Module 2 Week 5 Exam Infection Control-Neuro

The nurse is preparing to care for a client diagnosed with Clostridioides difficile (C. difficile) infection. Which of the following infection control measures should the nurse implement? Select all that apply. Wear a gown and gloves when entering the client's room. Place the client in a negative pressure isolation room. Perform hand hygiene using soap and water after client care. Use alcohol-based hand sanitizer after removing gloves. Clean the client's environment using a bleach-based disinfectant.

The nurse has completed care for a client in contact, droplet, and splash precautions. The nurse is preparing to remove personal protective equipment (PPE). Arrange the steps for removing PPE in the correct order. The first step is to. The second step is to. The third step is to. The forth step is to. The last step is to.

The nurse is caring for a client diagnosed with pulmonary tuberculosis who is placed on airborne precautions. Which infection control measures should the nurse implement to prevent the spread of infection? (Select all that apply). Place the client in a negative pressure isolation room with the door closed. Ensure the client wears a surgical maskin the room and when leaving the room. Health care workers wear an N95 or higher-level respiratory mask. Use ultraviolet germicidal irradiation (UVGI) or a HEPA filter in the room. Allow the client to ambulate outside the room only when medically necessary while wearing a surgical mask. Use proper hand hygiene before and after patient contact.

The nurse is reviewing infection control measures for various infectious diseases. Identify which precautions are required for each condition, airborne isolation, droplet isolation, contact isolation. Some infectious conditions require more than one isolation. Measles. Chickenpox (Varicella). C. difficile. Influenza. Tuberculosis. MRSA. Meningitis (Neisseria meningitidis). COVID-19. Disseminated Herpes Zoster. Respiratory Syncytial Virus.

The emergency department nurse receives reports on four clients. Which client should the nurse assign to an isolation room first?. A 5-year-old child with impetigo, presenting with honey-colored crusted lesions around the mouth and hands. A 6-year-old child with varicella (chickenpox), exhibiting fever, vesicular rash, and itching. A 10-year-old child with pertussis (whooping cough), having frequent paroxysmal coughing fits with post-tussive vomiting. A 15-year-old child with a large abscess on the leg, testing positive for methicillin-resistant Staphylococcus aureus (MRSA).

The nurse is preparing for several client admissions. Which of the following clients require airborne isolation precautions? Select all that apply. A client with tuberculosis (TB) who has a persistent cough and night sweats. A client with localized herpes zoster (shingles). A client with influenza experiencing fever, chills, and muscle aches. A client with measles (rubeola) exhibiting Koplik spots and a red rash. A client with varicella (chickenpox) with open vesicular lesions.

The nurse is preparing room assignments. Which of the following clients require contact precautions? Select all that apply. A client with Clostridioides difficile (C. difficile) experiencing profuse diarrhea. A client with methicillin-resistant Staphylococcus aureus (MRSA) wound infection. A client with respiratory syncytial virus (RSV) with increased respiratory secretions. A client with pertussis experiencing uncontrollable coughing fits. A client with scabies presenting with intense itching and skin burrows.

A client with methicillin-resistant Staphylococcus aureus (MRSA) requires hospitalization. Which client would be the most appropriate roommate?. A client with community-acquired pneumonia requiring droplet precautions. A client with influenza experiencing fever and cough. A client with folliculitis caused by Staphylococcus presenting a raised red rash requiring contact precautions. A client with active tuberculosis (TB) requiring airborne precautions.

A client with end-stage renal disease (ESRD) receiving hemodialysis is admitted to the medical-surgical unit. The charge nurse must assign the client to a semiprivate room. Which room assignment would be the most appropriate?. A client with influenza, experiencing fever, chills, and a productive cough. A client with cellulitis and a draining MRSA wound infection requiring contact precautions. A client with tuberculosis (TB) on airborne precautions receiving antitubercular therapy. A client recovering from a total knee replacement.

A client arrives at the emergency department after sustaining a head injury from a fall. The nurse notes that the client is confused, has a Glasgow Coma Scale (GCS) score of 11, and is exhibiting unequal pupil size with a sluggish reaction to light. The client's blood pressure is 160/90 mmHg, heart rate is 50 bpm, and respirations are irregular. Which action should the nurse take first?. Prepare the client for immediate intubation and mechanical ventilation. Notify the primary health care provider (PHCP) of the client's neurological deterioration. Initiate seizure precautions and maintain a quiet, low-stimulus environment. Elevate the head of the bed to 30 degrees to facilitate venous drainage, ensuring the neck remains midline.

A client presents to the emergency department after hitting their head on a kitchen counter. The client is alert and oriented, denies loss of consciousness, and reports a mild headache. The nurse observes a small bruise on the forehead. Which intervention should the nurse implement as the priority?. Administer Ibuprofen for pain relief. Monitor the client for signs of worsening neurological function. Allow the client to rest alone in a dark, quiet room. Instruct the client to apply heat packs to the injury site to reduce swelling.

A pediatric client is admitted to the emergency department with a high fever, irritability, photophobia, and a positive Brudzinski sign. The healthcare provider suspects bacterial meningitis. The nurse obtains vital signs, noting a blood pressure of 86/50 mmHg, a heart rate of 128 bpm, and a urine output of 10 mL/hr. Which action should the nurse take first?. Administer prescribed intravenous antibiotics immediately. Initiate Droplet precautions. Initiate aggressive fluid resuscitation with intravenous crystalloid solutions. Perform a complete neurological assessment and monitor for seizure activity.

A school-aged client with a history of epilepsy is brought to the emergency department after experiencing a tonic-clonic seizure at school. The teacher reports that the seizure lasted approximately two minutes and was preceded by the client staring blankly for a few seconds. Upon arrival, the client is in a postictal state, disoriented, and lethargic. Which nursing intervention is the priority?. Administer a prescribed dose of anti seizure medication. Maintain the client in a side-lying position. Obtain a detailed history of the event. Educate the parents about seizure precautions at home.

A nurse is caring for a child experiencing a seizure. Which of the following interventions should the nurse implement? Select all that apply. Ensure airway patency. Place a tongue depressor in the child's mouth to prevent biting. Clear the area of any hazards or hard objects. Restrain the child's movements to prevent injury. Loosen restrictive clothing. Administer food or liquids immediately after the seizure to prevent dehydration. Time the seizure episode.

A client diagnosed with multiple sclerosis (MS) presents with increasing difficulty in walking, muscle weakness, and new onset of urinary incontinence. The client reports worsening fatigue despite resting, and the nurse notes diplopia and hyperreflexia on assessment. Which nursing intervention should be the priority at this time?. Encourage the client to increase physical activity to build endurance. Instruct the client to avoid overheating and chilling to prevent exacerbations. Implement a bladder training program to address urinary incontinence. Assess for signs of an infection and monitor temperature closely.

A nurse is developing a plan of care for a client diagnosed with multiple sclerosis (MS). Which of the following nursing interventions are appropriate in the care of this client? Select all that apply. Encourage the client to balance periods of rest with activity to prevent fatigue. Teach the client to take hot showers to relieve muscle stiffness. Implement a bladder training program to manage urinary incontinence. Advise the client to avoid exposure to extreme temperatures. Recommend a high-sodium diet to help maintain fluid balance. Provide assistive devices as needed to support mobility. Encourage prolonged bed rest during exacerbations.

A client with Myasthenia Gravis presents with increasing muscle weakness, difficulty breathing, and drooping eyelids. The nurse notes a respiratory rate of 10 breaths per minute, oxygen saturation of 88% on room air, and diminished breath sounds. Which intervention should be the priority?. Administer the scheduled dose of anticholinesterase medication. Prepare for intubation and mechanical ventilation. Place the client in a high Fowler's position. Assess for signs of infection that could trigger an exacerbation.

A client with Myasthenia Gravis (MG) presents to the emergency department with increasing muscle weakness, excessive salivation, bradycardia, and respiratory distress. The nurse notes the client has been taking increased doses of pyridostigmine over the past few days. Which intervention should the nurse perform first?. Administer an additional dose of pyridostigmine. Prepare to administer atropine as prescribed. Elevate the head of the bed 30 degrees. Obtain a stat arterial blood gas (ABG) sample to assess for respiratory failure.

A nurse is teaching a group of student nurses about differentiating myasthenic crisis from cholinergic crisis in clients with Myasthenia Gravis (MG). Which of the following statements by the student nurse demonstrates an accurate understanding of the differences between these two conditions? Select all that apply. "Both myasthenic crisis and cholinergic crisis result in muscle weakness, but administering edrophonium will worsen a myasthenic crisis.". "Myasthenic crisis occurs due to an underdose of anticholinesterase, while cholinergic crisis is caused by overmedication with anticholinesterase.". "Excessive salivation, bradycardia, and respiratory depression are hallmark signs of a cholinergic crisis.". "If a client improves after receiving edrophonium, it indicates a cholinergic crisis.". "Both conditions can cause respiratory failure, but atropine is only effective in treating cholinergic crisis.". "The most important priority in managing either crisis is securing the airway and ensuring adequate ventilation.".

A nurse is caring for a client with Parkinson's disease who reports experiencing increasing difficulty with mobility, frequent falls, stiffness upon waking up, difficulty swallowing, and episodes of confusion. Which nursing action should the nurse implement first?. Encourage the client to participate in physical therapy exercises. Assist the client with ambulation using a gait belt and walker. Assess neurological status. Administer antiparkinsonian medications.

A nurse is caring for a client diagnosed with Guillain-Barre Syndrome (GBS). Which of the following nursing interventions are appropriate in the care of this client? Select all that apply. Monitor respiratory status and prepare for intubation if necessary. Encourage early ambulation to promote circulation. Administer corticosteroids to reduce inflammation and speed recovery. Assess for autonomic dysfunction, including blood pressure fluctuations and dysrhythmias. Provide active range-of-motion exercises to prevent contractures. Monitor for signs of infection, particularly respiratory and urinary tract infections. Administer muscle relaxants to alleviate spasms and rigidity.

A client diagnosed with Guillain-Barre Syndrome (GBS) is admitted to the intensive care unit due to rapidly worsening muscle weakness and respiratory distress. The nurse notes hypotension, diminished deep tendon reflexes, and difficulty clearing secretions. Which intervention should the nurse prioritize first?. Administer high-dose corticosteroids to reduce inflammation. Prepare the client for plasmapheresis or IV immunoglobulin (IVIG) therapy. Initiate passive range-of-motion exercises to prevent contractures. Administer a neuromuscular blocking agent to prevent further paralysis.

A nurse is assessing a client with progressive muscle weakness and paresthesia who is suspected of having Guillain-Barre Syndrome (GBS). The nurse reviews the client's past medical history. Which of the following findings would place the client at the highest risk for developing GBS?. History of uncontrolled hypertension and hyperlipidemia. Recent upper respiratory tract infection or gastrointestinal infection. Long-standing history of diabetes mellitus with peripheral neuropathy. Prior diagnosis of multiple sclerosis with relapsing-remitting symptoms.

A nurse is caring for a client with a severe head injury who is exhibiting signs of increased intracranial pressure (ICP). Which of the following trends in vital signs would the nurse expect or not expect?. Increasing systolic blood pressure (widening pulse pressure). Decreasing heart rate (bradycardia). Irregular respirations (Cheyne-Stokes or Biot's breathing). Decreasing temperature. Increasing temperature (hyperthermia). Decreasing systolic blood pressure. Increasing heart rate (tachycardia).