A patient started Alendronate (Fosamax) once a week for the treatment of osteoporosis. The nurse determines that further instruction about the drug is needed when what is said by the patient?

Choice A reason: Prolonged rehabilitation unit stays increase MRSA risk due to extended exposure to healthcare settings, where resistant bacteria thrive. However, this risk is less specific than antibiotic use, as it depends on factors like hygiene practices and patient contact. MRSA colonization often results from environmental exposure, but antibiotics directly drive resistance development.

Choice B reason: Recent antibiotic use is the highest risk factor for hospital-acquired MRSA, as it disrupts normal microbial flora, promoting resistant strain overgrowth. Broad-spectrum antibiotics, like fluoroquinolones or cephalosporins, select for MRSA by eliminating susceptible bacteria, allowing resistant strains to colonize skin or mucous membranes, increasing infection risk significantly.

Choice C reason: Recent surgical procedures elevate MRSA risk due to invasive interventions breaching skin barriers, providing entry points for bacteria. Surgical wounds are susceptible to colonization, but this risk is secondary to antibiotic use, which directly fosters resistant strain selection and proliferation in the hospital environment.

Choice D reason: Current intensive care unit stays increase MRSA risk due to critical illness, invasive devices, and frequent antibiotic exposure. However, this is less specific than recent antibiotic use, which directly alters microbial ecology, promoting MRSA colonization and infection across various hospital settings, not just ICUs.

Choice A reason: Acknowledging the client’s fear without validating the hallucination (delirium tremens from alcohol withdrawal) is therapeutic. It validates emotions, builds trust, and allows de-escalation, addressing the psychological distress of the withdrawal process, making this the appropriate response.

Choice B reason: Asking about the bugs may reinforce the hallucination, increasing distress in delirium tremens. It does not address the client’s fear or provide reassurance, making it less effective than acknowledging their emotional state.

Choice C reason: Assuring the bugs are harmless dismisses the client’s distress and may not de-escalate the situation. Hallucinations in alcohol withdrawal are terrifying, requiring emotional validation over minimization, making this choice inappropriate.

Choice D reason: Stating it’s part of withdrawal is factual but lacks empathy and may not address immediate fear. It risks alienating the client, as it does not validate their experience, making it less appropriate than acknowledging their fear.