Chapter 23 Care of Patients with Infection

Chapter 23: Care of Patients with Infection MULTIPLE CHOICE 1. Thenursinginstructorexplaininginfectiontellsstudentsthatwhichfactor is thebestandmostimportant barrier to infection? a. Colonization by host bacteria b. Gastrointestinal secretions c. Inflammatory processes d. Skin and mucous membranes ANS: D Theskinandmucousmembranesarethemostimportantbarrieragainstinfection. Theotheroptionsarealso barriers, but are considered secondary to skin and mucousmembranes. DIF: Understanding/Comprehension REF: 416 KEY: Infection| physiology MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation 2. A nursing manager is concerned about the number of infections on the hospital unit. What action by the manager would best help prevent these infections? a. Auditing staff members hand hygiene practices b. Ensuring clients are placed in appropriate isolation c. Establishingapolicy to removeurinarycathetersquickly d. Teachingstaffmembersaboutinfectioncontrolmethods ANS: A All methods will help prevent infection; however, health care workers lack of hand hygiene is the biggest cause of healthcare-associated infections. The manager can start with a hand hygiene audit to see if this is a contributing cause. DIF: Applying/Application REF: 417 KEY: Infection control| infection| hand hygiene MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 3. A student nurse askswhy brushing clients teeth with a toothbrush in the intensive care unit is important to infection control. What response by the registered nurse is best? a. It mechanically removes biofilm on teeth. b. Its easier to clean all surfaces with a brush. c. Oral care is important to all our clients. d. Toothbrushes last longer than oral swabs. ANS: A Biofilms are a complex group of bacteria that function within a slimy gel on surfaces such as teeth. Mechanical disruption (i.e., toothbrushing with friction) is the bestway to control them. The other answers are not accurate DIF: Understanding/Comprehension REF: 421 KEY: Infection| infection control| oral care MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 4. A client is admitted with possible sepsis. Which action should the nurse perform first? a. Administer antibiotics. b. Give an antipyretic. c. Place the client in isolation. d. Obtain specified cultures. ANS: D Prior toadministering antibiotics, thenurseobtainstheorderedcultures.Broad-spectrumantibioticswillbe administered until the culture and sensitivity results are known. Antipyretics are given if the client is uncomfortable; fever is a defense mechanism. Giving antipyretics does not take priority over obtaining cultures. The client may or may not need isolation. DIF: Applying/Application REF: 424 KEY: Infection| antibiotics| cultures MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care 5. A client is hospitalized and on multiple antibiotics. The client develops frequent diarrhea. What action by the nurse is most important? a. Consult with the provider about obtaining stool cultures. b. Delegate frequent perianal care to unlicensed assistive personnel. c. Place the client on NPO status until the diarrhea resolves. d. Request a prescription for an anti-diarrheal medication. ANS: A Hospitalized clients who have three or more stools a day for 2 or more days are suspected of having infection with Clostridium difficile. The nurse should inform the practitioner and request stool cultures. Frequent perianal care is important and can be delegated but is not the priority. The client does not necessarily need to be NPO; if the client is NPO, the nurse ensures he or she is getting appropriate IV fluids to prevent dehydration.Anti-diarrhealmedicationmayormaynotbeappropriate, andthediarrheaservesastheportalof exit for the infection. DIF: Applying/Application REF: 428 KEY: Infection| cultures| communication MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential 6. A nurse is observing as an unlicensed assistive personnel (UAP) performs hygiene and changes a clients bed linens. What action by the UAP requires intervention by the nurse? a. Not using gloves while combing the clients hair b. Rinsing the clients commode pan after use c. Shaking dirty linens and placing them on the floor d. Wearing gloves when providing perianal care ANS: C Shaking dirty linens (or even clean linens) can spread microbes through the air. Placing linens on the floor contaminatesthe floor surface and can lead to infection spread via shoes. The other actions areappropriate. If the client has a scalp infection or infestation, the UAP should wear gloves; otherwise it is not required. DIF: Applying/Application REF: 419 KEY: Infection| infection control| supervision| unlicensed assistive personnel (UAP) MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control 7. Ahospitalunit is participating in abioterrorism drill. Aclient is admittedwith inhalationanthrax. Under what type of precautions does the charge nurse admit the client?