The nurse is caring for a client with a wound on their leg. During the nurse's assessment, the client explains that he is not feeling well. The nurse knows that a systemic response to a wound infection would be?

Exudate

Pain

Hyperthermia

Hardening of the tissue

Answer and Explanation

The Correct Answer is C

A.   Exudate: Exudate refers to the fluid, such as pus or serum, that is discharged from a wound.
While exudate may be present in infected wounds, it is not a systemic response.
B.   Pain: Pain is a localized response to tissue injury and may be present in infected wounds, but it is not a systemic response.
C.   Hyperthermia: Hyperthermia, or an elevated body temperature (fever), is a common systemic response to infection, including wound infections. It indicates the body's immune response to the infection.
D.   Hardening of the tissue: Hardening of the tissue, known as induration, may occur in infected wounds due to inflammation but is not a specific systemic response.

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Correct Answer is B

Explanation

A. A 49-year-old who works in food services: While individuals working in food services may be at risk of exposure to influenza, they are not in the highest priority group. Age and underlying health conditions are typically prioritized over occupational risk factors.

B. An 88-year-old who lives in an apartment for senior citizens: Older adults, especially those living in congregate settings like senior citizen apartments, are at higher risk of complications from influenza. Therefore, the 88-year-old should have the highest priority to receive the vaccine.

C. A 26-year-old with three young children: While having young children may increase the risk of exposure to influenza, younger adults without underlying health conditions are generally at lower risk of severe complications compared to older adults.

D. A 15-year-old who plays ice hockey: While participation in activities like ice hockey may increase the risk of exposure to respiratory infections, age and health status are more significant factors in determining priority for influenza vaccination.

A. Perform hand hygiene before, during, and after direct contact with the client B. Encourage the client to consume a diet high in protein C. Change the client's bed linens each day D. Place the client in a room with positive pressure airflow

Correct Answer is A

Explanation

A. Perform hand hygiene before, during, and after direct contact with the client: Hand hygiene is one of the most effective strategies to interrupt the transmission of infections. It helps prevent the spread of pathogens from one person to another, reducing the risk of healthcare-associated infections.
B. Encourage the client to consume a diet high in protein: While proper nutrition is important for overall health and immune function, it does not directly address the transmission of the client's infection.

C. Change the client's bed linens each day: Changing bed linens regularly is important for maintaining cleanliness and comfort but is not sufficient to interrupt the transmission of infection.

D. Place the client in a room with positive pressure airflow: Positive pressure airflow rooms are typically used for patients with compromised immune systems to protect them from airborne pathogens. This strategy is not applicable for all types of infections and may not be necessary for every client with an infection.

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The nurse is caring for a client with a wound on their leg. During the nurse's assessment, the client explains that he is not feeling well. The nurse knows that a systemic response to a wound infection would be?

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Naxlex Comprehensive Predictor Exams

There are limited amounts of influenza vaccine currently available in the clinic. Which individual should the nurse identify as having the highest priority to receive vaccination at this time?

Correct Answer is B

Explanation

A nurse is caring for a client who has an infection. The nurse should use which of the following strategies to interrupt the transmission of the client's infection?

Correct Answer is A

Explanation

A nurse is collecting data from a client who reports finding a new skin lesion. Which of the following actions is the nurse's priority?

A nurse is collecting data from four clients who have wounds. The nurse should recognize that which of the following clients has a manifestation of a wound infection?

A patient is admitted for treatment for a severe ulcerated pressure injury exhibiting signs of infection. The HCP prescribes open wet dressings to be applied every 6 hours for a period of 30 minutes for one week. For which part of the prescription does the nurse clarify with the physician?

The nurse is caring for a client with a wound on their leg. During the nurse's assessment, the client explains that he is not feeling well. The nurse knows that a systemic response to a wound infection would be?

A patient has been recently diagnosed with an upper respiratory infection. His brother arrives and would like to visit. The patient says he is not feeling strong enough to have visitors. Which symptom would indicate to the nurse that the client is developing a complication?

A nurse is caring for a client who has developed a Clostridium difficile (C. diff) infection following antibiotic therapy. Which of the following actions should the nurse take?

Which of the following interventions can help manage pain associated with impaired skin integrity?

Which of the following is an example of a reservoir in the chain of infection?