A client with a contaminated wound asks the nurse, "What does tetanus prophylaxis involve?" Which response by the nurse is accurate?

"Tetanus prophylaxis includes administering Td vaccine only if the wound is severe.”

"Tetanus prophylaxis involves giving TIG and Td vaccine depending on wound type and vaccination history.”

"Tetanus prophylaxis is not necessary if you received the DTP vaccine in childhood.”

"Tetanus prophylaxis consists of giving Td vaccine every 5 years to maintain immunity.”

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Administering the Td vaccine only if the wound is severe is not the correct response. Tetanus prophylaxis is recommended based on wound type and vaccination history, not just the severity of the wound.

Choice B rationale:

This is the correct response. Tetanus prophylaxis involves giving Tetanus Immunoglobulin (TIG) for immediate protection against tetanus toxin, along with the Tetanus and Diphtheria (Td) vaccine to promote long-term immunity. The decision to administer TIG and Td vaccine depends on the patient's wound type and their vaccination history.

Choice C rationale:

Tetanus prophylaxis is necessary even if the client received the DTP vaccine in childhood. The immunity from childhood vaccines may wane over time, and tetanus prophylaxis is recommended after potential exposure to the tetanus-causing bacteria.

Choice D rationale:

Giving the Td vaccine every 5 years is not the correct approach. The recommended schedule for Td booster doses is every 10 years, not every 5 years.

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Correct Answer is C

Explanation

Choice A rationale:

Anemia is not a complication typically associated with shingles. Shingles is caused by the varicella-zoster virus, and it primarily affects the nerves and skin, leading to a painful rash.

Choice B rationale:

Migraine headaches are not directly related to shingles. Shingles affects sensory nerves and typically presents with localized pain and a rash along the affected nerve's pathway.

Choice C rationale:

The nurse should monitor for postherpetic neuralgia in this client. Postherpetic neuralgia is a common complication of shingles that involves persistent and severe pain in the area where the rash was present. It occurs due to nerve damage caused by the virus, and the pain can last for weeks to months after the rash has healed.

Choice D rationale:

Asthma is not a complication associated with shingles. Shingles is a viral infection that primarily affects the skin and nerves and does not involve the respiratory system.

A. "Apply corticosteroids topically to reduce inflammation.” B. "Use over-the-counter antibiotics to prevent secondary infection.” C. "Start antiviral drugs within 72 hours of rash onset.” D. "Consider topical capsaicin for neuropathic pain relief.”

Correct Answer is D

Explanation

Choice A rationale:

Topical corticosteroids can help reduce inflammation in various skin conditions, but they are not the best option for managing pain associated with shingles (herpes zoster) Corticosteroids primarily target inflammation and do not provide effective pain relief in neuropathic pain, which is characteristic of shingles.

Choice B rationale:

Antibiotics are not useful for managing the pain caused by shingles. Shingles is a viral infection, not a bacterial one, so antibiotics would not be effective in reducing pain or preventing secondary infection.

Choice C rationale:

Starting antiviral drugs, such as acyclovir, valacyclovir, or famciclovir, within 72 hours of rash onset is essential for managing shingles. These medications can help reduce the severity and duration of the illness and may also decrease the risk of developing complications like postherpetic neuralgia.

Choice D rationale:

Topical capsaicin is an appropriate option for neuropathic pain relief in shingles. Capsaicin, derived from chili peppers, works by desensitizing the nerve endings and reducing pain signals. However, it may cause a burning sensation initially, and the client should be advised on proper application and hand hygiene afterward.

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A client with a contaminated wound asks the nurse, "What does tetanus prophylaxis involve?" Which response by the nurse is accurate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

(Quoted statement) A client with shingles asks the nurse about the best way to manage pain. Which response by the nurse is accurate?

Correct Answer is D

Explanation

Which intervention is essential for a nurse caring for a patient with chickenpox?

A nurse is caring for a client with chickenpox. Which nursing intervention should the nurse prioritize to prevent transmission of the virus?

A nurse is providing education to a client with shingles. Which statement by the nurse is correct?

(Select all that apply): A nurse is caring for a client with shingles. Which interventions should the nurse include in the client's care? Select all that apply.

A client with a contaminated wound asks the nurse, "What does tetanus prophylaxis involve?" Which response by the nurse is accurate?

(Select all that apply):. A nurse is teaching a community group about preventing tetanus. Which actions should the nurse include in the teaching? (Select all that apply)

(Quoted statement) A nurse is educating a client's family about chickenpox. The family asks, "What should we do if the child starts scratching the rash?" Which response by the nurse is appropriate?

(Select all that apply):. A nurse is providing wound care instructions to a patient who has a contaminated wound. Which actions should the nurse include in the instructions? (Select all that apply)