The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test.
Which action should the nurse take?

Choice A rationale

Obtaining a prescription for an indwelling urinary catheter in a client with a T4 spinal cord injury who is at risk for urinary tract infections (UTIs) is generally discouraged for long-term management. Indwelling catheters significantly increase the risk of UTIs due to biofilm formation and the introduction of bacteria into the sterile urinary tract. Intermittent catheterization or other bladder management strategies are preferred to minimize this risk.

Choice B rationale

Encouraging fluid intake at and between meals is a critical intervention for preventing urinary tract infections in clients with spinal cord injuries. Increased fluid intake promotes frequent bladder emptying, which helps to flush bacteria from the urinary tract, reducing bacterial stasis and colonization. Adequate hydration maintains urine flow and dilutes bacterial concentrations, thereby lowering the risk of ascending infections.

Choice C rationale

Offering the client the bedpan every 2 hours might not be an effective strategy for preventing UTIs in a client with a T4 spinal cord injury. This injury level often results in a neurogenic bladder, where the client may not have normal sensation or control over bladder emptying. Regular, scheduled emptying, often through intermittent catheterization, is more effective in preventing overdistention and residual urine, which are risk factors for UTIs.

Choice D rationale

Cleansing the perineum from back to front is an incorrect technique and significantly increases the risk of urinary tract infections. This method can introduce fecal bacteria, such as Escherichia coli, from the anal area into the urethra, leading to ascending UTIs. The correct and scientifically sound method for perineal cleansing is from front to back, which prevents the migration of enteric microorganisms to the urinary meatus.

Choice A rationale

Motor weakness is a common symptom in both hemorrhagic and thrombotic strokes because both types of stroke disrupt blood flow to brain regions responsible for motor control. Ischemic damage or compression from hemorrhage within motor cortex or descending motor tracts can lead to similar presentations of contralateral hemiparesis or hemiplegia, making it non-specific for differentiation.

Choice B rationale

Sensory changes, such as paresthesia or numbness, can occur in both hemorrhagic and thrombotic strokes. This is due to damage to sensory pathways in the brain, including the thalamus or somatosensory cortex. The specific location and extent of brain injury determine the precise sensory deficits, which can be similar regardless of stroke etiology.

Choice C rationale

A sudden onset of severe headache is a hallmark symptom distinguishing hemorrhagic stroke. This intense headache, often described as "the worst headache of my life," results from the rapid increase in intracranial pressure and meningeal irritation caused by blood extravasation into the subarachnoid space or brain parenchyma, unlike thrombotic strokes.

Choice D rationale

A history of hypertension is a significant risk factor for both hemorrhagic and thrombotic strokes. Chronic uncontrolled hypertension damages arterial walls, predisposing them to rupture in hemorrhagic stroke or promoting atherosclerosis and thrombus formation in ischemic stroke. Therefore, its presence does not specifically differentiate between the two types.