Unit 3 Ch.21: Multidrug Resistant Organisms

A client who has been imprisoned for a long time has come to the health-care facility. To which multidrug-resistant (MDR) organism is the client most susceptible? 1. Acinetobacter baumannii 2. Clostridium difficile 3. Vancomycin Resistant Enterococci (VRE) 4. Methicillin-resistant Staphylococcus aureus (MRSA)

Option 1: A baumannii can be acquired by a client who has undergone a tracheostomy as well as enteral feeding. Option 2: A client is exposed to C difficile through feeding tubes or chemotherapy. Option 3: Prolonged hospitalization as well as a weakened immune system can lead to VRE infection. Option 4: A client who has been in prison for a long time is susceptible to community-acquired MRSA.

Which clients are most exposed to Acinetobacter baumannii infection? Select all that apply. 1. A client who has undergone a tracheostomy procedure 2. A client who is a member of the military personnel 3. A client who has undergone chemotherapy 4. A client who is undergoing mechanical ventilation 5. A client who is an athlete by profession

Option 1: A client who has undergone a tracheostomy procedure is at risk for acquiring an A baumannii infection. Option 2: A member of the military personnel is susceptible to community-acquired methicillin-resistant Staphylococcus aureus. Option 3: A client who has undergone chemotherapy is susceptible to Clostridium difficile infection. Option 4: A client who is undergoing mechanical ventilation is at risk for acquiring an A baumannii infection. Option 5: An athlete is susceptible to community-acquired methicillin-resistant Staphylococcus aureus.

Which multidrug-resistant organism (MDR) is known to be the most virulent when compared with other MDRs? 1. Acinetobacter baumannii 2. Vancomycin-resistant Enterococcus (VRE) 3. Colostridium difficile 4. Methicillin-resistant Staphylococcus aureus (MRSA)

Option 1: Ac. baumannii is known to be the most virulent when compared with other MDRs, such as VRE, C. diff and methicillin-resistant Staphylococcus aureus (MRSA). Option 2: VRE is not seen in the community and is almost exclusively found in health-care settings. VRE is not known to be the most virulent organism, as is Acinetobacter. Option 3: C. diff is found in a health-care setting rather than in the community. But C. diff is not known to be the most virulent organism, as is Acinetobacter. Option 4: MRSA is the most common infection in the community and is not considered to be the most virulent organism, as is Acinetobacter.

Which assessment performed by the nurse monitors for decreased renal function in a client with a multidrug-resistant (MDR) organism infection? 1. White blood cell (WBC) count 2. Serum creatinine level 3. Oxygen-saturation level 4. Surgical site monitoring

Option 1: Increased WBC count may occur in a client with Clostridium difficile infection. It does not indicate decreased renal function. Option 2: Increased serum creatinine level may occur in a client with an adverse reaction to antibiotic treatment, since this can indicate decreased renal function. Option 3: Decreased oxygen-saturation level can be a symptom of pneumonia caused by an MDR organism. It does not indicate decreased renal function. Option 4: An infected wound or surgical site may be painful or have purulent drainage, which may be caused by an MDR organism. It does not indicate decreased renal function.

What is true regarding Acinetobacter? Select all that apply. 1. Meningitis is a disease that is often caused by Acinetobacter. 2. Antibiotic-associated diarrhea is most commonly caused by Acinetobacter. 3. Acute-care settings or intensive-care units are the ideal places for Acinetobacter. 4. Avoid antiperistaltic agents in an individual who has been diagnosed with Acinetobacter. 5. Intubated clients easily get affected with Acinetobacter.

Option 1: Acinetobacter infections are known to cause diseases like meningitis. Option 2: Clostridium difficile is the cause of most antibiotic-associated diarrhea. Option 3: Acinetobacter infections are not commonly seen in communities. Instead, they are often seen in acute-care settings or intensive-care units. Option 4: Once diagnosed with C. diff, antiperistaltic agents are avoided because they may delay clearance of toxins from the colon. Option 5: Acinetobacter infections usually affect clients who have been intubated. This is because of their increased susceptibility to the infections.

An RN is teaching a group of LPNs about Clostridium difficile. Which statement made by an LPN indicates the need for further instruction? Select all that apply. 1. "C difficile is a spore-forming, gram-negative anaerobic bacillus." 2. "C difficile is transmitted through the oral-fecal route." 3. "C difficile infection is spread through the hands of health-care workers." 4. "C difficile lives for only 5 days on surfaces. 5. "C difficile-infected clients must be placed into contact isolation."

Option 1: C difficile is a spore-forming, gram-positive anaerobic bacillus, not a gram-negative one. Option 2: The organism is transmitted through the oral-fecal route. Option 3: The infection spreads through the hands of health-care workers. Option 4: C difficile can live for months on surfaces, skinfolds, and on the hands of health-care workers. Option 5: It is imperative that clients infected with C difficile be placed into contact isolation.

Which intervention would be prescribed to alleviate the discomfort of a client suffering from a multidrug-resistant (MDR) organism infection along with a painful and swollen wound? 1. Chest physiotherapy 2. Early mobilization 3. Pain medication administration 4. Supplemental oxygen administration

Option 1: Chest physiotherapy is administered to a client with MDR pneumonia to mobilize secretions and to increase oxygen saturations. The primary health-care provider should order pain medications to decrease the pain. Option 2: Early mobilization is performed to decrease the risk of atelectasis secondary to MDR pneumonia. In this case, since the client is suffering from a painful and swollen wound, the primary health-care provider should order pain medications to decrease the pain. Option 3: The primary health-care provider should order pain medications to be administered to decrease pain from a swollen wound or a surgical-site infection. Option 4: Supplemental oxygen is administered to increase oxygen saturation secondary to MDR pneumonia. The primary health-care provider should order pain medications to decrease pain.

A registered nurse is teaching a group of nursing students about contact isolation precautions. Which statement of a nursing student indicates a need for further teaching? 1. "A client who is colonized or infected with multidrug-resistant organisms is placed on contact isolation precautions." 2. "Hand hygiene needs to be performed only before donning gowns and gloves." 3. "Gowns and gloves must be donned before entering the isolation room." 4. "Gowns and gloves must be taken off before exiting the isolation room."

Option 1: Clients in health-care settings who are either colonized or infected with multidrug-resistant organisms are placed on contact isolation precautions. Option 2: All health-care workers should follow and maintain proper hand hygiene before donning gowns and gloves and after taking them off. Hand hygiene should be performed to minimize the spread of infections to self and other clients. Option 3: Isolation gowns and gloves should be donned by all health-care workers before entering the room of a client suffering from infection caused by a multidrug-resistant organism. Option 4: Isolation gowns and gloves should be taken off before leaving the room of a client with and infection caused by a multidrug-resistant organism.

What important point should the nurse keep in mind when administering quinupristin-dalfopristin intravenously to a client with a vancomycin-resistant Enterococcus (VRE) infections? 1. It can cause a Clostridium difficile infection. 2. It can be caustic to the vein. 3. It can cause sun sensitivity. 4. It can cause muscle pain and weakness.

Option 1: Clindamycin is one of the more commonly used antibiotics used to treat community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. The most common side effect of clindamycin is C. diff infection. Option 2: Quinupristin-dalfopristin is administered intravenously for treating vancomycin-resistant Enterococcus (VRE) infections; however, this medication can be caustic to veins. Therefore, peripherally inserted central catheter (PICC) placement is recommended if long-term use is required. Option 3: When administered for treating community-acquired methicillin-resistant Staphylococcus Aureus (CA-MRSA) infection, sulfamethoxazole-trimethoprim can cause sun sensitivity; therefore, the client is asked to use sunscreen when going outdoors. Option 4: When administered for treating methicillin-resistant Staphylococcus aureus (MRSA) infection, intravenous daptomycin can cause muscle pain and weakness; therefore, creatine phosphokinase (CPK) levels are drawn weekly to assess the client for rhabdomyolysis.

Which statement regarding nursing diagnoses for multidrug-resistant (MDR) organism infection is true? 1. A risk for perineal skin breakdown is associated with frequent stools. 2. Ineffective airway clearance is related to multidrug-resistant wound infection. 3. Impaired tissue integrity is related to multidrug-resistant pneumonia. 4. Impaired urinary elimination is related to Colostridium difficile (C. diff) infection.

Option 1: Frequent stools may result increase the risk of perineal skin breakdown. Option 2: Multidrug-resistant pneumonia may result in ineffective airway clearance. Option 3: Multidrug-resistant wound infection may result in impaired tissue integrity. Option 4: Impaired urinary elimination is related to urinary tract infection (UTI), which is secondary to a multidrug-resistant organism.

Which clinical manifestations are indicative of dehydration in a client suffering from multidrug-resistant (MDR) organism infection? 1. Swollen, painful wound with purulent drainage 2. Decreased oxygen saturation 3. Decreased skin turgor and dry mucous membranes 4. Elevated body temperature

Option 1: If the client is suffering from an infected wound or surgical site, then signs include red, swollen, painful, and a warm-to-the-touch wound, which may have purulent drainage. Option 2: Decreased oxygen saturation may be a symptom associated with pneumonia. Option 3: Decreased skin turgor and dry mucous membranes are signs indicating that the client is suffering from dehydration. Option 4: An elevated body temperature indicates fever.

Which multidrug-resistant (MDR) organism infection can be treated with intravenous ampicillin-sulbactam administration? 1. Clostridium difficile infection 2. Acinetobacter baumannii infection 3. Vancomycin-resistant Enterococcus (VRE) infection 4. Methicillin-resistant Staphylococcus aureus (MRSA) infection

Option 1: Intravenous ampicillin-sulbactam is usually not ordered for C. diff infection. Instead, oral vancomycin or metronidazole may be prescribed. Option 2: Intravenous ampicillin-sulbactam is usually ordered for clients with Acinetobacter baumannii infection. Option 3: Intravenous ampicillin-sulbactam is usually not ordered for VRE infection. Instead, quinupristin-dalfopristin may be given intravenously. Option 4: Intravenous ampicillin-sulbactam is not usually ordered for MRSA infection. Instead, vancomycin is usually administered intravenously or orally.

An RN is teaching a group of nursing students about isolation precautions. Which statement made by a nursing student indicates the need for further instruction? Select all that apply. 1. "I should perform hand hygiene before I put on the isolation gown and gloves." 2. "I should remove the isolation gown and gloves immediately after leaving the isolated client's room." 3. "I should perform hand hygiene after I leave the client's room." 4. "I must tie the isolation gown at the neck and chest to prevent bacterial transmission." 5. "I should use isolation precautions when working with clients infected with either Clostridium difficile or Acinetobacter."

Option 1: It is imperative for the nurse to perform hand hygiene before putting on the isolation gown and gloves. Option 2: The nurse must remove the isolation gown and gloves before he or she leaves the isolation room, not after leaving it. Option 3: It is imperative for the nurse to perform hand hygiene immediately after leaving the isolation room. Option 4: The nurse must tie the isolation gown at the neck and the waist, not the chest, to prevent bacteria transmission. Option 5: The nurse must use isolation precautions when working with clients infected with either C difficile or Acinetobacter, as well as methicillin-resistant S Aureus and vancomycin-resistant Enterococci (VRE).

An RN is teaching a group of LPNs about Clostridium difficile infection and hygiene. Which statement made by an LPN indicates the need for further instruction? 1. "I should always perform hand hygiene when coming in contact with a client who has C difficile infection." 2. "I should use alcohol-based hand sanitizers to kill C difficile spores." 3. "I should use soap and water to physically remove C difficile spores." 4. "I should place a client with a C difficile infection on contact isolation precautions."

Option 1: It is imperative for the nurse to perform hand hygiene when coming in contact with a client who has a C difficile infection. Option 2: The nurse should never use alcohol-based hand sanitizers to kill C difficile spores, as they do not kill the organism but only displace it. Option 3: Soap and water with mechanical hand wash are used to physically remove C difficile spores. Option 4: It is imperative for the nurse to place a client who has a C difficile infection in contact isolation.

An RN is teaching a group of LPNs about the epidemiology of Clostridium difficile. Which statements made by an LPN indicate the need for further instruction? Select all that apply. 1. "Newborns and children in the first years of life have some of the highest rates of colonization." 2. "The risk of colonization decreases steadily each day during hospitalization due to the daily risk of exposure to C difficile spores in a health-care setting." 3. "People older than 85 years of age are two times more likely to become infected with C difficile than people aged 65 to 84 years." 4. "The mortality attributable to C difficile is high when compared to that associated with methicillin-resistant S aureus (MRSA) and vancomycin-resistant Enterococci (VRE)." 5. "C difficile infection spreads from the use of antimicrobials, particularly clindamycin, cephalosporins, and fluoroquinolones."

Option 1: Newborns and children in the first years of life have the highest rate of colonization. Option 2: The risk of colonization increases steadily each day during hospitalization due to the daily risk of exposure to C difficile spores in a health-care setting. Option 3: It is true that people older than 85 years of age are two times more likely to become infected with C difficile than people aged 65 to 84 years. Option 4: The mortality attributable to C difficile is low, not high, when compared to that associated with MRSA and VRE. Option 5: C difficile infection spreads mainly from the use of antimicrobials, particularly clindamycin, cephalosporins, and fluoroquinolones.

Which condition is likely to cause vancomycin-resistant Enterococcus (VRE) infection? 1. Prolonged exposure to vancomycin and cephalosporins 2. Use of clindamycin, cephalosporins, and fluroquinolones 3. Use of histamine-2 receptor blockers and proton pump inhibitors 4. Exposure to mechanical ventilation

Option 1: Prolonged exposure to antibiotics, especially exposure to vancomycin and cephalosporins may cause VRE infections. Option 2: Use of antimicrobials, particularly clindamycin, cephalosporins, and fluroquinolones, may cause Colostridium difficile infections. Option 3: Use of acid-suppressing medications, such as histamine-2 receptor blockers and proton pump inhibitors, may cause Clostridium difficile infections. Option 4: Clients who are under mechanical ventilation may develop Acinetobacter baumannii infections.

The nursing supervisor is teaching a group of LPNs about the pathophysiology of methicillin-resistant Staphylococcus aureus (MRSA). Which statements made by an LPN show a need for further instruction? Select all that apply. 1. "The microorganism can be spread if an infected person touches the source of infection and then touches an object or surface." 2. "Staphylococcus aureus is an aerobic, gram-negative, sporulating, coagulase-positive bacterium." 3. "MRSA is coated with a fibrin wall, which accepts the process of phagocytosis." 4. "The microorganism is easily spread from one client to another." 5. "MRSA is an exogenous pathogen."

Option 1: The microorganism may be spread if an infected person touches the source of infection and then touches an object or surface. Option 2: S aureus is an aerobic, gram-negative, nonsporulating, coagulase-positive bacterium. Option 3: MRSA is coated with a fibrin wall, which rejects the process of phagocytosis. It does not accept it. Option 4: The microorganism is spread from one client to another. Option 5: MRSA is an endogenous pathogen, not an exogenous one, as the pathogen resides within the body.

A registered nurse is teaching a nursing student about the precautionary measures to be taken to prevent the spread of multidrug-resistant (MDR) organism infections. Which points reiterated by the nursing student indicate a need for further training? Select all that apply. 1. Clean the perineum area, and apply moisture barriers. 2. Use alcohol-based cleansers when caring for a client infected with Clostridium difficile. 3. Use fecal diversion or containment systems in the stool-incontinent client. 4. Administer a causative antimicrobial agent to a client infected with Clostridium difficile. 5. Prevent the client affected with MDR organisms from ambulating.

Option 1: The nurse should apply moisture barriers after cleaning the perineum area to prevent skin breakdown or incontinence-associated dermatitis (IAD), which is secondary to C. diff-associated diarrhea. Option 2: The nurse should use soap and water when caring for a client infected with C. diff, since it helps to remove the bacteria. Alcohol-based cleansers are effective against other MDR organisms, such as Acinetobacter baumannii, vancomycin-resistant Enterococcus (VRE), and methicillin-resistant Staphylococcus aureus (MRSA), but not against C. diff. Option 3: The nurse should use fecal diversion or containment systems to prevent skin breakdown in the stool-incontinent client infected with C. diff. Option 4: The nurse should stop administering a causative antimicrobial agent to a client infected with C. diff, as per the order. This decreases the risk of C. diff-associated diarrhea. Option 5: The nurse should encourage early ambulation in a client affected with MDR organisms. This decreases the risk of atelectasis, which is secondary to MDR pneumonia.

A client has been assessed with toxic megacolon. Which multidrug-resistant organism is most likely to be responsible for this condition? 1. Vancomycin-resistant Enterococcus (VRE) 2. Acinetobacter 3. Clostridium difficile 4. Methicillin-resistant Staphylococcus aureus (MRSA)

Option 1: VRE is responsible for endocarditis in a client. Option 2: Acinetobacter increases the length of stay in the hospital for the client along with increasing resistance to antibiotics. The organism may be responsible for sepsis and the death of a client. Option 3: C difficile has been responsible for toxic megacolon in the client. Option 4: MRSA infections lead to increased morbidity and mortality. The client has multisystem organ failure followed by death.

The primary health-care provider prescribes sulfamethoxazole-trimethoprim for a client. Which best describes the reason for this prescription? 1. The client has acquired a Clostridium difficile infection. 2. The client has acquired a vancomycin-resistant Enterococci (VRE) infection. 3. The client has acquired a methicillin-resistant Staphylococcus aureus (MRSA) infection. 4. The client has acquired an Acinetobacter infection.

Option 1: Vancomycin is prescribed for a client with a C difficile infection. Option 2: Quinupristin-dalfopristin is prescribed for a client with VRE infection. Option 3: Sulfamethoxazole-trimethoprim is prescribed for a client with MRSA infection. Option 4: Doripenem and polymyxin B are prescribed for clients with an Acinetobacter infection.