Med-Surg Chapter 23 - Care of patients with Infection (2)

Cleansing hands with an alcohol-based hand rub is appropriate in which situation?

After handing oral medications to a patient Alcohol-based hand rubs (ABHRs) are not appropriate if one's hands are visibly dirty, soiled, or feel sticky, or if you have just toileted.

A client has been admitted to the hospital for a virulent infection and is started on antibiotics. The client has laboratory work pending to determine if the diagnosis is meningitis. After starting the antibiotics, what action by the nurse is best?

Assess the client frequently for worsening of his or her condition Meningitis is a disease caused by endotoxins, which are released with cell lysis. Antibiotics often work by lysing cell membranes, which would increase the amount of endotoxin present in the client's body

A nursing manager is concerned about the number of infections on the hospital unit. What action by the manager would best help prevent these infections?

Auditing staff members' hand hygiene practices lack of hand hygiene is the biggest cause of healthcare-associated infections.

Which statement about the transmission of hepatitis C is correct?

Equipment or linen soiled with blood or body fluids should be washed with bleach or a disinfectant to prevent infection. Hepatitis C is a bloodborne pathogen. Equipment or linen that is soiled with blood or body fluids can be a likely source of infection.

Which information does the nurse include when teaching a client about antibiotic therapy for infection?

Take all antibiotics as prescribed, unless side effects develop. Antibiotics should be taken as prescribed, not when symptoms occur. Teach the client about possible side effects and allergic manifestations.

A nurse receives report from the laboratory on a client who was admitted for fever. The laboratory technician states that the client has "a shift to the left" on the white blood cell count. What action by the nurse is most important?

Notify the provider and request antibiotics A shift to the left indicates an increase in immature neutrophils and is often seen in infections, especially those caused by bacteria. The nurse should notify the provider and request antibiotics

Which intervention is the most appropriate to address the priority problem of feelings of isolation when caring for a client who is placed on Transmission-Based Precautions?

Provide education on the mode of transmission. Education is the main intervention for addressing a client's feeling of isolation when placed on Transmission-Based Precautions.

While in the hospital, the client has developed a methicillin-resistant infection in the foot. The client had undergone surgical débridement for gangrene. Which precaution is best for this client?

Wear a gown and gloves to prevent contact with the client or client-contaminated items. Caregivers should wear a gown to prevent contact with the client or contaminated items when caring for a client with this infection; this is the best way to prevent the spread of infection.

The student nurse learns that effective antimicrobial therapy requires which factors to be present? (Select all that apply.)

- Appropriate drug - Proper route of administration - Sufficient dose - Sufficient length of treatment

The nurse is caring for four patients, and understands that which is at greatest risk of infection?

24-year old with chronic kidney disease The patient's immune status plays a large role in determining risk for infection. Congenital abnormalities, acquired health problems (for example, kidney injury, steroid dependence, cancer, AIDS) and advancing age can increase a patient's risk of developing immunologic deficiencies.

Which client is at greatest risk for developing an infection?

A 65-year-old woman who had coronary bypass surgery 4 days ago Older clients such as the 65-year-old with decreased vascularity to the integumentary system (from the bypass surgery) and compromised skin (surgical incision) are at risk for infection.

Which nurse does the charge nurse assign to care for a 64-year-old client who has pneumonia and requires IV antibiotic therapy and IV fluids at 200 mL/hr?

A float RN with 7 years of experience on the inpatient oncology unit The float RN with experience on the inpatient oncology unit would be familiar with complications and assessment for IV fluids and pneumonia.

A client is being admitted with suspected tuberculosis (TB). What actions by the nurse are best? (Select all that apply.)

Admit the client to a negative-airflow room. Order specialized masks/respirators for caregiving.

A student nurse asks the nursing instructor why older adults are more prone to infection than other adults. What reasons does the nursing instructor give? (Select all that apply.)

Age-related decrease in immune function Decreased cough and gag reflexes Diminished acidity of gastric secretions Thinning skin that is less protective

Which statement about why multidrug-resistant organisms and other infections are increasing in incidence is correct?

Antibiotics have been given to clients for conditions that do not require antibiotics. Antibiotics have often been prescribed for conditions that do not require them, or have been given at higher doses or for longer periods of time than needed.

What health care-acquired infection (HCAI) occurs most frequently?

Catheter-associated urinary tract infection (CA-UTI) Urinary tract infection (UTI) is one of the most common health care-acquired infections (HCAIs). More than half of patients in adult intensive care units (ICUs) have urinary catheters in place. Indwelling urinary catheters are a primary cause of CAUTIs (catheter-associated UTIs).

A client with an infection has a fever. What actions by the nurse help increase the client's comfort? (Select all that apply.)

Change the client's gown and linens when damp. Offer cool fluids to the client frequently.

Which action by the nurse is most helpful to prevent clients from acquiring infections while hospitalized?

Consistently using appropriate hand hygiene Consistent practice of proper hand hygiene is the best method to prevent infection, as most healthcare-associated infections are due to staff members' contaminated hands.

A client is hospitalized and on multiple antibiotics. The client develops frequent diarrhea.

Consult with the provider about obtaining stool cultures Hospitalized clients who have three or more stools a day for 2 or more days are suspected of having infection with Clostridium difficile. The nurse should inform the practitioner and request stool cultures

A 14-year-old client has severe fatigue, swollen glands, and a low-grade fever. Which blood test result is used to confirm a diagnosis of mononucleosis?

Decreased neutrophil count In a client with mononucleosis, a white blood cell count would show a decrease in neutrophils.

A client has a wound infection to the right arm. What comfort measure can the nurse delegate to the unlicensed assistive personnel (UAP)?

Elevate the arm above the level of the heart Elevating the extremity above the level of the heart will help with swelling and pain

A hospitalized client is placed on Contact Precautions. The client needs to have a computed tomography (CT) scan. What action by the nurse is most appropriate?

Ensure that the radiology department is aware of the isolation precautions Clients in isolation should leave their rooms only when necessary, such as for a CT scan that cannot be done portably in the room. The nurse should ensure that the receiving department is aware of the isolation precautions needed to care for the client

Which is a common clinical manifestation of infectious disease?

Fever Fever (generally a temperature above 101° F [38.3° C]) is a common clinical manifestation of infection.

Which statement about handwashing is in accordance with recommendations by the Centers for Disease Control and Prevention?

Handwashing must be done after contact with the client's intact skin, such as when taking a pulse. Microorganisms that can be transmitted to another client can be found on intact skin.

The student nurse caring for clients understands that which factors must be present to transmit infection? (Select all that apply.)

Host Mode of transmission Portal of entry Reservoir

Which statement by a nursing student indicates a need for further teaching by the nurse regarding infection control for a client who has an open, draining wound?

I will wear a mask each time I enter the client's room. The mode of infection transmission for this situation is by direct contact. Therefore, the student needs to avoid contact with the wound by using a gown, gloves, and hand hygiene. A mask is not needed in this situation.

A priority problem of hyperthermia is identified by the long-term-care RN who is caring for a client with a urinary tract infection. Which intervention is most appropriate to delegate to a nursing assistant?

Increase fluid intake by assisting the client to choose preferred beverages. Nursing assistants can provide dietary choices to clients, and allowing them to select the beverage of their choice will improve oral intake. In clients with hyperthermia (fever), fluid volume loss is increased from rapid evaporation of body fluids and increased perspiration.

A client has been placed on Contact Precautions. The client's family is very afraid to visit for fear of being "contaminated" by the client. What action by the nurse is best?

Inform them that the infection is the issue, not the client. Families and clients often have negative reactions to isolation precautions. The nurse can explain that the infection is the problem, not the client, and encourage them to visit because following the precautions will prevent them from acquiring the infection.

A student nurse asks why brushing clients' teeth with a toothbrush in the intensive care unit is important to infection control. What response by the registered nurse is best?

It mechanically removes biofilm on teeth Biofilms are a complex group of bacteria that function within a slimy gel on surfaces such as teeth. Mechanical disruption (i.e., toothbrushing with friction) is the best way to control them.

A client is admitted with possible sepsis. Which action should the nurse perform first?

Obtain specified cultures Prior to administering antibiotics, the nurse obtains the ordered cultures. Broad-spectrum antibiotics will be administered until the culture and sensitivity results are known

A client is admitted with fever, myalgia, and a papular rash on the face, palms, and soles of the feet. What action should the nurse take first?

Place the client on Airborne Precautions This client has manifestations of smallpox, a public health emergency, and should be placed on Airborne Precautions first before other care measures are implemented.

A nurse is caring for a client who has methicillin-resistant Staphylococcus aureus (MRSA) infection cultured from the urine. What action by the nurse is most appropriate?

Prepare to administer vancomycin (Vancocin) Vancomycin is one of a few drugs approved to treat MRSA. The others include linezolid (Zyvox) and ceftaroline fosamil (Teflaro).

The nurse manager for a long-term care facility is in charge of implementing a plan to decrease the spread of infection within the facility. Which part of the plan is most appropriate to delegate to nursing assistants working at the facility?

Reinforcing the need for handwashing after caring for clients All caregivers have a responsibility to reinforce basic handwashing, including that provided for nursing assistants. A higher level of administration is required to evaluate the performance of another worker.

Which actions aid in the prevention and early detection of infection in a client at risk? (Select all that apply.)

Remove unnecessary medical devices. Obtain cultures as needed. Promote sufficient nutritional intake.

A nurse is observing as an unlicensed assistive personnel (UAP) performs hygiene and changes a client's bed linens. What action by the UAP requires intervention by the nurse?

Shaking dirty linens and placing them on the floor Shaking dirty linens (or even clean linens) can spread microbes through the air. Placing linens on the floor contaminates the floor surface and can lead to infection spread via shoes

The nursing instructor explaining infection tells students that which factor is the best and most important barrier to infection?

Skin and mucous membranes The skin and mucous membranes are the most important barrier against infection.

A hospital unit is participating in a bioterrorism drill. A "client" is admitted with inhalation anthrax. Under what type of precautions does the charge nurse admit the "client"?

Standard Precautions Only Standard Precautions are needed. No other special precautions are required for the "client" because inhalation anthrax is not spread person to person.

A client who was treated last month for a bad case of bronchitis and walking pneumonia reports many of the same symptoms today. Which factor in the client's antibiotic therapy most likely caused the client's relapse?

Taking the antibiotic most days Antibiotics not taken as prescribed can result in recurring symptoms, as well as the development of drug-resistant infections and other emerging infections.

Which statements are true regarding Standard Precautions? (Select all that apply.)

Use personal protective equipment as needed for client care. Wear gloves when touching client excretions or secretions.

Which precaution is best for the nurse to take to prevent the transmission of Clostridium difficile infection?

Wear gloves when contact with body secretions or body fluids is expected. The nurse must wear gloves and wash hands before and after potential exposure to the client's body secretions or fluids.

A client is admitted with a catheter-associated methicillin-resistant Staphylococcus aureus (MRSA) infection. Which personal protective equipment is appropriate when providing client care? (Select all that apply.)

gloves gown