ATI LPN
Timby's Introductory Medical-Surgical Nursing Thirteenth, North American Edition
Chapter 12 : Infection Questions
Question 1 of 5
The nurse gave a client an injection and, when attempting to recap the needle, sustained a needlestick injury to the finger. What is the priority action by the nurse?
Correct Answer: A
Rationale: Should needlestick injury or other exposure to a potential blood-borne pathogen occur, healthcare workers are advised to follow postexposure recommendations; report the injury or exposure to one's supervisor immediately; document the injury in writing; identify the person or source of blood; obtain the HIV and HBV statuses of the source of blood, if it is legal to do so. Unless the client gives permission, testing and revealing HIV status are prohibited. Obtain counseling on the potential for infection. Receive the most appropriate postexposure prophylaxis; be tested for disease antibodies at appropriate intervals. Receive instructions on monitoring potential symptoms and medical follow-up.
Question 2 of 5
The nurse is caring for a client with an abscess on the back. The nurse observes purulent drainage coming from the abscess. What type of specimen does the nurse anticipate the physician will order to determine the type of bacteria present in the exudate?
Correct Answer: D
Rationale: A culture identifies bacteria in a specimen taken from a person with symptoms of an infection. The source of the specimen may be body fluids or wastes, such as blood, sputum, urine, or feces, or the purulent exudate, collection of pus, from an open wound. A test for ova and parasites is a stool specimen that is examined for evidence of any forms in the infecting microorganism's life cycle. A WBC count may determine that infection is present in the body but does not isolate the bacteria. A sensitivity test is done to determine which antibiotic inhibits the growth of a nonviral microorganism and will be most effective in treating the infection.
Question 3 of 5
A nurse is having a yearly employee tuberculin skin test. Which skin test results would indicate a positive result?
Correct Answer: A
Rationale: The size of the induration, not including the surrounding area of erythema, is measured in millimeters. The measurement determines whether the reaction is significant. For example, a tuberculin skin test is considered positive if the induration is 10 mm or greater in persons with no known risk factors for TB; smaller measurements are significant in certain risk groups, such as immunocompromised clients. The other answers are not indicative of positive results.
Question 4 of 5
A client is hospitalized for an infected decubitus ulcer of the sacral area. The physician is planning to remove the dead and damaged tissue. What type of procedure will the nurse prepare the client for?
Correct Answer: B
Rationale: Debridement is the removal of dead and damaged tissue surgically. Application of a dry dressing will not debride the wound, nor will the administration of Neupogen or injecting antibiotics into the wound.
Question 5 of 5
A client is in the acute care facility for the administration of intravenous (IV) antibiotics to treat bacterial pneumonia. The client begins to have severe diarrhea 3 days after the IV antibiotics with abdominal cramping and pain. What does the nurse suspect the client has developed due to the antibiotic use?
Correct Answer: D
Rationale: When a client is taking an antibiotic, a superinfection can result from overgrowth of microorganisms not affected by the drug. This can lead to a serious inflammation of the colon called pseudomembranous colitis accompanied by potentially life-threatening diarrhea. The nurse should report fever, abdominal cramps, and severe diarrhea immediately. The other choices are not related to the use of the antibiotics.