Chapter 31: Infection Prevention and Management

A nurse in an oncology care unit is reviewing the laboratory test results of several clients. The nurse identifies that the client with which leukocyte count most likely has an infection?

18,000 cells/mm

A nurse is reviewing the laboratory test results of a client who at high risk for septic shock. Which serum lactate level would the nurse identify as indicating sepsis?

3.2 mmol/L

The nurse is speaking to the physician regarding the client's frequent diarrhea episode since IV antibiotics. The nurse states "I am concernedthat Mr. Clark has developed Image result for Clostridium Difficile infection." Which part of the SBSAR communication will this statement fall in?

A= Assessment

A nurse is preparing to obtain a specimen for an aerobic wound culture. The nurse would obtain the specimen from which area?

Area of active drainage

Assessment of a client's temperature reveals hyperpyrexia. The nurse interprets this as indicating that the client's temperature is most likely which of the following?

Greater than 40.5C

A physician performs lumbar puncture and advises the nurse to send the obtained cerebrospinal fluid for Gram stains. The nurse understands that this type of testing is beneficial for which reason?

Helps to determine prescribed antibiotic therapy

A nurse is preparing a class for a group of new parents about infections and infants. When reviewing the development of the infant's immune system, what would the nurse be least likely to include?

Newborns have little difficult localizing infections.

A nurse is caring for a client who has neutropenia resulting from chemotherapy. Which precaution would be least appropriate to include when caring for this client?

Obtaining rectal temperatures

A nurse is providing care for a client who has had gall bladder surgery. It is the first postoperative day and the client is exhibiting a fever. The nurse suspects which of the following as the most likely cause?

Physiologic stress

During an interaction with a client who is HIV-positive, the nurse learns that the client has nonspecific symptoms such as nausea, fever, general weakness, and aches and pains. The nurse interprets these findings as reflecting which stage of the communicable period?

Prodromal period

The nurse assessing a client who had elevated temperature an hour ago determines that the client is in the crisis phase of fever. Which of the folloiwng would lead the nurse to this conclusion?

Profuse diaphoresis

A group of students is reviewing information about cellular and humoral immunity. The group demonstrates understanding of these concepts when they identify what as a function of cellular immunity?

Reactivate if the same antigen reappears

A school nurse is conducting a program for the parents of school-age children. As part of the program the nurse would address which disease as common for this age group?

Streptococcal Infection

A group of nursing students is reviewing the various white blood cells and how they function in infection. The students demonstrate understanding of the information when they identify which cell as important in synthesizing immunoglobulins?

T-lymphcyctes

The nurse is conducting assessment on a client with cancer who is undergoing treatments. The client is complaining of having the flu. Which question should be asked?

- "Has anyone in the family recently been sick?" - "Have you been frequently out in the community?" - "Are you taking steroids?"

The local high school has been exposed to Methicillin-resistant Staphylococcus aureus (MRSA) infection and the school nurse is preparing an education plan on prevention of MRSA. Which steps should the nurse include? Select all that apply.

- 20-second hand washing - Use of hand sanitizer when necessary - Keep draining wounds covered - Online research on MRSA

The mother of a client who is acutely ill and is responding well to the antibiotic treatment states, "I know this antibiotic will heal my child." The mother requires future education based on which statement? Select all that apply.

- Antibiotics do not heal - Antibiotics slow the growth or kill the microorganism - Antibiotics prevent future damage to the system affected.

While the nurse is conducting morning rounds, the nurse notices that the child's temperature has gradually increased for the past 3 days. Which assessment should the nurse do next?

- Auscultate lung sounds - Check site of wound - Check IV site for infiltration - Review how compliant the client has been with ambulation

When describing the inflammatory response to a group of nursing students, what would the instructor most likely include as a local effect? Select all that apply.

- Erthyema - Edema - Pain

The nurse is assessing a client with an infection and suspects that the client may be developing systemic inflammatory response syndrome. What would support the nurse's suspicions? Select all that apply.

- Heart rate 110 beats/minute - Respiratory rate of 26/minute - Chills