A nurse is planning discharge to home for a client who has a high risk of developing sepsis. Which of the following Instructions should the nurse include in the teaching?
"If you have a cat, wear gloves when cleaning the litter box.
"Floss your teeth after every meal."
"Store your toothbrush in a glass filled with distilled water."
"Do not consume cold drinks that have been left out for more than 1 hour."
The Correct Answer is A
A. "If you have a cat, wear gloves when cleaning the litter box.": Cat litter can contain Toxoplasma or Bartonella, which can increase the risk of infection and sepsis in immunocompromised clients. Wearing gloves reduces exposure to potential pathogens.
B. "Floss your teeth after every meal.": Flossing after every meal may be too frequent and could cause irritation or gum injury, which increases the risk of infection. Good oral hygiene is important, but over-flossing should be avoided, especially for clients at risk of sepsis.
C. "Store your toothbrush in a glass filled with distilled water.": Storing a toothbrush in distilled water does not provide additional protection against infection. The toothbrush should simply be kept clean and dry to avoid bacterial growth.
D. "Do not consume cold drinks that have been left out for more than 1 hour.": This advice is generally good for food safety but is not specifically related to sepsis risk. The main focus should be on preventing infections that could lead to sepsis, rather than on drink temperature.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Nosebleed: A nosebleed is not typically associated with dialysis disequilibrium. It may be related to other factors like dry air or blood pressure changes, but it is not a classic symptom of dialysis disequilibrium.
B. Malaise: Malaise can occur after hemodialysis due to various reasons, such as fluid shifts, but it is not a specific indicator of dialysis disequilibrium.
C. Headache: Headache is a common symptom of dialysis disequilibrium, which occurs due to rapid changes in fluid and electrolyte balance during hemodialysis. This can lead to cerebral edema, which manifests as a headache.
D. Elevated temperature: An elevated temperature is not a typical sign of dialysis disequilibrium. It could indicate an infection or other issues related to dialysis, but it is not directly related to disequilibrium.
Correct Answer is D
Explanation
A. Increased joint pain: Joint pain is not a typical sign of overexposure to phototherapy. While psoriatic arthritis can occur in individuals with psoriasis, it is not directly linked to phototherapy overexposure.
B. Increased body temperature: While phototherapy may slightly raise the body's temperature, a significant increase in body temperature is not a typical indication of overexposure. This could suggest another underlying issue, such as infection or heatstroke.
C. Cool, moist extremities: Cool, moist extremities are not typically associated with phototherapy overexposure. This finding is more indicative of circulatory or other systemic issues, which do not directly result from phototherapy.
D. Small blisters on the skin: Small blisters on the skin are a common sign of overexposure to phototherapy. Phototherapy uses ultraviolet (UV) light, and excessive exposure can lead to skin damage, including burns or blisters, similar to sunburn.
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