A nurse is caring for an 18-month-old toddler who has acute diarrhea caused by Clostridium difficile bacteria. Which of the following actions should the nurse take?
Use a bleach-based solution to clean the bedside table.
Encourage family members to use hand sanitizer when exiting the room.
Place the toddler in a negative-airflow room.
Administer loperamide 1 mg PO.
The Correct Answer is A
Choice A reason:
Using a bleach-based solution to clean the bedside table is an appropriate measure to prevent the spread of Clostridium difficile bacteria, as bleach is effective in killing spores.
Choice B reason:
While hand sanitizer is useful for killing many types of bacteria and viruses, it may not be as effective against Clostridium difficile spores. Washing hands with soap and water is preferred.
Choice C reason:
Placing the toddler in a negative-airflow room is not necessary for managing Clostridium difficile diarrhea. Standard precautions and proper hygiene are sufficient.
Choice D reason:
Loperamide is not typically recommended for managing Clostridium difficile diarrhea, as it may worsen the condition by slowing down the bowel motility. The primary treatment is discontinuing the antibiotic that caused the infection and, in some cases, using specific antibiotics to target the C. difficile bacteria.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason:
When suctioning a tracheostomy tube, it's important to limit the suctioning time to 3 to 4 seconds to avoid hypoxia and trauma to the airway.
Choice B reason:
Sterile technique, not clean technique, is used when performing tracheostomy suctioning to prevent infection.
Choice C reason:
The catheter should be sized appropriately for the tracheostomy tube, but it should not fit too snugly to avoid causing trauma to the airway.
Choice D reason:
Instilling saline prior to suctioning is not recommended as it can lead to complications, including aspiration and increased risk of infection.
Correct Answer is B
Explanation
A: Suctioning the client's airway every 2 hours is not indicated based on the provided information. The adolescent does not have a condition that compromises airway clearance, and routine suctioning can cause trauma or stimulate a vagal response, potentially leading to bradycardia.
B: Maintaining the client's head of the bed at 30° is appropriate for reducing intracranial pressure and facilitating venous drainage. The patient's symptoms of nuchal rigidity and severe headache suggest increased intracranial pressure, possibly due to meningitis, which is supported by the diagnostic results.
C: Keeping the client's room well lit is not advisable as the patient reports photophobia, which is a sensitivity to light. A well-lit room could exacerbate discomfort and pain.
D: Checking the client's temperature every 8 hours is important but not the priority intervention. The patient's condition requires more frequent monitoring due to the positive blood culture and sensitivity, indicating an active infection. More frequent temperature checks would be warranted.
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