A nurse is planning discharge to home for a client who has a high risk of developing sepsis. Which of the following Instructions should the nurse include in the teaching?

"If you have a cat, wear gloves when cleaning the litter box.

"Floss your teeth after every meal."

"Store your toothbrush in a glass filled with distilled water."

"Do not consume cold drinks that have been left out for more than 1 hour."

Answer and Explanation

The Correct Answer is A

A. "If you have a cat, wear gloves when cleaning the litter box.": Cat litter can contain Toxoplasma or Bartonella, which can increase the risk of infection and sepsis in immunocompromised clients. Wearing gloves reduces exposure to potential pathogens.
B. "Floss your teeth after every meal.": Flossing after every meal may be too frequent and could cause irritation or gum injury, which increases the risk of infection. Good oral hygiene is important, but over-flossing should be avoided, especially for clients at risk of sepsis.
C. "Store your toothbrush in a glass filled with distilled water.": Storing a toothbrush in distilled water does not provide additional protection against infection. The toothbrush should simply be kept clean and dry to avoid bacterial growth.
D. "Do not consume cold drinks that have been left out for more than 1 hour.": This advice is generally good for food safety but is not specifically related to sepsis risk. The main focus should be on preventing infections that could lead to sepsis, rather than on drink temperature.

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Correct Answer is C

Explanation

A. "I had symptoms of asthma when I was a child.": Childhood asthma is not a significant concern in end-stage liver disease or transplant eligibility. It does not have a direct impact on the client’s current health status or the potential success of the liver transplant.

B. "My parent has type 2 diabetes mellitus.": While family medical history is relevant, having a parent with type 2 diabetes mellitus is not a contraindication for liver transplantation. The client’s own health status and adherence to medical care are more important.

C. "I am not very good about taking prescribed medication.": Post-transplant care requires strict adherence to medications, especially immunosuppressive drugs, to prevent organ rejection. If the client has a history of nonadherence, this can jeopardize the success of the transplant.

D. "I wish my family was more supportive of my decision.": This statement pertains to psychosocial concerns and can be addressed with counseling or support services. It does not pose an immediate medical concern for the transplant process.

A. Temperature 38.7° C (101.7° F) B. Heart rate 110/min C. Respiratory rate 14/min D. Spo2 92%

Correct Answer is C

Explanation

A. Temperature 38.7° C (101.7° F): A temperature of 38.7° C (101.7° F) is elevated and may indicate an infection or inflammation, which is not expected after an EGD. A mild fever could occur briefly, but temperatures above 100.4° F should be monitored closely.

B. Heart rate 110/min: A heart rate of 110/min is elevated and may suggest tachycardia due to pain, anxiety, or potential complications. An elevated heart rate should be assessed further, as it is not typical during the recovery phase of an EGD procedure.

C. Respiratory rate 14/min: A respiratory rate of 14/min is within the normal range for an adult (12-20/min), indicating that the client is breathing comfortably and is recovering well from the procedure. This is an expected finding post-procedure.

D. SpO2 92%: An SpO2 level of 92% is slightly low. The normal range for oxygen saturation is typically 95-100%, and a reading of 92% may indicate mild hypoxemia, which should be further evaluated, especially if the client is recovering from sedation.

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A nurse is planning discharge to home for a client who has a high risk of developing sepsis. Which of the following Instructions should the nurse include in the teaching?

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Explanation

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