520 Sepsis

A client with toxic shock has been receiving ceftriaxone sodium, 1 g every 12 hours. In addition to culture and sensitivity studies, which other laboratory finding does the nurse monitor? a. spinal fluid analysis b. serum osmolality c. serum creatinine d. arterial blood gases

c. serum creatinine Explanation: The nurse monitors the blood levels of antibiotics, white blood cells, serum creatinine, and blood urea nitrogen because of the decreased perfusion to the kidneys, which are responsible for filtering out the ceftriaxone sodium. It is possible that the clearance of the antibiotic has been decreased enough to cause toxicity. Increased levels of these laboratory values should be reported to the health care provider (HCP) immediately. A spinal fluid analysis is done to examine cerebral spinal fluid, but there is no indication of central nervous system involvement in this case. Arterial blood gases are used to determine actual blood gas levels and assess acid-base balance. Serum osmolality is used to monitor fluid and electrolyte balance.

A client with severe arthritis has been receiving maintenance therapy of prednisone 10 mg/day for the past 6 weeks. The nurse should instruct the client to immediately report which symptom? a. joint pain b. respiratory infection c. constipation d. joint swelling

b. respiratory infection Explanation: Clients receiving chronic steroid therapy can become immunosuppressed and are prone to infections. Signs of infection can also be masked with prednisone. Signs and symptoms of infection should be reported immediately. Joint pain, constipation, and joint swelling are not related to the adverse effects of steroid therapy.

The nurse is caring for an 83-year-old client admitted to the health-care facility with a new onset of confusion and a low-grade fever. Which of the following age-related changes might contribute to decreased functioning of the immune system? a. Thickening of the skin b. Decreased kidney function c. Increased ciliary action d. Increased gastric secretions

b. Decreased kidney function Explanation: Decreased kidney function, changes in lower urinary tract function (enlargement of the prostate), and altered genitourinary tract flora all contribute to increased urinary tract infections. With age, the skin thins, gastric secretions decrease, and ciliary action decreases.

The client who does not respond adequately to fluid replacement has a prescription for an IV infusion of dopamine hydrochloride at 5 mcg/kg/min. To determine that the drug is having the desired effect, what should the nurse assess? a. increased renal and mesenteric blood flow b. reduced preload and afterload c. increased cardiac output d. vasoconstriction

c. increased cardiac output Explanation: At medium doses (4 to 8 mcg/kg/minute), dopamine hydrochloride slightly increases the heart rate and improves contractility to increase cardiac output and improve tissue perfusion. When given at low doses (0.5 to 3.0 mcg/kg/minute), dopamine increases renal and mesenteric blood flow. At high doses (8 to 10 mcg/kg/minute), dopamine produces vasoconstriction, which is an undesirable effect. Dopamine is not given to affect preload and afterload.

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first? a. Administer the antidote for penicillin, as ordered, and continue to monitor the client's vital signs. b. Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. c. Prepare to administer a corticosteroid IV. d. Insert an indwelling urinary catheter and begin to infuse I.V. fluids, as ordered.

b. Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. Explanation: To reverse anaphylactic shock, the nurse first should administer epinephrine, a potent bronchodilator, as ordered. The physician is likely to order additional medications, such as antihistamines and corticosteroids; if these medications do not relieve the respiratory compromise associated with anaphylaxis, the nurse should prepare to intubate the client. No antidote for penicillin exists. However, the nurse should continue to monitor the client's vital signs. A client who remains hypotensive may need fluid resuscitation and fluid intake and output monitoring. However, administering epinephrine is the first priority.

A nurse in the infection prevention and control program is conducting an assessment of infection control practices. The nurse is evaluating the infection control actions taken on the unit for a client with a decreased white blood cell count. Which infection control practice does the nurse consider most important for this client? a. using antimicrobial soap when providing care b. implementing respiratory isolation procedures c. requesting prophylactic antibiotic treatment d. adhering diligently to aseptic technique

d. adhering diligently to aseptic technique Explanation: The client in this scenario is neutropenic, which places the client at risk for contracting an infection. All measures of aseptic technique must be used to protect the client. The other options do not provide complete protection for the client.

A nurse is caring for a female client who is receiving antibiotics to treat a gram-negative bacterial infection. The client experiences an adverse effect related to the destruction of the normal flora in the GI tract. What finding does the nurse expect to assess? a. Elevated liver enzymes b. Vaginitis c. Oral candidiasis d. Diarrhea

d. Diarrhea Explanation: Broad-spectrum antibiotics that destroy aerobic and anaerobic bacteria also destroy the normal flora of the GI tract, which are responsible for absorbing water and certain nutrients (such as vitamin K). Destruction of the GI flora, in turn, leads to diarrhea. Although antibiotics may cause platelet dysfunction, stomatitis, renal dysfunction (indicated by oliguria and dysuria), and liver dysfunction, these adverse effects don't result from destruction of the GI flora. Oral candidiasis and vaginitis are not related to GI flora.

Nurses were identified by the Centers for Disease Control and Prevention (CDC) as the people most likely to care for clients infected after the intentional release of the smallpox virus. Based on CDC guidelines, which group should volunteer to receive the smallpox vaccine? a. Nurses vaccinated against smallpox as children who are now working in a pediatric unit. b. Nurses born after 1971 who are employed as triage nurses in large medical center emergency departments. c. Nurses who served in the military and are now working in public health settings. d. Nurses age 50 and older who work in the emergency departments of community hospitals.

d. Nurses age 50 and older who work in the emergency departments of community hospitals. Explanation: The CDC recommends the smallpox vaccine for nurses who received the vaccine as children (which includes those older than age 50) who work in the emergency department; emergency department nurses are most likely to care for those infected with the smallpox virus. Nurses born after 1971 weren't previously vaccinated against smallpox so the vaccine isn't currently recommended for those nurses. Military history doesn't dictate whether or not the vaccine is recommended. Nurses who work in the pediatric unit aren't at high risk for smallpox exposure; therefore, the vaccine isn't recommended for this group.

Which is least likely a danger associated with pancytopenia? a. anemia b. infection c. bleeding d. hypothyroidism

d. hypothyroidism Explanation: Hypothyroidism is not associated with pancytopenia. Various anemias are associated with pancytopenia owing to the reduction in all cellular elements of the blood. Bleeding and clotting difficulties can be associated with pancytopenia. Infection is a common danger associated with pancytopenia.

On the fourth day after surgery, a client's incision is red and inflamed. There is moderate drainage from the incision. The client has a temperature of 102°F (38.9°C). The total white blood cell (WBC) count is 10,000/mm3 (10 × 109/L). What should the nurse do first? a.Encourage the client to increase the fluid intake. b. Cleanse the incision site with soap and water. c. Notify the health care provider (HCP). d. Place an absorbent dressing over the incision.

c. Notify the health care provider (HCP). Explanation: The findings (WBC count above normal, inflammation and drainage at the incision site, and an elevated temperature) indicate that the client has an infection. The nurse should first notify the HCP. Encouraging fluids will be helpful, but it is not the first action. The nurse should not cleanse the site or place a dressing over the incision until the HCP writes a prescription to do so.