152 Infection Quizlet

Which statement best describes health care-associated infections? A) The infection develops in response to various antibiotics. B) Clients are admitted to the hospital with an infectious disease. C) The infection was not incubating at the time of admission. D) They develop in more than 15% of hospitalized clients.

C) The infection was not incubating at the time of admission.

A patient is to receive antibiotic therapy with a cephalosporin. When assessing the patient's drug history, the nurse recognizes that an allergy to which drug class may be a possible contraindication to cephalosporin therapy?

Penicillins

What is not an appropriate infection assessment question? A) Do you feel fatigued? B) Have you had a fever? C) Are your immunizations up to date? D) Do you drive a red Chrysler Seabring with out appropriate air bags? E) Have you had 2 cups of coffee in one sitting?

D and E

The nurse knows the use of tetracyclines is limited in children due to the occurrence of which side effect?

Discoloration of teeth.

An older adult client diagnosed with urge incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? Select all that apply. Dry mouth Increased blood pressure Constipation Increased intraocular pressure Reddish-orange urine color

Dry mouth Constipation Increased intraocular pressure

A patient is in the HIV clinic for a follow-up appointment. He has been on antiretroviral therapy for HIV for more than 3 years. The nurse will assess for which potential adverse effects of long-term antiretroviral therapy? (Select all that apply.)

Lipodystrophy Liver damage Osteoporosis Type 2 diabetes

CBC with WBC Differential count:

One of the most critical laboratory tests to evaluate the presence of infection

When patients are receiving aminoglycosides, the nurse must monitor for tinnitus and dizziness, which may indicate what problem?

Ototoxicity

A​ 14-month-old child is admitted to the intensive care unit for treatment of severe bronchiolitis caused by respiratory syncytial virus​ (RSV). Which medication does the nurse anticipate will be prescribed for this​ client?

Ribavirin

Which statement accurately describes the action of antiseptics?

They are used to inhibit the growth of organisms on living tissue.

Which nonpharmacologic therapy is appropriate for a child with respiratory syncytial virus​ (RSV)?

cluster care to allow for rest periods

Sepsis

common type of systemic infection, the presence of pathogens in blood or other tissues throughout the body

not with antibiotics, if not resolved short course anti-inflammatory

how do you treat serous otitis?

During antibiotic therapy, the nurse will assess the client for a condition that may occur because of the disruption of normal flora. The nurse knows this as what condition? A) Superinfection B) Hypersensitivity C) Allergic reaction D) Organ toxicity

A) Superinfection

What is the priority assessment data for a client prescribed antibiotic therapy? A) Immunizations B) Cardiac dysrhythmias C) Allergies D) History of seizures

C) Allergies

What are some laboratory diagnostic tests that might be considered when treating a patient with infection? A) CBC B) WBC C) STD D)ERS

-A -B -D

Fungal Infections

-Grow as single cell or multicellular -Contained by the body's Natural Flora -Fungi imperfecti > affecting immunocompromised individuals, leading to death -Belongs to Kingdom fungi, including: -Fungus -yeast (single cell) -mold (multicellular filamentous) -mushrooms (multicellular filamentous)

Common Pathogens of Virus:

-HIV -Hepatitis A, B, C, or E virus -Human papillomavirus -Ebola virus -Hantavirus -SARS-associated coronavirus -Respiratory syncytial virus

In an effort to prevent superinfections of the GI tract such as Clostridium difficile, the nurse will instruct clients to eat which foods? A) Cultured dairy products such as yogurt B) Low-fat meats such as chicken and pork C) Multigrain wheat bread D) Raw fruits and vegetables

A) Cultured dairy products such as yogurt

Classification of Antibiotic & Antiviral Agents

Antibiotic:: -Penicillin -Cephalosporins (1st, 2nd, 3rd, 4th generations) -Fluoroquinolones -Tetracyclines -Macrolides -Aminoglycosides Antiviral Agents:: -Adamantane -Antiviral chemokine receptor agonist -Antiviral interferon -Neuraminidase inhibitors -Non-nucleoside reverse-transcriptase inhibitors -Nucleoside reverse-transcriptase inhibitors -Protease inhibitors -Purine nucleosides

A client with active genital herpes has a cesarean birth. The nurse teaches the mother how to limit transmission of the virus to her newborn. The nurse concludes that the instructions have been understood when the mother makes what statement? 1 "I should avoid kissing the baby on the lips." 2 "I have to wear gloves when I'm holding the baby." 3 "I should wash my clothes and my baby's clothes separately." 4 "I have to wash my hands with soap and water before handling the baby."

4 The herpes virus disintegrates rapidly on contact with soap used in meticulous hand washing. The lesion is in the genital area, not on the lips; kissing will not affect the infant. Wearing gloves when holding the infant is not necessary; nor is washing the infant's clothes separately.

72. The 29-year-old client is admitted to the medical floor diagnosed with meningitis. Which assessment by the nurse has priority? 1. Assess lung sounds. 2. Assess the six cardinal fields of gaze. 3. Assess apical pulse. 4. Assess level of consciousness.

4. Meningitis directly affects the client's brain. Therefore, assessing the neurological status would have priority for this client.

Bacterial resistance to antibiotics can occur with which situations? (Select all that apply.) A) Antibiotics that are prescribed to treat a viral infection B) Clients stop taking an antibiotic when they feel better. C) Antibiotics that are prescribed according to culture and sensitivity reports D) Microorganisms arriving from foreign countries and overseas ports E) Taking an antibiotic and an antiviral medication at the same time

A) Antibiotics that are prescribed to treat a viral infection B) Clients stop taking an antibiotic when they feel better.

The nurse would monitor which laboratory values in a patient receiving intravenous gentamicin (Garamycin)? A.Blood urea nitrogen (BUN) and creatinine B.Prothrombin time (PT) and partial thromboplastin time (PTT) C.Hematocrit and hemoglobin D.Serum glutamic-oxaloacetic transaminase (SGOT) and alanine transaminase (ALT)

A.Blood urea nitrogen (BUN) and creatinine

The nurse is monitoring a patient who has been on antibiotic therapy for 2 weeks. Today the patient tells the nurse that he has had watery diarrhea since the day before and is having abdominal cramps. His oral temperature is 101 F (38.3 C). Based on these findings, which conclusion will the nurse draw? A.The patient needs to be tested for Clostridium difficile infection. B.The patient's original infection has not responded to the antibiotic therapy. C.The patient will need to take a different antibiotic. D.The patient is showing typical adverse effects of antibiotic therapy.

A.The patient needs to be tested for Clostridium difficile infection.

When a patient is on aminoglycoside therapy, the nurse will monitor the patient for which indicators of potential toxicity? A.Tinnitus and dizziness B.Fever C.White blood cell count of 8000 cells/mm3 D.Decreased blood urea nitrogen (BUN) levels

A.Tinnitus and dizziness

During antibiotic therapy, the nurse will monitor closely for signs and symptoms of a hypersensitivity reaction. Which of these assessment findings may be an indication of a hypersensitivity reaction? (Select all that apply.) A.Wheezing B.Black, hairy tongue C.Swelling of the tongue D.Itching E.Shortness of breath F.Diarrhea

A.Wheezing C.Swelling of the tongue D.Itching E.Shortness of breath

The nurse would teach a patient receiving metronidazole (Flagyl) to avoid ingestion of which drink? A.Wine B.Milk C.Coffee D.Orange juice

A.Wine

When teaching a patient being discharged on linezolid (Z) to treat methicilin-resistant Staphylococcus aureus (MRSA), the nurse must emphasize the importance of A.avoiding ingestion of foods containing tyramine. B.taking the medication with an antacid to avoid gastrointestinal upset. C.stopping the drug as soon as the patient feels better. D.reporting any occurrence of constipation.

A.avoiding ingestion of foods containing tyramine.

A patient with a long-term intravenous catheter is going home. The nurse knows that if he is allergic to seafood, which antiseptic agent is contraindicated? A.povidone-iodine (Betadine) B.chlorhexidine gluconate (Hibiclens) C.hydrogen peroxide D.isopropyl alcohol

A.povidone-iodine (Betadine)

A patient who has been hospitalized for 2 weeks has developed a pressure ulcer that contains multidrug-resistant Staphylococcus aureus (MRSA). Which drug would the nurse expect to be chosen for therapy? A.vancomycin (Vancocin) B.metronidozole (Flagyl) C.tobramycin (Nebcin) D.ciprofloxacin (Cipro)

A.vancomycin (Vancocin)

The nurse is providing counseling to a woman who is HIV positive and has just discovered that she is pregnant. Which anti-HIV drug is given to HIV-infected pregnant women to prevent transmission of the virus to the infant? a. Acyclovir (Zovirax) b. Zidovudine (Retrovir) c. Ribavirin (Virazole) d. Foscarnet (Foscavir)

ANS: B Zidovudine, along with various other antiretroviral drugs, is given to HIV-infected pregnant women and even to newborn babies to prevent maternal transmission of the virus to the infant. The other drugs are non-HIV antiviral drugs.

Bacteria that is part of Normal Flora, but can become pathogenic when an individual is immunocompromised

Acinetobacter

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. Microorganisms are more susceptible to antibiotics today than when they were given years ago. Additional precautions are taken, along with Standard Precautions, to prevent infection. Most antibiotics are effective for infection.

Antibiotics have been given to clients for conditions that do not require antibiotics.

What is Asepsis? A) Infection B)freedom from and prevention of disease causing contamination C) Homeostasis resulting from the clean environment D) Freedom from sexually transmitted diseases.

B

Which interventions would help control infections? A) reduce water intake B) Administer antibiotics C) Administer Xanax D) Provide adequate nutrition E) Monitor response to drug therapy

B,D, and E

The nurse is taking the health history of a client suspected of having bacterial meningitis. Which question is most important for the nurse to ask? A. "When was your last tetanus vaccination?" B. "Do you live in a crowded residence?" C. "Have you traveled out of the country in the last month?" D. "Have you had any viral infections recently?"

B. "Do you live in a crowded residence?" Rationale: Meningococcal meningitis tends to occur in outbreaks. It is most likely to occur in areas of high-density population, such as college dormitories, prisons, and military barracks. The other questions do not identify risk factors for bacterial meningitis.

A patient is prescribed linezolid (Zyvox) to treat hospital-acquired pneumonia. It is most important for the nurse to determine if the patient is also taking which medication? A.A diuretic B.A selective serotonin reuptake inhibitor C.A cardiac glycoside D.A thyroid replacement drug

B. A selective serotonin reuptake inhibitor Rationale: Linezolid has the potential to strengthen the vasopressor (prohypertensive) effects of various vasopressive drugs such as dopamine by an unclear mechanism. Also, there have been postmarketing case reports of this drug causing serotonin syndrome when used concurrently with serotonergic drugs such as the selective serotonin reuptake inhibitor (SSRI) antidepressants. It is recommended that the SSRI be stopped while the patient is receiving linezolid therapy if possible.

A patient is receiving Augmentin (amoxicillin and clavulanic acid) liquid solution through a PEG tube. What is the purpose of the clavulanic acid? A.It works synergistically with the antibiotic to improve potency. B.It inhibits the action of the enzymes produced by beta-lactamase-producing bacteria. C.It protects the antibiotic from the harmful gastric acid secretions in the stomach. D.It enhances the absorption of the antibiotic in the small intestine.

B.It inhibits the action of the enzymes produced by beta-lactamase-producing bacteria Rationale: The clavulanic acid works to inhibit the action of the enzymes produced by the bacteria, which would normally inactivate the antibiotic.

When reviewing the medication orders for a patient who is taking penicillin, the nurse notes that the patient is also taking the oral anticoagulant warfarin (Coumadin). What possible effect may occur as the result of an interaction between these drugs? A.The warfarin will reduce the antiinfective action of the penicillin. B.The penicillin will cause an enhanced anticoagulant effect of the warfarin. C.The warfarin will increase the effectiveness of the penicillin. D.The penicillin will cause the anticoagulant effect of the warfarin to decrease.

B.The penicillin will cause an enhanced anticoagulant effect of the warfarin.

The nurse should assess a patient for nephrotoxicity and ototoxicity when administering which antimicrobial? A.erthromycin B.gentamicin C.clindamycin D.cefazolin

B.gentamicin

Sepsis & septic shock

Bacterial infection Leads to.. Excessive host response Leads to... Host factors lead to cellular damage Leads to... Organ damage Leads to... DEATH

The mother of a child diagnosed with bronchiolitis caused by respiratory syncytial virus​ (RSV) is upset to learn that the child will be admitted to a​ semi-private room. Which explanation by the nurse is the most appropriate regarding this room​ assignment?

Because RSV is highly​ contagious, pediatric clients with RSV are isolated or roomed with other pediatric clients who also have RSV

Which of the following is a priority for a nurse to include in a teaching plan for a patient who desires self-management and alternative strategies? Body alignment and superficial heat and cooling Patient-controlled analgesia (PCA) pump Neurostimulation Peripheral nerve blocks

Body alignment and superficial heat and cooling

Surpainfection

Broad spectrum antibiotics eliminate a wide range of normal flora not just those causing infection

What standard precaution would the nurse use as part of medical asepsis? A) proper catheter insertion B) A special N95 respirator C) appropriate hand hygiene D) Sterilization

C

Three days following intracranial surgery a client develops fever, nuchal rigidity, and headache. The nurse would suspect A. Cerebral emboli B. Extradural hematoma C. Meningitis D. Diabetic neuropathy

C. Meningitis Rational The classic manifestations of meningitis are nuchal rigidity (rigidity of the neck), Brudzinski's sign and Kernig's sign, and photophobia. Intracranial surgery places the client at high risk of developing meningitis.

A group of office workers is concerned because a package was opened that contained a white powder substance. There is a concern that the white powder is anthrax. Which drug does the nurse anticipate being prescribed for the office workers? A.daptomycin (Cubicin) B.colistimethate (Coly-Mycin) C.ciprofloxacin (Cipro) D.quinupristin/dalfopristin (Synercid)

C. colistimethate (Coly-Mycin) Rationale: Ciprofloxacin (Cipro) is the drug of choice for the treatment of anthrax (infection with Bacillus anthracis).

The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? A."Milk and cheese products result in increased levels of tetracycline." B."Take the medication until you are feeling better." C."Avoid direct sunlight and tanning beds while on this medication." D."Antacids taken with the medication help to reduce gastrointestinal distress."

C."Avoid direct sunlight and tanning beds while on this medication."

During drug therapy with a tetracycline antibiotic, a patient complains of some nausea and decreased appetite. Which statement is the nurse's best advice to the patient? A."Take it with cheese and crackers or yogart." B."Take an antacid with each dose as needed." C."Drink a full glass of water with each dose." D."Take each dose with a glass of milk."

C."Drink a full glass of water with each dose."

A patient is admitted with a fever of 102.8 F (39.3 C), origin unknown. Assessment reveals cloudy, foul-smelling urine that is dark amber in color. Orders have just been written to obtain stat urine and blood cultures and to administer an antibiotic intravenously. The nurse will complete these orders in which sequence? A.Urine culture, antibiotic dose, blood culture B.Antibiotic dose, blood and urine cultures C.Blood and urine cultures, antibiotic dose D.Blood culture, antibiotic dose, urine culture

C.Blood and urine cultures, antibiotic dose

A patient will be having oral surgery and has received an antibiotic to take for 1 week before the surgery. The nurse knows that this is an example of which type of therapy? A.Empirical B.Resistance C.Prophylactic D.Definitive

C.Prophylactic

Which is a complication of vancomycin infusions? A.Cardiomyopathy B.Angioedema C.Red man syndrome D.Neurotoxicity

C.Red man syndrome

The nurse is reviewing the medication orders for a patient who will be receiving linezolid (Zyvox) therapy. Which other medication or medication class, if ordered, would be a potential interaction concern? A.Phenytoin B.Anticoagulants C.Selective serotonin reuptake inhibitor antidepressants D.Calcium channel blockers

C.Selective serotonin reuptake inhibitor antidepressants

During intravenous quinolone therapy in an 88-year-old patient, which potential problem is of most concern when assessing for adverse effects? A.Hepatotoxicity B.Rhabdomyolysis C.Tendon rupture D.Nephrotoxicity

C.Tendon rupture Rationale: A black box warning is required by the U.S. Food and Drug Administration for all quinolones because of the increased risk of tendonitis and tendon rupture with use of the drugs. This effect is more common in elderly patients, patients with renal failure, and those receiving concurrent glucocorticoid therapy (e.g., prednisone).

During drug therapy for pneumonia, a female patient develops a vaginal superinfection. The nurse explains that this infection is caused by A.an allergic reaction to the antibiotics. B.resistance of the pneumonia-causing bacteria to the drugs. C.large doses of antibiotics that kill normal flora. D.the infection spreading from her lungs to the new site of infection.

C.large doses of antibiotics that kill normal flora.

The nurse is reviewing the medication history of a patient who will be taking a sulfonamide antibiotic. During sulfonamide therapy, a significant drug interaction may occur with which of these drugs or drug classes? (Select all that apply.) A.Opioids B.Antihistamines C.phenytoin (Dilantin) D.Oral contraceptives E.Sulfonylureas F.warfarin (Coumadin)

C.phenytoin (Dilantin) D.Oral contraceptives E.Sulfonylureas F.warfarin (Coumadin)

Mr. R., a 50 year old banker, is scheduled for colon surgery tomorrow. The surgeon is planning to administer a prophylactic antibiotic. What drug is frequently used for this purpose and why?

Cefoxitin (Mefoxin) is frequently used in patients undergoing abdominal surgeries because it can effectively kill intestinal bacteria, including anaerobic bacteria.

Which activity does the RN team leader on a large medical-surgical unit assign to the LPN/LVN? Assessment of a client scheduled for surgery who is crying and expressing fear that the pain will be intolerable Assessment of a client using a transcutaneous electrical nerve stimulation unit to relieve chronic pain Complex dressing changes for a sacral wound for a client with type 2 diabetes who was given prescriptions for pain medication before wound care Instructions to a postoperative hip replacement client who has just been placed on patient-controlled analgesia for pain relief

Complex dressing changes for a sacral wound for a client with type 2 diabetes who was given prescriptions for pain medication before wound care Complex dressing changes for a sacral wound for a client with type 2 diabetes who was given prescriptions for pain medication before wound care would be assigned to the LPN/LVN. LPN/LVN education and scope of practice include working within practice parameters to administer pain medication and to perform dressing changes.Assessments and client education are not within the LPN/LVN scope of practice.

A patient has a prescription for a sulfa drug as treatment for a urinary tract infection. She is also taking an oral contraceptive, an oral sulfonylurea antidiabetic drug, and phenytoin for a history of seizures. Which drug may pose a potential serious interaction with the sulfa drug? A.The oral contraceptive B.The oral antidiabetic drug C.The phenytoin D.All of these

D. All of these Rationale: The combination of the sulfa drug with the oral contraceptive may reduce the effectiveness of the contraceptive. The combination with the oral antidiabetic drug may potentiate the hypoglycemic effect of the sulfonylurea drug, while the combination with the phenytoin may potentiate the toxic effects of the phenytoin.

A 58-year-old man is receiving vancomycin as part of the treatment for a severe bone infection. After the infusion, he begins to experience some itching and flushing of the neck, face, and upper body. He reports no chills or difficulty breathing. The nurse should suspect: A.an allergic reaction has occurred. B.an anaphylactic reaction is about to occur. C.the medication will not be effective for the bone infection. D.the IV dose may have infused too quickly.

D. the IV dose may have infused too quickly. Rationale: These symptoms are know as red man syndrome and may occur during or after an infusion of vancomycin. This syndrome is characterized by flushing and/or itching of the head, face, neck, and upper trunk area. Symptoms can usually be alleviated by slowing the rate of infusion to at least 1 hour. Red man syndrome is bothersome but usually not harmful. Rapid infusions may also cause hypotension.

A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response? A."One antibiotic is not strong enough to fight the infection." B."We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms." C."We can give a reduced amount of each one if we give them together." D."The combined effect to both antibiotics is greater than each of them alone."

D."The combined effect to both antibiotics is greater than each of them alone."

The nurse is reviewing the sputum culture results of a patient with pneumonia and notes that the patient has a gram-positive infection. Which generation of cephalosporin is most appropriate for this type of infection? A.Second-generation B.Fourth-generation C.Third-generation D.First-generation

D.First-generation

The nurse checks the patient's laboratory work prior to administering a dose of vancomycin (Vancocin) and finds that the trough vancomycin level is 24 mcg/mL. What will the nurse do next? A.Repeat the test to verify results. B.Administer the vancomycin C.Hold the drug, and administer 4 hours later. D.Hold the drug, and notify the prescriber.

D.Hold the drug, and notify the prescriber.

The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration? A.Restricting fluids during vancomycin therapy B.Discontinuing the drug immediately if red man syndrome occurs C.Monitoring blood pressure for hypertension during the infusion D.Infusing the drug over at least 1 hour

D.Infusing the drug over at least 1 hour

A patient has a urinary tract infection. The nurse knows that which class of drugs is especially useful for such infections? A.Tetracyclines B.Macrolides C.Carbapenems D.Sulfonamides

D.Sulfonamides

A 79-year-old patient is receiving a quinolone as treatment for a complicated incision infection. The nurse will monitor for which adverse effect that is associated with these drugs? A.Neuralgia B.Double vision C.Hypotension D.Tendonitis and tendon rupture

D.Tendonitis and tendon rupture

The nurse will question the use of a floroquinolone antibiotic in a patient already prescribed which medication? A.omeprazole B.metoprolol C.furosemide D.amiodarone

D.amiodarone

A patient has been diagnosed with Klebsiella pneumoniae carbapenemases (KPC). The nurse expects to see orders for which drug? A.linezolid (Zyvox), an oxazolidinone B.dapsone (Cubicin), a miscellaneous antibiotic C.ciprofloxacin (Cipro), a quinolone D.colistimethate sodium (Coly-Mycin), a polypeptide antibiotic

D.colistimethate sodium (Coly-Mycin), a polypeptide antibiotic

Aseptic Technique

Effort to keep the patient as free from exposure to infection causing pathogens as possible

A client diagnosed with urge incontinence is started on tolterodine (Detrol). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? Select all that apply. Take the drug at bedtime. Encourage increased fluids. Increase fiber intake. Limit the intake of dairy products. Use hard candy for dry mouth.

Encourage increased fluids. Increase fiber intake. Use hard candy for dry mouth

The nurse is establishing a plan of care for a hospitalized client with chronic pain caused by fibromyalgia. Which nursing action does the nurse delegate to a nursing assistant? Application of a transcutaneous electrical nerve stimulation (TENS) device Education about nonpharmacologic interventions for pain control Referral to available community resources for pain management Engagement in conversation about the client's family to distract the client

Engagement in conversation about the client's family to distract the client

Which statement about the transmission of hepatitis C is correct? Feces are a likely body fluid by which to transmit the disease. Airborne Precautions are used for the prevention of hepatitis C. Equipment or linen soiled with blood or body fluids should be washed with bleach or a disinfectant to prevent infection. No precautions are necessary with the use of nail clippers or scissors.

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. Washing with bleach or a disinfectant will help prevent the spread of infection.Feces are not a likely source of transmission of hepatitis C. The hepatitis C virus is not airborne, so Airborne Precautions are not necessary. Hepatitis C can be spread by contact with contaminated items, such as clippers or scissors, so these items should be disinfected regularly.

The nurse is caring for a client who had a fractured ankle repaired. Twenty minutes after receiving 1.5 mg of hydromorphone (Dilaudid) IV push, the client is slow to respond and has constricted pupils and a respiratory rate of 6 breaths/min. What action does the nurse take initially? Calls the care provider for a change in the medication order Changes the order to every 6 hours rather than every 4 hours Gives the client a dose of naloxone (Narcan) 0.4 mg IV Performs a cognitive assessment on the client

Gives the client a dose of naloxone (Narcan) 0.4 mg IV

A client with cancer who is taking pain medication states, "I am still having pain." During the assessment, the client does not exhibit any physical manifestations of pain. What does the nurse do next? Decreases the client's standard pain medication dose Gives the client a placebo and monitors the outcome Gives the pain medication as requested Withholds the pain medication

Gives the pain medication as requested

A patient is in contact isolation for a bacterial infection. The nurse is going to implement which of the following interventions for this patient? Prevent all visitors from entering the room at any time during hospitalization. Use personal protective equipment only when knowingly coming into contact with pathogens. Help to ensure adequate social interaction and support. Communicate with the patient over the call light whenever possible.

Help to ensure adequate social interaction and support. Frequently, patients in contact isolation do experience a decrease in social interaction because of the isolation. The nurse must help provide adequate social stimulation for the patient. Frequently, this is done by educating the family and friends regarding isolation practices. Isolation does not mean that the patient cannot have visitors. Visitors must be educated on how to maintain the contact isolation while with the patient, especially hygiene guidelines. Personal protective equipment must be used when entering the room of a patient in contact isolation. Nurses and visitors do not always know when they will come into contact with a pathogen, especially if it is highly virulent. The patient in contact isolation should have regular face-to-face contact with the nurse. The nurse should not use the call light system to communicate with a patient in isolation any more than any other patient.

A hospitalized client expresses satisfaction after using a recommended complementary and alternative medicine (CAM) therapy, saying that pain was diminished and anxiety reduced. Which CAM did the client most likely use? Herbs Homeopathy Imagery Tai chi

Imagery The CAM most likely used was imagery. Imagery is often used for reducing pain, nausea and vomiting, and anxiety.Certain CAM therapies are not typically used for pain control. Herbs are typically used as a means to promote health, prevent disease, or cure a variety of ailments. Homeopathic medicine uses small doses of specially prepared plant extracts and minerals to promote healing. Tai chi integrates body movements, mind concentration, muscle relaxation, and breathing to achieve a desired outcome.

Individual Risk Factors

Immunodeficiency Compromised host -Being very young or elderly - May develop as genetic factors, malnutrition, preexisting infection with other pathogen, acute or chronic psychological or environmental stress, use of medications Chronic Disease Compromised host -Disease such as diabetes mellitus, inflammatory disorders, cancers, and hepatic or respiratory disorders - Pathologic changes within these body system may alter the structural integrity of the system and create and environment conductive to infection Environmental Conditions - Exposure to unsafe sanitary conditions make individual vulnerable to multitude of pathogens Crowded living conditions increase spread of disease, presence or absence of clean food and water

Which statement accurately describes the method of action of quinolones?

Interruption of bacterial DNA replication

Differential count

Measures the percentage of each type of leukocyte present in the specimen

A 65-year-old woman has fallen while sweeping her driveway, sustaining a tissue injury. She describes her condition as an aching, throbbing back. Which type of pain are these complaints most indicative of? Neuropathic pain Nociceptive pain Chronic pain Mixed pain syndrome

Nociceptive pain

Which nursing activity illustrates proper aseptic technique during catheter care? Applying Betadine ointment to the perineal area after catheterization Irrigating the catheter daily Positioning the collection bag below the height of the bladder Sending a urine specimen to the laboratory for testing

Positioning the collection bag below the height of the bladder

A patient is receiving imipenem/cilastatin (Primaxin) and asks the nurse, "Why does that medicine bag have two names listed? Am I receiving two drugs?" What is the best explanation for the patient?

Primaxin does contain 2 drugs, but one of the drugs (cilastin) works to prevent the antibiotic (imipinem) from being destroyed by bacterial enzymes that can make the antibiotic ineffective.

What will prevent the spread of infection when a child with respiratory syncytial virus​ (RSV) is admitted to a care​ area?

Prohibit contact between clients with and without RSV

During change-of-shift report, the day shift staff learns that a client who had back surgery has been reporting increasing lower back pain during the night. It is most appropriate for which day staff member to assess the client's pain? LPN/LVN who is responsible for administering medications to the client RN nurse manager who is in charge of coordinating care for several units RN team leader who is responsible for updating the care plan for the client RN who has floated to the unit from the emergency department

RN team leader who is responsible for updating the care plan for the client The RN team leader who is responsible for updating the client's care plan would assess this client's level of pain and the need for a change in the plan of care.The LPN/LVN will assist with management of the client's pain, but assessment would be done by the RN. The RN nurse manager has the education and scope of practice to assess the client's pain, but providing direct client care is not the designated role for this nurse. The RN from the emergency department will not be familiar with assessments and interventions for postoperative back pain.

A postoperative client is receiving epidural analgesia and reports itching. What does the nurse do next? Reduces the analgesic dose Gives diphenhydramine (Benadryl) Gives an antiemetic Calls the surgeon

Reduces the analgesic dose The next action taken by the nurse is to reduce the analgesic dose. Pruritus (itching) is a common side effect of epidural opioids and is first treated by reducing the analgesic dose.Because epidural-induced pruritus does not appear to be caused by histamine release, diphenhydramine (Benadryl) may not be effective in relieving itching and may work only via its sedating effects. Antiemetics are given to relieve nausea and vomiting. If a health care provider needs to be called, it would be the anesthesiologist, not the surgeon.

Which information does the nurse include when teaching a client about antibiotic therapy for infection? Take all antibiotics as prescribed, unless side effects develop. Take antibiotics until symptoms subside, and then stop taking the drugs. Take antibiotics when symptoms of infection develop. Share antibiotics with family members who develop the same infection.

Take all antibiotics as prescribed, unless side effects develop. Antibiotics should be taken as prescribed until they are gone. Teach the client about possible side effects and allergic manifestations. The provider must be contacted immediately if any side effects develop.Antibiotics must be taken until they are gone, even if the client feels better or when symptoms of infection appear. They should be taken only by the person for whom they are prescribed and not shared with anyone else.

The mother of a​ 2-year-old child with bronchiolitis caused by respiratory syncytial virus​ (RSV) asks why the child has been coughing so much. Which response by the nurse is the most​ appropriate?

The virus causes cellular debris that creates large amounts of mucus that stimulate the cough reflex."

Which clients with an indwelling urinary catheter does the nurse reassess to determine whether the catheterization needs to be continued or can be discontinued? Select all that apply. Three-day postoperative client client in the step-down unit Comatose client with careful monitoring of intake and output (I&O) Incontinent client with perineal skin breakdown Incontinent older adult in long-term care

Three-day postoperative client client in the step-down unit Incontinent older adult in long-term care

A 32-year-old female with a urinary tract infection (UTI) reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100°F (37.8°C). Which drug does the primary health care provider prescribe? Nitrofurantoin (Macrodantin) after intercourse Estrogen (Premarin) Trimethoprim/sulfamethoxazole (Bactrim) Phenazopyridine (Pyridium) with intercourse

Trimethoprim/sulfamethoxazole (Bactrim) The primary health care provider prescribes trimethoprim/sulfamethoxazole to a 32-year-old woman with a UTI who reports urinary frequency, urgency, and some discomfort upon urination. Guidelines indicate that a 3-day course of trimethoprim/sulfamethoxazole is effective in treating uncomplicated, community-acquired UTI in women.Drugs from the same class as nitrofurantoin reduce bacteria in the urinary tract by inhibiting bacterial reproduction (bacteriostatic action). This client needs a drug that will kill bacteria. Estrogen cream may help prevent recurrent UTIs in postmenopausal women, which this client is not (at age 32). Use of Premarin is related to problems with incontinence. Phenazopyridine (Pyridium) is not used to treat infection, but symptoms of a UTI.

3A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (unlicensed assistive personnel [UAP])? Assisting the client in developing a schedule for when to take prescribed antibiotics Inserting a straight catheter as necessary if the client is unable to empty the bladder Teaching the client how to use the Credé maneuver to empty the bladder more fully Using a bladder scanner (with training) to check residual bladder volume after the client voids

Using a bladder scanner (with training) to check residual bladder volume after the client voids

feed upright, breastfeed, avoid smoking and air pollution, use small day cares, immunizations up to date, use of pacifiers

What PT teaching should you give to parents of new borns to prevent otitis media?

Sean is a 19 year old college freshman who has been diagnosed with gonorrhea. The provider has prescribed doxycycline therapy. During the nursing assessment, Sean discusses his diet, which includes "lots of meat, milk, and veggies." Sean also tells the nurse that he jogs frequently and is a member of the tennis team. a. In addition to instruction about sexually transmitted infections, what patient teaching about the medication does Shaun require? b. A few days later, Sean calls and complains of an upset stomach and diarrhea. What does the nurse suspect might be wrong with Sean?

a. Sean must not take doxycycline with milk because that can result in a significant reduction in the absorption of the drug. He needs to be aware that tetracyclines can cause photosensitivity; he needs to avoid direct exposure to sunlight and use sunscreen or protective clothing. b. The diarrhea is probably the result of alteration of the intestinal flora caused by the drug therapy.

Which are manifestations of dehydration in a child with​ bronchiolitis?

delayed capillary​ refill, weak peripheral​ pulses, decreased urine output and dry sticky mucous membranes

The nurse is teaching the parents of a​ 3-year-old child with respiratory syncytial virus​ (RSV) on ways to help the child recover quickly from the disorder. What should the nurse include in this​ teaching?

encouraging the child to blow the nose to keep the airway clear. The parents should also provide frequent small meals so that the child does not become fatigued while eating. The child should be permitted to rest and nap as much as possible and the parents should wash their hands thoroughly after caring for the child. no visits whatsoever from friends (contagious)

Exotoxins

enzymes released by gram-positive bacteria into the host

WBC types:

-Neutrophils (55-70%) -Lymphocytes (20-40%) -Monocytes (2-8%) -Eosinophils -Basophils (0.5-1%)

Inflammation:

-Part of the body's response to a foreign antigen, with many of the symptoms of infection being those of the body's inflammatory response (redness, swelling, and pain).

Stress:

-Physical, emotional, or environmental—challenges the immune system and makes it more vulnerable to damage, less able to respond effectively and efficiently to pathogen invasion, and more difficult for the body to respond to treatment for an infection.

Methicillin resistant HAIs:

-Staphylococcus aureus (MRSA) -Clostridium difficile (C diff) -Vancomycin resistant Enterococci (VRE)

Septic Shock Characteristics

-Systemic vasodilation hypotension -Tachycardia -Vascular leakage & oedeme -Compromised nutrient blood flow to organs -Respiratory distress & multiple organ failure

Common Pathogens of Fungus:

-Tinea pedis -Candidiasis -Histoplasmosis -Lobomycosis -Cryptococcosis -Aspergillosis -Coccidioidomycosis

Pathogen Invasion

-When a pathogen invades the body, a number of immune system responses are initiated to minimize tissue and organ damage -B lymphocytes activated to differentiate into plasma cells for production of antibodies and memory cells -T lymphocytes directly kill invading organism -Macrophages and monocytes initiate phagocytosis -Complement system is activated to enhance the entire immune response and inflammatory response

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? Select all that apply. "Your urine will be strained after the procedure." "Be sure to finish all of your antibiotics." "Immediately call the primary health care provider if you notice bruising." "Remember to drink at least 3 liters of fluid a day to promote urine flow." "You will need to change the incisional dressing once a day."

"Your urine will be strained after the procedure." "Be sure to finish all of your antibiotics." "Remember to drink at least 3 liters of fluid a day to promote urine flow."

Medical Asepsis

(Clean technique) procedures to reduce the number of microorganisms and prevent the number of microorganisms from rising and prevent spread

After an infusion of colistimethate (Coly-Mycin), the nurse will report to the prescriber if the patient complains of which adverse effects? (Select all that apply.)

*Numbness *Vertigo *Upset stomach

What are some of the effects of infection on the body's defense system? A) Elevated temperature B) Elevated BP C) Bradycardia D) tachypnea

-A -B -D

Which of the following would be considered appropriate nursing diagnosis for a patient with infection? A) Risk for infection B) Imbalanced nutrition C) Acute infection D) Knowledge deficit

-A -B -D

Which of these patients have diseases that were caused from blood-borne pathogens? A) A male with Hepatitis C B) A female with C. Diff C) A male with HIV D) A female with Hepatitis B

-A -C -D

Agents

-Bactericidal Agent: attack & kill bacteria directly -Bacteriostatic Agent: Interfere with replication of pathogens -Antiviral Agents: Either kill viruses or suppress their replication, preventing their ability to multiply and reproduce -Antifungal Agents: kill fungal organisms

Immunity:

-Critical in providing a level of surveillance for early identification of pathogen entry into the body. -The immune system is the first line of defense against infection and the body's primary method of response to an invading organism.

Tissue Integrity:

-Critical to avoiding infection, with the skin being the largest component of the immune system.

Other types of infections

-Infection will develop that begins as one type and after an additional pathogen is introduced, a secondary infection occurs • Health care acquired infections are MRSA, C-Diff, vancomycin-resistant enterococci (VRE) • Some bacteria are part of the normal flora but can become pathogenic (Escherichia coli) *Some bacteria are always pathogenic, are never part of the normal flora, by may cause subclinical infection (mycobacterium tuberculosis)

Recommendations for infection control proposed by the CDC:

-Keep hands clean by washing thoroughly with soap and water (for at least 20 seconds) or using an alcohol-based hand rub (for at least 15 seconds; not as effective if hands are visibly dirty or greasy), keep cuts and scrapes clean and covered with a bandage until healed, avoid contact with other people's wounds and bandages, and refrain from sharing personal items such as towels or razors. -In athletic settings, participants should shower immediately after participation and before using whirlpools. Uniforms should be washed and dried after each use. In health care settings, prevention of infection requires following accepted principles of hand hygiene, Standard Precautions, and contact precautions. Visitors should follow hand hygiene principles and avoid touching wound dressings, catheters, or wound sites of an infected person.

Populations at Risk

-Linked to some population groups based on age, socioeconomic status, and geographic location • Uninsured or underinsured may be at risk for absent or insufficient preventive health care • Not all populations have resources available for screenings or treatments or vaccinations *Geographic locations worldwide prevalence disease and infection in specific age or ethnic groups

Nutrition:

-Maintaining adequate Nutrition and rest is also necessary for the body to respond to active infection treatment regimens and support the work of an immune response.

Infection control has been defined by the World Health Organization as:

-Measures aimed at the protection of those who might be vulnerable to acquiring an infection, including both individuals residing in the community and persons receiving care for health care problems within a wide variety of settings. -The basic tenant of infection control is identified as hygiene and encompasses such topics as patient safety, infection control and prevention in health care, injection safety, and food safety

Pathogen

-Microorganisms that cause human disease -Found on skin, mucous membranes, linings of respiratory tract, gastrointestinal tract, urinary tract, mouth & eyes

National Institute of Allergy and Infectious Diseases (NIAID)

-NIAID issued a statement of concern about the increasingly difficult process of disease management given the microbial resistance that has emerged against some of the most powerful antimicrobials. -NIAID particularly expressed concern related to treating staphylococcal infection, tuberculosis, influenza, gonorrhea, Candida infection, and malaria

Systemic Inflammatory Response Syndrome (SIRS)

-This term describes the clinical manifestations that result from the systemic response to infection. -Criteria for SIRS are considered to be met if at least 2 out of 4 clinical findings are present... 1. Temp: greater than 100.4 or less than 96.8 2. HR greater than 90bpm 3. RR greater than 20 breaths/min. Or arterial carbon dioxide tension (PaCO2) lower than 32mmHg 4. WBC count higher than 12,000 or lower than 4,000

Viral Infection

-nucleic acid within a protein shell Requires invasion of a host for replication -Can cause immediately disease or may remain relatively dormant for years -Cause cellular injury by blocking its genetically prescribed protein synthesis processes and using the cell's metabolic process for the reproduction

Bacterial Infection

-one cell organisms without a true nucleus or cellular organelles -Synthesizes: DNA, RNA, proteins -Require a host for suitable environment to multiply -Cause cellular injury by releasing toxins. (exotoxins or endotoxins)

Which are examples of actively acquired specific immunity? Select all that apply. 1 Recovery from measles 2 Recovery from chickenpox 3 Maternal immunoglobulin in the neonate 4 Immunization with live or killed vaccines 5 Injection of human gamma immunoglobulin

1, 2, 4 Naturally acquired active-type immunity is seen in a client who has recovered from measles or chickenpox or who has been immunized with a live- or killed-virus vaccine. Maternal immunoglobulin in a neonate and an injection of human gamma immunoglobulin into a client are examples of passively acquired specific immunity.

A client with tuberculosis is prescribed rifampin. What does the nurse teach the client about this medication? Select all that apply. 1 "Avoid drinking alcohol while you are on this drug." 2 "Report immediately if you find a yellow appearance to the skin." 3 "Wear a protective clothing and sunscreen when going out in sunlight." 4 "Your soft contact lenses will become permanently stained with this drug." 5 "Immediately consult your physician if you find reddish orange tinge in your urine."

1, 2, 4 Rifampin is an antitubercular drug that kills slow-growing organisms residing in the caseating granulomas. Rifampin may cause liver damage, so alcohol should be avoided as it potentiates liver damage. Yellow appearance to the skin is a sign of liver failure. Therefore, a client on rifampin therapy is taught to report the presence of any yellowing of the skin. Rifampin permanently stains soft contact lenses and therefore the client is made aware to avoid wearing them while on the medication. Pyrazinamide causes photosensitivity reactions and therefore a client on that drug therapy is advised to wear protective clothing and sunscreen when going outdoors. The nurse should inform the client that rifampin changes the color of body secretions, which is normal and harmless.

67. The nurse is preparing a client diagnosed with rule-out meningitis for a lumbar puncture. Which interventions should the nurse implement? Select all that apply. 1. Obtain an informed consent from the client or significant other. 2. Have the client empty the bladder prior to the procedure. 3. Place the client in a side-lying position with the back arched. 4. Instruct the client to breathe rapidly and deeply during the procedure. 5. Explain to the client what to expect during the procedure.

1. A lumbar puncture is an invasive procedure; therefore, an informed consent is required. 2. This could be offered for client comfort during the procedure. 3. This position increases the space between the vertebrae, which allows the HCP easier entry into the spinal column. 5. The nurse should always explain to the client what is happening prior to and during a procedure.

68. The nurse is caring for a client diagnosed with meningitis. Which collaborative intervention should be included in the plan of care? 1. Administer antibiotics. 2. Obtain a sputum culture. 3. Monitor the pulse oximeter. 4. Assess intake and output.

1. A nurse administering antibiotics is a collaborative intervention because the HCP must write an order for the intervention; nurses cannot prescribe medications unless they have additional education and licensure and are nurse practitioners with prescriptive authority.

6 elements for the process of infection

1. Pathogen 2. Susceptible host 3. Reservoir (where the pathogen live & multiply) 4. Portal of exit from reservoir (feces, urine, saliva, blood, skin, GI tract) 5. Mode of transmission 6. Portal of entry to the susceptible host (broken skin, sexual contact, mouth, respiratory tract, GI tract, contaminated food & water)

Successful prevention and treatment of infections must be tempered by the following facts:

1. Some community- or hospital-acquired bacterial infections are now difficult to treat because of emerging antibiotic resistance (e.g., MRSA and VRE) 2. prevalence of hospital-acquired infections is increasing in the form of both MRSA and C. diff. 3. tuberculosis remains one of the world's leading causes of death 4. foodborne and waterborne bacteria (Salmonella and Campylobacter) continue to cause debilitating diarrheal disease throughout the world

70. Which statement best describes the scientific rationale for alternating a nonnarcotic antipyretic and a nonsteroidal anti-inflammatory drug (NSAID) every two (2) hours to a female client diagnosed with bacterial meningitis? 1. This regimen helps to decrease the purulent exudate surrounding the meninges. 2. These medications will decrease intracranial pressure and brain metabolism. 3. These medications will increase the client's memory and orientation. 4. This will help prevent a yeast infection secondary to antibiotic therapy.

2. Fever increases cerebral metabolism and intracranial pressure. Therefore, measures are taken to reduce body temperature as soon as possible, and alternating Tylenol and Motrin would be appropriate.

A patient is to receive 2 million units of penicillin G potassium per day, every 6 hours in IV piggyback doses. The medication is available in vials of 1 million units/50 mL, and each dose needs to be mixed in 50 mL of D5W. How many milliliters will the nurse draw up for each IV piggyback dose?

25 mL per dose. Each dose will contain 500,000 units (every 6 hours will be 4 doses per day; divide 2 million units per day by 4 to get 500,000 units per dose.)

The nurse is caring for four clients in the medical unit. Which nursing instruction indicates a need for correction? 1 Client A Abnormal vaginal bleeding. Avoid super absorbent tampons 2 Client B Diarrhea. Wash hands frequently 3 Client C AIDS. Never share your eating utensils. 4 Client D Tuberculosis. Wear a mask during transport to other areas.

3 Client C Human immunodeficiency virus leads to acquired immunodeficiency syndrome. The virus in client C cannot be transmitted through sharing eating utensils, hugging, dry kissing, shaking hands, and using toilet seats. The nurse should advise client A to use sanitary pads rather than superabsorbent tampons to prevent toxic shock syndrome due to Staphylococcus aureus infection. Client B with diarrhea should wash hands frequently to reduce the transmission of the disease. The nurse should advise client D with tuberculosis to wear a mask to prevent the transmission of Mycobacterium tuberculosis from small droplets when being transported.

When assessing the oral cavity of a newly admitted client with acquired immunodeficiency syndrome (AIDS), the nurse identifies areas of white plaque on the client's tongue and palate. What is the nurse's initial response? 1 Instruct the client to perform meticulous oral hygiene at least once daily. 2 Scrape an area of one of the lesions and send the specimen for a biopsy. 3 Document the presence of the lesions, describing their size, location, and color. 4 Consider that these lesions are universally found in clients with AIDS and require no treatment.

3 Documentation of nursing findings during assessment is a nursing function; this facilitates early treatment. Scraping an area of one of the lesions and sending the specimen for a biopsy medical intervention is beyond the scope of nursing practice. Inadequate oral hygiene has not been identified as a cause of plaques; once-daily treatment is insufficient for anyone. Candida is a frequent secondary infection in clients with AIDS; it is treated when present.

A client reports neck stiffness, severe headache, and a decreased level of consciousness. What condition does the nurse suspect? 1 Encephalitis 2 Brain abscess 3 Viral meningitis 4 Bacterial meningitis

4 Bacterial meningitis is caused by a bacterium such as Streptococcus pneumonia. Fever, severe headache, neck stiffness, photophobia, and decreased levels of consciousness are symptoms that indicate bacterial meningitis. Encephalitis is the acute inflammation of brain. Nausea and vomiting are symptoms of encephalitis. Headache, fever, nausea, and vomiting are the symptoms of brain abscess. Headache, fever, and photophobia are the symptoms of viral meningitis.

A male client with small overgrowths on the skin in the cervical region arrives at the hospital. The laboratory report reveals the presence of human papillomavirus type 16. Which condition is associated with this virus? 1 Balanitis 2 Prosthitis 3 Genital warts 4 Penile carcinoma

4 Human papillomavirus type 16 is commonly associated with penile carcinoma. Uncircumcised males may be at higher risk for infections such as balanitis and prosthitis. Human papillomavirus types 11 and 6 are commonly associated with genital warts.

A primary healthcare provider diagnoses late-stage (tertiary) syphilis in a client. Which statement made by the client supports this diagnosis? 1 "I noticed a wart on my penis." 2 "I have sores all over my mouth." 3 "I've been having a sore throat lately." 4 "I'm having trouble keeping my balance."

4 Neurotoxicity, as manifested by ataxia (balance problems), is evidence of tertiary syphilis, which may involve the central nervous system (CNS) or cardiovascular system. A wart on the penis occurs in the secondary stage of syphilis. Sores all over the mouth occur in the first and secondary stage of syphilis. Sore throat with flulike symptoms occurs in the secondary stage of syphilis.

The nurse is concerned that a​ 9-month-old child being treated for bronchiolitis caused by respiratory syncytial virus​ (RSV) is developing respiratory distress. Which assessment findings support this​ concern?

Manifestations of the increased work of breathing include​ grunting, retractions, and rapid respiratory rate

Exogenous Infection

Microorganisms found outside the individual and don't exist as normal flora

Bacteria that is always pathogenic, never part of Normal Flora, & may cause subclinical infection:

Mycobacterium tuberculosis

Urosepsis or Bacteremia

Spread of bacteria to the bloodstream

Pyelonephritis

Spread of bacteria to the kidney

Bacteria that is part of Normal Flora, but can cause infection if deep tissue is reached:

Staphylococcus epidermidis

Nutritional and dietary care Respiratory care Stoma and pouch care Wiping from front to back (asepsis)

Stoma and pouch care

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 before jogging 2 miles daily Taking the antibiotic most days Taking the antibiotic as prescribed Taking the antibiotic with a full glass of water

Taking the antibiotic most days

Culture & Sensitivity:

Test is done to identify the invading pathogen and to determine the antimicrobial most likely to be effective in treatment

Sepsis Severe Sepsis Septic Shock

The Systemic inflammatory response to infection Organ dysfunction secondary to sepsis. Hypotension secondary to sepsis that is resistant to adequate fluid administration & associated with hypoperfusion

The nurse manager on the surgical unit is making assignments for the day. Who is assigned to check and program the patient-controlled analgesia (PCA) pumps on the unit? A pharmacy technician One registered nurse (RN) and a licensed practical/vocational nurse (OPN/LVN)(LPN/LVN) One registered nurse (RN) and a certified nursing assistant (CNA) Two registered nurses (RNs)

Two registered nurses (RNs) To prevent drug errors, it is recommended that two RNs program the dosing parameters into the PCA delivery device to prevent drug errors.A pharmacy technician, a licensed practical/vocational nurse, or a CNA would not be authorized or credentialed to perform this task.

Infection

invasion & multiplication of microorganisms in body tissues which may be unapparent or the result of local cellular injury caused by competitive metabolism, toxins, intracellular replication, or antigen-antibody response.

A postoperative client is requesting medication for pain every 4 hours. In planning effective pain management, what assessment question does the nurse ask the client before administering the medication? "Are you bleeding?" "Are you able to last more than 4 hours?" "Is your pain controlled between doses?" "What do you do for pain when you're at home?"

"Is your pain controlled between doses?"

A patient is to receive medication through a feeding tube. The order reads, "Give amoxicillin 250 mg per feeding tube every 8 hours." When reconstituted, the concentration of the medication is 125 mg/5 mL. How many milliliters will the nurse give per dose?

10 mL

63. The nurse is assessing the client diagnosed with bacterial meningitis. Which clinical manifestations would support the diagnosis of bacterial meningitis? 1. Positive Babinski's sign and peripheral paresthesia. 2. Negative Chvostek's sign and facial tingling. 3. Positive Kernig's sign and nuchal rigidity. 4. Negative Trousseau's sign and nystagmus.

3. A positive Kernig's sign (client unable to extend leg when lying flat) and nuchal rigidity (stiff neck) are signs of bacterial meningitis, occurring because the meninges surrounding the brain and spinal column are irritated.

Which of the following would be considered appropriate nursing diagnosis for a patient with infection? A) Risk for infection B) Imbalanced nutrition C) Acute infection D) Knowledge deficit

A,B, and D

MRSA- methicillin resistant staph aureas

Caused by a strain of staph bacteria resistant to antibiotics used to treat common staph

The nurse provides teaching to the parents of a child with bronchiolitis about care needed at home. Which statement by the parents indicates instructions have been​ effective?

Give extra fluids -keeps the secretions thin and easier to remove thru coughing or suctioning -prevent dehydration

Iatrogenic Infection

HAI caused by an invasive diagnostic or therapeutic procedure

Chronic Otitis

If a pt has eustachian dysfunction and has a perforated tympanic membrane what will they most likely have?

A hospitalized client anticipates a daily painful dressing change. Which complementary and alternative medicine therapy might the nurse offer before the procedure? Animal-assisted therapy Hydrotherapy Imagery Acupuncture

Imagery

Multisystem Failure

Inadequate tissue perfusion, over extended compensatory mechanisms, and host cell damage will result in irreversible organ failure and death of the host

Endogenous Infection

Occurs when part of the pts flora becomes altered and over growth results

A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? Select all that apply. "Be certain to wear sunscreen and protective clothing." "Drink at least 3 liters of fluids every day." "Take this drug with 8 ounces (236 ml) of water." "Try to urinate frequently to keep your bladder empty." "You will need to take all of this drug to get the benefits."

"Be certain to wear sunscreen and protective clothing." "Drink at least 3 liters of fluids every day." "Take this drug with 8 ounces (236 ml) of water." "You will need to take all of this drug to get the benefits."

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for post procedure home care? "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." "Do not share your toilet with family members for the next 24 hours." "Please be sure to stand when you are urinating." "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

"Do not share your toilet with family members for the next 24 hours."

"A small-lumen catheter will help prevent injury to my urethra." "I will use a new, sterile catheter each time I do the procedure." "My family members can be taught to help me if I need it." "Proper handwashing before I start the procedure is very important."

"I will use a new, sterile catheter each time I do the procedure."

In the role of client advocate, what does the nurse do first for a client who reports pain? Administers pain medication Assesses the level of pain Believes the client's report of pain Calls the provider for a medication order

Believes the client's report of pain

The nurse is teaching a class of junior high school students about infection control through effective hand washing. Which statement made by a student indicates the need for further teaching? "Hand sanitizer works just as well as washing with soap and water." "If I sing the song "Happy Birthday" twice through while scrubbing my hands, that should be long enough." "I need to read the label on the hand sanitizer to be sure that it's at least 60% alcohol." "We should all wash our hands before eating lunch every day."

"Hand sanitizer works just as well as washing with soap and water." Hand sanitizer does not work as well as soap and water, because it is not effective against all pathogens or in all situations. For example, hand sanitizer should not be used when hands are visibly dirty. Repeating the song "Happy Birthday" twice takes about 20 seconds, which is how long hands should be rubbed together with soap. Hand sanitizer needs to be at least 60% alcohol to be effective. Hand washing before eating is recommended by the Centers for Disease Control.

A patient is being prepared for colon surgery and will be receiving neomycin tablets during the day before surgery. He asks the nurse why he needs to take this medicine before he even has surgery. What is the nurse's best response?

"It helps to reduce the number of bacteria in your intestines before surgery."

A client who is using patient-controlled analgesia (PCA) is asleep. The nurse observes a family member pushing the PCA button for the sleeping client. What does the nurse say to the visitor? "Please allow the client to push the button when needed." "Please don't touch any equipment in the client's room." "Thank you. I am sure the client appreciated that." "The client is asleep and is not in pain."

"Please allow the client to push the button when needed."

A client being discharged after hip replacement says, "I am going to use hypnosis instead of medication to manage my pain. I believe in mind over body." How does the nurse respond? "I will discuss cancelling your medication order with your provider." "That sounds like a great plan; can you tell me more about it?" "That sounds like a wonderful idea; and I think it will definitely work!" "Your plan will not work; people with your type of pain need narcotics."

"That sounds like a great plan; can you tell me more about it?"

When asked about drug allergies, a patient says, " I can't take sulfa drugs because I'm allergic to them." Which question will the nurse ask next?

"What happened when you took the sulfa drug?"

The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection (UTI). What does the nurse instruct the client to do? "Douche—but only once a month." "Use only white toilet paper." "Wipe from front to back." "Wipe with the softest toilet paper available."

"Wipe from front to back."

The nurse is reviewing the list of medications for a patient who will be starting antibiotic therapy with an aminoglycoside. Which medication, if present, may present a potential interaction with the aminoglycoside? (Select all that apply.)

*Furosemide (Lasix), a loop diuretic *Warfarin (Coumadin), an oral anticoagulant *Vancomycin (Vancocin), an antibiotic

A patient who is receiving Vancomycin (Vancocin) therapy needs to notify the nurse immediately if which effects are noted? (Select all that apply.)

*Ringing in the ears *Dizziness *Hearing loss

During a class on health care associated infections, the nurse shares several facts about these infections. Which statements about health care associated infections are true? (Select ALL that apply)

*They are contracted in a hospital or institution. *They are more difficult to treat. *The organisms that cause these infections are more virulent.

Common Pathogens of Bacteria:

-Methicillin-resistant Staphylococcus aureus -Clostridium difficile -Vancomycin-resistant Enterococci -Streptococcus pyogenes (group A) -Corynebacterium diphtheria -Escherichia coli -Mycobacterium tuberculosis -Pseudomonas aeruginosa -Neisseria gonorrhoeae -Clostridium tetani

Which of the following clinical manifestations does the nurse associate with rubeola? 1 Macular rash 2 Paroxysmal cough 3 Enlarged parotid glands 4 Generalized vesicular lesions

1 Rubeola (measles) starts with a discrete maculopapular rash on the face that spreads downward, eventually becoming confluent. A paroxysmal cough occurs with whooping cough. Enlarged parotid glands occur with mumps. Generalized vesicular lesions occur with chickenpox.

Septic shock mortality rate:

Approx. 25-50%

Which nursing diagnosis is appropriate for a patient who has started aminoglycoside therapy? A.Risk for injury (renal damage) B.Constipation C.Disturbed body image related to gynecomastia D.Imbalanced nutrition, less than body requirements, related to nausea

A.Risk for injury (renal damage)

A postoperative client reports, "I have pain from a mild headache." Which PRN medication does the nurse administer? Acetaminophen (Tylenol) Hydromorphone (Dilaudid) Midazolam (Versed) Oxycodone hydrochloride/acetaminophen (Tylox)

Acetaminophen (Tylenol)

A client with chronic pain feels no relief with high-dose opioids and says, "I just can't manage living right now." What intervention does the nurse anticipate the health care provider will order for this client? Adding acetaminophen (Tylenol) Adding duloxetine (Cymbalta) as adjuvant therapy Increasing the opioid dose to control the pain Replacing the opioid with desipramine (Norpramin) for depression

Adding duloxetine (Cymbalta) as adjuvant therapy

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? Administer morphine sulfate 4 mg IV. Begin an infusion of metoclopramide (Reglan) 10 mg IV. Obtain a urine specimen for urinalysis. Start an infusion of 0.9% normal saline at 100 mL/hr.

Administer morphine sulfate 4 mg IV.

1928

Alexander Flemming discovered Penicillin

Which is not a factor effecting susceptibility? A) Infants immature immune system B) What school the patient attended C) Males with enlarged prostate D) A blood pressure of 122/60

B and D

When planning care for a patient receiving once-daily intravenous gentamicin therapy, the nurse schedules a trough drug level to be drawn A.18 hours after completing the antibiotic infusion. B.12 hours after completing the antibiotic infusion. C.60 minutes after beginning the antibiotic infusion. D.30 minutes after beginning the antibiotic infusion.

B.12 hours after completing the antibiotic infusion.

The nurse is preparing to use an antiseptic. Which statement is correct regarding how antiseptics differ from disinfectants? A.Antiseptics are used only on living tissue to kill microoranisms. B.Disinfectants are used only on nonliving objects to destroy organisms. C.Disinfectants are used as preoperative skin preparation. D.Antiseptics are used to sterilize surgical equipment.

B.Disinfectants are used only on nonliving objects to destroy organisms.

A patient is receiving his third intravenous dose of a penicillin drug. He calls the nurse to report that he is feeling "anxious" and is having trouble breathing. What will the nurse do first? A.Check for allergies. B.Stop the antibiotic infusion. C.Notify the prescriber. D.Take the patient's vital signs.

B.Stop the antibiotic infusion.

When reviewing the allergy history of a patient, the nurse notes that the patient is allergic to penicillin. Based on this finding, the nurse would question an order for which class of antibiotics? A.Sufonamides B.Tetracyclines C.Quinolones D.Cephalosporins

D.Cephalosporins

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? Select all that apply. Dysuria Enuresis Frequency Nocturia Urgency Polyuria

Dysuria Frequency Nocturia Urgency

A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? Bladder training Credé method Habit training Kegel exercises

Habit training Habit training (scheduled toileting) will be most effective in reducing incontinence for a cognitively impaired client because the caregiver is responsible for helping the client to a toilet on a scheduled basis.Bladder training, the Credé method, and learning Kegel exercises require that the client be alert, cooperative, and able to assist with his or her own training.

Which statement about handwashing is in accordance with recommendations by the Centers for Disease Control and Prevention? If gloves are worn between treatments for clients sharing a room, handwashing is not necessary until the nurse has finished assessing the second client. Handwashing must be done after contact with the client's intact skin, such as when taking a pulse. Handwashing does not need to be done after resetting a client's IV pump. If the hands are not visibly soiled, washing the hands is not necessary.

Handwashing must be done after contact with the client's intact skin, such as when taking a pulse.

A postoperative client is vomiting and states, "I am having a lot of pain—about a 7 on a scale of 0 to 10." Which route of administration does the nurse choose to administer an analgesic to the client? Intravenous Oral Rectal Transdermal

Intravenous The intravenous route is the best choice for fast relief of nausea and pain.Oral pain medication may exacerbate the client's nausea and is not the best choice. The rectal route and the transdermal route are not the routes of choice for short-term pain control because their effect is not as rapid or controlled as that of other routes.

Chronic infection

Long term- lasting longer than 12 weeks -some cases noncurable

Most common & important exemplars of each body system:

Neurologic • Encephalitis • Meningitis Respiratory • Pneumonia • Respiratory syncytial virus Cardiovascular • Endocarditis • Myocarditis Eyes • Conjunctivitis Ears • Otitis media Skin • Cellulitis • Methicillin-resistant Staphylococcus aureus • Pressure ulcers Gastrointestinal • Clostridium difficile • Gastroenteritis • Hepatitis • Tapeworm Genitourinary • Cystitis • Pyelonephritis • Urinary tract infection Reproductive • Candida albicans • Chlamydia trachomatis • Group B Streptococci • Herpes simplex virus • Human papillomavirus • Neisseria gonorrhoeae Systemic • HIV • Measles • Mumps • Sepsis

Which statement is true about assessing pain in an older adult client? The nurse should assess for present and past pain. Older adults typically believe that expressing pain is acceptable. Older adults are at great risk for undertreated pain. Older adults usually believe that pain signifies a minor illness.

Older adults are at great risk for undertreated pain.

The nurse manager for an oncology unit is evaluating a newly hired staff nurse. Which action by the nurse is of greatest concern to the nurse manager? Asking a client with chest pain if the pain is sharp and stabbing Instructing a confused postoperative client about how to use patient-controlled analgesia Preparing to administer a placebo to a client with chronic back pain Requesting that a client with chronic pain describe the specific location of the pain

Preparing to administer a placebo to a client with chronic back pain The action by the newly hired staff nurse of greatest concern to the nurse manager is preparing to administer a placebo to a client with chronic back pain. Current national guidelines from regulatory agencies and nursing organizations indicate that placebos would never be used for clients who are experiencing pain

Which actions aid in the prevention and early detection of infection in a client at risk? Select all that apply. Inspect the skin for coolness and pallor. Promote sufficient nutritional intake. Encourage fluid intake, as appropriate. Monitor the red blood cell (RBC) count. Obtain cultures as needed. Remove unnecessary medical devices.

Promote sufficient nutritional intake. Obtain cultures as needed. Remove unnecessary medical devices. NOT ENCOURAGE MORE FLUIDS.. IT DOESN'T DIRECTION RELATE TO PREVENTION OR DETECTION OF INFECTION

A patient has been admitted to the unit with a stage IV pressure ulcer. After 2 days, the wound culture results come back positive for MRSA. The nurse knows that the drug of choice for the treatment of MRSA infection is which drug?

Vancomycin (Vancocin)

Vascular, Nervous System, Renal System & Respiratory Compensation

Vascular Compensation: - Permeability will increase and allow for the shift of fluid from the intravascular compartment to the extravascular/extracellular spaces in the tissues, leading to hypovolemia and hypotension Nervous System Compensation: - Compensate for the hypotension with peripheral vascular constriction and shunting of blood from nonessential to essential organs such as brain, heart and lungs Renal system Compensation: - Compensate by creating a vasodilatory response of the glomeruli in an attempt to maintain an internal degree of pressure to continue filtration Decreased urine output to retain cardiovascular volume Respiratory Compensation: - Compensate for inadequate tissue perfusion or hypoxemia by increasing the rate of respiration *****This process will be hampered by cardiovascular decompensation, leading to decreased cardiac output and fluid accumulation and pulmonary edema

​Four-year-old Grayson Mills has just been diagnosed with a mild case of bronchiolitis. What action should the nurse take to help Grayson at this​ time?

humidifier

Disseminated

spread of infection from an initial site to other areas of the body

The nurse is preparing a plan of care for an infant diagnosed with acute bronchiolitis due to respiratory syncytial virus​ (RSV). Which nursing diagnosis should the nurse select to guide this infant​'s ​care?

reduced activity tolerance

allergies, exposed pollution and tobacco, winter months, cleft lip, use of pacifiers, putting children to bed with bottle, enlarged adenoids, day care centers

risk factors for otitis media

Haemophilus Influenza B

what vaccine should children get to prevent ear infections?

Eighteen month old Jeremy Young is brought to the emergency department by his mother. After seeing​ Jeremy, the nurse suspects Jeremy has bronchiolitis. What manifestation did Jeremy demonstrate for the nurse to come to this​ conclusion?

wheezing

after conditions are observed for 48-72 hours

when should Acute Otitis be treated with Antibiotics?

The nurse is reviewing the drugs ordered for a patient. A drug interaction occurs between penicillins and which drugs? (Select all that apply.)

*Oral contraceptives *NSAIDs *Warfarin

64. The nurse is assessing the client diagnosed with meningococcal meningitis. Which assessment data would warrant notifying the HCP? 1. Purpuric lesions on the face. 2. Complaints of light hurting the eyes. 3. Dull, aching, frontal headache. 4. Not remembering the day of the week.

1. In clients with meningococcal meningitis, purpuric lesions over the face and extremity are the signs of a fulminating infection that can lead to death within a few hours.

A nurse is caring for a client with an infection caused by group A beta-hemolytic streptococci. The nurse should assess this client for responses associated with which illness? 1 Hepatitis A 2 Rheumatic fever 3 Spinal meningitis 4 Rheumatoid arthritis

2 Rheumatic fever Antibodies produced against group A beta-hemolytic streptococci sometimes interact with antigens in the heart's valves, causing damage and symptoms of rheumatic heart disease; early recognition and treatment of streptococcal infections have limited the occurrence of rheumatic heart disease. Hepatitis A, an inflammation of the liver, is caused by the hepatitis A virus (HAV), not by bacteria. The most common causes of meningitis, an infection of the membranes surrounding the brain and spinal cord, include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Rheumatoid arthritis is believed to be an autoimmune disorder; it is not caused by microorganisms.

66. The nurse is developing a plan of care for a client diagnosed with aseptic meningitis secondary to a brain tumor. Which nursing goal would be most appropriate for the client problem "altered cerebral tissue perfusion"? 1. The client will be able to complete activities of daily living. 2. The client will be protected from injury if seizure activity occurs. 3. The client will be afebrile for 48 hours prior to discharge. 4. The client will have elastic tissue turgor with ready recoil.

2. A client with a problem of altered cerebral tissue perfusion is at risk for seizure activity secondary to focal areas of cortical irritability; therefore, the client should be on seizure precautions.

69. The client is diagnosed with meningococcal meningitis. Which preventive measure would the nurse expect the health-care provider to order for the significant others in the home? 1. The Haemophilus influenzae vaccine. 2. Antimicrobial chemoprophylaxis. 3. A 10-day dose pack of corticosteroids. 4. A gamma globulin injection.

2. Chemoprophylaxis includes administering medication that will prevent infection or eradicate the bacteria and the development of symptoms in people who have been in close proximity to the client. Medications include rifampin (Rifadin), ciprofloxacin (Cipro), and ceftriaxone (Rocephin).

62. The public health nurse is giving a lecture on potential outbreaks of infectious meningitis. Which population is most at risk for an outbreak? 1. Clients recently discharged from the hospital. 2. Residents of a college dormitory. 3. Individuals who visit a third world country. 4. Employees in a high-rise office building.

2. Outbreaks of infectious meningitis are most likely to occur in dense community groups such as college campuses, jails, and military installations.

61. The wife of the client diagnosed with septic meningitis asks the nurse, "I am so scared. What is meningitis?" Which statement would be the most appropriate response by the nurse? 1. "There is bleeding into his brain causing irritation of the meninges." 2. "A virus has infected the brain and meninges, causing inflammation." 3. "This is a bacterial infection of the tissues that cover the brain and spinal cord." 4. "This is an inflammation of the brain parenchyma caused by a mosquito bite."

3. Septic meningitis refers to meningitis caused by bacteria; the most common form of bacterial meningitis is caused by the Neisseria meningitides bacteria.

65. Which type of precautions should the nurse implement for the client diagnosed with septic meningitis? 1. Standard Precautions. 2. Airborne Precautions. 3. Contact Precautions. 4. Droplet Precautions.

4. Droplet Precautions are respiratory precautions used for organisms that have a limited span of transmission. Precautions include staying at least four (4) feet away from the client or wearing a standard isolation mask and gloves when coming in close contact with the client. Clients are in isolation for 24 to 48 hours after initiation of antibiotics.

The nurse is teaching a class of junior high school students about infection control through effective hand washing. Which statement made by a student indicates the need for further teaching? A "Hand sanitizer works just as well as washing with soap and water." B "If I sing the song "Happy Birthday" twice through while scrubbing my hands, that should be long enough." C "I need to read the label on the hand sanitizer to be sure that it's at least 60% alcohol." D "We should all wash our hands before eating lunch every day."

A Hand sanitizer does not work as well as soap and water, because it is not effective against all pathogens or in all situations. For example, hand sanitizer should not be used when hands are visibly dirty. Repeating the song "Happy Birthday" twice takes about 20 seconds, which is how long hands should be rubbed together with soap. Hand sanitizer needs to be at least 60% alcohol to be effective. Hand washing before eating is recommended by the Centers for Disease Control.

Which client is at greatest risk for developing an infection? A 54-year-old man with hypertension A 17-year-old girl with a fractured tibia in a cast A 65-year-old woman who had coronary bypass surgery 4 days ago A 71-year-old man in a nursing home

A 65-year-old woman who had coronary bypass surgery 4 days ago Older clients such as the 65-year-old people with decreased vascularity to the integumentary system (from the bypass surgery) and compromised skin (surgical incision) are at risk for infection.No coexisting conditions are present for the client with hypertension to be at risk for infection. The 71-year-old client in a nursing home is not at highest risk because no coexisting conditions make this client most vulnerable to infection.

Acute Otitis media

A child comes in with an upper respiratory infection and is pulling on their ear what will they likely be diagnosed with next?

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? An experienced LPN/LVN who has worked on the medical unit for 10 years An RN with experience in the operating room who transferred a month ago to the medical unit A float RN with 7 years of experience on the inpatient oncology unit An RN who has worked mostly on the same-day surgery unit since graduating a year ago

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.LPN/LVNs do not have the scope of practice to provide care to this client. The RN with experience in the operating room or the RN who has worked mostly on the same-day surgery unit does not have the experience needed to care for an unstable client on an unfamiliar unit.

What are some of the effects of infection on the body's defense system? A) Elevated temperature B) Elevated BP C) Bradycardia D) tachypnea

A, B and D

What are some laboratory diagnostic tests that might be considered when treating a patient with infection? A) CBC B) WBC C) STD D)ERS

A,B and D

A client has meningitis following brain surgery. What comfort measures may the nurse delegate to the unlicensed assistive personnel (UAP)? (select all that apply) A. Applying a cool washcloth to the head B. Assisting the client to a position of comfort C. Keeping voices soft and soothing D. Maintaining low lighting in the room E. providing antipyretics for fever

A. Applying a cool washcloth to the head B. Assisting the client to a position of comfort C. Keeping voices soft and soothing D. Maintaining low lighting in the room Rationale: The client with meningitis often has high fever, pain, and some degree of confusion. Cool washcloths to the forehead are comforting and help with pain. Allowing the client to assume a position of comfort also helps manage pain. Keeping voices low and lights dimmed also helps convey caring in a nonthreatening manner. The nurse provides antipyretics for fever.

The nurse should observe a client with bacterial meningitis for A. Sensory deficits B. High blood pressure C. Hypothermia D. Muscle spasms

A. Sensory Deficits Rationale: Other general manifestations related to infection are also present, such as fever, tachycardia, headache, prostration, chills, fever, nausea, and vomiting. The client may be irritable at first, but as the infection progresses, the sensorium often becomes clouded, and coma may develop.

A patient who has undergone a lung transplant has contracted cytomegalovirus (CMV) retinitis. The nurse expects which drug to be ordered for this patient? a.Acyclovir (Zovirax) b.Ganciclovir (Cytovene) c.Ribavirin (Virazole) d.Amantadine (Symmetrel)

ANS: B Ganciclovir is indicated for the treatment of cytomegalovirus retinitis. Acyclovir is used for herpes simplex types 1 and 2, herpes zoster, and chickenpox; amantadine is used for influenza type A; and zanamivir is used for influenza types A and B.

A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse's best response to his request? a. "Now that you've had the flu, you will need a booster vaccination, not the antiviral drug." b. "We will need to do a blood test to verify that you actually have the flu." c. "Drug therapy should be started within 2 days of symptom onset, not 4 days." d. "We'll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective."

ANS: C These drugs need to be started within 2 days of influenza symptom onset; they can be used for prophylaxis and treatment of influenza. The other options are incorrect.

A patient who is diagnosed with shingles is taking topical acyclovir, and the nurse is providinginstructions about adverse effects. The nurse will discuss which adverse effects of topical acyclovir therapy? a.Insomnia and nervousness b.Temporary swelling and rash c.Burning when applied d.This medication has no adverse effects

ANS: C Transient burning may occur with topical application of acyclovir. The other options are incorrect.

A patient who is HIV- positive has been receiving medication therapy that includes zidovudine(Retrovir). However, the prescriber has decided to stop the zidovudine because of its dose-limiting adverse effect. Which of these conditions is the dose-limiting adverse effect of zidovudine therapy? a. Retinitis b. Renal toxicity c. Hepatoxicity d. Bone marrow suppression

ANS: D Bone marrow suppression is often the reason that a patient with HIV infection has to be switched to another anti-HIV drug such as didanosine. The two drugs can be taken together, cutting back on the dosages of both and thus decreasing the likelihood of toxicity. The other options are incorrect.

An infant has been hospitalized with a severe lung infection caused by the respiratory syncytial virus (RSV) and will be receiving medication via the inhalation route. The nurse expects which drug to be used? a.Acyclovir (Zovirax) b.Ganciclovir (Cytovene) c.Amantadine (Symmetrel) d.Ribavirin (Virazole)

ANS: D The inhalational form of ribavirin (Virazole) is used primarily in the treatment of hospitalized infants with severe lower respiratory tract infections caused by RSV. The other drugs listed arenot used for the treatment of RSV.

A nurse is assessing a postoperative patient who is complaining of the incision site being warm, red and tender to the touch. What does the nurse interpret from the assessment? A) Septicemia B) Local infection C) Healing process D) Systemic infection

B

Which of the following patients is at greatest risk for contracting a primary bacterial infection? A A patient with newly diagnosed diabetes mellitus B A patient whose lab results reveal leukopenia C A patient receiving broad-spectrum antibiotics D A patient following laparoscopic cholecystectomy

B The patient with a decrease in the number of white blood cells (leukopenia) is at greatest risk for contracting a primary infection because of a weakened primary defense system. A patient with a diagnosis of diabetes mellitus is at greater risk for infection than a patient who does not have the disease but does not have the greatest risk of the four patients described. The patient receiving broad-spectrum antibiotics already has an infection and is at risk for a secondary infection. The patient who has undergone a surgical procedure is at risk for a bacterial infection but does not have the greatest risk of the patients described. Laparoscopy minimizes invasion and tissue impairment.

Which information should the nurse include in discharge teaching for a client prescribed doxycycline (Vibramycin)? A) "Take the medication with milk to minimize gastrointestinal upset." B) "Apply sunscreen or wear protective clothing when outdoors." C) "Take the medication until you have no fever and feel better." D) "Keep the remainder of the medication in case of recurrence."

B) "Apply sunscreen or wear protective clothing when outdoors."

When administering a nonsteroidal antiinflammatory drug and a penicillin drug together, the displacement of the penicillin antibiotic from the protein-binding sites will result in which effect? A) Absence of free drug in the blood B) Increased free drug in blood C) Decreased free drug in blood D) No change in free drug in blood

B) Increased free drug in blood

The nurse is assessing the results of diagnostic tests on a client's cerebrospinal fluid (CSF). Which values and observations does the nurse correlate as most indicative of bacterial meningitis? (select all that apply.) A. Clear B. Cloudy C. Normal protein level D. Increased protein level E. Normal glucose level F. Decreased glucose level

B. Cloudy D. Increased protein level F. Decreased glucose level Rationale: Viral meningitis does not cause cloudiness or increased turbidity of CSF. Protein levels are slightly increased, and glucose levels are normal. In bacterial meningitis, the presence of bacteria and white blood cells causes the fluid to be cloudy.

A patient is in contact isolation for a bacterial infection. The nurse is going to implement which of the following interventions for this patient? A Prevent all visitors from entering the room at any time during hospitalization. B Use personal protective equipment only when knowingly coming into contact with pathogens. C Help to ensure adequate social interaction and support. D Communicate with the patient over the call light whenever possible

C Frequently, patients in contact isolation do experience a decrease in social interaction because of the isolation. The nurse must help provide adequate social stimulation for the patient. Frequently, this is done by educating the family and friends regarding isolation practices. Isolation does not mean that the patient cannot have visitors. Visitors must be educated on how to maintain the contact isolation while with the patient, especially hygiene guidelines. Personal protective equipment must be used when entering the room of a patient in contact isolation. Nurses and visitors do not always know when they will come into contact with a pathogen, especially if it is highly virulent. The patient in contact isolation should have regular face-to-face contact with the nurse. The nurse should not use the call light system to communicate with a patient in isolation any more than any other patient.

A client who is allergic to penicillin is at increased risk for an allergy to which drug? A) Erythromycin (E-mycin) B) Gentamicin (Garamycin) C) Cefazolin sodium (Ancef) D) Demeclocycline (Declomycin)

C) Cefazolin sodium (Ancef)

Which adverse effect can result if tetracycline is administered to children younger than 8 years of age? A) Delayed growth development B) Drug-induced neurotoxicity C) Permanent discoloration of the teeth D) Gastrointestinal (GI) and rectal bleeding

C) Permanent discoloration of the teeth

After patient teaching, the patient is able to verbalize that which occurrence can delay wound healing after surgery? A Adequate arterial blood flow to the wound B Supplemental oxygen therapy C A healthy diet D An increased hospital stay

D An increased hospital stay increases the risk for hospital-acquired infections, which can delay wound healing. Adequate arterial blood flow improves, rather than delays, wound healing. Supplemental oxygen can increase wound healing. A healthy diet is important to wound healing.

A 5-year-old boy with early flu symptoms is at school working with some math blocks. He sneezes into his hand and then continues working with his blocks. An unvaccinated teacher's helper cleans up the blocks when the child leaves them on the table. After touching the blocks, she rubs her nose with her hand. Which represents the most likely mode of transmission? A The 5-year-old boy B The unvaccinated teacher's helper C The hand-to-nose contact D The unwashed math block

D The boy has the flu and sneezes into his hand while at school. When he works with the math blocks, he leaves the flu virus on the toys. The teacher's helper picks up the virus with the blocks. When the parent touches her nose with her hand, the virus enters the susceptible host. The blocks act as the mode of transmission. The boy carries the pathogen, and his sneeze is the portal of exit. The teacher's helper is the susceptible host. The hand-to-nose contact is the portal of entry

A client prescribed azithromycin (Zithromax) expresses concern regarding GI upset that was experienced when previously prescribed an erythromycin antibiotic. What is the nurse's best response? A) "Take an over-the-counter antiemetic to lessen the nausea." B) "I will call the health care provider and request a different antibiotic." C) "Stop taking the drug if you experience heartburn and diarrhea." D) "This drug is like erythromycin with less gastrointestinal adverse effects."

D) "This drug is like erythromycin with less gastrointestinal adverse effects."

When planning care for a client receiving a sulfonamide antibiotic, it is important for the nurse to perform which intervention? A) Take the medication with dairy products such as milk or yogurt. B) Advise the client to report any tinnitus to the health care provider. C) Avoid direct sun exposure and tanning beds. D) Encourage fluid intake of 2000 to 3000 mL/day.

D) Encourage fluid intake of 2000 to 3000 mL/day.

A​ 3-year-old child is admitted in December with severe bronchiolitis. Which question should the nurse include when reviewing the child​'s health history with the​ parents?

Did the child have an annual influenza ​vaccination?

Which is a common clinical manifestation of infectious disease? Dry and pink skin Hypothermia Decreased respiratory rate Fever

Fever

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? Monitor for improvement after antibiotic therapy is initiated. Teach the client the reason for taking antibiotics as prescribed. Administer acetaminophen (Tylenol) 650 mg orally for elevated temperature. Increase fluid intake by assisting the client to choose approved and preferred beverages.

Increase fluid intake by assisting the client to choose approved and preferred beverages.

The nurse will instruct a patient who is receiving a tetracycline antibiotic to take it using which guideline?

It needs to be taken with 8 oz of water.

Which is a preventive measure for​ bronchiolitis?

Palivizumab

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? Evaluating each other's handwashing technique Deciding which brand of handwashing soap to use Reinforcing the need for handwashing after caring for clients Determining which clients are most likely to infect other residents

Reinforcing the need for handwashing after caring for clients

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. Assign the client to a private room with a negative airflow. Wear a mask when working within 3 feet (91 cm) of the client. Have the client wear a surgical mask when being transported out of the

Wear a gown and gloves to prevent contact with the client or client-contaminated items.

What is pandemic? A) more cases than normal for the population or specific area B) A world-wide epidemic of a disease C) A world-wide spread of micro algae D) An increase in panda express restaurants in the the area

B

What patients do standard precautions apply? A) Patients with blood-born infections B) All patients receiving care C) Tom Brady D) Patients with infected, draining wounds

B

What is infection? A) Establishment of a pathogen in a susceptible host. B) Establishment of a bacteria in a susceptible host C) A virus causing redness and swelling at area of injury D) A pathogen that causes amputation

A

Tinea Pedis

Athletes foot

cephalosporin, trimethoprim-sulfamethoxazole

treatment if an allergy to amoxicillin?

A patient who is diagnosed with genital herpes is taking topical acyclovir. The nurse will provide which teaching for this patient? (Select all that apply.)

"Be sure to wash your hands thoroughly before and after applying this medicine." "Use a clean glove when applying this ointment." "You will need to avoid touching the area around your eyes." "You will have to practice abstinence when these lesions are active."

The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? "I need to be drinking at least 1.5 to 2.5 liters of fluids every day." "It is a good idea for me to reduce germs by taking a tub bath daily." "Trying to get to the bathroom to urinate every 6 hours is important for me." "Urinating 1000 mL on a daily basis is a good amount for me."

"I need to be drinking at least 1.5 to 2.5 liters of fluids every day."

The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? "I must avoid drinking carbonated beverages." "I need to douche vaginally once a week." "I need to drink 2½ liters of fluid every day." "I will not drink fluids after 8 PM each evening."

"I need to drink 2½ liters of fluid every day."

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? "I am so relieved that I can continue eating my fried fish meals every week." "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." "My wife will be happy to know that I can keep enjoying her liver and onions recipe." "I will no longer be able to have red wine with my dinner."

"I will no longer be able to have red wine with my dinner."

The family of a client with chronic cancer pain says to the nurse, "Can you please reduce Dad's pain medication so that we can spend more quality time with him?" How does the nurse respond? "I will ask his oncologist about your question." "Let's ask your father about your request." "No, his pain relief is more important than your concerns." "Yes, this is a valuable way for all of you to make needed adjustments."

"Let's ask your father about your request." The nurse will respond by indicating that the client's desires about analgesia are the most important consideration in this scenario, and so he would be consulted initially about his family's request. This open-ended type of question acknowledges the family, while keeping the client as the major decision maker.

Collaborative Interventions of Infection

-Antimicrobials - Antibiotic agents - Antiviral agents - Antifungal agents • Nutrition and Fluids - Replacement of fluids and electrolytes - Adequate rest and nutrition provide the body with energy needed for optimal functioning of the immune system and resolution of infection

What types of infections could be contracted from an accidental needle stick? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) HIV E) Tuberculosis

-B -C -D

A 53-year-old postmenopausal woman reports "leaking urine" when she laughs and is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? "They can relieve your anxiety associated with incontinence." "They help your bladder to empty." "They may be used to improve urethral resistance." "They decrease your bladder's tone."

"They may be used to improve urethral resistance." The nurse tells the 53-year-old postmenopausal woman with stress incontinence that certain drugs may be used to improve urethral resistance. Bladder pressure is greater than urethral resistance so drugs may be used to improve urethral resistance.Relieving anxiety has not been shown to improve stress incontinence. No drugs have been shown to promote bladder emptying, and this is not usually the problem with stress incontinence. Emptying the bladder is accomplished by the individual or, if that is not possible, by using a catheter. Decreasing bladder tone would not be a desired outcome for a woman with incontinence.

A client with osteoarthritis pain tells the nurse, "I take two arthritis-strength Tylenol (650 mg) every 8 hours." How does the nurse respond? "Aspirin would be a better, more effective choice for your pain relief." "More Tylenol is needed to provide effective pain relief for you." "That is the appropriate dose of Tylenol for your pain." "You will need to have routine liver and kidney function laboratory tests."

"You will need to have routine liver and kidney function laboratory tests." The nurse responds by informing the client that taking Tylenol, especially high doses of it, would need routine liver and kidney function laboratory testing done. Hepatotoxicity and nephrotoxicity are adverse effects associated with long-term use of Tylenol.Acetaminophen (Tylenol) is a better choice for pain relief than aspirin because it has fewer side effects on the gastrointestinal system, such as bleeding. The client is actually taking more than the recommended upper limit of Tylenol; no more than 3600 mg daily would be used, and no more than 2400 mg for older adults.

71. The client diagnosed with septic meningitis is admitted to the medical floor at noon. Which health-care provider's order would have the highest priority? 1. Administer an intravenous antibiotic. 2. Obtain the client's lunch tray. 3. Provide a quiet, calm, and dark room. 4. Weigh the client in hospital attire.

1. The antibiotic has the highest priority because failure to treat a bacterial infection can result in shock, systemic sepsis, and death.

The home care nurse is evaluating the care provided to an​ 18-month-old child recovering at home from bronchiolitis caused by respiratory syncytial virus​ (RSV). Which observation indicates that the parents have provided adequate​ care?

98% RA

Clinical Spectrum of infection:

>Infection >Bacteremia >Sepsis >Severe Sepsis >Septic Shock

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4°F (37.4°C) A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours

Which client does the RN arriving for duty assess first? A 27-year-old who has chronic severe back pain with movement A 51-year-old with lung cancer who reports pain "whenever I cough" A 56-year-old with acute pancreatitis who reports increasing abdominal pain A 63-year-old who reports ongoing pain associated with rheumatoid arthritis

A 56-year-old with acute pancreatitis who reports increasing abdominal pain

middle ear effusion

A Pt presenting with negative pressure in the middle ear with serous fluid is experiencing what?

A client with a known heart condition is prescribed an antibiotic before a dental procedure. What type of antibiotic therapy is this considered? A) Prophylactic B) Supportive C) Definitive D) Empiric

A) Prophylactic

Which of the following patients is at greatest risk for contracting a primary bacterial infection? A patient with newly diagnosed diabetes mellitus A patient whose lab results reveal leukopenia A patient receiving broad-spectrum antibiotics A patient following laparoscopic cholecystectomy

A patient whose lab results reveal leukopenia The patient with a decrease in the number of white blood cells (leukopenia) is at greatest risk for contracting a primary infection because of a weakened primary defense system. A patient with a diagnosis of diabetes mellitus is at greater risk for infection than a patient who does not have the disease but does not have the greatest risk of the four patients described. The patient receiving broad-spectrum antibiotics already has an infection and is at risk for a secondary infection. The patient who has undergone a surgical procedure is at risk for a bacterial infection but does not have the greatest risk of the patients described. Laparoscopy minimizes invasion and tissue impairment.

A client with cancer is receiving low-dose oral morphine but is reporting both "sharp, tingly" pain and constipation. What intervention does the nurse implement first? Administers ordered docusate sodium (Colace) and gabapentin (Neurontin) Decreases the morphine (morphine sulfate) dosage for the client Gives the client a Fleet's (sodium biphosphate) enema Records the client's bowel movements

Administers ordered docusate sodium (Colace) and gabapentin (Neurontin) As a first intervention, docusate (Colace) and gabapentin (Neurontin) take priority. Docusate is a stool softener and gabapentin is an adjuvant for neuropathic pain.Constipation is a side effect of morphine, but decreasing the morphine dose will cause this client's pain to become even worse. Giving an enema is not the first intervention that should be tried by the nurse. Recording bowel movements is helpful for assessment, but does nothing to relieve the client's constipation.

After patient teaching, the patient is able to verbalize that which occurrence can delay wound healing after surgery? Adequate arterial blood flow to the wound Supplemental oxygen therapy A healthy diet An increased hospital stay

An increased hospital stay An increased hospital stay increases the risk for hospital-acquired infections, which can delay wound healing. Adequate arterial blood flow improves, rather than delays, wound healing. Supplemental oxygen can increase wound healing. A healthy diet is important to wound healing.

When completing an admission assessment, the patient states that she is allergic to sulfa drugs. What will the nurse do next? A. Mark the allergy on her medical record. B. Place an "allergy" armband on the patient. C. Ask the patient for more information about the allergic reaction she had. D. Notify the physician about the patient's allergy.

C.Ask the patient for more information about the allergic reaction she had. Rationale: Some patients will say they are "allergic" to drugs when in fact what they experienced was a common and mild adverse effect. The nurse should clarify the patient's statements with open-ended questions.

The nurse is monitoring for therapeutic results of antibiotic therapy in a patient with an infection. Which laboratory value would indicate therapeutic effectiveness of this therapy? A.Increased red blood cell count B.Increased hemoglobin level C.Decreased white blood cell count D.Decreased platelet count

C.Decreased white blood cell count

Describe disseminated. A) Infection limited to a certain area of the body. B) A bacteria that was dismantled by the immune system C) An infection that affects the body as a whole, or that has spread throughout the whole body. D)Term used to describe a spread of infection from an initial site to other areas of the body.

D

A client reports increasing pain during dressing changes. Which interventions are recommended for the client? Select all that apply. Assistance by the client with the dressing change Distraction Epidural analgesic Music therapy Premedication Transcutaneous electrical nerve stimulation (TENS)

Distraction Music therapy Premedication ten's is effective in controlling certain types of pain, like incisional pain, but its use during a dressing pain isnt feasible...

Bacteria that is part of Normal Flora, but can become pathogenic:

Escherichia coli

Clinical Nursing skills for Infection:

Hand hygiene • Personal protective equipment • Gloves • Mask • Protective eyewear • Gown • Cap • Isolation precautions • Sterility • Collecting specimens for culture • Medication administration

HAI (hospital acquired infection)

Infections associated with the delivery of health care services in a facility such as a hospital or nursing home

Infection is complimented by:

Inflammation

Which intervention is important for the nurse to perform before beginning antibiotic therapy?

Obtain a specimen for culture and sensitivity

A client with extensive burn injuries is to be weaned from long-term opioid use. What type of opioid dependence does the nurse expect this client to have? Addiction Tolerance Physical dependence Pseudoaddiction

Physical dependence

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? Encourage family and friends to call the client. Provide education on the mode of transmission of infection. Encourage the client to watch television. Ask a certified hospital chaplain to visit the client.

Provide education on the mode of transmission of infection. Education is the most appropriate and main intervention for addressing a client's feeling of isolation when placed on Transmission-Based Precautions. It is important to teach the client and family about the mode of transmission and mechanisms that prevent spread to others. The nurse needs to assess coping mechanisms that the client has used in the past.Encouraging phone calls and distraction activities like watching television may be effective interventions. Engaging a certified hospital chaplain to visit the client may help alleviate the client's stress, anxiety, or depression.

A common adverse effect that occurs when vancomycin (Vancocin) is infused too quickly is which of the following?

Red man's syndrome

Sandra has bronchitis and has been taking an antibiotic for 1 week. She calls the nurse and complains of severe genital itching and a whitish discharge in her vaginal area. What has happened and what caused it?

She is experiencing supra-infection because the antibiotics she has been taking for bronchitis have reduced the normal vaginal bacteria flora, and the yeast that is usually kept in balance by this normal flora has an opportunity to grow and cause infection.

The parents of a child diagnosed with bronchiolitis ask the nurse how the disorder is treated. Which response by the nurse is the most​ appropriate?

The focus is on managing symptoms and providing supportive​ care no real tx, it's viral dexamethasone bronchodilators don't do anything

A newly admitted client who was in an automobile accident has a concussion and is reporting pain from a fractured femur and broken fingers. Which staff member does the charge nurse on the orthopedic unit assign to care for this client? An experienced RN travel nurse who arrived on the unit this morning An LPN/LVN who has worked on the orthopedic unit for 6 years The neurology unit RN who has floated to the orthopedic unit The RN orthopedic case manager who is responsible for discharge planning

The neurology unit RN who has floated to the orthopedic unit

A 5-year-old boy with early flu symptoms is at school working with some math blocks. He sneezes into his hand and then continues working with his blocks. An unvaccinated teacher's helper cleans up the blocks when the child leaves them on the table. After touching the blocks, she rubs her nose with her hand. Which represents the most likely mode of transmission? The 5-year-old boy The unvaccinated teacher's helper The hand-to-nose contact The unwashed math blocks

The unwashed math blocks The boy has the flu and sneezes into his hand while at school. When he works with the math blocks, he leaves the flu virus on the toys. The teacher's helper picks up the virus with the blocks. When the parent touches her nose with her hand, the virus enters the susceptible host. The blocks act as the mode of transmission. The boy carries the pathogen, and his sneeze is the portal of exit. The teacher's helper is the susceptible host. The hand-to-nose contact is the portal of entry.

Question 15 of 34 The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? Select all that apply. Cleanse the perineum from back to front after using the bathroom. Try to take in 64 ounces (2 liters) of fluid each day. Be sure to complete the full course of antibiotics. If urine remains cloudy, call the clinic. Expect some flank discomfort until the antibiotic has worked.

Try to take in 64 ounces (2 liters) of fluid each day. Be sure to complete the full course of antibiotics. If urine remains cloudy, call the clinic.

Stephanie is a 70-year-old retired schoolteacher who is interested in nondrug, mind-body therapies, self-management, and alternative strategies to deal with joint discomfort from rheumatoid arthritis. Which of the following options should you suggest for her plan of care, considering her expressed wishes? Using a stationary exercise bicycle and free weights and attending a spinning class Using mind-body therapies such as music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy Drinking chamomile tea and applying icy/hot gel Receiving acupuncture and attending church services

Using mind-body therapies such as music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy Mind-body therapies are designed to enhance the mind's capacity to affect bodily functions and symptoms and include music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy, among many others. Although getting exercise, drinking chamomile tea and applying gels, and receiving acupuncture and attending church services may be beneficial, they are not classified as mind-body therapies in combination as specified in these answer choices.

Which precaution is best for the nurse to take to prevent the transmission of Clostridium difficile infection? Carefully wash hands that are visibly soiled. Wear a mask and gloves when the client's body secretions or body fluids are likely to be handled. Wear a mask with eye protection and perform proper handwashing. Wear gloves when contact with body secretions or body fluids is expected.

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. C. difficile infection requires contact precautions. Hands must be properly washed before and after any contact with the client with C. difficile infection. Alcohol-based hand rubs are not effective for hand hygiene in the care of clients with C. difficile.Hands must be washed even if not visibly soiled. It is not necessary to wear a mask when caring for clients with C. difficile infection. A mask and eye protection are not necessary to prevent transmission of C. difficile.

Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. Pain should be reassessed at which minimum interval? Select all that apply. With each new report of pain Before and after administration of narcotic analgesics Every 10 minutes Every shift

With each new report of pain Before and after administration of narcotic analgesics

Systemic infection

affects the body as a whole, or has spread throughout the body

The school nurse teaches a group of daycare teachers on the manifestations of respiratory syncytial virus​ (RSV). Which teacher​'s statement indicates that additional instruction is​ required?

babies are only irritable cuz they miss mommy Vomiting, diarrhea, rapid​ breathing, and a change in eating pattern, and irritability

dehydration

weak, threadym, rapid pulse and low BP

antihistamines or decongestants

what can you use to treat symptoms but not the actually infection in Otitis media?

Pandemic

worldwide epidemic

Postoperative surgical patients should be given alternating doses of acetaminophen and which medication throughout the postoperative course, unless contraindicated? Antihistamine Local anesthetic Opioids Nonsteroidal anti-inflammatory drug (NSAID)

Nonsteroidal anti-inflammatory drug (NSAID)

Healthcare-associated infections are difficult to treat . Which patients would be considered at an increased risk? A) A patient who underwent bronchoscopy B) A patient who receives broad-spectrum antibiotics C) A patient who has an indwelling urinary catherter D) A patient who is suffering from diabetes Melitius E) A patient with a fever

A,B,C and D

Which of these patients have diseases that were caused from blood-borne pathogens? A) A male with Aepatitis C B) A female with C. Diff C) A male with HIV D) A female with Hepatitis B

A,C and D

Protozoa Infections

-Generally, infect individuals with compromised immune responses -Found in dead material in water and soil, spread by fecal-oral route by ingesting food or water that is contaminated

Common Pathogens of Parasite / Protozoa

-Giardiasis -Trichinosis -Toxoplasmosis -Malaria -Ascariasis -Pediculosis -Cryptosporidiosis -Pneumocystis jirovecii pneumonia

Primary Prevention of Infection

-Hand hygiene and Standard Precautions - Keep hands clean - Use alcohol based hand rub - Keep cuts and scraped clean and covered - Refrain from sharing person items such as towels or razors • Immunizations - Administration of vaccination HPV, hepatitis A and B, measles, mumps, and rubella, influenza, tetanus

Stages of Infection

-Incubation period (non infectious stage) -Prodromal stage (non specific signs/symptoms) -Illness stage (manifests signs/symptoms that can be diagnosed) -Convalescence (begins healing)

What are the elements in the chain of infection? A) An infection agent B) A vaccine schedule C) A source of pathogen growth D) A clean surrounding E) A susceptible host

A,C, and, D

Categories of Infection:

-Bacterial -Viral -Fungal -Protozoa / Parasitic

Which clients with long-term urinary problems does the nurse refer to community resources and support groups? Select all that apply. A 32-year-old with a cystectomy A 44-year-old with a Kock pouch A 48-year-old with urinary calculi A 78-year-old with urinary incontinence An 80-year-old with dementia

A 32-year-old with a cystectomy A 44-year-old with a Kock pouch A 78-year-old with urinary incontinence

An adolescent comes to the school nurse complaining of a 2-day history of low-grade fever, exhaustion, and lack of energy and appetite. He has been tardy to school twice in the past week. Which assessment should the nurse use to identify the possible origin of the problem? 1 Eliciting the Kernig sign 2 Eliciting the Brudzinski sign 3 Checking for lymphadenopathy 4 Checking the pupillary response to light and accommodation

3 Checking for lymphadenopathy Infectious mononucleosis is caused by the Epstein-Barr virus. Mononucleosis is common in people between the age of 15 and 30 years. Signs and symptoms of mononucleosis include fever, fatigue, swollen lymph glands, and enlargement of the liver and spleen. Pupillary response to light and accommodation is checked as part of a neurologic assessment. The Kernig sign (asking the child to straighten a leg that is bent at a 90-degree angle at the knee) and Brudzinski sign (asking a child who is lying flat to bend his head and try to put his chin on his chest) are elicited as part of the assessment when meningitis is suspected.

A patient will be taking oral neomycin before having bowel surgery. The order reads, "Give 1 g per hour for 4 doses PO." The patient cannot swallow pills, so an oral solution has been ordered. The solution is 125 mg/5 mL. How many milliliters will the nurse give for each 1 g dose?

40 mL

The nurse is planning a dressing change on a postoperative mastectomy client. The client is receiving acetaminophen and oxycodone (Percocet) orally for pain every 4 hours and is due to receive them at 4:00 p.m. When will the nurse change the dressing? 3:30 p.m. 4:00 p.m. 4:30 p.m. 7:00 p.m.

4:30 p.m.

Normal WBC count in adults & children over 2

5,000-10,000/mm3

Nurse is administering IV Acyclovir (zovirax) to a patient with a viral infection. Which admin technique is correct? a. Infuse Acyclovir IV slowly, over at least 1 hour b. Infuse by rapid bolus c. Refrigerate Acyclovir IV d. Restrict oral fluids

ANS: A Intravenous acyclovir is stable for 12 hours at room temperature and often precipitates when refrigerated. Intravenous infusions must be diluted as recommended (e.g., with 5% dextrose in water or normal saline) and infused with caution. Infusion over longer than 1 hour is suggested to avoid the renal tubular damage seen with more rapid infusions. Adequate hydration should be encouraged (unless contraindicated) during the infusion and for several hours afterward to prevent drug-related crystalluria.

A patient is receiving cidofovir (Vistide) as part of treatment for a viral infection, and the nurse is preparing to administer probenecid, which is also ordered. Which is the rationale for administering probenecid along with the cidofovir treatment? a. It has a synergistic effect when given with cidofovir, thus making the antiviral medication more effective. b. The probenecid also prevents the replication of the virus. c. Concurrent drug therapy with probenecid reduces the nephrotoxicity of the cidofovir. d. The probenecid reduces the adverse gastrointestinal effects of the cidofovir.

ANS: C Probenecid is recommended as concurrent drug therapy with cidofovir to help alleviate the nephrotoxic effects of probenecid. The other options are incorrect.

A patient is taking a combination of antiviral drugs as treatment for early stages of HIV infection. While discussing the drug therapy, the patient asks the nurse if the drugs will kill the virus. When answering, the nurse keeps in mind which fact about antiviral drugs? a. They are given for palliative reasons only. b. They will be effective as long as the patient is not exposed to the virus again. c. They can be given in large enough doses to eradicate the virus without harming the body's healthy cells. d. They may also kill healthy cells while killing viruses

ANS: D Because viruses reproduce in human cells, selective killing is difficult; consequently, many healthy human cells, in addition to virally infected cells, may be killed in the process, and this results in the serious toxicities that are involved with these drugs. The other options are incorrect.

What types of infections could be contracted from an accidental needle stick? A) Hepatitis A B) Hepatits B C) Hepatitis C D) HIV E) Tuberculosis

B,C and D

Which statement accurately describes the method of action of penicillin?

Inhibition of bacterial cell wall synthesis.

Localized infection

limited to a specific body area

During a home​ visit, the community health nurse becomes concerned that a​ 2-year-old child is at risk for contracting respiratory syncytial virus​ (RSV). Which observations would lead the nurse to this​ conclusion?

living in socioeconomically disadvantaged​ circumstances, exposure to secondhand​ smoke, questionable use of soap to wash​ hands, and sharing drinking utensils

Epidemic

more cases of an infectious disease than is normal for the population or geographical area

Endemic

native or confined to a particular region or people

​Six-year-old Kerry Teng has been diagnosed with bronchiolitis. What will the nurse include when assessing​ Kerry?

observe for labored respirations and be aware of the​ child's skin​ color, assessing whether it is​ pale, dusky, or cyanotic

Endotoxins

part of bacterial cell wall of gram-neg bacteria that cause damage to the host, even if bacteria is dead

What are risk factors for the development of​ bronchiolitis?

premature​ birth, attendance at​ daycare, chronic lung​ disease, and exposure to secondhand cigarette smoke. Age younger than 2 years is a risk factor for the development of bronchiolitis.

pulling at ear, crying at night, acting out, irritability, hearing impairment, poor feeding, malaise

s/s for children with otitis media

decreased hearing, snapping or popping sounds, maybe vertigo, temperature maybe present and tinnitis

s/s with an adult with Otitis media?

Acute infection

short term- resolves in few days or weeks