NU372 Week 1 EAQ Evolve Elsevier: Infection (Custom Quiz)

Which infection requires airborne precautions? Select all that apply. One, some, or all responses may be correct. o Measles o Influenza o Clostridium difficile o Bacterial meningitis o Methicillin-resistant Staphylococcus aureus (MRSA)

o Measles · Varicella, measles, and tuberculosis require airborne precautions because these infections spread through small particles in the air. Droplet precautions are implemented to prevent the spread of influenza and bacterial meningitis. C. difficile and MRSA require the use of contact precautions.

Which characteristic of urine changes in the presence of a urinary tract infection (UTI)? o Clarity o Viscosity o Glucose level o Specific gravity

o Clarity · Cloudy urine usually indicates drainage associated with infection. Viscosity is a characteristic that is not measurable in urine. Urinary glucose levels are not affected by UTIs. Specific gravity yields information related to fluid balance.

Which nursing action will be most helpful in preventing transmission of influenza in crowded communities? o Teaching correct hand-washing techniques o Demonstrating how to cover the mouth when coughing o Educating about the importance of having annual vaccinations o Giving antiviral medications within 48 hours of symptom development

o Educating about the importance of having annual vaccinations · Immunization is the most effective way to prevent communicable diseases. Hand washing will be helpful in decreasing person-to-person spread of influenza, but not as effective as preventing influenza through immunization. Covering the mouth when coughing helps decrease respiratory droplet spread, but is not as effective as immunization in preventing influenza transmission. Antiviral medications such as oseltamivir need to be started within 48 hours after symptoms develop and will shorten the course of the infection, but do not decrease transmission as effectively as immunization.

A 2-year-old toddler has hearing loss caused by recurrent otitis media. Which treatment would the nurse anticipate that the practitioner will recommend? o Eardrops o Myringotomy o Mastoidectomy o Steroid therapy

o Myringotomy · Myringotomy is a surgical opening into the eardrum to permit drainage of accumulated fluid associated with otitis media. Eardrops are not used because they will obscure the view of the tympanic membrane. Removal of the mastoid will not relieve pressure within inflamed ears. Antibiotics, not steroids, are used for an infectious process.

A client is being admitted to a medical unit with a diagnosis of pulmonary tuberculosis. Which type of room would the nurse assign this client? o Private room o Semiprivate room o Room with windows that can be opened o Negative-airflow room

o Negative-airflow room · Tuberculosis is an airborne contagious disease that is best contained in a negative-airflow room. Negative-airflow rooms are always private. A private room, semiprivate room, and a room with windows that can be opened are not appropriate for the standard of care for a client diagnosed with tuberculosis. Additionally, opening windows would present a possible safety hazard in a client's room.

A client with tuberculosis asks the nurse about the communicability of the disease. Which response would the nurse use? o "Tuberculosis is not communicable at this time." o "Untreated active tuberculosis is communicable." o "Tuberculosis is communicable during the primary stage." o "With the newer long-term therapies, tuberculosis is not communicable."

o "Untreated active tuberculosis is communicable." · The statement that untreated active tuberculosis is communicable is an accurate statement; treatment is necessary to stop communicability. The statement that tuberculosis is not communicable at this time is false reassurance; untreated active tuberculosis is communicable. Tuberculosis is not communicable when there is no active infection; the primary complex refers to the presence of a primary (Ghon) tubercle and enlarged lymph nodes and is the initial response to exposure; active disease may or may not occur. Tuberculosis is a communicable disease; close contacts would be screened via a skin test.

Which client would the nurse consider to have the highest risk of pneumonia? o Client 1 o Client 2 o Client 3 o Client 4

o Client 4 · Client 4, who is an older adult with chronic lung disease and has received the pneumococcal vaccination more than 5 years ago, has the highest risk of pneumonia. An infection may occur because older adults with chronic lung disease are at a higher risk of infection. Client 1 received the pneumococcal vaccination in the past 3 months and thus has a lower risk of pneumonia. Client 2 received a pneumococcal vaccination in the past 2 years and may not have an elevated risk of pneumonia. Client 3 may have a lower risk of pneumonia due to receiving the pneumococcal vaccine a year ago.

Which client would the nurse state shows symptoms of influenza? o Client 1 o Client 2 o Client 3 o Client 4

o Client 4 · Headache, muscle aches, fever, chills, fatigue, weakness, sore throat, cough, watery nasal discharge lasting for more than a week, nausea, vomiting, and diarrhea are the signs and symptoms of seasonal influenza, which is an acute, viral respiratory infection. Headache, nasal irritation, sneezing, nasal congestion, watery drainage from the nose, and itchy and watery eyes are the symptoms of rhinitis, an infection of the nose. A client with sinusitis, which is an infection of the sinuses, will show symptoms such as pain over the cheek, pain to the back of the head, and general facial pain that worsens when bending forward, purulent nasal drainage, and fever. Throat soreness and dryness, throat pain, pain on swallowing, difficulty swallowing, and fever are symptoms that may be experienced by a client with tonsillitis, which is an infection of the tonsils.

Which intervention is most important in preventing hospital-acquired catheter-associated urinary tract infections (CAUTIs)? o Removing the catheter o Keeping the drainage bag off of the floor o Washing hands before and after assessing the catheter o Cleansing the urinary meatus with soap and water daily

o Removing the catheter · Research demonstrates that decreasing the use of indwelling urinary catheters is the most important intervention to prevent CAUTIs. Keeping the drainage bag off the floor, washing hands before and after assessing the catheter, and cleansing the urinary meatus daily with soap and water will help reduce infections; however, these are not the most important interventions to prevent CAUTIs.

Which factor would the nurse consider when the parent of a 10-month-old infant expresses frustration that this is the baby's third otitis media in 3 months? o Analgesics are contraindicated. o Oral antibiotics will be prescribed. o The labyrinth and cochlea are inflamed. o The eustachian tube is short and horizontal.

o The eustachian tube is short and horizontal. · This anatomical difference in young children permits easier migration of microorganisms from the oral cavity into the middle ear, predisposing them to otitis media. Analgesics such as acetaminophen or ibuprofen are recommended to relieve discomfort. Studies have shown that antibiotics are not always necessary in children over 6 months old without severe symptoms. Antibiotic therapy is necessary when the infant has a fever or is in severe pain. The labyrinth and cochlea are part of the inner ear and are not affected by otitis media.

The nurse is preparing discharge instructions for a client who acquired a nosocomial Clostridium difficile infection. Which would the nurse include in the instructions? o Anticipate that nausea and vomiting will continue until the infection is no longer present. o The infection causes diarrhea accompanied by flatus and abdominal discomfort. o Consume a diet that is high in fiber and low in fat. o Other than routine hand washing, it is not necessary to perform special disinfection procedures.

o The infection causes diarrhea accompanied by flatus and abdominal discomfort. · The main clinical manifestation of C. difficile is diarrhea accompanied by excessive flatus and abdominal discomfort. Nausea and vomiting are not associated with this infectious disease. Clients should follow a nutritionally balanced diet high in fiber and low in fats with no specific restrictions. Cleaning and disinfection of items in the home is key to preventing spread of the infection because the C. difficile spore is relatively resistant.

Which strategy is most effective for preventing the transmission of infection? o Wearing gloves and a gown o Applying face mask and a gown o Applying a face mask and gloves o Wearing gloves and hand hygiene

o Wearing gloves and hand hygiene · The combination of hand hygiene and wearing gloves is the most effective strategy for preventing infection transmission. A gown and face mask are considered personal protective equipment; however, they are not considered the most effective strategy to prevent the transmission of infection.

Which instruction would the nurse provide to the client who has been diagnosed with a urinary tract infection? o Void every 2 hours. o Record fluid intake and urinary output. o Pour warm water over the vulva after voiding. o Urinate after intercourse.

o Urinate after intercourse. · During sexual intercourse, bacteria from the perineum, vagina, and anus can move near the urethra because of the anatomic proximity of these organs. Voiding promptly after intercourse can help decrease the ascent of bacteria up the urethra to the bladder. Voiding every 2 hours is unnecessary, but the client should be encouraged to void when the urge occurs. Intake and output need not be measured. Pouring warm water over the vulva after voiding is unnecessary for cystitis; it may be used as a part of perineal care for other problems.

The nurse is providing care to a client after surgery to correct an upper urinary tract obstruction. Which assessment finding would the nurse report to the surgeon? o Incisional pain o Absent bowel sounds o Urine output of 20 mL/h o Serosanguineous drainage on the dressing

o Urine output of 20 mL/h · A urinary output of 50 mL/h or greater is necessary to prevent stasis and consequent infections after this type of surgery. The nurse would notify the surgeon of the assessment findings because this may indicate a urinary tract obstruction. Incisional pain, absent bowel sounds, and serosanguineous drainage are acceptable assessment findings for this client after this procedure and require continued monitoring but do not necessarily require reporting to the surgeon.

The nurse is providing instruction to a parent of a child with influenza. Which statement by the parent indicates the need for further instruction? o "I'll manage the fever with baby aspirin." o "We'll make sure to get a flu shot next season." o "Providing fluids will help relieve the symptoms." o "Staying home from school will prevent transmission."

o "I'll manage the fever with baby aspirin." · The use of aspirin to treat the fever associated with influenza is contraindicated; it is associated with Reye syndrome, which involves a toxic encephalopathy and hepatic dysfunction. Inactivated influenza viral vaccines are effective in the prevention of influenza. Fever may lead to dehydration; fluids help maintain hydration. The influenza virus can be spread by direct contact or through contact with surfaces contaminated with the virus; staying home prevents the spread of the disease to other students.

When admitting an older client, the stool specimen confirmed a diagnosis of a methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse inquires about potentially assigning Room 2010, Bed B, the same isolation room as another client (2010, Bed A) who has MRSA. Which response would the nurse receive? o "The other client's infection is not contagious." o "This is the usual practice when antibiotic therapy is started." o "Placing clients with the same infection in 1 room is safe." o "As soon as a private room becomes available, we will move the client."

o "Placing clients with the same infection in 1 room is safe." · There is no need to separate 1 client with MRSA from another client with the same infection. MRSA infections are highly contagious. MRSA infections are resistant to most antibiotics, especially methicillin. Clients with the same infection can remain in the same room; contact precautions are necessary to protect visitors and staff members.

When a client in the clinic is offered the influenza vaccine and states, "I had the vaccination already last year, so I won't need it now," which response will the nurse give? o "The flu vaccine is recommended for everyone." o "You only need 1 flu shot in your lifetime to achieve immunity." o "As long as you are younger than 50 years old, you will not really need vaccination." o "The immunization changes, so you need to get vaccine annually to stay protected."

o "The immunization changes, so you need to get vaccine annually to stay protected." · The influenza vaccine changes to best suit the strains circulating during a particular flu season. Therefore, people need to be vaccinated annually. The flu vaccine is safe for most adults, but some people with allergies to components of the vaccine cannot receive it. One influenza vaccination is not adequate for lifetime immunity; an annual vaccination is recommended. Although it is especially important that higher-risk individuals such as adults older than 50 are vaccinated, annual influenza vaccination is recommended for all individuals older than 6 months.

A client arrives at a health clinic stating, "I am here to have my tuberculin skin test read." The nurse notes that there is a 7-mm indurated area at the injection site. Which statement made by the nurse correctly describes this result? o "The result indicates that you have active tuberculosis." o "The result indicates that you are infected with the tuberculosis organism." o "The result indicates that there are no tuberculin antibodies in your system." o "The result indicates that you have a secondary infection related to the tuberculin organism."

o "The result indicates that you are infected with the tuberculosis organism." · An indurated area 5 mm or larger noted 48 to 72 hours after the tuberculin test indicates that the person is infected with the tuberculin organism. A positive tuberculin skin test accompanied by fever, coughing, weakness, and positive chest x-ray are manifestations of active tuberculosis. The other choices are incorrect.

The new nurse is approached by a surveyor from the department of health. The surveyor asks the nurse about the best way to prevent the spread of infection. Which answer by the nurse is correct? o "Let me get my preceptor." o "Wash your hands before and after any client care." o "Clean all instruments and work surfaces with an approved disinfectant." o "Ensure proper disposal of all items contaminated with blood or body fluids."

o "Wash your hands before and after any client care." · The best means to prevent the spread of infection is to break the chain of infection. This is most easily accomplished by the simple act of hand washing before and after all client contact. "Let me get my preceptor" and "Clean all instruments and work surfaces with an approved disinfectant" may be correct, but they are not the best responses for this situation. It is not necessary that all items contaminated with blood or body fluids be disposed.

Which client is at an increased risk for hospital-acquired pneumonia? Select all that apply. One, some, or all responses may be correct. o Client who was admitted yesterday with hypoxia and fever o Client who has been on mechanical ventilation for 5 days o Client who reports being on an airplane with other sick individuals o Client who presents to the emergency department with cough and crackles o Client who was admitted to the hospital 5 days ago for abdominal pain

o Client who was admitted to the hospital 5 days ago for abdominal pain · Hospital-acquired pneumonia occurs in nonintubated clients and begins 48 hours after admission. A client admitted 5 days ago with abdominal pain would meet the criteria and is at increased risk for hospital-acquired pneumonia. A client admitted the previous day has not been in the hospital at least 48 hours. A client on mechanical ventilation is intubated and does not meet the criteria for hospital-acquired pneumonia. A client who has been on an airplane with other ill individuals would be at risk for community-acquired pneumonia. A client in the emergency department has not been admitted to the hospital.

The nurse would include which instruction to the parents of a child being treated with oral ampicillin for otitis media? o Complete the entire course of antibiotic therapy. o Herbal fever remedies are highly discouraged. o Administer the medication with meals. o Stop the antibiotic therapy when the child no longer has a fever

o Complete the entire course of antibiotic therapy. · Once antibiotic therapy is initiated, the antibiotics start to destroy specific bacterial infections that the health care provider is trying to treat. Antibiotic therapy takes a specific dose and number of days to completely eliminate the bacteria. If the caregivers start a dose and stop it before the course is complete, the remaining bacteria have a chance to grow again, become resistant to antibiotic treatment, and multiply. The nurse would not discourage use of herbal fever remedies; however, the herbal treatment would be reviewed to see if it is contraindicated. Ampicillin would be taken 1 to 2 hours after meals. Antibiotic therapy would be completed as prescribed.

Which findings in the older adult client are associated with a urinary tract infection (UTI)? Select all that apply. One, some, or all responses may be correct. o Fever o Urgency o Confusion o Incontinence o Slight rise in temperature

o Confusion o Incontinence o Slight rise in temperature · An older adult client with a urinary tract infection (UTI) is likely to appear confused and may experience incontinence, whereas a younger client is cognitively intact and typically experiences urgency. The older adult client may develop only a slight rise in temperature, whereas the hallmark symptoms of a UTI in a younger client are fever, dysuria, and urgency.

Which category of isolation would the nurse implement for a client who is positive for Clostridium difficile? o Airborne precautions o Droplet precautions o Contact precautions o Protective environment

o Contact precautions · Contact precautions should be used for direct client or environmental contact with blood or body fluids from an infected client. This includes colonization of infection with multidrug-resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA), stool infected with Clostridium difficile, draining wounds where secretions are not contained, or scabies. Airborne precautions are used for infected droplets smaller than 5 mcg, such as measles, chickenpox (varicella), or pulmonary tuberculosis (TB). Droplet precautions are used for droplets larger than 5 mcg and when within 3 feet (0.9 m) of the client, such as streptococcal pharyngitis, mumps, and influenza. Protective environment focuses on clients with a compromised immune system to protect them from incoming pathogens.

A client with a methicillin-resistant Staphylococcus aureus (MRSA) infected wound is scheduled for a computed tomography (CT) scan. To ensure client and visitor safety during transport, the nurse would implement which precaution? o No special precautions are required. o Cover the infected site with a dressing. o Drape the client with a covering labeled biohazardous. o Place a surgical mask on the client.

o Cover the infected site with a dressing. · Covering the infected site with a dressing will contain secretions and set up a barrier, thus decreasing the risk for transmission to others. Contact precautions must be used for clients with known or suspected infections transmitted by direct contact or contact with items in the environment. Draping the client with a sheet marked biohazardous does not protect the client's privacy. A wound infected with MRSA can be transmitted to others via contact, not through the airborne route; thus a mask is unnecessary.

Which intervention would the nurse perform to prevent disease transmission when caring for a hospitalized client with influenza? o Dispose of all sharps. o Administer antibiotics. o Don a mask in the room. o Wear a disposable gown

o Don a mask in the room. · The way to prevent the transmission of influenza is by instituting droplet precautions. The care involved is to wear a mask when in the client's room. Disposing of all sharps prevents the transmission of bloodborne diseases. Antibiotics are not effective against viral infections such as influenza. Gowns are used when preventing transmission of contaminated body fluids such as stool or urine.

When caring for a client with pneumonia, which nursing intervention is the highest priority? o Increase fluid intake. o Employ breathing exercises and controlled coughing. o Ambulate as much as possible. o Maintain a nothing-by-mouth (NPO) status.

o Employ breathing exercises and controlled coughing. · For most clients, the most effective means of preventing fluid consolidation in the lungs with a diagnosis of pneumonia is to keep active by deep breathing and controlled coughing exercises. Increased fluid intake and ambulation are important aspects of care if not contraindicated, but they are secondary to deep breathing and coughing. Keeping the client NPO is not necessary; unless contraindicated, the client with pneumonia is usually offered the regular diet as tolerated.

A client with active tuberculosis is walking down the hall to obtain a glass of juice from the kitchen, even after having received education regarding airborne precautions. Which nursing intervention would the nurse implement at this time? o Ensure regular visits by staff members to meet the client needs. o Explore what the airborne precautions mean to the client. o Report the situation to the infection control nurse immediately. o Reteach the concepts of airborne precautions to the client.

o Explore what the airborne precautions mean to the client. · Communication facilitates joint solution of the problem; the nurse must first determine the client's understanding and perceptions before solutions to the problem can be attempted. Ensuring regular visits by staff members will not collect data about why the client is leaving the room. Reporting the situation to the infection control nurse abdicates the responsibility of the primary nurse. Reteaching the concepts of airborne precautions to the client may be done, but not until further assessment is performed to determine the reason why the client is leaving the room.

The nurse is providing colostomy care to a client with methicillin-resistant Staphylococcus aureus (MRSA) infection. Which personal protective equipment (PPE) would the nurse use? Select all that apply. One, some, or all responses may be correct. o Gloves o Gown o Mask o Goggles o Shoe covers o Hair bonnet

o Gloves o Gown o Goggles · Standard PPE, which should be used for performing colostomy care in a client positive for MRSA, includes gloves, gown, and goggles. A combination mask/eye shield may be used when caring for this client; however, a mask is not necessary. A mask would be necessary if the client had MRSA of the nares. Shoe covers and hair bonnet are not required for this client care situation.

The nurse is teaching unlicensed assistant personnel about ways to prevent the spread of infection. The nurse decides to emphasize the need to break the cycle of infection. Which teaching would be priority? o Hand washing before and after providing client care o Cleaning all equipment with an approved disinfectant after use o Wearing personal protective equipment (PPE) when providing client care o Using medical and surgical aseptic techniques at all times

o Hand washing before and after providing client care · Hand washing before and after providing care is the single most effective means of preventing the spread of infection by breaking the cycle of infection. Although all the other interventions are acceptable procedures and may assist in preventing the spread of infection, none are as effective as hand washing.

Which finding in a urinalysis indicates a urinary tract infection? o Crystals o Bilirubin o Ketones o Leukoesterase

o Leukoesterase · Leukoesterases are released by white blood cells in response to an infection or inflammation. The presence of this chemical in urine indicates a urinary tract infection. The presence of crystals in the urine indicates that the specimen had been allowed to stand. Presence of bilirubin in the urine indicates anorexia nervosa, diabetic ketoacidosis, and prolonged fasting. The presence of ketones indicates diabetic ketoacidosis.

When caring for a client on isoniazid therapy for tuberculosis, the nurse would focus on which diagnostic testing for this client? o Creatinine o Hearing tests o Electrocardiogram o Liver function tests

o Liver function tests · Isoniazid can damage the liver enough to lead to death, so liver function should be monitored. Creatinine would be tracked for renal dysfunction, which is not a focus of isoniazid therapy because isoniazid is metabolized by the liver. Aminoglycosides can cause ototoxicity, causing hearing loss. Bedaquiline can cause prolonged QT, detected through electrocardiogram.

Which clinical manifestation is associated with cellulitis? o Lymphadenopathy o Occasional papules o Vesicles that evolve into pustules o Isolated erythematous pustules

o Lymphadenopathy · Cellulitis is accompanied by lymphadenopathy. Occasional papules are present in folliculitis. Herpes simplex viral infections evolve the vesicles into pustules. Isolated erythematous pustules occur in folliculitis bacterial infections.

A client admitted with urinary retention has an indwelling urinary catheter prescribed. Which action would the nurse implement to prevent the client from developing a urinary tract infection? o Assess urine specific gravity. o Collect a weekly urine specimen. o Maintain the prescribed hydration. o Empty the drainage bag once a day.

o Maintain the prescribed hydration. · Promoting hydration maintains urine production that flushes the bladder, thereby preventing urinary stasis and possible infection. Although assessing urine specific gravity and collecting a weekly urine specimen for culture and sensitivity may help identify a urinary tract infection, these actions will not prevent it. The nurse should empty the collection bag once every shift unless the bag is full and needs emptying sooner.

When a client with pneumonia is experiencing dyspnea because of difficulty expectorating thick respiratory secretions, which action by the nurse will be most helpful? o Administer continuous oxygen. o Offer fluids at frequent intervals. o Place the client in a high-Fowler position. o Administer prescribed steroid inhaler.

o Offer fluids at frequent intervals. · Increased fluid intake helps liquefy respiratory secretions, which promotes expectoration. The client may need oxygen administration, but the airways must be cleared before oxygen can effectively reach the alveoli. Placing the client in a high Fowler position will help increase lung expansion, but will not improve cough effort or make secretions easier to expectorate. Steroid inhalers may decrease airway inflammation, but will not help make respiratory secretions easier to expectorate.

An older client with shortness of breath is admitted to the hospital. The medical history reveals and a diagnosis of pneumonia 3 days ago. Which vital sign assessment would be seen as a sign that the client needs immediate medical attention? o Oxygen saturation: 89% o Body temperature: 101°F o Blood pressure: 130/80 mm Hg o Respiratory rate: 26 beats/minute

o Oxygen saturation: 89% · An oxygen saturation of less than 90% observed in a client with pneumonia indicates that the client is at risk of respiratory depression. Oxygen saturation would take priority in initiating the care. The client's body temperature indicates fever due to pneumonia, which should be considered secondary to the oxygen saturation problem. The blood pressure reading is normal. The increased respiratory rate may be due to fever, which would be considered secondary to the oxygen saturation problem.

Which observations by the nurse indicate a client with pneumonia is able to use an incentive spirometer correctly? Select all that apply. One, some, or all responses may be correct. o Records the volume of the air inspired o Performs 10 breaths per session every hour o Inhales air fully before inserting the mouthpiece o Takes a long, slow, deep breath keeping the mouthpiece in place o Exhales deep breaths with the mouthpiece in their mouth

o Records the volume of the air inspired o Performs 10 breaths per session every hour o Takes a long, slow, deep breath keeping the mouthpiece in place · The use of incentive spirometry is to improve inspiratory muscle action and to prevent or reverse atelectasis in clients with pneumonia. The client would exhale fully, then insert the mouthpiece and inhale. Having the client inhale the air before inserting the mouthpiece may cause harm to the client and needs correction. After the process is completed, the volume of air inspired is recorded. A client with pneumonia is instructed to perform 10 breaths per session every hour while awake. Taking a long, slow, deep breath keeping the mouthpiece in place helps improve inspiratory muscle action.

A primary health care provider diagnoses the client's condition as otitis media. Which assessment finding supports that diagnosis? o Nodules on the pinna o Redness of the eardrum o Lesions in the external canal o Excessive cerumen in the external canal

o Redness of the eardrum · Many conditions are associated with a decrease in hearing acuity. One such condition is otitis media. This condition is diagnosed by redness of the eardrum observed during the otoscopic examination. Nodules on the pinna may be an indication of rheumatoid arthritis, chronic gout, or basal or squamous cell carcinoma. Lesions in the external canal may cause a decrease in hearing acuity, but not the manifestation of otitis media. Excessive soft cerumen in the external canal affects the hearing acuity, but not the manifestation of otitis media.

Which intervention is most beneficial in preventing a catheter-associated urinary tract infection in a postoperative client? o Pouring warm water over the perineum o Ensuring the patency of the catheter o Removing the catheter within 24 hours o Cleaning the catheter insertion site

o Removing the catheter within 24 hours · Clients who undergo surgery are at a greater risk of acquiring catheter-associated urinary tract infections. Infections can be prevented by removing the catheter within 24 hours if the client does not need it. Removing the catheter within 24 hours would be the best intervention. Although pouring warm water over the perineum helps voiding in the postoperative client and also reduces the chances of infection, this action would not be as beneficial as the former intervention. The catheter should be maintained in its place to avoid leakage and infection. Cleaning the catheter insertion site will definitely reduce the risk of infection, but this action cannot prevent infections if the catheter is inserted for a long time.

Which assessment finding for a client with pneumonia would be most important for the nurse to communicate to the health care provider? o Cough productive of rust-colored sputum o Sharp chest pain with deep inspiration o Oral temperature 103°F (39.4°C) o Respiratory rate 38 breaths per minute

o Respiratory rate 38 breaths per minute · A respiratory rate of 38 breaths per minute indicates respiratory distress and the nurse would communicate the rate immediately to the provider and anticipate implementation of actions such as oxygen administration using a nonrebreather mask or mechanical ventilation. A cough productive of rust-colored sputum is typical with pneumonia. Sharp chest pain with deep inspiration may occur with inflammation of the parietal pleura. Fever is frequently seen with pneumonia.

Which information will the employee health nurse include when teaching about ways to prevent transmission of influenza in the workplace? Select all that apply. One, some, or all responses may be correct. o Sneeze or cough into the upper sleeve. o Avoid use of over-the-counter antihistamines. o Use alcohol-based hand sanitizers after blowing the nose. o Turn the head away from others when coughing or sneezing. o Antiviral medications are the most effective means of transmission prevention.

o Sneeze or cough into the upper sleeve. o Use alcohol-based hand sanitizers after blowing the nose. o Turn the head away from others when coughing or sneezing. · Sneezing or coughing into the upper sleeve is recommended because it minimizes droplet spread and prevents the influenza virus from getting on the hands, where it can easily be spread to environmental surfaces. Alcohol-based hand sanitizer use after blowing the nose will reduce transmission of influenza virus to environmental surfaces. Turning the head away from others when coughing or sneezing decreases droplet spread. Over-the-counter antihistamines are recommended for control of rhinitis and nasal congestion. Although antiviral medications may help reduce symptoms and transmission if they are started within the first 2 days after symptoms develop, the most effective means to reduce influenza transmission is annual vaccination.

Which should the nurse include when teaching a client with Clostridium difficile about decreasing the risk of transmission to family members? o Increase fluid intake o A high-fiber diet o Soap and water for hand washing o Wash hands with an alcohol-based hand sanitizer

o Soap and water for hand washing · Alcohol does not kill C. difficile spores. Use of soap and water is more efficacious than alcohol-based hand rubs. Increased fluids and increased fiber do not decrease the risk of transmission of C. difficile.

The nurse is caring for a client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) in the urine. The health care provider orders an indwelling urinary catheter to be inserted. Which safeguard would the nurse take during this procedure? o Droplet precautions o Reverse isolation o Surgical asepsis o Medical asepsis

o Surgical asepsis · Catheter insertion requires the procedure to be performed under sterile technique. Droplet precautions are used with certain respiratory illnesses. Reverse isolation is used with clients who may be immunocompromised. Medical asepsis involves clean technique/gloving.

Which information would the nurse include when teaching about why women are more susceptible to urinary tract infections than men? o Inadequate fluid intake o Poor hygienic practices o The length of the urethra o The disruption of mucous membranes

o The length of the urethra · The length of the urethra is shorter in women than in men; therefore microorganisms have a shorter distance to travel to reach the bladder. The proximity of the meatus to the anus in women also increases the incidence of urinary tract infections. Fluid intake may or may not be adequate in both men and women and does not account for the difference. Hygienic practices can be inadequate in men or women. Mucous membranes are continuous in both men and women.

The nurse prepares a male client with a history of recurrent urinary tract infections (UTIs) for discharge after a ureterolithotomy. Which clinical manifestations of a UTI would the nurse teach this client to recognize? o Urgency or frequency of urination o An increase of ketones in the urine o The inability to maintain an erection o Pain radiating to the external genitalia

o Urgency or frequency of urination · Urgency or frequency of urination occurs with a urinary tract infection because of bladder irritability; burning on urination and fever are additional signs of a UTI. Increased ketones indicate diabetes mellitus, starvation, or dehydration. A UTI does not affect the ability of a male to maintain an erection. Pain radiating to the external genitalia is a symptom of a urinary calculus, not an infection.

A client recovering from deep, partial-thickness burns develops chills, fever, flank pain, and malaise. Which prescribed diagnostic test would the nurse expect to confirm a tentative urinary tract diagnosis? o Cystoscopy and bilirubin level o Specific gravity and pH of the urine o Urinalysis and urine culture and sensitivity o Creatinine clearance and albumin/globulin (A/G) ratio

o Urinalysis and urine culture and sensitivity · The client's manifestations may indicate a urinary tract infection. A culture of the urine will identify the microorganism, and sensitivity will identify the most appropriate antibiotic. A cystoscopy is too invasive as a screening procedure; altered bilirubin results indicate liver or biliary problems, not urinary signs and symptoms. Creatinine clearance reflects renal function; A/G ratio reflects liver function. Although an increased urine specific gravity may indicate red blood cells, white blood cells, or casts in the urine, which are associated with urinary tract infection, it will not identify the causative organism.