Which patients will the nurse identify as at risk for Acinetobacter baumannii infection? Select all that apply.

A patient who has undergone a tracheostomy procedure

A patient who is undergoing mechanical ventilation

Which intervention would the nurse expect to perform when caring for a patient diagnosed with a multidrug-resistant organism (MDRO)? Select all that apply.

Initiate and maintain contact isolation

Ensure the patient remains hydrated

Use moisture barrier creams and monitor for stool incontinence

Teach the patient about proper and expected antimicrobial therapy

Which multidrug-resistant organism will the nurse monitor for in the patient who resides in a prison?

Methicillin-resistant Staphylococcus aureus (MRSA)

Which intervention would the nurse perform when a patient is suspected of having a clostridioides difficile (c. difficile) infection?

Collect and send a stool specimen for testing promptly

Which best describes the term “colonized” with respect to the human body?

It is phenomenon in which a healthy host carries bacteria without active infection.

The nurse is teaching about the pathophysiology of methicillin-resistant Staphylococcus aureus (MRSA). Which statements show a need for further instruction? Select all that apply.

"Staphylococcus aureus is an aerobic, gram-negative, sporulating, coagulase-positive bacterium."

"Methicillin-resistant Staphylococcus aureus (MRSA) is coated with a fibrin wall. which accepts the process of phagocytosis."

"Methicillin-resistant Staphylococcus aureus (MRSA)is an exogenous pathogen."

Which action by the patient would indicate additional teaching about C. diff management is needed?

The patient tells their family they cannot visit in the hospital

Which action by the patient would indicate correct teaching about C. diff management?

The patient uses soap and water to perform hand hygiene

The patient reports skin irritation or breakdown in the perineal area.

The patient drinks additional fluid throughout the day.

Which complication will the nurse monitor for in the patient who has multidrug-resistant Acinetobacter infection?

Additional days for mechanical ventilation

Which patient teaching would the nurse include when administering vancomycin to the patient diagnosed with methicillin resistant staphylococcus areas (MRSA)?

Expect medication peak and trough levels to be drawn and monitored.

Which multidrug-resistant organism is resistant to the antimicrobial clindamycin?

Clostridioides difficile

The nurse is teaching about isolation precautions for the patient with methicillin-resistant Staphylococcus aureus (MRSA). Which statement about the image indicates the need for further instruction? Select all that apply.

"I should remove the isolation gown and gloves immediately after leaving the isolated patient's room."

"I should perform hand hygiene after I leave the patient's room."

"I must tie the isolation gown at the neck and chest to prevent bacterial transmission."

The nurse is teaching about isolation precautions for the patient with methicillin-resistant Staphylococcus aureus (MRSA). Which statement about the image indicates true statement? Select all that apply.

"I should perform hand hygiene before I put on the isolation gown and gloves."

"I should use isolation precautions when working with patients infected with either Clostridioides difficile or Acinetobacter as well as MRSA and vancomycin-resistant enterococci (VRE).

Which is a risk factor for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection?

IV drug use

Place in correct order the steps used to maintain proper isolation precautions when preparing to care for the patient with a multidrug-resistant organism (MDRO).

1. Complete initial hand hygiene

2. Don gloves, gown, and, if indicated, mask

3. Provide patient care

4. Remove gown, gloves, and mask

5. Complete final hand hygiene

6. Exit patient's room

Which medication is bacteriostatic against enterococci and staphylococci?

Linezolid

Which laboratory finding in the report is most concerning in the patient with methicillin-resistant Staphylococcus aureus (MRSA) who is receiving vancomycin therapy?

Creatinine level

Which multidrug-resistant organism will the nurse be most concerned about when the patient demonstrates a reddened wound with purulent drainage?

Vancomycin-resistant enterococci (VRE)

A nurse is teaching a group about the epidemiology of Clostridioides difficile. Which statements indicate the need for further instruction? Select all that apply.

The risk of colonization decreases steadily each day during hospitalization

The mortality rate is high when compared to methicillin-resistant Staphylococcus aureus (MRSA)

A nurse is teaching a group about the epidemiology of Clostridioides difficile. Which statements indicate facts about this? Select all that apply.

1.Newborns and children in the first years of life have some of the highest rates of colonization".

2.People older than 85 years of age two times more likely to become infected with C.diff than people aged 65 to 84 years.

3.C.diff infection spreads from the use of antimicrobials, particularly clindamycin.

Which statement made by the nurse regarding Clostridioides difficile indicates the need for further instruction?

"I should use alcohol-based hand sanitizers to kill C. diff spores."

Which statement made by the nurse regarding Clostridioides difficile indicates facts?

"I should always perform hand hygiene when caring for a patient who has C.diff infection."

"I should use soap and water to physically remove C.diff spores."

"I should place a patient with a C.diff infection on contact isolation precaution."

Which conditions are considered the clinical manifestations of infection with vancomycin resistant enterococci (VRE)? Select all that apply.

A.Pimples

B. Bloodstream infections

C. Abscesses

D. Surgical site infections

E. Impetigo

B. Bloodstream infections

D. Surgical site infections

The patient being treated for a persistent respiratory infection with penicillin takes acid-reducing medication and develops severe watery diarrhea. Which intervention would the nurse perform first?

Place the patient in contact isolation

Which factor has led to the development of clostridioides difficile infections?

Increased use of antibiotics and S. aureus infections.

Which multidrug-resistant organism is most likely to be responsible for a patient developing toxic megacolon?

A. Vancomycin-resistant enterococci (VRE)

B. Acinetobacter

C. Clostridioides difficile

D. Methicillin-resistant Staphylococcus aureus (MRSA)

C. Clostridioides difficile

Which multidrug-resistant organism (MDRO) will the nurse consider when a female patient presents with gastrointestinal and genital tract infections?

A. Methicillin-resistant Staphylococcus aureus (MRSA)

B. Acinetobacter baumannii

C. Vancomycin-resistant enterococci (VRE)

D. Clostridioides difficile

C. Vancomycin-resistant enterococci (VRE)

A 79-year-old patient arrives at the emergency department with foot pain and a wound. Which actions should the nurse anticipate with the care? Select all that apply.

A.Apply an isolation gown, securing it at the neck and leaving the waist loose

B. Placing the patient in reverse isolation

C. Performing hand hygiene before applying an isolation gown

D. Providing pain medication and antipyretics

E. Removing dirty gloves and gown before leaving the patient’s room

F. Anticipate vancomycin as a part of the treatment plan

G. Culture wound and perform wound care

H. Perform hand hygiene before leaving the patient’s room.

C.Performing hand hygiene before applying an isolation gown

D. Providing pain medication and antipyretics

E. Removing dirty gloves and gown before leaving the patient’s room

F. Anticipate vancomycin as a part of the treatment plan

G. Culture wound and perform wound care

H. Perform hand hygiene before leaving the patient’s room.

Which multidrug-resistant organism (MDRO) is the patient receiving enteral feedings at most risk for developing?

A.Clostridioides difficile

B.Acinetobacter baumannii

C.Vancomycin-resistant enterococci (VRE)

D.Methicillin-resistant Staphylococcus aureus (MRSA)

D.Methicillin-resistant Staphylococcus aureus (MRSA)

Which intervention by the nurse would be most effective in helping prevent multidrug-resistant infections among hospitalized patients?

A.Implementing surveillance in at-risk groups

B.Administering antibiotic therapy to at-risk individuals

C.Implementing contact precautions for all patients

D.Utilizing proper hand washing when caring for all patients

D. Utilizing proper hand washing when caring for all patients

While caring for a patient with a multidrug-resistant organism, when should the nurse complete this action?

Before donning and after removing personal protective equipment

Between each client-centered activity in the room

After leaving the room of the patient in contact precautions

After touching monitoring equipment in the patient’s room

Before donning and after removing personal protective equipment

Which points, made by the nurse, indicate a need for further training when caring for patients with multidrug-resistant infections? Select all that apply.

A. clean the perineum area and apply moisture barriers

B. Use alcohol-based cleansers when caring for a patient infected with Clostridioides difficile

C. Routinely assess the patient's oxygen saturations

D.Instruct family to limit visits to telephone or video

E.Prevent the patient infected with MDR organisms from ambulating

B. Use alcohol-based cleansers when caring for a patient infected with Clostridioides difficile

D. Instruct family to limit visits to telephone or video

E. Prevent the patient infected with MDR organisms from ambulating

Which type of infection does vancomycin-resistant enterococci (VRE) cause?

A. Surgical site infection

B. Impetigo

C. Peritonitis

D. Pimples

C. Peritonitis

The nurse is identifying a patient’s risk for having methicillin-resistant Staphylococcus aureus (MRSA). Which situation places a person at a higher risk of contracting a MRSA infection? Select all that apply.

A. An immune-compromised patient who went to the doctor’s office for treatment of cold-like symptoms

B. A patient who was recently discharged from the hospital after an abdominal surgery

C. A patient who lives alone in a condominium within an apartment complex

D. A patient who receives regular dialysis treatments at an outpatient dialysis center

E. A patient whose family members have a history of MRSA, but the patient has had limited contact with them

A. An immune-compromised patient who went to the doctor’s office for treatment of cold-like symptoms

B. A patient who was recently discharged from the hospital after an abdominal surgery

C. A patient who lives alone in a condominium within an apartment complex

D. A patient who receives regular dialysis treatments at an outpatient dialysis center

A patient presents to the clinic with a minor skin infection that cultures positive for S. aureus. The patient is upset, saying, “My mother died from a staph infection.” How should the nurse respond?

A. “MRSA can be deadly, we’ll do more tests to determine if that is what you have.”

B. “Your immune system plays a large part in determining if this is MRSA.”

C. “S. aureus from a skin infection is rarely MRSA.”

D. "S. aureus is typically resistant to antibiotics.”

C. “S. aureus from a skin infection is rarely MRSA.”

The nurse is delivering the intravenous medication most commonly used to treat MRSA. Which complication can occur from this medication? Select all that apply.

Nephrotoxicity

Hepatotoxicity

Ototoxicity

Neurotoxicity

Ophthalmic toxicity

Nephrotoxicity

Hepatotoxicity

Ototoxicity

Neurotoxicity

Ophthalmic toxicity

Which statements about multidrug-resistant organisms (MDROs) are accurate? Select all that apply.

A. Touching contaminated equipment spreads MDROs.

B. COVID-19 surges do not affect the development of MDROs

C. MDROs cause nosocomial infections.

D. Clostridioides difficile (C. diff) is an MDRO that causes respiratory symptoms.

E. Hand washing prevents the spread of MDROs.

A. Touching contaminated equipment spreads MDROs.

C. MDROs cause nosocomial infections.

E. Hand washing prevents the spread of MDROs.

When considering the epidemiological presence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which statement is most accurate?

A. All patients who test positive for CA-MRSA are symptomatic.

B. The most likely location for detection of CA-MRSA is in the peripheral joints of the lower extremities.

C. CA-MRSA is found in bodies of stagnant water.

D. Most CA-MRSA infections are of the skin and soft tissue.

D. Most CA-MRSA infections are of the skin and soft tissue.

Mr. Nguyen is an older adult admitted to the hospital from a long-term care facility for treatment of a hip fracture that occurred during a fall. Upon admitting the patient to the surgical unit, the nurse obtains assessment data based on a provided patient history.

Which factors, if noted in Mr. Nguyen’s history, would increase the risk of him having methicillin-resistant Staphylococcus aureus (MRSA)? Select all that apply.

A. History of type 2 diabetes, controlled with medication

B.He is a widower

C. Resides in a long-term care facility

D. Surgery required to correct the hip fracture

E. Patient is male

A. History of type 2 diabetes, controlled with medication

C. Resides in a long-term care facility

D. Surgery required to correct the hip fracture

Risk factors for MRSA include history of type 2 diabetes, residence in a long-term care environment where patients have frequent contact with multiple people, and invasive medical or surgical procedures.

Based on the admission assessment, the nurse identifies that Mr. Nguyen should be screened for MRSA. Which method would the nurse use to obtain a specimen, and from which anatomical location would the specimen be obtained to show colonization?

Intradermal injection; inner aspect of arm

Sterile swab; anterior nares

Blood specimen; venous access

Imaging study; chest x-ray

Sterile swab; anterior nares

While the nursing staff is waiting for test results, which method would be instituted as part of a prevention strategy?

A. Initiation of reverse isolation

B. Two shower applications of Kwell shampoo

C. Use of personal protective equipment (PPE) throughout the course of hospitalization

D. Strict hand washing utilized in all patient care interactions

D. Strict hand washing utilized in all patient care interactions

Test results confirm that Mr. Nguyen is positive for MRSA. Based on this result, the nurse should institute which type of precaution?

A. Contact precaution

B. Bloodborne precaution

C. Placement in a private room with an antechamber washroom

D. Placement in a laminar flow room

A. Contact precaution

Mr. Nguyen is going to be medicated for MRSA. Based on the information provided, which pharmacological statement is accurate about MRSA treatments?

A.It is not necessary to obtain a peak level for vancomycin as the dosage indicated for this type of therapy is at the lower therapeutic range.

B. While the patient is taking linezolid, he should refrain from using sugar substitutes.

C.There is an increased likelihood for the patient to experience constipation while being treated with clindamycin.

D. Decolonization using mupirocin ointment should be instituted alone or concurrently with other treatments.

D. Decolonization using mupirocin ointment should be instituted alone or concurrently with other treatments.

Decolonization treatment for MRSA is provided intranasally with mupirocin ointment alone or in conjunction with antimicrobial therapy. When using vancomycin as a therapy treatment, use of peak/trough level monitoring is required to verify that dosages are both safe and therapeutic. Patients taking linezolid should avoid foods with high tyramine contents, not sugar substitutes. The patient taking clindamycin is at risk for diarrhea and C. diff infection.

Mr. Nguyen progresses through hospitalization, and following the surgical revision, the surgical site becomes positive for MRSA. Based on this new finding, the provider initiated intravenous therapy of vancomycin. Mr. Nguyen has been on this therapy for 5 days. Which assessment data should the nurse evaluate before hanging the next scheduled dose of therapy? Select all that apply.

A. Patient’s current weight

B. Documentation of peak level before start of scheduled dose

C. Determination of trough level before start of scheduled dose

D. Patency of intravenous access site

E. Hydration status

C. Determination of trough level before start of scheduled dose

D. Patency of intravenous access site

When hanging ongoing vancomycin therapy, it is important to know the trough level before initiation of dosing. If the trough level is too high, then the dosage may be adjusted or held to prevent potential nephrotoxicity. A peak level is the drug’s highest serum level and would not be obtained before the start of the scheduled dose.t is important to note that the intravenous site can be accessed since the medication is an irritant.

After several days of intravenous treatment, Mr. Nguyen is asking when he will no longer need to be on contact precautions. What statement by the nurse is correct?

A. After 10 days of IV vancomycin administration

B. After three or more surveillance tests show clearance

C. Until discharge

D. For the rest of his life

B. After three or more surveillance tests show clearance

The nurse observes a student in Mr. Nguyen’s room. Which situations require correction by the nurse? Select all that apply.

A.Isolation gown and gloves are removed as the student enters the hallway.

B.Hand hygiene is performed before the isolation gown and gloves are applied.

C. Isolation gown is secured only at the waist.

D. Hand hygiene is performed after the student leaves the room.

E. Student checks Mr. Nguyen’s identification band before giving a medication.

A.Isolation gown and gloves are removed as the student enters the hallway.

C. Isolation gown is secured only at the waist.

D. Hand hygiene is performed after the student leaves the room.

To prevent transmission, the nurse must (1) perform hand hygiene before putting on isolation gowns and gloves; (2) secure isolation gowns at the neck and waist to effectively prevent bacteria transmission; (3) remove gowns and gloves before leaving the isolation patient’s room; and (4) perform hand hygiene before the healthcare worker leaves the isolation patient’s room.

Which finding alerts the nurse to the possibility of a hospitalized patient developing hospital-acquired methicillin-resistant Staphylococcus aureus? Select all that apply.

A. Patient has intravenous line.

B. Patient has frequently used antibiotic therapy.

C. Patient is on a full-liquid diet.

D.Patient just had a pacemaker placed.

E. Patient is allergic to sulfa.

A. Patient has intravenous line.

B. Patient has frequently used antibiotic therapy.

D.Patient just had a pacemaker placed.

The patient tells the nurse, “Who cares if I have MRSA? Just give me some antibiotics and everything will be okay.” What is the nurse’s best response to this patient statement?

A. “The correct antibiotic therapy will clear up this infection, so there is no need to worry.”

B. “Antibiotics can be given, but it is equally important to make sure that no complications arise due to the presence of MRSA.”

C. “Using antibiotics more frequently will only lead to further antibiotic resistance.”

D. “As long as you are asymptomatic, you don’t need any antibiotic therapy.”

B. “Antibiotics can be given, but it is equally important to make sure that no complications arise due to the presence of MRSA.”

What nursing action is considered to be a best practice for stopping the spread of methicillin-resistant Staphylococcus aureus in the clinical setting?

Assessing vital signs

Changing the patient’s water pitcher

Using proper hand hygiene

Changing the first postoperative dressing using sterile techniqueNext

Using proper hand hygiene

Which statement indicates that the nurse understands pharmacological treatment of hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA)?

A. Ampicillin is the most likely drug that the physician will order.

B. Alternative therapies should be used for patients who have allergies to penicillin as this is the drug of choice for MRSA.

C. Vancomycin therapy will be initiated via parenteral route.

D. Serum blood work evaluating the patient’s uric acid level will be required during the course of therapy.Next

C. Vancomycin therapy will be initiated via parenteral route.

In reviewing a patient’s hospital chart, the nurse notes that in addition to multiple comorbidities, the patient has been diagnosed with hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA). Based on this finding the nurse anticipates which likely outcome?

A. The hospital stay will be shorter than originally assumed.

B. The clinical diagnosis of HA-MRSA will have no direct effect on patient’s outcome.

C. It is likely that the patient will require blood transfusions for stabilization.

D. Patient is at risk for increased morbidity and mortality as a result of HA-MRSA diagnosis.

D. Patient is at risk for increased morbidity and mortality as a result of HA-MRSA diagnosis.

The nurse reviews the patient’s risk for having a multidrug-resistant organism (MDRO). Identify the risk factors this patient has for each MDRO listed. Select all that apply in each row.

Hospital-Acquired MRSA

Residing in long-tern care facility

Comorbid condtions

The nurse reviews the patient’s risk for having a multidrug-resistant organism (MDRO). Identify the risk factors this patient has for each MDRO listed. Select all that apply in each row.

Clostridioides difficile

Comorbid condtions

Older than 64 years of age

Enteral feeding via tube

The nurse reviews the patient’s risk for having a multidrug-resistant organism (MDRO). Identify the risk factors this patient has for each MDRO listed. Select all that apply in each row.

Acinetobacter baumannii

Residing in long-tern care facility

Enteral feeding via tube

What should the nurse request when asking the healthcare provider for admission orders? Select all that apply.

Intravenous antibiotics

Urine for culture

Contact isolation precautions

Antipyretic

Complete blood count

BUN and creatinine levels

Code status

The nurse is implementing the orders from the healthcare provider. Drag the six nurse’s actions to the right in order of priority.

Place in isolation

Obtain a culture of the urine and pressure injury

Place intravenous catheter

Draw blood for labs

Administer intravenous clindamycin

Administer antipyretic

Identify the orders the nurse anticipates from the healthcare provider. Select all that apply.

Stop clindamycin

Begin vancomycin via PEG tube

Monitor intake and output

Apply moisture barrier to buttocks after each bowel movement

Apply fecal diversion or containment system

Report signs of dehydration