Infection

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective? "I should massage my feet and legs with oil or lotion." "I should apply heat intermittently to my feet and legs." "I should eat foods high in protein and carbohydrate kilocalories." "I should control my blood glucose with diet, exercise, and medication."

"I should control my blood glucose with diet, exercise, and medication." Controlling the diabetes decreases the risk of infection; this is the best prevention.

A nurse is teaching a female client with a history of multiple urinary tract infections (UTIs). Which statement indicates the client understands the teaching about preventing UTIs? - "I should wipe from back to front." - "I should take a tub bath at least 3 times per week." - "I should take at least 1,000 mg of vitamin C each day." - "I should limit my fluid intake to limit my trips to the bathroom."

- "I should take at least 1,000 mg of vitamin C each day." The client demonstrates understanding of teaching when she states that she should take vitamin C each day. Increasing vitamin C intake to at least 1,000 mg per day helps acidify the urine, decreasing the amount of bacteria that can grow.

To confirm a diagnosis of a urinary tract infection for a client who develops chills, fever, flank pain, and malaise while recovering from deep partial-thickness burns, which prescribed diagnostic tests would the nurse anticipate? 1.Urinalysis and urine culture and sensitivity 2.Cystoscopy and bilirubin level 3.Creatinine clearance and albumin/globulin (A/G) ratio 4.Specific gravity and pH of the urine

1.Urinalysis and urine culture and sensitivity The client's manifestations may indicate a urinary tract infection, and a culture of the urine will identify the microorganism. A cystoscopy is too invasive as a screening procedure. Altered bilirubin results indicate liver or biliary problems, not urinary signs and symptoms. Creatinine clearance reflects renal function and A/G ratio reflects liver function. An increased urine specific gravity may indicate red blood cells (RBCs), white blood cells (WBCs), or casts in the urine and are associated with urinary tract infection, but it will not identify the causative organism.

The nurse is teaching a client with cellulitis about home care measures to increase comfort. Which instruction should the nurse​ provide? (Select all that​ apply.) A."Apply sterile saline dressings to the affected area to promote​ drainage." B."Keep the affected area below the level of the heart to promote​ circulation." C."Apply ice packs to the affected area to reduce​ edema." D."Wash hands thoroughly before touching the affected​ area." E."Get enough​ rest."

A,D,E A."Apply sterile saline dressings to the affected area to promote​ drainage." D."Wash hands thoroughly before touching the affected​ area." E."Get enough​ rest." -The client with cellulitis should get adequate rest and perform infection control​ measures, like good hand hygiene and use of sterile dressings. Sterile saline dressings will help reduce edema and promote​ drainage, but ice packs should not be applied to the affected area. To reduce​ swelling, the affected area should be elevated above the level of the​ heart, not kept below the level of the heart.

A patient hourly urine output is recorded. Which of the following output rates should be brought to the attention of the registered nurse immediately? a. 15 mL/hr b. 40 mL/hr c. 60 mL/hr d. 80 mL/hr

ANS: A Urine output should be 30 mL/hr, so 15 mL/hr should be reported.

The nurse is caring for a patient who has chronic kidney disease and is very weak due to low hemoglobin. Which of the following does the nurse understand is the best explanation for the anemia? a. Chronic hypertension associated with chronic kidney disease suppresses the bone marrow. b. Metabolic acidosis associated with chronic kidney disease increases red blood cell fragility. c. There is loss of red blood cells in the urine with kidney disease. d. Secretion of erythropoietin by the diseased kidney is reduced

ANS: D Secretion of erythropoietin by the diseased kidney is reduced.

A client with a stage 2 pressure ulcer has methicillin-resistant Staphylococcus aureus (MRSA) cultured from the wound. Contact precautions are initiated. Which rule must be observed to follow contact precautions? A. A clean gown and gloves must be worn when in contact with the client. B. Everyone who enters the room must wear an N-95 respirator mask. C. All linen and trash must be marked as contaminated and send to biohazard waste. D. Place the client in a room with a client with an upper respiratory infection.

Answer: A. A clean gown and gloves must be worn when in contact with the client. Option A: A clean gown and gloves must be worn when any contact is anticipated with the client or with contaminated items in the room. Option B: A respirator mask is required only with airborne precautions, not contact precautions. Option C: All linen must be double-bagged and clearly marked as contaminated. Option D: The client should be placed in a private room or in a room with a client with an active infection caused by the same organism and no other infections.

As the infection control nurse in an acute care hospital, which action will you take to most effectively reduce the incidence of health-care-associated infections? A. Screen all newly admitted clients for colonization or infection with MRSA. B. Develop policies that automatically start antibiotic therapy for clients colonized by multi-drug resistant organisms. C. Ensure that dispensers for alcohol-based hand rubs are readily available in all client care areas of the hospital. D. Require nursing staff to don gowns to change wound dressings for all clients.

Answer: C. Ensure that dispensers for alcohol-based hand rubs are readily available in all client care areas of the hospital. Option C: Because the hands of health care workers are the most common means of transmission of infection from one client to another, the most effective method of preventing the spread of infection is to make supplies for hand hygiene readily available for staff to use. Option A: Although some hospitals have started screening newly admitted clients for MRSA, there is no evidence that this decreases the spread of infection. Option B: Because administration of antibiotics to individuals who are colonized by bacteria may promote the development of antibiotic resistance, antibiotic use should be restricted to clients who have clinical manifestations of infection. Option D: Wearing a gown to care for clients who are not on contact precautions is not necessary.

A client is admitted with cellulitis. Which manifestation should the nurse​ monitor? (Select all that​ apply.) A.Itching B.Tenderness C.Malaise D.Fever E.Chills

B,C,D,E B.Tenderness C.Malaise D.Fever E.Chills HOT, TENDER, ERYTHEMATOUS AND EDEMATOUS AREA, CHILLS, FEVER, MALAISE are manifestations the client may experience with cellulitis Itching is not a manifestation experienced with cellulitis

Which statement by a client who has methicillin-resistant Staphylococcus aureus (MRSA) in the urine would indicate that the client is correctly following the medical treatment plan? A. "When I leave my room, I will wear a mask." B. "I should wash my hands after I go to the bathroom." C. "My children can sit on my bed during their visit." D. "I need to wear gloves when I eat my lunch."

B. "I should wash my hands after I go to the bathroom."

A nurse removes a central line access device once the patient no longer requires intravenous (IV) antibiotics. This action is an example of which strategy to prevent antimicrobial resistance established by the Centers for Disease Control and Prevention (CDC)? A. Preventing transmission B. Proper diagnosis C. Preventing infection D. Prudent antibiotic use

C. Preventing infection The CDC's campaign to prevent the development of antimicrobial resistance in hospitals focuses on four approaches: (1) prevent infection, (2) diagnose and treat infection effectively, (3) use antimicrobials wisely, and (4) prevent transmission. Expeditious removal of invasive devices, such as IV catheters, and restricting these devices to essential use are examples of the CDC's strategy to prevent infection.

The nurse collects a drainage sample to be cultured from the affected area of a client with cellulitis. Which organism should the nurse suspect is the most likely cause of the​ cellulitis? A.Escherichia coli B.Bacillus subtilis C.Staphylococcus aureus D.Group A Streptococcus

C.Staphylococcus aureus -Staphylococcus aureus is the most common cause of​ cellulitis, followed by group A Streptococcus. Bacillus subtilis and Escherichia coli are not causes of cellulitis.

Which complication may be caused by sepsis in burns? Diarrhea Constipation Paralytic ileus Curling's ulcer

Paralytic ileus Paralytic ileus, or hypoactive bowel, is a complication caused by sepsis in clients with burns. Diarrhea can be caused by the use of enteral feedings or antibiotics. Constipation can occur as a side effect of opioid analgesics, decreased mobility, and a low-fiber diet. Curling's ulcer is a type of gastroduodenal ulcer characterized by diffuse superficial lesions. It is caused by a generalized stress response to decreased blood flow to the gastrointestinal tract in clients with burns.

A patient is at risk for septic shock when a microorganism invades the body. Which microorganism is the MOST common cause of sepsis?* A. Fungus B. Virus C. Parasite D. Bacteria

The answer is D. Gram-positive or gram-negative bacteria are the MOST common cause of sepsis.

The caregiver of an older client with flu reports to a geriatric nurse that the client has shallow respiration. What advice can the geriatric nurse give the caretaker to improve the client's ease of breathing? a. Put a humidifier at the​ client's bedside. b. Elevate the head of the​ client's bed. c. Use a face mask. d. Give antipyretic medications. e. Give analgesic medications.

a, b RationaleElevating the head of the bed will put the client in an upright position and improve the ease of breathing. A​ humidifier, which increases the water content of inhaled​ air, will also improve the ease of breathing. Using a face mask prevents the spread of infection but does not ease breathing. Giving antipyretic or analgesic medications helps with​ comfort, not breathing.

The nurse emphasizes that a pt diagnosed with atopic dermatitis should be discouraged from scratching. The pt asks why scratching should be prevented. How would the nurse respond? "Lesions can become more contagious after scratching." "Dermatitis can spread to other areas of the body with scratching." "Skin breaks caused by scratching can lead to infection." "Scratching produces changes that are precursors to skin cancer."

"Skin breaks caused by scratching can lead to infection." Scratching can break the integrity of the skin, leaving it vulnerable to infection. Dermatitis is a response to an allergen; it is not contagious. Scratching will not cause the dermatitis to spread. There are no data to indicate that scratching or dermatitis is a precursor to skin cancer.

The nurse is caring for a 90-year-old resident in a long-term care facility who is becomingprogressively confused and irritable. What should the nurse do next? a.Request an order for a urinalysis. b.Hold the patient's antihypertensive medications. c.Assess the patient for fecal impaction. d.Notify the charge nurse.

ANS: A Sudden confusion and irritability may indicate a urinary tract infection (UTI) in the olderadult. There is no supportive information indicating issues with the patient's antihypertensivemedications or the presence of a fecal impaction.

For a client with a history of frequent urinary tract infections (UTIs), in addition to increasing fluid intake, which instruction would the nurse provide? A. Empty the bladder every 3 hours B. Take warm bubble baths C. Wipe from back to front D. Take a prophylactic antibiotic after sexual intercourse

A. Empty the bladder every 3 hours Emptying the bladder every 3 hours helps prevent stasis of urine (urinary stasis supports bacterial growth). Tub baths with soapy bubbles are thought to increase the risk of UTIs because soap is irritating to mucous membranes. The concern about wiping from back to front is allowing fecal material to enter the perineal area and potentially cause irritation. Taking a prophylactic antibiotic after sexual intercourse is an inappropriate use of antibiotics that may support the development of resistant strains of bacteria. Antibiotics should be used judiciously and be prescribed by a licensed health care provider.

A client diagnosed with pyelonephritis asks the nurse "What is the disease?" The nurse's best response "Pyelonephritis is an: A. inflammation of the kidney and renal pelvis." B. inflammation of the prostate gland." C. inflammation of the urethra." D. inflammation of the bladder."

A. inflammation of the kidney and renal pelvis."Rationale:Pyelonephritis is an inflammation of the kidney and renal pelvis. Prostatis is an inflammation of the prostate gland. Urethritis is an inflammation of the urethra. Cystitis is an inflammation of the bladder.

A patient with glomerulonephritis asks, "How could I have gotten this?" How should the nurse respond? a. "Have you had a sore throat or skin infection recently?" b. "Glomerulonephritis almost always follows a bladder infection." c. "Glomerulonephritis often results from having unprotected sex." d. "Has anyone in your family had glomerulonephritis?"

ANS: A Glomerulonephritis can be caused by a variety of factors but is most commonly associated with a group A beta-hemolytic streptococcus infection following a streptococcal infection of the throat or skin.

A patient hospitalized for orthopedic surgery had a urinary catheter inserted. The patient later develops a urinary tract infection and asks the nurse what caused it. What is the appropriate response by the nurse? a. "Bacteria probably ascended the catheter, causing the infection." b. "You probably did not void frequently enough." c. "There was a change in the pH of your urine." d. "There are always bacteria on your perineum that enter your urine."

ANS: A Urinary tract infections are almost always caused by an ascending infection, starting at the external urinary meatus and progressing toward the bladder and kidneys. Instrumentation, or having instruments or tubes inserted into the urinary meatus, is a predisposing cause

Individuals of low socioeconomic status are at an increased risk for infection because of which of the following? (Select all that apply.) a. Uninsured or underinsured status b. Easy access to health screenings c. High cost of medications d. Inadequate nutrition e. Mostly female gender

ANS: A, C, D Individuals of low socioeconomic status tend to be part of the underinsured or uninsured population. Lack of insurance decreases accessibility to health care in general and health screening services specifically. High costs of medication and nutritious food also make this population at higher risk for infection. Gender has not been shown to be an increased risk factor for infection in the lower socioeconomic population.

Which set of assessment data is consistent for a patient with severe infection that could lead to system failure? a. Blood pressure (BP) 92/52, pulse (P) 56 beats/min, respiratory rate (RR) 10 breaths/min, urine output 1200 mL in past 24 hours b. BP 90/48, P 112 beats/min, RR 26 breaths/min, urine output 240 mL in past 24 hours c. BP 112/64, P 98 beats/min, RR 18 breaths/min, urine output 2400 mL in past 24 N hours d. BP 152/90, P 52 beats/min, RR 12 breaths/min, urine output 4800 mL in past 24 hours

ANS: B The patient with severe infection presents with low BP and compensating elevations in pulse to move lower volumes of blood more rapidly and respiration to increase access to oxygen. Urine output decreases to counteract the decreased circulating blood volume and hypotension. These vital signs are all too low: Blood pressure (BP) 92/52, pulse (P) 56 beats/min, respiratory rate (RR) 10 breaths/min, urine output 1200 mL in past 24 hours. The patient with severe infection does have a low BP, but the pulse and respiratory rate increase to compensate. This data is all within normal limits: BP 112/64, P 98 beats/min, RR 18 breaths/min, urine output 2400 mL in past 24 hours. This set of data reflects an elevated BP with a decrease in pulse and respiratory rates along with normal urine output: BP 152/90, P 52 beats/min, RR 12 breaths/min, urine output 4800 mL in past 24 hours. None of these is a typical response to severe infection.

A 19-year-old patient reports flank pain and scanty urination. The nurse notices periorbital edema, and the urinalysis reveals white blood cells, red blood cells, albumin, and casts. What question would be most important for the nurse to include in data collection? a. "Have you had any gastrointestinal problems lately?" b. "Have you had a strep infection of the throat or skin recently?" c. "Are you sexually active?" d. "Is your vision blurred?"

ANS: B The patient has symptoms of glomerulonephritis, which can be caused by a variety of factors but is most commonly associated with a group A beta-hemolytic streptococcus infection following a streptococcal infection of the throat or skin.

The nurse is working on a plan of care with her patient which includes turning and positioning and adequate nutrition to help the patient maintain intact skin integrity. The nurse helps the patient to realize that this breaks the chain of infection by eliminating which element? a. Host b. Mode of transmission c. Portal of entry d. Reservoir

ANS: C Broken or impaired skin creates a portal of entry for pathogens. By maintaining intact tissue, the patient and the nurse have broken the chain of infection by eliminating a portal of entry. Host is incorrect because you are not eliminating the person or organism. Intact tissue does not eliminate the mode of transmission. Skin can still be used to transfer pathogens regardless of it being intact or broken. Intact skin does not eliminate the location for pathogens to live and grow.

Which of these data collection techniques is the best determinant of a patient's fluid volume status that must be done on every patient with chronic kidney disease? a. Intake and output b. Vital signs c. Daily weight d. Skin turgor

ANS: C Monitor weight daily at the same time; report gain of more than 2 pounds. Those retaining fluid will have weight gain.

While reviewing the complete blood count (CBC) of a patient on her unit, the nurse notes elevated basophil and eosinophil readings. The nurse realizes that this is most indicative of which type of infection? a. Bacterial b. Fungal c. Parasitic d. Viral

ANS: C Parasitic infections are frequently indicated on a CBC by elevated basophil and eosinophil levels. Bacterial infections do not lead to elevated basophil and eosinophil levels but elevated B and T lymphocytes, neutrophils, and monocytes. Fungal infections do not lead to elevated basophil and eosinophil levels. Viral infections create elevations in B and T lymphocytes, neutrophils, and monocytes

The nurse is reviewing the history and physical of a patient who has an infection. What term would the nurse understand describes an infection of the kidneys? a. Urethritis b. Cystitis c. Pyelonephritis d. Hepatitis

ANS: C Pyelonephritis is infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys.

The nurse is assessing the affected area for a client hospitalized for treatment of cellulitis. During the​ assessment, the nurse notes that redness in the affected area extends a bit beyond the border traced during the previous assessment. Which action should the nurse take based on this​ finding? A. Immediately notify the healthcare provider of this change. B. Increase the elevation level of the affected body part. C. Ask the client if they have noticed any change in pain. D. Trace along the new border with a marker.

ANS: D In the event of change in size of the affected​ area, the nurse places a new mark so that future healthcare providers can clearly see if the wound enlarges. Immediate notification of the healthcare provider may not be warranted at this​ time; not enough information is provided to indicate a need for this action. Asking the client if they have noticed a change in pain would not directly address this situation. Increasing the elevation level of the affected body part would not directly address this finding.

In order to provide an intervention for a patient, the nurse is often responsible for obtaining a sample of exudate for culture. What information will this provide? a. Whether a patient has an infection. b. Where an infection is located. c. The type of cells that are being utilized by the body to attack an infection. d. The specific type of pathogen that is causing an infection.

ANS: D People can transmit pathogens even if they don't currently feel ill. Some carriers never experience the full symptoms of a pathogen. A CBC will identify that the patient has an infection. Inspection and radiography will help identify where an infection is located. The CBC with differential will identify the white blood cells being used by the body to fight an infection. The culture will grow the microorganisms in the sample for identification of the specific type of pathogen.

The nurse is reinforcing teaching on antibiotic use for a urinary tract infection (UTI). Which of the following statements by the patient would indicate a correct understanding of the teaching? a. "I will take the antibiotics until my urine is no longer cloudy." b. "I will take the antibiotics whenever I feel discomfort from urinating." c. "I will take the antibiotics until my temperature has been normal for 3 days." d. "I will take the antibiotics until they are gone regardless of symptoms."

ANS: D Take prescribed medication for a UTI until it is all gone.

The nurse is reinforcing 24-hour fluid intake teaching for a patient to prevent further urinary tract infections. Which of the following amounts if stated by the client would indicate a correct understanding of the teaching? a. "1.000 mL." b. "1,000 mL." c. "2,500 mL." d. "3,000 mL."

ANS: D to prevent urinary tract infections (UTIs) drink up to 3,000 mL of fluid a day if there are no fluid restrictions from the physician.

You're providing care to four patients. Select all the patients who are at risk for developing sepsis: (SATA) A. A 35-year-old female who is hospitalized with renal insufficiency and has a Foley catheter and central line in place. B. A 55-year-old male who is a recent kidney transplant recipient. C. A 78-year-old female with diabetes mellitus who is recovering from colon surgery. D. A 65-year-old male recovering from right lobectomy for treatment of lung cancer.

All the answers are correct. All the patients have risk factors for developing sepsis. Remember the mnemonic: Septic..... Suppressed immune system (AIDS/HIV, immunosuppressive therapy, steroids, chemo, pregnancy, malnutrition).... Extreme age (infants and elderly)... Post-op (surgical/invasive procedures).... Transplant recipients..... Indwelling devices (Foley catheter, central lines, trachs)..... Chronic diseases (diabetes, hepatitis, alcoholism, renal insufficiency)

A client is diagnosed with methicillin resistant staphylococcus aureus pneumonia. What type of isolation is MOST appropriate for this client? a. Reverse isolation b. Respiratory isolation c. Standard precautions d. Contact isolation

Answer D. Contact or Body Substance Isolation (BSI) involves the use of barrier protection (e.g. gloves, mask, gown, or protective eyewear as appropriate) whenever direct contact with any body fluid is expected. When determining the type of isolation to use, one must consider the mode of transmission. The hands of personnel continues to be the principal mode of transmission for methicillin resistant staphylococcus aureus (MRSA). Because the organism is limited to the sputum in this example, precautions are taken if contact with the patient"s sputum is expected. A private room and BSI, along with good hand washing techniques, are the best defense against the spread of MRSA pneumonia

The nurse is caring for an older client whose​ C-reactive protein test is elevated. Which interpretation should the nurse derive from this​ result? A. The result is an indication that the client has asthma. B. The client probably has suffered a stroke. C. The client is suffering from gallbladder disease. D. The increased result may be an indicator of overall poor health.

D. The increased result may be an indicator of overall poor health. In older​ adults, C-reactive protein​ (an inflammatory​ marker) may be an indicator of overall poor​ health, which makes them more susceptible to chronic illnesses and cognitive decline. More diagnostic information is needed to determine if the client is experiencing a specific inflammatory disease like gallbladder or asthma.​ C-reactive protein is not elevated with a stroke.

The nurse has completed discharge teaching for a client who is being discharged to home after treatment for cellulitis. Which statement by the client during evaluation of the response to teaching would the nurse need to​ clarify? A."Before doing wound​ care, I need to scrub my hands with soap and water for at least 20​ seconds." B."I should wash the wound at least once daily with soap and​ water." C.I need to carefully monitor the size of the wound to make sure it is not​ increasing." D."After cleaning the​ wound, I need to apply antibiotic ointment and a clean​ bandage."

D."After cleaning the​ wound, I need to apply antibiotic ointment and a clean​ bandage." -After cleaning the​ wound, a​ sterile, not a​ clean, bandage should be applied. All other statements reflect appropriate care for cellulitis.

The nurse examines a wound on a client with a history of cellulitis. Which manifestation suggests​ cellulitis? A.Intact skin with nonblanchable redness and elevated borders B.Reddened skin with indistinct borders and covered by a​ yellow, fibrous film C.Pink or red skin with circumscribed regular borders D.Red or lilac edematous skin with a​ well-defined, nonelevated border

D.Red or lilac edematous skin with a​ well-defined, nonelevated border -Cellulitis wounds are generally red or lilac with​ irregular, well-defined borders. They are also edematous.​ Elevated, indistinct, or regular borders do not characterize cellulitis wounds

A patient with a fever is lethargic and has a blood pressure of 89/56. The patient's white blood cell count is elevated. The physician suspects the patient is developing septic shock. What other findings indicate this patient is in the "early" or "compensated" stage of septic shock? Select all that apply:* A. Urinary output of 60 mL over 4 hours B. Warm and flushed skin C. Tachycardia D. Bradypnea

The answers are B and C. In septic shock, vasodilation is occurring and this leads to WARM and FLUSHED skin in the early stage. However, in the late stage the skin will be cool and clammy. Tachycardia and TACHYpnea (not bradypnea) occurs in the early stage too as a compensatory mechanism. Oliguria (option A) is in the late stage or uncompensated when the kidneys are starting to fail.