Nokea
The nurse is providing discharge instructions to a client with hepatitis A. Which of the following instructions should the nurse include?
- A. You will need to take daily showers or baths with chlorhexidine.
- B. It is important to clean common surfaces with warm soapy water.
- C. You will need to have repeat stool testing to determine if you are still infectious.
- D. Check with your primary healthcare provider prior to taking any medications.
Correct Answer: D
Rationale: Clients with hepatitis A should consult their healthcare provider before taking medications due to potential liver toxicity risks.
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The nurse is caring for a client with a central venous catheter (CVC). The nurse knows which of the following is a common symptom of Central Line-Associated Bloodstream Infections (CLABSI)?
- A. Diarrhea
- B. Fever and chills
- C. Productive cough
- D. Muscle spasms
Correct Answer: B
Rationale: Fever and chills are hallmark symptoms of CLABSI, indicating a systemic infection originating from the catheter site.
The nurse is assessing a client for bacterial meningitis. Which of the following assessments should the nurse perform? Select all that apply.
- A. Oral temperature
- B. Patellar reflexes
- C. Weber and Rinne tests
- D. Glasgow Coma Scale
- E. Orthostatic blood pressure
Correct Answer: A,D
Rationale: Oral temperature assesses for fever, a key symptom of meningitis, and the Glasgow Coma Scale evaluates neurological status, critical for detecting meningitis-related changes.
The nurse is planning a community health course about the prevention of Lyme disease. Which of the following information should the nurse include?
- A. You should try limiting your outdoor activities between 10 a.m. and 4 p.m.
- B. Wear sunglasses that wrap around and block UVA and UVB rays.
- C. Wear long-sleeved clothing when in heavily wooded areas.
- D. Apply sunscreen with at least an SPF of 30.
Correct Answer: C
Rationale: Wearing long-sleeved clothing in wooded areas reduces skin exposure to ticks, which transmit Lyme disease.
The nurse is triaging a client who reports recent international travel. The primary healthcare provider (PHCP) suspects the client may have severe acute respiratory syndrome (SARS). The nurse should initially
- A. place the client on contact and airborne precautions.
- B. obtain blood, urine, and sputum for culture.
- C. prepare the client for a chest radiograph (x-ray).
- D. infuse 0.9 saline at 100mL/hr.
Correct Answer: A
Rationale: SARS requires contact and airborne precautions to prevent transmission due to its respiratory spread.
The nurse is talking to a group of women about the dangers and ways of acquiring toxic shock syndrome (TSS). The nurse would mention that all of the following women have a high risk of acquiring TSS, except for:
- A. A teenage girl using an absorbent tampon.
- B. A 29-year-old woman using a cervical cap.
- C. A 31-year-old woman using a diaphragm.
- D. A 35-year-old woman using oral contraceptives.
Correct Answer: D
Rationale: Oral contraceptives do not increase the risk of TSS, unlike tampons, cervical caps, and diaphragms, which can promote bacterial growth if left in place too long.