A nurse is serving on a committee that is developing infectious disease protocols. Which of the following instructions should the nurse include in the protocol for clients who have Clostridium difficile?

Disinfect hands using an alcohol-based waterless antiseptic.

Wear an N95 respirator when caring for the client.

Use diluted bleach to clean solled equipment.

Provide a room with negative-pressure airflow.

Answer and Explanation

The Correct Answer is C

A. Disinfecting hands using an alcohol-based waterless antiseptic is not effective against Clostridium difficile spores. C. difficile is a bacterium that forms spores, which are resistant to alcohol-based hand sanitizers. Handwashing with soap and water is recommended for effective removal of the spores.

B. Wearing an N95 respirator is not specifically indicated for caring for clients with Clostridium difficile. The primary mode of transmission for C. difficile is fecal-oral, and standard precautions, including gloves and gowns, are usually sufficient. N95 respirators are more commonly used for airborne precautions.

C. Using diluted bleach to clean soiled equipment is the correct instruction. Clostridium difficile spores are resistant to many disinfectants, but bleach (sodium hypochlorite) is effective in killing C. difficile spores. Diluted bleach solutions are recommended for cleaning surfaces and equipment that may be contaminated with C. difficile.

D. Providing a room with negative-pressure airflow is not typically necessary for clients with Clostridium difficile. Standard precautions, including appropriate cleaning and disinfection, are generally sufficient to prevent the spread of C. difficile in healthcare settings.

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Correct Answer is A

Explanation

A. Engage the client in a repetitive activity as a distraction:

This is the correct answer. Redirecting the client's focus to a repetitive and calming activity can help distract them from the source of agitation and potentially de-escalate the situation.

B. Place the client in a seclusion room:

Seclusion should only be used in situations where it is absolutely necessary for the safety of the client or others. Placing a client with dementia in seclusion is not the first choice and should be avoided if possible.

C. Apply wrist restraints to the client:

Restraints should be a last resort and used only when there is an imminent risk of harm to the client or others. Restraints can escalate agitation and should not be the initial response.

D. Administer PRN haloperidol IM to the client:

The use of medication should be considered later in the escalation process and after other non-pharmacological interventions have been attempted. It is not the first intervention, especially when there are non-pharmacological options available.

A. Shake the suspension well before each administration. B. Dilute the suspension with 38 mL water prior to initial use. C. Store the suspension in the refrigerator. D. Discard the suspension 14 days after opening the bottle

Correct Answer is A

Explanation

A. Shake the suspension well before each administration.

The medication label specifically states, "IMPORTANT: SHAKE WELL BEFORE EACH USE," and "THIS PRODUCT MUST BE SHAKEN WELL ESPECIALLY PRIOR TO INITIAL USE." This indicates the necessity of shaking the suspension before administration to ensure proper mixing of the medication.

B. Dilute the suspension with 38 mL water prior to initial use.

There is no indication on the label to dilute the suspension with water. The label emphasizes shaking well before use, but dilution is not mentioned.

C. Store the suspension in the refrigerator.

The storage instructions on the label state, "Store at 20° to 25°C (68° to 77° F) see USP controlled room temperature." Refrigeration is not mentioned, and it is not recommended to deviate from the specified storage conditions.

D. Discard the suspension 14 days after opening the bottle.

The label does not provide specific information about the shelf life after opening. Therefore, it is essential to follow the specific instructions on the label or refer to the package insert for complete prescribing information regarding the expiration or discard date after opening. The information on the label does not specify a 14-day limit.

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