A nurse is caring for four clients.
Which of the following clients should the nurse identify as at risk for inner ear inflammation?

A client who has tested positive for Helicobacter pylori.

A client who has a viral respiratory infection.

A client who has a tumor pressing on the pituitary gland.

A client who is taking ampicillin.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Helicobacter pylori infection is associated with gastrointestinal conditions like peptic ulcers and gastritis, not with inner ear inflammation.

Choice B rationale

Viral respiratory infections can spread to the middle ear through the Eustachian tube, potentially leading to inflammation and infection of the inner ear (otitis media).

Choice C rationale

A tumor pressing on the pituitary gland can cause hormonal imbalances but is not directly related to inner ear inflammation.

Choice D rationale

Ampicillin, an antibiotic, is used to treat bacterial infections but does not inherently increase the risk of inner ear inflammation.

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Free Nursing Study Resources

Correct Answer is C,B,D,A

Explanation

The correct order is:

1. Ensure a method to communicate during the procedure.

2. Wear clean gloves to remove the tracheostomy dressing.

3. Clean the inner cannula using a small brush.

4. Apply clean tracheostomy ties.

A. Document in the client's electronic medical record that the specimen was sent to the laboratory. B. Wipe the sample port with an alcohol wipe and let the alcohol dry. C. Empty the urine into a sterile container labeled with the client identifiers. D. Attach a sterile needleless syringe to the sample port and aspirate the specimen. E. Clamp the catheter tubing distal to the sampling port for 15 min.

Correct Answer is E,B,D,C,A

Explanation

Choice Erationale

Clamping the catheter tubing distal to the sampling port for 15 minutes helps to ensure that enough urine is collected in the tubing for an adequate sample.

Choice B rationale

Wiping the sample port with an alcohol wipe and letting it dry is essential to prevent contamination of the specimen with microorganisms from the outside of the port.

Choice D rationale

Attaching a sterile needleless syringe to the sample port and aspirating the specimen prevents the introduction of infection and ensures that the sample is sterile.

Choice Crationale

Emptying the urine into a sterile container labeled with the client's identifiers ensures proper identification and prevents contamination of the sample.

Choice Arationale

Documenting in the client's electronic medical record that the specimen was sent to the laboratory provides a record of the procedure and helps ensure that the sample is properly processed.

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A nurse is caring for four clients.Which of the following clients should the nurse identify as at risk for inner ear inflammation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to perform tracheostomy care for a client. In which order should the nurse take the following steps? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Correct Answer is C,B,D,A

Explanation

A nurse is obtaining a sterile urine specimen from a client who has an indwelling urinary catheter. Identify the sequence the nurse should follow.

Correct Answer is E,B,D,C,A

Explanation

A nurse is contributing to the plan of care for a client who has viral meningitis.Which of the following interventions should the nurse recommend?

A nurse is caring for a client who has a new diagnosis of tuberculosis (TB). The client asks the nurse why she needs to take four different antituberculosis medications.Which of the following replies should the nurse make?

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A nurse is preparing to perform a sterile dressing change for a client who has a stage III pressure ulcer.Which of the following actions should the nurse plan to take?

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A nurse is caring for four clients.
Which of the following clients should the nurse identify as at risk for inner ear inflammation?