An adult client in the intensive care unit (ICU) with a central venous catheter has developed signs and symptoms that are suggestive of a central line-associated bloodstream infection (CLABSI). What is most likely the cause of the infection?

The client was treated for vancomycin-resistant enterococcus (VRE) during a previous admission.

The client had blood cultures drawn from the central line.

The client's central line dressing was changed using clean technique.

The client has received antibiotics and intravenous fluids through the same line.

Answer and Explanation

The Correct Answer is C

A. The treatment for vancomycin-resistant enterococcus (VRE) in a previous admission is not directly related to the development of CLABSI in the current situation. The infection is more likely caused by improper handling or maintenance of the central line.
B. Drawing blood cultures from the central line, while not ideal, is not the most likely cause of CLABSI. Proper technique can mitigate the risk of introducing infection during this procedure.
C. Changing the central line dressing using clean technique instead of sterile technique increases the risk of introducing pathogens to the central line site, leading to a central line-associated bloodstream infection (CLABSI).
D. Receiving antibiotics and intravenous fluids through the same line does not typically cause CLABSI if the line is properly maintained and sterile techniques are observed during administration.

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Correct Answer is D

Explanation

A. Decreased cardiac output is not a primary concern with chlorine exposure, which primarily affects the respiratory system.
B. Hypovolemia is not directly related to chlorine gas exposure. The primary concern is respiratory damage.
C. Chronic pain is not an immediate or primary finding in chlorine gas exposure; the focus is on acute respiratory effects.
D. Pulmonary edema is a common and severe consequence of chlorine gas inhalation due to the corrosive effect of chlorine on the respiratory tract, leading to fluid accumulation in the lungs.

A. Inject the insulin 15-30 minutes before a meal. B. Assess for hypoglycemia 4 hrs. after the insulin injection. C. Monitor for an increase in appetite. D. Administer with insulin glargine in the same syringe.

Correct Answer is A

Explanation

A. Insulin lispro is a rapid-acting insulin that should be administered 15-30 minutes before a meal to manage blood glucose levels effectively. This timing helps to match the peak action of the insulin with the rise in blood glucose levels after eating.
B. Hypoglycemia from insulin lispro typically occurs within 1-3 hours of administration, not 4 hours later. Regular monitoring during this time frame is more appropriate.
C. An increase in appetite is not a direct result of insulin lispro administration and does not indicate insulin effectiveness or safety.
D. Insulin lispro and insulin glargine should not be mixed in the same syringe as they have different action profiles and pH levels, which can affect their efficacy.

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An adult client in the intensive care unit (ICU) with a central venous catheter has developed signs and symptoms that are suggestive of a central line-associated bloodstream infection (CLABSI). What is most likely the cause of the infection?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The emergency department (ED) staff has been notified of the imminent arrival of a client who has experienced respiratory exposure to the chemical agent chlorine. Which finding should the anticipate with this exposure?

Correct Answer is D

Explanation

A nurse is preparing to administer insulin lispro to a client who has diabetes mellitus type 1. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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