Author Question: A nurse is planning an in-service on preventing infection for the hospital staff nurses on a ... (Read 41 times)

xroflmao · **on:** Jun 25, 2018

A nurse is planning an in-service on preventing infection for the hospital staff nurses on a medical-surgical unit. Which nursing intervention is most effective in reducing the risk of infections?

A) Raising the temperature in the client's room
B) Assessing vital signs once daily
C) Wearing a mask for client care
D) Performing hand hygiene

Question 2

A client receives the yellow fever vaccine before traveling to the Amazon Basin and asks the nurse how the vaccine provides protection. Which responses by the nurse is the most appropriate?

Select all that apply.
A) Human macrophages engulf the weakened vaccine virus as if it is dangerous and antigens stimulate the immune system to attack it.
B) In the lymph nodes, part of the lymphoid system, the macrophages present yellow fever antigens to T cells and B cells.
C) A response from yellow fever-specific T cells is activated. B cells secrete yellow fever antibodies.
D) The body's immune system eats away at the protective sheath (myelin) that covers the nerves.
E) The initial weak infection is eliminated and the client is left with a supply of memory T and B cells for future protection against yellow fever.

vish98 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Answer: D

Hand hygiene is always the first and best way to stop the spread of microorganisms, which cause infections. Raising the temperature in a client's room would contribute to the growth of microorganisms. Assessing vital signs is important but should be done more frequently than once daily. Wearing a mask for all clients is not practical and is unnecessary unless a microorganism is airborne and the client is in isolation.

Answer to Question 2

Answer: A, B, C, E

Macrophages ingest antigens and signal helper T cells that antigens are present. Lymph nodes filter foreign products or antigens from the lymph system and house and support proliferation of lymphocytes and macrophages. Antibodies directly attack and destroy antigens either before or after antigens invade body cells. The immune system damaging the myelin is an autoimmune response in MS. Memory B cells and T cells remember how to identify the antigen and will reactivate at a future time if the same type of antigen is present.