Elsevier Adaptive Quizzing: Safety and Infection Control

At which interval are humidified oxygen systems replaced to prevent infection? 1. 1 day 2. 3 days 3. 5 days 4. 7 days

Answer: 1. 1 day Rationale: Humidified oxygen delivery needs to be changed out daily to prevent infection. Every 3 to 5 days is too long to wait and may promote infection. Oxygen delivery without humidification will need to be changed out every 7 days.

Which noninvasive assessment and management skills certification would the nurse be required to use for airway maintenance and cardiopulmonary resuscitation (CPR)? 1. Basic Life Support (BLS) 2. Certified Emergency Nurse (CEN) 3. Advanced Cardiac Life Support (ACLS) 4. Pediatric Advanced Life Support (PALS)

Answer: 1. Basic Life Support (BLS) Rationale: BLS is the certification for emergency nursing that includes assessment and management skills for airway maintenance and CPR. CEN is emergency nursing certification that validates the core emergency nursing knowledge base. ACLS involves invasive airway management skills, pharmacology, electrical therapies, and special resuscitation. PALS involves neonatal and pediatric resuscitation.

Which action is the priority when the nurse is establishing a therapeutic environment for a client? 1. Ensuring the client's safety 2. Accepting the client's individuality 3. Promoting the client's independence 4. Explaining to the client what is being done

Answer: 1. Ensuring the client's safety Rationale: Safety is the priority before any other intervention is provided. Accepting the client's individuality, promoting the client's independence, and explaining to the client what is bing done are all important, but less of a priority.

Which medication for treatment of gastroesophageal reflux disease would be contraindicated in the pregnant client? 1. Ranitidine 2. Misoprostol 3. Esomeprazole 4. Calcium carbonate

Answer: 2. Misoprostol Rationale: Misoprostol is contraindicated in pregnancy because it can cause uterine contractions, expelling the developing fetus. Ranitidine, esomeprazole, and calcium carbonate are not contraindicated during pregnancy.

Which hospital department plays a primary role in disaster preparedness? 1. Medical department 2. Surgical department 3. Emergency department 4. Mental health department

Answer: 3. Emergency department Rationale: The emergency department plays a primary role in emergency disaster preparedness. Although all departments in the hospital contribute to disaster planning, the only department that plays a primary role is the emergency department.

Which would the nurse state is an example of a natural disaster? 1. Floods 2. Terrorism 3. Fire explosion 4. Building collapse

Answer: 1. Floods Rationale: External disasters can be natural, such as floods, earthquakes, or tornadoes. Acts of terrorism are external disasters that use technology such as explosive devices or a malfunction of a nuclear reactor. A fire explosion is an internal disaster. A building collapse is a consequence of internal or external disaster.

Which issue related to antibiotic use is an increased risk for the older adult? 1. Allergy 2. Toxicity 3. Resistance 4. Superinfection

Answer: 2. Toxicity Rationale: The older adult is at increased risk for toxicity related to antibiotic use because of reduced metabolism and excretion of medications. Allergy, resistance, and superinfection are a risk for all antibiotic recipients but not an increased risk in the older adult population.

A child with meningitis suddenly assumes an opisthotonic position. In which position would the nurse position the child? 1. Side-lying 2. Knee-chest 3. High-Fowler 4. Trendelenburg

Answer: 1. Side-lying Rationale: Maximal safety and comfort are ensured with the side-lying position because the child's neck and back are hyperextended. The knee-chest position is impossible because the child is in a rigid opisthotonic position, with the neck and back hyperextended. The high-Fowler is impossible because the child is in a rigid position with the neck and back hyperextended. The Trendelenburg position increases intracranial pressure and is contraindicated in meningitis.

Which statement shows that the newly diagnosed asthma patient understands how to use a peak expiratory flow meter (PEFM)? 1. 'I have to blow out as fast and hard into the machine as I can.' 2. 'I can stand or sit to use the flow meter. I just can't lie down.' 3. 'I have to take three readings and record the average on the flow sheet.' 4. 'I'll use the meter whenever I can throughout the day; it doesn't really matter when.'

Answer: 1. 'I have to blow out as fast and hard into the machine as I can.' Rationale: A PEFM is used to measure the amount of air being exhaled. To adequately measure this, the client must blow out fast and hard. The client should use the PEFM while in a standing position to permit better expansion of the lungs. The highest of three readings, not the average, is recorded. The readings should be obtained close to the same time each day to ensure consistency.

The nurse is preparing a child who has undergone a myringotomy for discharge. Which would the parents be taught about their child's care at home? 1. Insert earplugs whenever a bath is given. 2. Keep cotton in the ears until drainage subsides. 3. Keep the child out of school until the ears are healed. 4. Clean the child's ears with cotton-tipped swabs after each bath.

Answer: 1. Insert earplugs whenever a bath is given. Rationale: Water in the ears after myringotomy supports the growth of pathogens and should be avoided. The ears should be kept open to the air and allowed to drain naturally. There is no reason to keep the child isolated. Cleaning the ears with cotton swabs is contraindicated because it may result in trauma.

Which primary objective of nursing interventions would the nurse maintain for clients with dementia, delirium, and other neurocognitive disorders? 1. Safety within the environment 2. Enhancement of psychological faculties 3. Participation in educational activities 4. Face-to-face contact with other clients

Answer: 1. Safety within the environment Rationale: Safety within the environment is the primary objective of nursing interventions. Clients with neurocognitive disorders need an environment that will keep them safe, because their own abilities to interpret and respond appropriately are diminished. People with dementia, delirium, and other neurocognitive disorders usually have a declining level of unction in all areas. Maintaining psychological function is often not possible. The primary objective is not to participate in education activities or have face-to-face contact with other clients. People with dementia, delirium, and other neurocognitive disorders have a limited ability to participate in educational activities and may also have a limited ability to interact socially with other clients.

Which would the nurse do first if an allergic reaction to a blood transfusion occurs? 1. Shut off the infusion. 2. Slow the rate of flow. 3. Administer an antihistamine. 4. Call the health care provider (HCP).

Answer: 1. Shut off the infusion. Rationale: The child is experiencing an allergic reaction, and the infusion must be stopped immediately to prevent serious complications. Slowing the rate of infusion will not halt the allergic reaction to the transfused blood. Administering an antihistamine is dangerous as an initial action because of the degree of allergic reaction cannot be determined at this time. Also, it requires an HCP's prescription. The HCP should be notified after the infusion has been stopped.

How do toddlers learn self-protection? 1. Through trial-and-error strategies 2. By imitating playmates and siblings 3. By obeying orders from mother and father 4. By playing with age-appropriate toys and puzzles

Answer: 1. Through trial-and-error strategies Rationale: The toddler is developing autonomy, is curious, and learns self-protection from experience. Toddlerhood play is parallel, not interactive. The struggle for autonomy at this age limits learning from siblings, even though the toddler attempts to copy their behavior. The toddler is still learning from experiences, not from others. The toddler is still attempting to distinguish the self as separate from the parents; the struggle for autonomy limits learning from parents. Toddlers learn gross and fine motor skills as they play with their toys, not self-protection.

The nurse explains to the parents of a 6-year-old child with a pinworm infestation how pinworms are transmitted. Which statement indicates that the teaching has been understood? 1. 'We need to keep the cat off the bed.' 2. 'She needs tow ash her hands before eating anything.' 3. 'She needs to cover her mouth whenever she coughs.' 4. 'We need to tell the school so that the cafeteria can be cleaned.'

Answer: 2. 'She needs tow ash her hands before eating anything.' Rationale: Pinworm infestation is transferred by way of the oral-anal route, and effective hand washing is the best way to prevent transmission. Cats do not transmit pinworms. The hands should be kept away from the nose and mouth; the child should be taught to cough into a tissue or the inside elbow of the arm. Cleaning the cafeteria is not an effective means of preventing the transmission of pinworms.

Which clinical condition is associated with lead poisoning? 1. Asthma 2. Anemia 3. Metabolic acidosis 4. Systemic infection

Answer: 2. Anemia Rationale: Lead can interfere with the binding of iron onto the heme molecule. This can cause anemia even though the child is not iron deficient. Asthma, metabolic acidosis, and a systemic infection are not associated with lead poisoning.

Which condition is commonly seen following infestation with pediculosis capitis (head lice)? 1. Eczema 2. Impetigo 3. Cellulitis 4. Folliculitis

Answer: 2. Impetigo Rationale: Impetigo may develop as a secondary bacterial infection because of breaks in the skin caused by scratching. Eczema is an allergic response and not related to episodes of pediculosis. Cellulitis is an extended inflammation that is not commonly found in children with pediculosis. Folliculitis is a pimple or an infection of the hair follicle; it does not occur as a result of pediculosis.

Which nursing action would be included in the plan of care for a child with acute poststreptococcal glomerulonephritis? 1. Encouraging fluids 2. Monitoring for seizures 3. Measuring abdominal girth 4. Checking for pupillary reactions

Answer: 2. Monitoring for seizures Rationale: Cerebral edema from hypertension or cerebral ischemia may occur, which may result in seizures. Increasing fluid intake may lead to an increase in blood pressure and edema. Measuring abdominal girth is appropriate for children with nephrotic syndrome, in which the child has hypoalbuminemia that causes fluid to shift from plasma to the abdominal cavity. Glomerulonephritis will not alter pupillary reactions.

Which initial action would the nurse take for a newly admitted client who reports memory loss, nervousness, insomnia, and fear of leaving the house? 1. Evaluate the client's adjustment to the unit. 2. Provide the client with a sense of security and safety. 3. Explore the client's memory loss and fear of going out. 4. Assess the client's perception of reasons for the hospitalization.

Answer: 2. Provide the client with a sense of security and safety. Rationale: The initial action is to provide the client with a sense of security and safety. The client is anxious and afraid of leaving home; the priority is the client's safety and security needs. It is too early to evaluate the client's adjustment to the unit. Additionally, if the client is not provided with a sense of security, adjustment probably will be unsatisfactory, because the anxiety will most likely escalate. Exploring the client's memory loss and fear of going out cannot be done until anxiety is reduced. The client is experiencing memory loss and may not be able to remember what precipitated admission to the hospital; some memory loss may be a result of high anxiety and thought blocking.

Which team member acts as a liaison between the health care facility and the media? 1. Triage officer 2. Public information officer 3. Medical command physician 4. Hospital incident commander

Answer: 2. Public information officer Rationale: The public information officer acts as a liaison between the health care facility and the media. The triage officer applies disaster triage tags after evaluating the client's condition. The medical command physician decides the number, acuity, and resource needs of clients. The hospital incident commander assumes overall leadership for implementing the emergency plan.

Which condition would the nurse monitor for in the client on aminoglycoside therapy and skeletal muscle relaxants? 1. Stroke 2. Respiratory arrest 3. Myocardial infarction 4. Abdominal discomfort

Answer: 2. Respiratory arrest Rationale: Aminoglycosides can intensify the effect of skeletal muscle relaxants, placing the client at risk for respiratory arrest. Aminoglycoside therapy with muscle relaxants does not increase the risk of stroke, myocardial infarction, or abdominal discomfort.

Which strategy would the nurse include in a plan of care for a client with Alzheimer disease? 1. Implement remotivational therapy. 2. Structure the environment for safety. 3. Arrange for long-term custodial care. 4. Stimulate thinking with new experiences.

Answer: 2. Structure the environment for safety. Rationale: Structuring the environment for safety supports the client's ability to function in a protected, safe milieu. Attempting to remotivate the client is not the priority; also, it is not always possible to remotivate a client with Alzheimer disease. There are no data to indicate that the client needs long-term custodial care at this time. Structure and routines will decrease anxiety and increase performance of activities of daily living; whereas, stimulating thinking with new experiences would be too overwhelming for a client with Alzheimer disease. Cognitive maintenance should be part of the focus of care.

Which of these age groups has the highest incidence of lead poisoning? 1. Adult 2. Toddler 3. Adolescent 4. School-age child

Answer: 2. Toddler Rationale: The incidence of lead poisoning is highest in late infancy and toddlerhood. Children at this stage explore the environment and because of their increased level of oral activity, put objects into their mouths. Adults have a greater risk of cardiovascular or pulmonary disease. Drowning and motor vehicle accidents are more common among adolescents. Bicycle accidents are more common among school-aged children.

The nurse is preparing to initiate antibiotic therapy for a client who developed an incisional infection. Which task would the nurse ensure has been completed before starting the first dose of intravenous antibiotics? 1. Red blood cell count 2. Wound culture 3. Knee x-ray 4. Urinalysis

Answer: 2. Wound culture Rationale: A wound culture always should be completed before the first dose of antibiotic. A wound culture is obtained to determine the organism that is growing. A broad spectrum antibiotic often is given first; after the organism has been identified an organism-specific antibiotic can be given. There is no indication that a red blood cell count is needed; however, a white blood cell count would be beneficial. A urinalysis is not needed, because data gathered during the assessment indicate an incisional infection. At the early stage of the infection, there is no need to obtain a knee x-ray.

After the nurse provides education about all-terrain vehicle (ATV) safety for a parent of a 11-year-old child, which statement made by the parent indicates an understanding of the information? 1. 'I will have my child ride with an adult.' 2. 'I will make sure my child wears a helmet.' 3. 'I will make sure my child does not get on an ATV.' 4. 'I will make sure my child has had safety training before he or she rides.'

Answer: 3. 'I will make sure my child does not get on an ATV.' Rationale: The American Academy of Pediatrics recommends that children under 16 years of age not ride in or operate an ATV. The child should not ride with another adult. When the child is 16 years of age and begins riding an ATV, safety gear such as a helmet should be worn and proper safety training should be implemented.

An 8-year-old girl who is hospitalized for intravenous (IV) antibiotic therapy tells the nurse that she is bored. The nurse has a discussion with the father about appropriate activities. Which activity suggested by the father would indicate a need for further teaching? 1. 'I'll bring a radio and CD player.' 2. 'I'll bring homework and school supplies.' 3. 'She'll enjoy having a rubber baseball and plastic bat.' 4. 'She'll enjoy rubber stamps and a pretty box to keep them in.'

Answer: 3. 'She'll enjoy having a rubber baseball and plastic bat.' Rationale: Playing with a bat and ball is an unsafe activity in a hospital setting; the IV catheter could b dislodged, and boisterous activity is dangerous to the other children on the unit. A radio and CD player, homework and school supplies, and rubber stamps and a collection box are all appropriate for the school-aged child.

Which intervention would the nurse encourage the parents of a child with plumbism (lead poisoning) to do? 1. Discourage the child's pica by providing nutritious snacks. 2. Move the family away from areas that are next to gas stations. 3. Assess the family home environment for lead sources and have them removed. 4. Have the child take repeat x-rays of the wrist and forearm for signs of a lead line.

Answer: 3. Assess the family home environment for lead sources and have them removed. Rationale: All sources of lead must be removed from the home if the problem is to be controlled. Sources include lead-painted surfaces and old plumbing that has lead solder. Although pica must be controlled if it is present, this alone will not eliminate the environmental risks. The data do not indicate that the child is engaging in pica. Leaded gasoline is no longer used in the United States. Chelation therapy is based on the blood lead level; changes in bone take longer to evaluate.

Which intervention would provide the greatest safety for a client admitted to a mental health unit because of suicidal ideation? 1. Seclusion room 2. Four-point restraints 3. Continual one-on-one supervision 4. Removal of unsafe objects from the environment

Answer: 3. Continual one-on-one supervision Rationale: The intervention that would provide the greatest safety is continual one-on-one supervision. A member of the health team provides a continuous presence to ensure the safety of a client who is at high risk for suicide. Seclusion and four-point restraints are overly restrictive. Although removing unsafe objects from the environment is important, clients who are intent on self-harm will find ways even if such objects are removed.

The nurse provides discharge teaching to a client who had a total hip replacement. The client states that the plan is to go swimming at the community pool the day after discharge. Which action would the nurse take in response to the client's comment? 1. Tell the client to take a friend along for safety. 2. Encourage participation in this activity, because it provides excellent range-of-motion exercise. 3. Explain that the incision should be be immersed in water until it has healed. 4. Let the client know that swimming can substitute for the prescribed physical therapy.

Answer: 3. Explain that the incision should be be immersed in water until it has healed. Rationale: Because of the risk for infection, the client should avoid tub baths, hot tubs, pools, and immersion in other bodies of water until after the wound has healed and these activities are approved by the primary health care provider. Immersion in water for a prolonged period interferes with wound healing, because water may macerate tissue. Having a friend along does not change the fact that immersion in water for a prolonged period will interfere with wound healing. The client needs to continue physical therapy after discharge whether or not the client goes swimming.

Which would the nurse describe as an example of an internal disaster? 1. Tornado 2. Hurricanes 3. Fire or explosion 4. Terrorism attacks

Answer: 3. Fire or explosion Rationale: An internal disaster refers to an event that impairs the hospital's normal functioning and disrupts normal client care activities. Examples include a fire or explosion and the loss of critical utilities. Tornado, hurricanes, and terrorist attacks are external disasters that result in the loss of lives and property.

The nurse is planning to teach the four-point alternate crutch gait to a 9-year-old child with cerebral palsy. How would the nurse explain this choice to the parents? 1. The child has minimal step ability in the lower extremities. 2. It provides for two points of support on the floor at all times. 3. It provides for equal but partial weight bearing on each limb. 4. The child has more power in the upper extremities than in the lower extremities.

Answer: 3. It provides for equal but partial weight bearing on each limb. Rationale: The four-point alternate crutch gait is a simple, slow, stable gait because there are always three points of support on the floor, with equal but partial weight bearing on each limb. The child has the ability to move, but the movement in the lower extremities is uncoordinated. The four-point gait provides for three points of support, not two, at all times. A four-point gait divides weight bearing equally among the limbs.

Which goal would be priority for the child with autism spectrum disorder who has frequent episodes of self-biting and head-banging and needs help with feeding and toileting? 1. Controlling repetitive behaviors 2. Being able to feed independently 3. Remaining safe from self-inflicted injury 4. Developing control of urinary elimination

Answer: 3. Remaining safe from self-inflicted injury Rationale: The priority goal is remaining safe from self-inflicted injury. The priority is safety; the child must be protected from self-harm. Repetitive behaviors are comforting, and unless they are harmful their limitation is not a priority. Although feeding independently is a basic need that may be achieved, it is not the priority.

Which initial action would the nurse take when a male toddler with autism spectrum disorder suddenly runs to the wall and starts banging his head on it? 1. Allow the toddler to act out feelings. 2. Ask the toddler to stop this behavior. 3. Restrain the toddler to prevent head injury. 4. Tell the toddler that the behavior is unacceptable.

Answer: 3. Restrain the toddler to prevent head injury. Rationale: The nurse would restrain the toddler to prevent head injury. The child with autism spectrum disorder needs protection from self-injury. Permitting the child to act out feelings is possible only if the acting out does not place the child in jeopardy. The child with autism spectrum disorder has difficulty following directions, especially when out of control; therefore, asking the toddler to stop this behavior will be ineffective. The child with autism spectrum disorder cannot separate self from behavior; a punitive approach will decrease the child's self-esteem.

Which intervention is the best approach to condom use for prevention of sexually transmitted infection? 1. Use of spermicide 2. Use of oil-based lubricants 3. Use of a condom with oral sex 4. Use of natural membrane condoms

Answer: 3. Use of a condom with oral sex Rationale: Condoms should be used with all sexual encounters, including oral sex, to reduce sexually transmitted infection. There is no evidence that spermicides prevent sexually transmitted infection. Oil-based lubricants can break down latex condoms permitting the transfer of disease. Natural membranes condoms allow the transfer of some infections.

Which action would the nurse identify as a potential contributor to staff post-traumatic stress disorder (PTSD) during a mass casualty assessment? 1. Working less than 12 hours 2. Encouraging and motivating team members 3. Working continuously without any breaks 4. Discussing feelings with the team members

Answer: 3. Working continuously without any breaks Rationale: Working continuously without any breaks will result in increased stress. Working less than 12 hours may reduce stress. By motivating team members, PTSD can be prevented. By discussing feelings with team members or nurse managers, stress can be reduced.

Which parental statement would the nurse recognize as indicating the need for further education about bicycle safety for a school-aged client? 1. 'My child should be able to place both feet on the ground while seated.' 2. 'My child should be able to easily grasp the brake handles and squeeze them.' 3. 'My child will be required to wear a bicycle helmet if he or she wants to ride a bike.' 4. 'My child should be able to safely ride after being supervised for a couple of weeks.'

Answer: 4. 'My child should be able to safely ride after being supervised for a couple of weeks.' Rationale: Children may not safely be able to ride their bike within a couple of weeks of learning. The child should be able to place the balls of both feet on the ground while sitting on the bike. The child should easily be able to grasp the brake handles and squeeze them. The child should always wear the appropriate safety equipment while riding his or her bike.

At which height is it no longer safe for a toddler to sleep in a crib? 1. 26 inches 2. 28 inches 3. 33 inches 4. 36 inches

Answer: 4. 36 inches Rationale: A toddler who has reached the height of 35 inches should be transitioned from a crib to a bed. At that height, children likely can pull themselves up and over the crib rail, putting them at risk for injury. Toddlers 26, 28, and 33 inches in height can remain in a crib because falling is not a concern.

The nurse teaches a father how to provide oral care for his child who is undergoing chemotherapy. The nurse determines that he needs further teaching when he tries to use which dental hygiene product? 1. A cotton swab 2. Mild toothpaste 3. Saline mouthwash 4. An electric toothbrush

Answer: 4. An electric toothbrush Rationale: An electric toothbrush vigorously massages the gums; this may be irritating and could cause the gums to hemorrhage. Cotton swabs may be used because they will not injure the mucous membranes. A mild toothpaste may be used because it will not injure the mucous membranes. A saline mouthwash is isotonic and will not injure the mucous membrane.

Which report by the client post transrectal prostate biopsy needs to be communicated to the health care provider as a possible sign of infection? 1. Soreness 2. Rust-colored semen 3. Light rectal bleeding 4. Discharge from the penis

Answer: 4. Discharge from the penis Rationale: Discharge from the penis should be communicated to the health care provider for possible infection because discharge is an indication of infection. Soreness, rust-colored semen, and light rectal bleeding are expected after transrectal prostate biopsy.

Which initial nursing intervention would the nurse take for an older adult with delirium who begins acting out while in the dayroom? 1. Instructing the client to be quiet 2. Allowing the client to act out until fatigue sets in 3. Guiding the client from the room by gently holding the client's arm 4. Giving the client one simple direction at a time in a firm, low-pitched voice

Answer: 4. Giving the client one simple direction at a time in a firm, low-pitched voice Rationale: Clients with delirium typically respond to simple directions stated one at a time in a firm, low-pitched voice. 'Be quiet' is a nontherapeutic order; furthermore, it is demeaning to the client. Allowing the client to act out until fatigue sets in will not help the client gain control and might be frightening to other clients in the dayroom. Guiding the client from the room by gently holding the client's arm is done only after giving simple directions and attempting to clam the client has failed. Touch should also be used cautiously in clients who have delirium because the client may misinterpret the gesture as aggressive.

Which substance will the home care nurse instruct a client to use after laryngectomy to cleanse the stoma site? 1. Sterile saline 2. Steroid cream 3. Oil-based lubricant 4. Mild soap and water

Answer: 4. Mild soap and water Rationale: Mild soap and water are used to cleanse the stoma site. Sterile saline, a humidifier, or pans of water can be used to humidify the air entering the stoma. There is not need to use steroid cream at the site unless instructed by the health care provider. Non-oil-based, rather than oil-based, lubricants can be used as needed for lubrication of the site.

Which type of needs would be places as a high priority in the prioritization of client care? 1. Developmental needs 2. Long-term care needs 3. Potential needs in care 4. Needs that affect safety

Answer: 4. Needs that affect safety Rationale: Needs related to survival and safety are the highest priority because these are an immediate threat to client health. Developmental needs and long-term care needs are low priority when prioritizing care because they are not an immediate threat to health. Potential needs in care are intermediate priority because they are best addressed before complications follow.

Which effect has resulted in the avoidance of tetracycline use in children under 8 years old? 1. Birth defects 2. Allergic responses 3. Severe nausea and vomiting 4. Permanent tooth discoloration

Answer: 4. Permanent tooth discoloration Rationale: Tetracycline use in children under the age of 8 years has been discontinued because it causes permanent tooth discoloration. Birth defects, allergic responses, and severe nausea and vomiting are not prevalent reasons for the discontinuation of tetracycline medications in children under 8 years old.

An adolescent girl with a seizure disorder refuses to wear a medical alert bracelet. Which would the nurse tell the girl that may help her wear the bracelet consistently? 1. Hide the bracelet under long-sleeved clothes. 2. Wear the bracelet when engaging in contact sports. 3. Ask her friends to wear bracelets that look like hers. 4. Select a bracelet similar to bracelets worn by her peers.

Answer: 4. Select a bracelet similar to bracelets worn by her peers. Rationale: Because adolescents have a developmental need to conform to their peers, the teenager should be able to select a bracelet of a design similar to that of those worn by her peers. Hiding the bracelet under long-sleeved clothes might be acceptable in cool weather, but not when it is warm and friends are wearing T-shirts. The bracelet should be worn at all times when the girl is not with responsible family members. Asking friends to wear a similar bracelet may be difficult, especially if the girl does not wish to tell her friends why she needs the bracelet.

Punctal occlusion is performed after the administration of eyedrops to prevent which from occurring? 1. Tearing 2. Infection 3. Allergic reaction 4. Systemic absorption

Answer: 4. Systemic absorption Rationale: Punctal occlusion prevents systemic absorption of the medication. For example, systemic absorption of beta-blockade used to treat glaucoma can affect heart rate and blood pressure. Punctal occlusion does not prevent tearing, infection, or allergic reaction.

Which nursing action is most effective in controlling the spread of infection for an infant with diarrhea? 1. Wearing a gown and gloves during care 2. Allowing only registered nurses to give direct care 3. Restricting visitors to the infant's immediate family 4. Washing hands before and after contact with the infant

Answer: 4. Washing hands before and after contact with the infant Rationale: The most effective method of preventing the spread of infection is hand washing not only before and after care but also before and after using gloves. A gown and gloves are not required for contact precautions. The level of education of the caregiver does not guarantee the correct technique for preventing the spread of infection. The risk for spread of infection is not in the number of visitors but in the aseptic technique practiced by these visitors.