A client receiving parenteral nutrition by central venous access reports feeling unwell. The nurse assesses the client and suspects that the central line has become infected. Which of the following findings indicate that the client has developed a systemic infection? Select all that apply.

Choice A Reason: "I ate shellfish about 2 weeks ago at a local restaurant." supports the medical diagnosis of hepatitis A, which is an infection of the liver caused by the hepatitis A virus (HAV). HAV is transmitted by fecal-oral route, meaning that it can be contracted by ingesting contaminated food or water, such as raw or undercooked shellfish from polluted waters. The incubation period for hepatitis A is about two to six weeks.

Choice B Reason: "I was an intravenous drug abuser in the past and shared needles." does not support the medical diagnosis of hepatitis A, but may indicate exposure to hepatitis B or C, which are infections of the liver caused by the hepatitis B virus (HBV) or hepatitis C virus (HCV). HBV and HCV are transmitted by blood or body fluids, meaning that they can be contracted by sharing needles, syringes, or other injection equipment with infected people.

Choice C Reason: "I had a blood transfusion in 1980 after major abdominal surgery." does not support the medical diagnosis of hepatitis A, but may indicate exposure to hepatitis B or C, which are infections of the liver caused by the hepatitis B virus (HBV) or hepatitis C virus (HCV). HBV and HCV are transmitted by blood or body fluids, meaning that they can be contracted by receiving blood transfusions or organ transplants from infected donors. However, since 1992, all donated blood in the United States has been screened for HBV and HCV.

Choice D Reason: "I have had unprotected sex with multiple partners." does not support the medical diagnosis of hepatitis A, but may indicate exposure to hepatitis B or C, which are infections of the liver caused by the hepatitis B virus (HBV) or hepatitis C virus (HCV). HBV and HCV are transmitted by blood or body fluids, meaning that they can be contracted by having unprotected sex with infected people. However, sexual transmission of HAV is rare, unless there is contact with fecal matter.

Choice A Reason: Reporting itching if it becomes bothersome is part of client teaching, as it may indicate inflammation or infection of the ear canal. External otitis is also known as swimmer's ear, as it can be caused by water trapped in the ear after swimming or bathing.

Choice B Reason: Using earplugs when swimming is part of client teaching, as it can prevent water from entering and irritating the ear canal. External otitis can be prevented by keeping the ear dry and avoiding trauma or foreign objects.

Choice C Reason: This is the correct choice. Inserting a cotton-tip applicator to remove excess wax is not part of client teaching, as it can damage or scratch the ear canal and increase the risk of infection. Wax helps protect and lubricate the ear canal and should not be removed unless it causes hearing impairment or discomfort.

Choice D Reason: Using a hairdryer set to low, 6 inches away from ear is part of client teaching, as it can help dry the ear canal after swimming or bathing. External otitis can be treated by applying warm compresses, using topical antibiotics or antifungals, and taking pain relievers or anti-inflammatory drugs.