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 D

Explanation

A. Endogenous Infection: Endogenous infections originate from the client's own microbiota and typically do not involve medical interventions such as urinary catheterization.
B. Systemic Infection: Systemic infections affect the entire body and may not necessarily be related to the urinary tract.
C. Exogenous Infection: Exogenous infections originate from sources outside the client's body.
While the urinary tract infection could be caused by bacteria from the environment, it is more specifically categorized as a healthcare-associated infection (HAI) due to the indwelling urinary catheter being a risk factor.
D. Health Care-Associated Infection: A healthcare-associated infection (HAI) occurs as a result of healthcare interventions and can include infections related to urinary catheterization, surgery, or other medical procedures.

A. Bullae B. Nodules C. Papules D. Macules

Correct Answer is B

Explanation

A. Bullae: Bullae are fluid-filled lesions larger than 0.5 cm in diameter.
B. Nodules: Nodules are elevated, solid lesions deeper and firmer than papules, typically larger than 0.5 cm in diameter.
C. Papules: Papules are elevated, solid lesions smaller than 0.5 cm in diameter.
D. Macules: Macules are flat, colored lesions that are smaller than 1 cm in diameter.

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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

A nurse inserts an indwelling urinary catheter for a client who is preoperative. Three days later, the client develops a urinary tract infection. The nurse should identify that the client has which of the following types of infections?

Correct Answer is D

Explanation

A nurse in a provider's office is collecting data from a client who has skin lesions. The nurse notes that the lesions are 2.5 cm in size, elevated, solid, and deep. The nurse should document the findings as which of the following skin lesions?

Correct Answer is B

Explanation

A nurse is caring for an older client and educating the student nurse on assessing the skin. The student nurse knows that an older client's skin is most likely to experience which of the following changes with aging?

A nurse is assisting with the admission of a client who has a new diagnosis of Methicillin- Resistant Staphylococcus aureus (MRSA). The nurse should plan to place the client in which of the following types of transmission-based precautions?

A nurse is reinforcing teaching with a client about treatment of Methicillin-Resistant Staphylococcus Aureus (MRSA). Which of the following information should the nurse include in the teaching?

Which of the following actions can the nurse take to help prevent a health care-associated infection in an incontinent patient?

A nurse is reviewing the laboratory results of a client who has a pressure ulcer. The nurse should identify an elevation in which of the following laboratory values as an indication that the client has developed an infection?

A nurse is caring for a client who has a Clostridium difficile infection. Which of the following cleansing agents should the nurse use for hand hygiene?

A nurse is assessing an older adult client who has a urinary tract infection (UTI). Which of the following findings should the nurse identify as unique for this age group?

A nurse is preparing to administer vancomycin 250 mg PO. The amount available is vancomycin 125 mg/ capsule. How many capsules should the nurse administer to the client with each dose? (Round to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)