A nurse is providing care for a patient who has a methicillin-resistant Staphylococcus aureus (MRSA) infection, which was cultured from the urine. What is the most appropriate action for the nurse to take?
Utilize a respirator when handling urine output.
Restrict visitors strictly to immediate family members only.
Wash hands only after removing gloves post-care.
Prepare to administer vancomycin.
The Correct Answer is D
Choice A rationale:
Utilizing a respirator when handling urine output is not the most appropriate action for a nurse caring for a patient with MRSA.
MRSA is not typically transmitted through the air, but rather through direct contact with infected wounds or contaminated surfaces.
While a respirator may offer some protection against airborne particles, it is not necessary for routine care of a patient with MRSA.
It is more important to focus on hand hygiene and other infection control measures.
Choice B rationale:
Restricting visitors strictly to immediate family members only is not necessary for a patient with MRSA.
While it is important to limit the number of visitors to reduce the risk of spreading infection, there is no need to restrict visitors to immediate family members only.
Visitors should be instructed on proper hand hygiene and other infection control measures, and they should avoid contact with the patient's wounds or dressings.
Choice C rationale:
Washing hands only after removing gloves post-care is not sufficient for preventing the spread of MRSA. It is important to wash hands before and after any contact with the patient, even when wearing gloves.
This is because gloves can become contaminated with bacteria, and hand washing helps to remove any bacteria that may have gotten on the hands.
Choice D rationale:
Preparing to administer vancomycin is the most appropriate action for a nurse caring for a patient with MRSA. Vancomycin is an antibiotic that is effective against MRSA.
It is often used to treat MRSA infections, and it can help to prevent the infection from spreading.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
While providing information about post-operative care and pain management is important, it may not directly address the patient's underlying anxiety or encourage them to express their concerns.
It could be perceived as dismissive of their feelings or as an attempt to control the conversation. It focuses on the future rather than the patient's present experience.
Choice B rationale:
This response, while intended to be reassuring, may minimize the patient's individual experience and feelings. It could make the patient feel as though their concerns are not being taken seriously.
It implies that anxiety is a normal and expected reaction, which may discourage the patient from sharing their specific worries.
Choice C rationale:
This response is open-ended and invites the patient to share their thoughts and feelings.
It demonstrates active listening and encourages the patient to take an active role in the conversation.
It allows the nurse to assess the patient's understanding of the surgery and to address any misconceptions or concerns. It conveys a sense of empathy and understanding, which can help to build trust and rapport with the patient.
Choice D rationale:
While offering to explain the procedure may be helpful, it may not be what the patient needs at the moment. It could overwhelm the patient with information, particularly if they are already feeling anxious.
It could shift the focus away from the patient's emotional needs and onto the technical aspects of the surgery.
Correct Answer is A
Explanation
Choice A rationale:
Prednisone is a corticosteroid that suppresses the body's natural production of cortisol. Cortisol is a hormone that is essential for life, and it plays a role in many important bodily functions, including:
Regulating blood sugar levels Maintaining blood pressure Reducing inflammation Responding to stress
When a person takes prednisone for a long period of time, their body begins to rely on the medication to provide cortisol. If the medication is stopped suddenly, the body cannot produce enough cortisol on its own, which can lead to a life-threatening condition called adrenal insufficiency.
Adrenal insufficiency can cause a variety of symptoms, including: Extreme fatigue
Weakness Dizziness Nausea Vomiting Abdominal pain Confusion
Loss of consciousness
To prevent adrenal insufficiency, it is important to taper off prednisone slowly over a period of time. This allows the body to gradually adjust to producing cortisol on its own.
Here are some additional details about why prednisone should never be discontinued abruptly: The risk of adrenal insufficiency is highest when prednisone has been taken for more than 3 weeks. The longer a person has been taking prednisone, the slower the taper should be.
It is important to follow the tapering instructions provided by the healthcare provider.
If a person experiences any symptoms of adrenal insufficiency, they should seek medical attention immediately.
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