Infection

Which food item, if selected by the patient, would prompt the nurse to provide additional education? Review the patient’s chart to make selection.

Following a major natural disaster, the charge nurse receives instruction from superiors to pair patients as roommates to increase the number of available rooms. The first patient to be paired is a 42-year-old patient with cellulitis who has a 103°C fever and tachycardia. The charge nurse places her in a room with which patient?

The nurse has instituted a process improvement project to reduce the number of central line-associated bloodstream infections (CLABSI) in the intensive care unit. During the first month after instituting the process change, the incidence of CLABSIs dropped from 8 the previous month to 2 for the month. Which action by the nurse is most appropriate?

The nurse receives report of four issues at 0800. Which situation is addressed first?

The nurse is supervising the student nurse who is making a call to the provider about a patient who is decompensating. The student states, “Hello, Dr. Smith. This is Carly and I’m taking care of Alex Wright in room 433. He is in the hospital after surgery for a ruptured appendix. Over my shift his temperature has increased by 4 degrees and his heart rate is elevated. His blood pressure is decreased from the previous shift as well. Could you please come examine him?” Which additional comments are the priority for the nurse to add? Select all that apply.

The patient is scheduled to undergo a Wood’s light examination. Which instruction does the nurse include in preprocedure teaching?

The patient receiving which medication is most likely to also require a prescription for miconazole?

The 60-year-old patient who was recently laid off from his factory job of 38 years presents to the emergency department complaining of severe superficial pain over the flank. Which assessment will be most important for diagnosis?

The 74-year-old otherwise healthy patient presents to the clinic complaining of severe pain and burning of the skin over the right flank. Upon assessment, the nurse notes two lines of vesicles that curve laterally away from the spine on the right side. The nurse provides which instruction to the patient regarding treatment?

The patient with shingles presents to the clinic for reassessment following treatment. The nurse asks the patient to perform which action to assess for complications of the condition?

The nurse monitors the patient with erysipelas for which symptoms that may indicate complications related to the condition? Select all that apply.

The 24-year-old patient presents to the emergency department complaining of malaise and intractable sore throat with onset 24 hours previously. Upon assessment, the nurse notes swollen cervical lymph nodes and a temperature of 39.3°C. The patient denies nasal discharge or cough. Which question by the nurse is most important?

The 15-year-old emancipated minor patient who weighs 32 kg presents to the emergency department with fever, malaise, cervical lymphadenopathy, and severe throat pain that was not preceded by an upper respiratory infection. The nurse anticipates providing teaching about which prescription?

The 12-year-old child is brought to the emergency room after being bitten by a family friend’s tarantula. The child is healthy and has received all scheduled vaccinations. Which medication must be given as soon as possible?

The patient seeking medical care for a spider bite asks the nurse why the Diphtheria, Tetanus, and Pertussis (DTaP) vaccine has been prescribed. Which response by the nurse is most appropriate?

The nurse most closely monitors the temperature for the patient who underwent which procedure?  

The nurse clarifies the order for a perineal prostatectomy for treatment of prostate cancer in the patient with which condition?   

The 62-year-old male patient presents to the office complaining of difficulty urinating, with a weak stream, waking multiple times in the night to urinate, and the feeling of not completely emptying the bladder that has been occurring for months. Which test must be performed first for this patient? 

The 3-year-old patient with acute pyelonephritis has the following orders:  Medications: 8 mg/kg ciprofloxacin IV q8h  Activity level: ambulatory as tolerated  Intravenous fluids: Infuse D5W with 0.25% NaCl via peripheral IV at 50 mL/h  Diet: Normal   The nurse is coordinating care for the patient with the unlicensed assistive personnel. Which statement by the UAP prompts further education by the nurse? 

The patient who has been prescribed methotrexate for the treatment of severe psoriasis has received medication teaching. Which statements indicate the teaching was effective? Select all that apply.

The patient has undergone a cystectomy with ureterosigmoidostomy. Which nursing interventions are included in the care plan? Select all that apply. 

The nurse is caring for a patient in the intensive care unit with breast cancer who has a radiation implant in the right breast. The patient is also receiving a chemotherapy regimen. Which additional patient is most appropriate to be assigned to the nurse?

The nurse is providing health promotion teaching to the parents of a child recently diagnosed with sickle cell anemia. Which statement does the nurse include in teaching? 

The nurse is providing health promotion and disease prevention education to the 15-year-old patient receiving chemotherapy. Which statement does the nurse include?  

The nurse assessing the 4-month-old brought to the emergency room for poor feeding and signs of dehydration notes the infant seems to be looking down and sclera is visible superior to the iris. The nurse reports this assessment to the provider and receives orders for care. Which order does the nurse question? 

The 13-year-old girl is brought to the clinic for treatment of vaginal candidiasis for the 2nd time in 6 months. Which question is most helpful by the nurse?  

The 3-year-old patient is brought to the clinic after three days of nausea, vomiting, and diarrhea. Which assessment most prompts the nurse to advocate for hospital admission?  

The patient receiving chemotherapy for breast cancer develops a fever of 39.8°F and heart rate of 121 bpm. Within hours, the blood pressure drops from 128/89 mmHg to 91/54 mmHg, capillary refill time increases to 5 seconds, and urine output drops to less than 0.5 mL/kg/hour. Right-sided weakness, slurring of the words, and confusion occurs rapidly and subsides within 2 hours. Hemoptysis is also noted and the gums are oozing. Multiple transfusions are ordered. Which blood product does the nurse administer first?

The 8-month-old patient has had 4 skin abscesses in the past 3 months that have required draining. Each abscess drains less than 5 mL non-purulent fluid. The infant appears well otherwise and the parents deny respiratory infections. The infant’s complete blood count shows an elevated white blood cell count without bands or segmented cells. Immunoglobulin levels are appropriate for the age of the infant. The patient has a positive nitroblue test. The nurse plans care to include which intervention? 

The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant’s vital signs are notable for a temperature of 40.8°C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.  

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. The nurse prepares to perform which diagnostic test for this patient?  

The 68-year-old patient is admitted after 5 days of extremely foul-smelling watery diarrhea with a temperature of 37.9°C, heart rate 118 bpm, and blood pressure 98/52 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which intervention is most important to prevent the spread of this condition to other patients? 

The 68-year-old patient is admitted after 3 days of extremely foul-smelling watery diarrhea with a temperature of 37.8°C, heart rate 122 bpm, and blood pressure 96/50 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which medication does the nurse administer without further discussion with the provider? 

The patient with acquired immunodeficiency syndrome who has been noncompliant with highly active antiretroviral therapy (HAART) presents to the emergency department with a productive cough, fever, night sweats, and weight loss. The patient’s chest x-ray reveals diffuse infiltrates bilaterally and the CD4 count is 182 cells/µL. Which question by the nurse is most important?  

The 20-year-old mother brings her 6-day-old infant to the clinic because the child has had yellow drainage from both eyes since yesterday that returns despite wiping it away. Upon assessment, bilateral eyes are closed due to a sticky, mucopurulent discharge. The mother reports a normal spontaneous vaginal delivery after an uncomplicated history. The baby went to breast immediately and the pair were discharged from the hospital 48 hours after birth. The nurse performs a swab of the drainage and anticipates which gram stain result? 

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The nurse is preparing the otherwise healthy 54-year-old patient for a right knee replacement surgery and checks to see if the patient is allergic to which medication? 

The 20-year-old student went on a mission trip to Ghana to help at a local hospital. She presented to the clinic 12 days after her return; she began to experience anorexia, flu-like symptoms, and fatigue. Ten days later, she noticed her eyes and skin looked yellow. Her history, assessment, and vitals are within normal limits except her yellow sclera and jaundiced skin. Initial lab studies reveal a total bilirubin of 16, indirect bilirubin of 8, AST of 1320 and ALT of 1400. The nurse prepares the patient for which test next? 

The 4-week-old neonate in the neonatal intensive care unit was born at 29 weeks gestation. The patient is stable on room air and has been tolerating nasogastric feedings of expressed breast milk. Generally an active and responsive patient, the nurse notes the patient is lethargic and does not react to his diaper change. Additionally, the patient’s heart rate is 194 bpm, respiratory rate is 82 breaths per minute, and the blood pressure is 54/21 mm Hg. The patient’s abdomen is distended and discolored; dark green emesis is noted as well. An abdominal x-ray is ordered and performed. Which x-ray findings are consistent with the patient’s clinical picture? Select all that apply.  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. The nurse anticipates which finding on the lumbar puncture result?  

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. Vital signs are normal and the patient seems to be breathing well. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient is admitted to the intensive care unit for further management and observation. The ICU nurse includes which interventions in the plan of care? Select all that apply.  

The 21-year-old intoxicated patient presents to the emergency department after sustaining an injury to the right hand during an altercation in a bar. He reports punching another individual in the face. An x-ray of the hand reveals a broken 4th proximal phalange and metacarpal. The corresponding knuckle has an open laceration. The nurse prepares the patient for which treatment?  

The patient with human immunodeficiency virus (HIV) presents with a disseminated rash. The nurse notes purple papules over the trunk, arms, and on mucous membranes. Some are scabbed. The patient’s CD4 count is 64. Although highly active antiretroviral therapy (HAART) has been prescribed, the patient reports being noncompliant because of intolerable side effects. The nurse suspects which infection is most responsible for this new rash? 

The patient with well-controlled chronic obstructive pulmonary disorder presents with a 3 day history of increased cough with sputum production, fever, and malaise. Upon assessment, breath sounds are clear after coughing and the patient appears to breathe comfortably with no retractions or nasal flaring. His chest x-ray is clear and his screening complete blood count is largely normal, with exception of a white blood cell count of 16. The nurse anticipates the provider to order which medication(s)? Select all that apply. 

The patient with active syphilis asks the nurse how the prescribed medication treats the infection. Which response by the nurse is correct?  

The nurse clarifies which order for the patient admitted with cellulitis caused by methicillin-resistant staphylococcus aureus?   

The patient with human immunodeficiency virus and a CD4 count of 158 has a purified protein derivative (PPD) skin test performed and is found to have a 7-mm induration with circumferential erythema. Which statement does the nurse make to the patient?  

The 24-year-old patient presents with flu-like symptoms and a diffuse maculopapular rash across her chest, trunk, and palms of the hands. Upon palpation, cervical lymph nodes are enlarged. The patient uses intravenous drugs and reports having unprotected sex. The patient’s labs are notable for negative HIV test, positive human chorionic gonadotropin test, and positive rapid plasma reagin test. The patient reports a history of anaphylaxis with penicillin administration. The nurse educates the patient about which treatment? 

The patient with cirrhosis is admitted with severe confusion, ascites, and jaundice. He has gained 10 kg in 2 weeks. He has been coughing blood and his stool is dark and tarry. Therapeutic paracentesis results are concerning for infection.  The nurse anticipates the patient to report not taking which medications that are ordered? Select all that apply.  

The 71-year-old previously healthy patient is admitted to the hospital for dehydration after 3 days of malaise and productive cough with green sputum. Right lower lobe consolidation is noted on x-ray. Leukocytosis is revealed by a complete blood count. Vitals are notable for a temp of 40.4°C, heart rate of 122 bpm, respiratory rate of 22, and blood pressure of 104/62 mm Hg. Oxygen saturation is 84% on room air, but improves to 100% with 2L 100% FiO2 via nasal cannula. The nurse prepares to administer which medications? Select all that apply.