A nurse is assessing a client who has a Clostridium difficile infection. The nurse should monitor for which of the following complications during the early stages of this infection?
Liver failure
Dehydration
Immunosuppression
Peripheral edema
The Correct Answer is B
A. Liver failure: Liver failure is not a common complication of Clostridium difficile infection.
B. Dehydration: Clostridium difficile causes severe diarrhea, which can lead to dehydration in the early stages.
C. Immunosuppression: Immunosuppression is not a direct complication of Clostridium difficile infection.
D. Peripheral edema: Peripheral edema is not commonly associated with Clostridium difficile infection.
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Related Questions
Correct Answer is D
Explanation
A. Plan to initiate a bladder retraining program for the client. This is important but not the immediate first action.
B. Protect the client's perineal skin with a moisture barrier. This is a preventive measure but not the first step in evidence-based practice.
C. Teach the client to perform pelvic floor muscle exercises. This is useful but not the immediate first action.
D. Request a prescription for catheter removal. Indwelling urinary catheters should be removed as soon as possible to reduce the risk of infection, which aligns with evidence-based practice.
Correct Answer is A
Explanation
A. Compile a list of the client's current medications to compare with new medications. Medication reconciliation is a key component of The Joint Commission's National Patient Safety Goals. It helps prevent medication errors by ensuring that all medications are reviewed and documented.
B. Label syringes, but not medicine cups or basins, during a procedure. All medications and solutions should be labeled to prevent medication errors, including those in syringes, medicine cups, and basins. Not labeling all items can lead to confusion and errors.
C. Use one client identifier for treatments, care, and services. Using at least two identifiers (e.g., name and date of birth) is recommended to ensure correct patient identification and reduce the risk of errors.
D. Perform a daily assessment of wounds using the Braden scale. The Braden scale is used for assessing pressure ulcer risk, not for daily wound assessment. While regular assessment of wounds is important, the Braden scale is not the correct tool for this purpose.
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