspected domestic violence, child abuse, or elder abuse. The nurse would ensure that clients in a community have received all necessary immunizations. To comply with Good Samaritan laws, the nurse would provide emergency assistance consistent with the level of expertise at an accident scene. Notifying the primary health care provider of client-related problems is not an example of complying with public health laws.

A client with a history of cardiac dysrhythmias is admitted to the hospital due to a fluid volume deficit caused by a pulmonary infection. The registered nurse assesses the recorded vital signs. Which vital sign assessment requires reassessment? (Select all that apply) A. Respiratory rate of 14 breaths/minute B. Blood pressure of 120/80 mm Hg C. Oxygen saturation of 95% D. Temporal temperature of 99.3°F (37.4°C) E. Radial pulse rate of 72 and irregular

A. Respiratory rate of 14 breaths/minute B. Blood pressure of 120/80 mm Hg C. Oxygen saturation of 95% Rationale: In pulmonary infections, the respiratory rate may increase and oxygen saturation may decrease. In fluid volume deficit, the blood pressure may be decreased. A respiratory rate of 14 breaths/minute, a blood pressure of 120/80 mm Hg, and an oxygen saturation of 95% are normal readings. The registered nurse would reassess these vital signs. The normal temperature range is 96.8°F (36°C) to 100.4 (38°C); this range is unaffected by a pulmonary infection. The nurse does not need to reassess the temperature. Cardiac dysrhythmias are associated with a pulse deficit in which the radial pulse would be irregular; reassessment would not be required.

Which intervention would the nurse anticipate incorporating into the plan of care for a client with bursitis of the left knee? (Select all that apply) A. Rest the affected joint. B. Apply a heat pack. C. Use a compression splint. D. Do gentle range-of-motion exercises. E. Take nonsteroidal anti-inflammatory drugs (NSAIDs) as needed for pain.

A. Rest the affected joint. C. Use a compression splint. E. Take nonsteroidal anti-inflammatory drugs (NSAIDs) as needed for pain. Rationale: Bursitis is an inflammation of the bursal sac surrounding the joint. Rest, use of a compression splint, and taking NSAIDs can help relieve bursitis. Use of an ice pack (not a heat pack) can also help with pain. Gentle range-of-motion exercises are not indicated for bursitis.

Which findings noted during assessment would lead the nurse to determine that a client is at an increased risk for infection? (Select all that apply) A. Surgical incision B. Urinary catheter C. Antibiotic therapy D. Intravenous access E. Diminished appetite

A. Surgical incision B. Urinary catheter C. Antibiotic therapy D. Intravenous access Rationale: Findings that increase the risk of infection in a client would be the presence of a surgical incision, a urinary catheter, and an intravenous access. These are all portals of entry for microorganisms. Antibiotic therapy can lead to a suprainfection that eliminates the normal flora.

The client is on neutropenic precautions. From which direction does the protective environment isolation help prevent the spread of infection? A. To the client from outside sources B. From the client to others C. From the client by using special techniques to destroy infectious fluids and secretions D. To the client by using special sterilization techniques for linens and personal items

A. To the client from outside sources Rationale: Protective environment isolation implies that the activities and actions of the nurse will protect the client from infectious agents because the client's own immune defense ability is compromised (neutropenia). Protective environment isolation is also referred to as reverse isolation. "From the client to others," "From the client by using special techniques to destroy infectious fluids and secretions," and "To the client by using special sterilization techniques for linens and personal items" are incorrect concepts related to protective environment isolation.

While assessing a client, the nurse finds inflammation of the skin at the bases of the client's nails. Which event or disorder would the nurse associate with the reason behind this condition? A. Trauma B. Trichinosis C. Pulmonary disease D. Iron-deficiency anemia

A. Trauma Rationale: Paronychia is an abnormality of the nail bed. The condition is marked by inflammation of the skin at the base of the nail; this condition may be caused by trauma or a local infection. Trichinosis is associated with red or brown linear streaks in the nail bed. Pulmonary diseases can cause changes in the angle between nail and nail base, which is a phenomenon known as clubbing. Koilonychia, a concave curvature of the nails, may occur as a result of iron-deficiency anemia.

Which client condition is an example of a cell-mediated immunity? (Select all that apply) A. Tuberculosis (TB) B. Graft rejection C. Allergic rhinitis D. Contact dermatitis E. Anaphylactic shock

A. Tuberculosis (TB) B. Graft rejection D. Contact dermatitis Rationale: Conditions such as TB, graft rejection, contact dermatitis, and fungal infections are examples of cell-mediated immunity. T lymphocytes and macrophages sensitize T cells and cytokines to provide protection against fungus, viruses (intracellular), chronic infectious agents, and tumor cells. Allergic rhinitis and anaphylactic shock are examples of humoral immunity that are mediated by antibodies released by B lymphocytes.

Which complication would the nurse monitor for in a client on strict bed rest for 3 days? (Select all that apply) A. Atelectasis B. Hypotension C. Constipation D. Pressure Injuries E. Urinary Tract Infection

All of the above

Which of these reactions would the nurse expect if the client is in the action stage? (Select all that apply) A. "I only take a bath once a week, but I don't see any infections on my skin." B. "I try to take a shower every day, but I skip it sometimes because of my tight work schedule." C. "I understand that bathing regularly is a good habit, but my bathroom is very cold in the mornings." D. "Please tell me how to get into the habit of taking a bath daily so that I can keep myself clean and healthy." E. "I want to take a bath regularly, but I don't have time because I need to look after my kids and my parents."

B. "I try to take a shower every day, but I skip it sometimes because of my tight work schedule." C. "I understand that bathing regularly is a good habit, but my bathroom is very cold in the mornings." E. "I want to take a bath regularly, but I don't have time because I need to look after my kids and my parents." Rationale: In the action stage, the client notices that old habits are hindering them from engaging in new behaviors. In this scenario, the client says that they try to take a daily shower but skip it sometimes because of a tight work schedule. In the second scenario, the client says that they understand the importance of taking baths but the bathroom is very cold. In another scenario, the client says that they want to take baths but they have to look after the family and don't have time. All these scenarios indicate that the client is in the action stage. Saying that they only take one bath a week but don't see any skin infections indicates that the client is in the precontemplation stage. Saying that they want to know how to get into the habit of taking regular baths indicates that the client is in the preparation stage.

A client arrives at a health clinic reports, "I am here to have my tuberculin skin test read." The nurse notes a 7-mm indurated area at the injection site. Which nurse ' s statement describes this result? A. "The result indicates that you have active tuberculosis." B. "The result indicates you are infected with the tuberculosis organism." C. "The result indicates there are no tuberculin antibodies in your system." D. "The result indicates you have a secondary infection related to the tuberculin organism."

B. "The result indicates you are infected with the tuberculosis organism." Rationale: An indurated area 5 mm or larger noted 48 to 72 hours after the tuberculin test indicates that the person is infected with the tuberculin organism. A positive tuberculin skin test accompanied by fever, coughing, weakness, and positive chest x-ray are manifestations of active tuberculosis. The other choices are incorrect.

Which nursing intervention is the priority when a client receiving chemotherapy develops a temperature of 102.2°F (39°C) when the temperature 6 hours ago was 99.2°F (37.3°C)? A. Assess the amount and color of urine; obtain a specimen for a urinalysis and culture. B. Administer the prescribed antipyretic and notify the primary health care provider of this change. C. Note the consistency of respiratory secretions and obtain a specimen for culture and sensitivity. D. Obtain the respirations, pulse, and blood pressure when rechecking the temperature in 1 hour.

B. Administer the prescribed antipyretic and notify the primary health care provider of this change. Rationale: Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately. The practitioner should be notified because this client is immunodeficient from both the disease and the chemotherapy. A search for the cause of the pyrexia then can be initiated. Assessing the amount and color of urine and obtaining a specimen for a urinalysis is not the immediate priority, although it is important because the cause of the pyrexia must be determined. Also, the increased amount of calcium and urates in the urine can cause renal complications if dehydration occurs. Noting the consistency of respiratory secretions and obtaining a specimen for culture is not the priority, although it is important because respiratory tract infections are a common occurrence in clients with multiple myeloma. More vigorous intervention than obtaining the respirations, pulse, and blood pressure is rechecking the temperature in 1 hour. This client has a disease in which the immunoglobulins are ineffective and the therapy further suppresses the immune system.

After a client experiences a cardiac arrest, the client is transferred to the intensive care unit (ICU). Which nursing intervention is the major attribute that affects the quality of care provided to the client? (Select all that apply) A. Develop a diet plan according to the client's food preference. B. Coordinate with the members of the ICU while transferring the client. C. Provide cardiopulmonary resuscitation before transferring the client. D. Encourage the client's family members to visit the client frequently. E. Administer digoxin to the client according to the prescription.

B. Coordinate with the members of the ICU while transferring the client. C. Provide cardiopulmonary resuscitation before transferring the client. E. Administer digoxin to the client according to the prescription. Rationale: The major attributes that affect the quality of care are coordinating with the members of different departments during transfers/transitions, providing the most important services, and acting within the scope of practice. Coordinating with the members of the ICU while transferring the client, providing cardiopulmonary resuscitation, and administering digoxin are the major attributes. Considering the client's preference is a minor attribute that affects the quality of care and helps provide patient-centered care. Developing a diet plan according to the client's food preference is a minor attribute. The nurse would take measures to prevent the risk of infection. The nurse would not ask the family members to visit the client frequently because it increases the risk of infection.

A client with a methicillin-resistant Staphylococcus aureus (MRSA) infected wound is scheduled for a computed tomography (CT) scan. To ensure client and visitor safety during transport, the nurse would implement which precaution? A. No special precautions are required. B. Cover the infected site with a dressing. C. Drape the client with a covering labeled biohazardous. D. Place a surgical mask on the client.

B. Cover the infected site with a dressing. Rationale: Covering the infected site with a dressing will contain secretions and set up a barrier, thus decreasing the risk for transmission to others. Contact precautions must be used for clients with known or suspected infections transmitted by direct contact or contact with items in the environment. Draping the client with a sheet marked biohazardous does not protect the client's privacy. A wound infected with MRSA can be transmitted to others via contact, not through the airborne route; thus a mask is unnecessary

Which assessment findings would the nurse identify in a client with clinical manifestations of rheumatoid arthritis (RA)? (Select all that apply) A. Obesity and asymmetric joint disease B. Development of antinuclear antibodies C. Inflammatory disease pattern D. Bilateral involvement of metacarpophalangeal joints E. Disease process involving the distal interphalangeal joints F. Disease in the weight-bearing joints and hands

B. Development of antinuclear antibodies C. Inflammatory disease pattern D. Bilateral involvement of metacarpophalangeal joints Rationale: RA is an autoimmune disorder identified by the presence of antinuclear antibodies. RA generally affects the joints of the wrist; metacarpophalangeal joints; proximal (not distal) interphalangeal joints; elbow; glenohumeral joints; cervical spine; and hip, knee, ankle, tarsal, and metatarsophalangeal joints bilaterally. RA involves inflammation of the joints bilaterally. Osteoarthritis involves degeneration of the joints. Obesity is a risk factor for osteoarthritis. Osteoarthritis asymmetrically affects weight-bearing joints and the hands.

Which infection would the nurse monitor for in the toddler based on structural characteristics at this age? (SATA) A. Bronchiolitis B. Ear Infection C. Acute Sinusitis D. Laryngotacheobronchitis (croup) E. Inflammation of the tonsils

B. Ear Infection C. Acute Sinusitis D. Laryngotacheobronchitis E. Inflammation of the tonsils

Which factor explains why a client who experiences an acute episode of rheumatoid arthritis has swollen finger joints? A. Urate crystals in the synovial tissue B. Inflammation in the joint's synovial lining C. Formation of bony spurs on the joint surfaces D. Deterioration and loss of articular cartilage joints

B. Inflammation in the joint's synovial lining Rationale: In rheumatoid arthritis, transformed autoantibodies attack synovium, producing inflammation. Urate crystals occur with gouty, not rheumatoid, arthritis. Formation of bony spurs on the joint surfaces is unrelated to rheumatoid arthritis. Deterioration and loss of articular cartilage in joints is osteoarthritis.

Which leukocyte would the nurse include when teaching about antibody-mediated immunity? (SATA) A. Monocyte B. Memory cell C. Helper T cell D. B-lymphocyte E. Cytotoxic T cell

B. Memory cell D. B-lymphocyte Rationale: Memory cells and B-lymphocytes are involved in antibody-mediated immunity. Monocytes are involved in inflammation. Helper T cells and cytotoxic T cells are involved in cell-mediated immunity.

Which therapeutic outcome is expected after administering ibuprofen? (Select all apply) A. Diuresis B. Pain relief C. Temperature reduction D. Bronchodilation E. Anticoagulation F. Reduced inflammation

B. Pain relief C. Temperature reduction F. Reduced inflammation Rationale: Prostaglandins accumulate at the site of an injury, causing pain; nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing the temperature to decline. NSAIDs inhibition of COX-2 is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.

The nurse is preparing discharge instructions for a client who acquired a nosocomial Clostridium difficile infection. Which would the nurse include in the instructions? A. Anticipate that nausea and vomiting will continue until the infection is no longer present. B. The infection causes diarrhea accompanied by flatus and abdominal discomfort. C. Consume a diet that is high in fiber and low in fat. D. Other than routine hand washing, it is not necessary to perform special disinfection procedures.

B. The infection causes diarrhea accompanied by flatus and abdominal discomfort. Rationale: The main clinical manifestation of C. difficile is diarrhea accompanied by excessive flatus and abdominal discomfort. Nausea and vomiting are not typically associated with this infectious disease. Clients should follow a nutritionally balanced diet with no specific restrictions. Cleaning and disinfection of items in the home is key to preventing spread of the infection because the C. difficile spore is relatively resistant.

After instructing an older client's adult child about age-related immune system changes and associated care measures, which statement indicates a need for further instruction? A. My parent has a private room at home." B. "My parent has received the pneumococcal vaccination recently." C. "My parent comes in for checkups only when experiencing a fever." D. "My parent has been given a second dose of the pertussis vaccination."

C. "My parent comes in for checkups only when experiencing a fever." Rationale: Older clients should have regular checkups even in the absence of fever. Because aging causes reduced neutrophil function, some infections may not show fever symptoms. Older adults should have a private room at home to avoid other adults who may have viral infections. Because older adults have a decreased production of antibodies against new antigens, the caretaker should ensure that the older client has received updated vaccinations against infectious diseases such as pneumococcus and pertussis.

Which response would the nurse provide during an education session at the local community center to a question asking why influenza vaccines are needed annually? A. "The influenza virus has a high level of infectivity, thus requiring an annual booster to keep rates of influenza low." B. "Because influenza is seasonal and has never been eradicated, the need for a vaccine is also seasonal annually." C. "The nature of the virus changes every year; the vaccine is developed based on the most prevalent type and variant being seen." D. "There are several types of influenza viruses with differing levels of virulence, making it difficult to develop a vaccine that will be effective against all types of influenza.

C. "The nature of the virus changes every year; the vaccine is developed based on the most prevalent type and variant being seen." Rationale: The type and prevalence of influenza viruses change from year to year, necessitating annual immunization with a vaccine that contains the type and variant most prevalent in that flu season. The need for an annual vaccine is not related to its level of infectivity, seasonality, or virulence.

The nurse caring for a client postsurgery takes necessary steps to achieve quality client care. Which nursing action satisfies the Quality and Safety Education for Nurses (QSEN) competency called informatics A. Washing the hands before handling the client's incision site B. Implementing a new method of monitoring the client's incision site for infection C. Documenting in the electronic health record (EHR) after performing wound debridement D. Locking the electronic health record (EHR) after every entrance of necessary information E. Using a computer-assisted instruction (CAI) program to provide better quality of care to the client

C. Documenting in the electronic health record (EHR) after performing wound debridement D. Locking the electronic health record (EHR) after every entrance of necessary information E. Using a computer-assisted instruction (CAI) program to provide better quality of care to the client Rationale: The nurse satisfies the informatics competency by using information and technology to communicate, manage knowledge, minimize errors, and support decision-making. Documenting in the client's electronic health record (EHR) after performing wound debridement enables the nurse to track the client's progress and store information for future reference. The nurse maintains confidentiality of the client's medical information by locking the electronic health record (EHR). This enables the nurse to manage knowledge appropriately and minimizes the possibility of legal issues. The nurse also satisfies the informatics competency by using computer-assisted instruction (CAI) programs to provide better quality of care to the client. To satisfy the safety competency, the nurse is required to reduce the risk for causing harm to the client by ensuring appropriate individual performances. In the given situation, the nurse washes hands to minimize the risk for infection. The nurse satisfies the quality improvement competency by implementing a new method of monitoring the client for infection.

The nurse is preparing to insert an intravenous (IV) catheter in a thin, emaciated client who is scheduled to begin intravenous fluid therapy. Which interventions would the nurse follow to provide high-quality care? (Select all apply) A. Insert an 18-gauge IV catheter B. Change the IV line every 7 days C. Flush the IV line with normal saline D. Insert the IV catheter in the client's femur E. Stop the insertion procedure when there is a break in technique

C. Flush the IV line with normal saline E. Stop the insertion procedure when there is a break in technique Rationale: The nurse would flush the IV line with normal saline to maintain patency. The nurse would stop the insertion procedure when there is a break in technique. This intervention helps prevent catheter-related bloodstream infections and provides high-quality care to the client. An 18-gauge needle is not an appropriate size needle to insert in a thin, emaciated client; it would cause unnecessary trauma and present a high risk of phlebitis. The nurse would change the IV line every 72 to 96 hours to prevent the risk of infection. The nurse would avoid inserting the catheter in the client's femur because it increases the risk of bloodborne infections

Which education would the nurse provide the parent of a 2-month-old infant about home care in the event of an immunization reaction? A. Give aspirin for pain; if swelling at the injection site develops, call the health care provider. B. Apply heat to the injection site for the first day after the injection; apply ice if the arm is inflamed. C. Give acetaminophen for fever; call the health care provider if the child exhibits marked drowsiness or seizures. D. Apply ice to the injection site if soreness develops; call the health care provider if the child comes down with a fever.

C. Give acetaminophen for fever; call the health care provider if the child exhibits marked drowsiness or seizures. Rationale: Fever is a common reaction to immunizations, and acetaminophen may be given to minimize discomfort. A central nervous system reaction such as marked drowsiness or seizures is rare and requires notification of the health care provider. Aspirin should not be given to infants and children because it is linked to Reye syndrome. Infants do not tolerate the application of ice, which will increase discomfort. Fever is a common reaction to the immunizations; it is not necessary to notify the health care provider.

A 5-month-old infant is brought to the pediatric clinic because of exposure to an adolescent sibling with measles. Which factor would the nurse consider when determining the infant's risk of infection? A. The infant's immunizations B. The infant's previous viral illnesses C. Maternal diseases and immunizations D. Maternal exposure to tuberculosis and herpes genitalis

C. Maternal diseases and immunizations Rationale: It is important to determine whether the infant has maternally transmitted antibodies against measles. The infant's previous viral illnesses have no relationship to the present exposure to measles. Vaccination against measles is performed when the infant reaches 12 to 15 months of age, so immunization history of the infant would not be relevant. Maternal exposure to tuberculosis and herpes genitalis is not relevant in the determination of whether the infant has passive immunity to measles.

The nurse is caring for a client with chronic inflammation of the bowel. For which most serious complication would the nurse monitor in this client? A. Ileus B. Pain C. Perforation D. Obstruction

C. Perforation Rationale: Because of chronic inflammation, the colon becomes thin and may perforate, causing peritonitis. Perforation will lead to a life-threatening sepsis. Other common complications such as ileus, pain, or obstruction require urgent intervention but are not initially life-threatening. Signs of acute perforation include severe abdominal pain, fever, chills, nausea, and vomiting.

The nurse is collecting case reports that can be analyzed using the failure mode effective analysis (FMEA) tool. Which case files would the nurse collect? (Select all that apply) A. A coma due to severe hemolytic transfusion reaction B. Depression committed suicide by falling off the terrace of the hospital C. Retained foreign body left during surgery that was removed immediately D. Wheelchair-bound client rescued from falling in the corridor of the hospital E. Urinary tract infection after 4 days of continuous catheterization

C. Retained foreign body left during surgery that was removed immediately D. Wheelchair-bound client rescued from falling in the corridor of the hospital E. Urinary tract infection after 4 days of continuous catheterization Rationale: The failure mode effective analysis (FMEA) tool is used to analyze the cause of near-miss events and adverse events. A retained foreign body after surgery if removed immediately is a type of near-miss event. A client developing a urinary tract infection after catheterization is a type of adverse event. A wheelchair-bound client was rescued from falling in the hospital corridor is a type of near-miss event. The cause of these events can be analyzed using the FMEA tool. A client in a coma due to severe hemolytic transfusion reaction and a depressed client who committed suicide are types of sentinel events. The cause of these events can be assessed by using the root cause analysis tool.

The nurse is caring for a client who had an above-the-knee amputation 1 week ago. Which action would the nurse take to control edema of the residual limb? A. Administer a diuretic as needed. B. Restrict the client's oral fluid intake. C. Rewrap the elastic bandage as necessary. D. Keep the residual limb elevated on a pillow.

C. Rewrap the elastic bandage as necessary. Rationale: Elastic bandages compress the residual limb, preventing edema and promoting residual limb shrinkage and molding; the bandage must be rewrapped when it loosens. Administering a diuretic as needed and restricting the client's oral intake have a systemic effect on fluid balance; edema of the residual limb is a localized response to inflammation. Prolonged elevation of the residual extremity can lead to a flexion contracture of the hip.

A client is admitted to the hospital with severe diarrhea, abdominal cramps, and vomiting for 5 days. Upon further assessment, the primary health care provider finds the symptoms occurred after the client ate eggs, salad dressings, and sandwich fillings. Which food-borne disease would the provider suspect in this client? A. Listeriosis B. Shigellosis C. Salmonellosis D. Staphylococcus

C. Salmonellosis Rationale: A client with salmonellosis will experience severe diarrhea, abdominal cramps, and vomiting; these symptoms last as long as 5 days after the intake of contaminated food. This disorder may be caused by Salmonella typhi or Salmonella paratyphi. The causative organism is usually present in such foods as eggs, salad dressings, and sandwich fillings. A client with listeriosis will experience severe diarrhea, fever, headache, pneumonia, meningitis, and endocarditis 3 to 21 days after infection. The symptoms of shigellosis range from cramps and diarrhea to a fatal dysentery that lasts for 3 to 14 days. Pain, vomiting, diarrhea, perspiration, headache, fever, and prostration lasting for 1 or 2 days are the symptoms of a Staphylococcus infection.

Which scenario would the nurse consider an output component of the nursing process? (Select all that apply) A. While assessing a client, the nurse finds a history of mental illness. B. While assessing a client who is obese, the nurse finds a history of asthma. C. The nurse notices the client's wounds healed after performing regular wound debridement. D. When changing the surgical site dressing, the nurse notices the client developed an infection. E. The nurse finds the client's blood pressure increased, even with timely medication administration.

C. The nurse notices the client's wounds healed after performing regular wound debridement. D. When changing the surgical site dressing, the nurse notices the client developed an infection. E. The nurse finds the client's blood pressure increased, even with timely medication administration. Rationale: The output component determines whether the client's health status has improved, declined, or is stable as a result of nursing care. Noticing that the client's wounds have healed after performing regular wound debridement is an example of output. Noticing the development of an infection at a client's surgical site after the dressing has been changed and noticing that the blood pressure level of a client has increased even after medication is administered on a timely basis are also examples of output. When the nurse discovers that a client has a history of mental illness, this finding is an example of input. When the nurse discovers that an obese client has a history of asthma, this finding is an example of input.

Which is the correct response to a parent whose child is undergoing chemotherapy and is not up to date on required immunizations for school? A. By this time your child has developed sufficient antibodies to provide immunity.' B. 'Maintaining current immunizations is critical. Make sure the series is completed.' C. This isn't the best time to finish the immunizations, because your child's immune system is suppressed.' D. 'It's important to complete the immunizations because your child needs to be protected from childhood diseases that could be fatal.

C. This isn't the best time to finish the immunizations, because your child's immune system is suppressed.' Rationale: Chemotherapy compromises the immune system. The vaccines may be administered after the completion of the chemotherapy protocol, once the immune system has returned to its previous state. The child has not developed sufficient antibodies; booster immunizations are needed, but not at this time. Administering immunizations at this time could prove fatal.

Which describes the purpose of preoperative antibiotics for a client scheduled for surgical resection of the colon and creation of a colostomy? A. To decrease peristalsis B. To minimize electrolyte imbalance C. To decrease bacteria in the intestines D. To treat inflammation caused by the malignancy

C. To decrease bacteria in the intestines Rationale: To decrease the possibility of contamination, the bacteria count in the colon is lowered with antibiotics before surgery. Preoperative antibiotics do not have an effect on peristalsis, electrolyte balance, or treating inflammation.

Which nursing intervention would prevent septic shock in the hospitalized client? A. Maintain the client in a normothermic state. B. Administer blood products to replace fluid losses. C. Use aseptic technique during all invasive procedures. D. Keep the critically ill client immobilized to reduce metabolic demands.

C. Use aseptic technique during all invasive procedures. Rationale: Septic shock occurs as a result of an uncontrolled infection, which may be prevented by using correct infection control practices. These include aseptic technique during all invasive procedures. Maintaining the client in a normothermic state, administering blood products, and keeping the critically ill client immobilized are not directly related to the prevention of septic shock.

A client who has rheumatoid arthritis participates in an individualized exercise program daily. Which statement from the client indicates to the nurse that the client understands the purpose of the program? A. "I know the exercises are important, so I do them as many times as I can." B. "I do my exercises when I go to physical therapy in the morning and afternoon. C. "Because I'm stiff in the morning, I do most of my exercises then, so I'm done for the day." D. "I do one set of exercises slowly after breakfast, then I space the rest of them throughout the day

D. "I do one set of exercises slowly after breakfast, then I space the rest of them throughout the day Rationale: Spacing activity protects joints from overuse, misuse, and stress, limiting inflammation; it provides a balance between rest and activity. The exercise program should be planned; too much activity can precipitate an exacerbation, and too little may cause contractures. Spaced range-of-motion exercises should be incorporated into daily living activities, not just twice a day. The actions expressed in the response "Because I'm stiff in the morning, I do most of my exercises then, so I'm done for the day" will cause stress at the joints, which may precipitate an exacerbation.

After teaching a male client about measures to maintain sexual health and prevent transmission of sexually transmitted infections (STIs), which client statement indicates effective learning? A. "I will use condoms when having sex with an infected partner." B. "I will perform a self-examination of my genitals every month before bathing." C. "I will refrain from getting the human papillomavirus vaccine (HPV) before 27 years." D. "I will consult with my primary health care provider when there is a rash or ulcer on my genitalia.

D. "I will consult with my primary health care provider when there is a rash or ulcer on my genitalia. Rationale: The client should consult a primary health care provider when there is a rash or ulcer on genitalia because these are the warning signs of an STI. Having sex with an infected partner with or without using condoms may increase the risk of contracting an STI. A male client should perform a genital self-examination every month after taking a bath, when the scrotal skin is less thick. The human papilloma virus (HPV) vaccine should be taken between 9 and 26 years of age.

Which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted? A. "Yes, both are antipyretics and have the same effect." B. "Acetaminophen irritates the stomach more than ibuprofen does." C. "Acetaminophen is the preferred treatment for rheumatoid arthritis." D. "Ibuprofen has anti-inflammatory properties, and acetaminophen does not.

D. "Ibuprofen has anti-inflammatory properties, and acetaminophen does not. Rationale: Atopic diseases, bacterial infections, anaphylaxis shock are disease conditions that trigger humoral immunity. Tuberculosis and contact dermatitis result in cell-mediated immunity

The parent of a newborn asks the nurse why, except for hepatitis B vaccine, the immunization schedule does not start until the infant is 2 months old. Which response would the nurse provide? A. "A newborn's spleen can't produce efficient antibodies." B. "Infants younger than 2 months are rarely exposed to infectious disease." C. "The immunization will attack the infant's immature immune system and cause the disease." D. "Maternal antibodies interfere with the development of active antibodies by the infant when immunized.

D. "Maternal antibodies interfere with the development of active antibodies by the infant when immunized. Rationale: Passive antibodies received from the mother will be diminished by age 8 weeks and will no longer interfere with the development of active immunity to most communicable diseases. The spleen does not produce antibodies. Young infants often are exposed to infectious diseases. The viruses in immunizations are inactivated or attenuated; they may cause irritability and fever but will not cause the related disease.

Which instruction indicates a lack of understanding of a nurse teaching a human immunodeficiency virus (HIV)-positive client about strategies to prevent opportunistic infections? A. 'Reuse cups after washing them with warm soapy water.' B. 'Rinse your toothbrush in liquid laundry bleach every week.' C. 'Wash your armpits, groin, and genitals with antimicrobial soap twice a day.' D. 'Purchase organic, unpasteurized apple cider for your vitamin C requirements.

D. 'Purchase organic, unpasteurized apple cider for your vitamin C requirements. Rationale: Unpasteurized fruit juices or milk may harbor bacteria harmful to a weakened immune system. The client should refrain from reusing cups without washing them. Weekly rinsing of a toothbrush in liquid laundry bleach helps prevent infectious pathogens from accumulating on the brush. The armpits, groin, and genitals tend to house higher amounts of microorganisms and should be cleaned twice a day with antimicrobial soap.

An adolescent is taken to the emergency department of the local hospital after stepping on a nail. The nurse asks if the client has had a tetanus immunization. The adolescent responds that all immunizations are up to date. A few days later, the client is admitted to the hospital with a diagnosis of tetanus. Which statement describes the nurse's responsibility in this situation? A. The nurse's judgment was adequate, and the client was treated accordingly. B. The possibility of tetanus was not foreseen because the client was immunized. C. Nurses would routinely administer immunization against tetanus after such an injury. D. Assessment by the nurse was incomplete, and, as a result, the treatment was insufficient

D. Assessment by the nurse was incomplete and, as a result, the treatment was insufficient Rationale: The nurse's data collection was not adequate because the nurse did not ask about the date of the previous tetanus inoculation. The nurse failed to support the life and well-being of a client. The nurse's assessment was not thorough in regard to determining the date of immunization. It was essential to determine when the client was last immunized; for a "tetanus-prone" wound, like a puncture from a rusty nail, some form of tetanus immunization usually is given. Administering immunization against tetanus is not an independent function of the nurse.

An adolescent is taken to the emergency department of the local hospital after stepping on a nail. The nurse asks if the client has had a tetanus immunization. The adolescent responds that all immunizations are up to date. A few days later, the client is admitted to the hospital with a diagnosis of tetanus. Which statement describes the nurse's responsibility in this situation? A. The nurse's judgment was adequate, and the client was treated accordingly. B. The possibility of tetanus was not foreseen because the client was immunized. C. Nurses would routinely administer immunization against tetanus after such an injury. D. Assessment by the nurse was incomplete and, as a result, the treatment was insufficient.

D. Assessment by the nurse was incomplete and, as a result, the treatment was insufficient.

Which client would the nurse suspect as having a type IV hypersensitive reaction when providing care for four clients with hypersensitivity reactions? A. Client A B. Client B C. Client C D. Client D

D. Client D

Which meal is most appropriate for a client with a large pressure injury? A. Hamburger with french fries B. Turkey meatloaf with brown rice C. Pasta and tomato sauce with a side salad D. Grilled chicken, steamed spinach, and a side of orange slices

D. Grilled chicken, steamed spinach, and a side of orange slices Rationale: People with a pressure wound need extra protein and vitamin C to reduce inflammation and promote wound healing. The grilled chicken is a good source of protein, and both spinach and orange slices are rich in vitamin C. The hamburger and turkey meatloaf are both good protein sources, but the meals are lacking in vitamin C. The pasta with tomato sauce contains vitamin C, but it is not a good source of protein.

Which recommendation would the nurse make to the family of a child with juvenile idiopathic arthritis who has difficulty getting ready for school in the morning due to joint pain and stiffness? A. Administer acetaminophen before bedtime. B. Ice the joints that are painful in the evening. C. Encourage a program of active exercise after awakening. D. Provide warm, moist heat to the affected joints before arising.

D. Provide warm, moist heat to the affected joints before arising. Rationale: Warm, moist heat will reduce inflammation and pain and thus promote mobility. Acetaminophen administered at night will not decrease pain the following morning. Ice will not be beneficial, regardless of when it is administered. Gentle stretching, not active exercise, should be employed.

The nurse creates a plan of care for a client with a risk of infection. Which is the desirable expected outcome for the client? A. All nursing functions will be completed by discharge. B. All invasive intravenous lines will remain patent. C. The client will remain awake, alert, and oriented at all times D. The client will be free of signs and symptoms of infection by discharge.

D. The client will be free of signs and symptoms of infection by discharge. Rationale: Whenever a client has an infection or is at risk for infection, the nurse's primary objective in providing care is to prevent infection or perform activities that will promote the client's being free from infection by the time of discharge. The other expected outcomes are desirable but are more general in nature.

Which type of delayed hypersensitivity reaction does the client pictured in the image likely have? A. Type I B. Type II C. Type III D. Type IV

D. Type IV Rationale: The client is having contact dermatitis of the skin to rubber boots. This image presents a clinical example of a delayed hypersensitivity reaction, a type IV reaction. This reaction is also known as a cell-mediated immune response. Anaphylactic reactions are type I reactions that occur only in susceptible people who are highly sensitized to specific allergens. Hemolytic transfusion reactions are type II reactions that occur when a recipient receives ABO-incompatible blood from a donor. Tissue damage will occur in type III reactions, which are immune-complex reactions usually occurring secondary to antigen-antibody complexes.

Arrange the steps required to stimulate antibody-mediated immunity in the sequence they occur. 1. Invasion of new antigens in the body 2. Interaction of the macrophage and helper T cells to recognize the antigen 3. Sensitization of B lymphocyte to the new antigen 4. Production of antibodies by B lymphocytes 5. Binding of antibodies to the antigen and formation of immune complex 6. Neutralization or elimination of the antigen

Rationale: Antibody-mediated immunity reaction is stimulated when a new antigen invades the body. The antigen is recognized in the body by the interaction of macrophage and helper T cells. Then sensitization of B lymphocytes to the new antigen occurs. Antibodies against the antigens are produced by B lymphocytes. These antibodies bind to the antigen, and the immune complex is formed, which causes cellular events that result in neutralization or elimination of the antigen.

Arrange the pathophysiological events of acne in the correct sequence. 1. Excessive sebum production 2. Alterations in follicular growth and differentiation 3. Colonization of Propionibacterium acnes 4. Immune response and inflammation

Rationale: Excessive sebum production occurs with the maturation of adrenocortical glands. This action is followed by alterations in follicular growth and differentiation. Propionibacterium acnes proliferate and increase in number. This proliferation leads to an accumulation of neutrophils, which causes the formation of papules, pustules, nodules, and cysts and subsequent inflammation.

The nurses in a health care facility have developed a new care plan to prevent the risk of infection in clients with an indwelling urinary catheter in place. To determine if the changes prevent infections, the nurse manager uses the plan-do-study-act (PDSA). Place in order the steps that the nurse manager would follow to evaluate the changes 1. Plan to test the change. 2. Try out the change. 3. Analyze what happened from the change. 4. Determine what was learned.

Rationale: PDSA helps the nurses determine whether the changes they are making in the care plan will help prevent urinary tract infections and improve the quality of care. While using this model, the nurse manager would first plan to test the changes made by the nurses. Then, the nurse manager tries out the changes suggested by nurses and analyzes the results of the new interventions. Finally, the nurse determines what is learned from the test and the results

Place in order the steps the nurse would follow when developing a protocol in the electronic health record for clients with indwelling urinary catheters to decrease the risk of urinary tract infections. 1. Meets with the nursing staff 2. Selects an assessment tool 3. Interviews the nursing staff 4. Designs the assessment screens 5. Evaluates and determines data 6. Selects a standardized language 7. Adds a decision support rule

Rationale: While designing a protocol, the nurse would first meet with the nursing staff to determine the evidence supporting urinary tract infections in clients with an indwelling urinary catheter. Based on the results, the nurse would select an assessment tool and other data to manage the risk of urinary tract infections. Then the nurse would determine the levels of risk and interview nursing staff to determine the workflow. With this information, the nurse would design the assessment screens, evaluate the results, and determine evidence. The nurse would select the appropriate language to retrieve the data entered in the electronic health record. The nurse would also add a decision support rule to determine the level of risk