Question 1

A female client comes to the clinic with a suspected lower urinary tract infection; urinalysis confirms a diagnosis of cystitis. Which symptoms reported by the client would be most consistent with this condition? Select all that apply.

Accepted Answer

11ecbb05_c9ee_21ee_b433_010f0417e458_MD0009_00 Urinary tract infections (UTIs) are usually bacterial in origin and are most often caused by Escherichia coli. The microorganisms from the perineal area enter the urethra, causing inflammation and infection (urethritis). They ascend to the bladder, where they multiply, causing inflammation and infection (cystitis). The bacteria may continue to ascend the urinary tract to the ureters and kidneys, causing inflammation and infection in the kidneys (pyelonephritis). A UTI is classified as upper or lower according to its location within the urinary tract. Cystitis is the most common community-acquired UTI. It is an infection of the lower urinary tract and involves inflammation of the bladder mucosa, leading to hyperemia, tissue hemorrhage, and pus formation. This inflammatory process leads to burning with urination (dysuria), urinary frequency and urgency, hematuria, and suprapubic discomfort (Options C, D, and F). (Options A and B) When the infection ascends to the kidneys (pyelonephritis), clients become very ill. They develop nausea, vomiting, fever with chills, and flank pain. Assessment shows costovertebral angle tenderness. If the infection is not recognized and treated, clients can become septic. costovertebral angle tenderness Educational objective: Cystitis is an infection of the bladder mucosa. Clients develop burning with urination (dysuria), urinary frequency and urgency, hematuria, and suprapubic discomfort. However, if the infection extends to the kidneys (pyelonephritis), clients become seriously ill with nausea, vomiting, fever with chills, and flank pain.

Question 2

A 59-year-old client comes to the clinic due to a blistering, linear rash on the left chest. The client reports itching and pain around the rash. What is the priority question for the nurse to ask the client?

Accepted Answer

11ecbb05_c9f1_a461_b433_dbbcc863bd45_MD0009_00 Herpes zoster, or shingles, has a characteristic unilateral, linear pattern of fluid-filled blisters. Affected clients commonly report pain and itching. Herpes zoster infection is due to the varicella-zoster virus (VZV), which also causes chickenpox. After initial VZV infection (chickenpox) in early childhood, the virus remains dormant in the sensory nerves. Reactivation of VZV when the immune system is compromised (eg, aging, immunosuppression) results in the formation of lesions along the distribution of one or more such nerves (dermatomal distribution). Vaccination can prevent shingles. If this rash is determined to be due to shingles, the affected area should be covered to prevent the spread of infection. Therefore, it is a priority to ask if this client has had chickenpox. (Options A, B, and D) This client's linear rash has a dermatomal distribution that is characteristic of herpes zoster. These questions should be addressed, but assessing a history of chickenpox is the priority. Educational objective: Herpes zoster (shingles) can occur in clients with a history of chickenpox (varicella-zoster virus exposure). The vesicular rash has a characteristic, linear dermatomal distribution and can present with severe pain. Vaccination prevents shingles.

Question 3

The spouse of an immunocompromised client is diagnosed with influenza virus infection. The spouse asks the office nurse how long contact with the client should be avoided to prevent the infection from spreading. What is the nurse's most appropriate response?

Accepted Answer

The influenza virus has an incubation period of 1-4 days, with peak transmission starting at about 1 day before symptoms appear and lasting up to 5-7 days after the illness stage begins (Option A). (Option B) Influenza is transmitted by inhaling droplets that an infected individual exhales into the air when sneezing, coughing, or speaking. If contact with others is unavoidable, wearing a mask can offer some protection against virus transmission. (Option C) Individuals with the influenza virus can transmit the virus during the incubation period and illness stage of the infection. It is not appropriate to assume that the spouse can no longer transmit the infection. (Option D) Although vaccination provides immunity against influenza in about 2 weeks after inoculation, it does not offer complete protection against all virus strains. Therefore, close contact with others should be avoided during the illness stage, especially those with an impaired immune system. Educational objective: Influenza is a highly contagious respiratory infection transmitted by airborne droplets and direct contact. It has an incubation period of 1-4 days, with peak transmission starting at about 1 day before symptoms appear and lasting up to 5-7 days after the illness stage begins. Vaccination does not offer complete protection against all virus strains.

Question 4

A home health nurse is giving an infection control presentation on pulmonary tuberculosis (TB) disease to a group of home health aides.  Which statement made by a home health aide indicates an understanding about the mode of transmission of pulmonary TB?

Accepted Answer

TB disease is spread from person to person via inhalation of airborne droplets containing tubercle bacilli bacteria. These droplets are coughed, sneezed, or exhaled (eg, breathing, singing, talking, laughing) into the air by an individual with active TB disease. The probability of becoming infected is related to sharing airspace and the amount of time spent with the client. All health care workers caring for clients with TB disease must follow standard and airborne transmission precautions and wear high-efficiency particulate or N95 respirator masks. (Options A, B, and C) Pulmonary TB is not spread via contact with the client's blood, urine, or soiled clothing, bed linens, or eating utensils. Educational objective: Mycobacterium tuberculosis microorganisms from a client with active pulmonary TB disease are transmitted to another person via airborne droplets.

Question 5

The nurse is caring for a 76-year-old client newly admitted with pneumonia and Clostridium difficile infection. Which of the following would be priority to report to the health care provider?

Accepted Answer

Clostridium difficile overgrowth in the intestine often occurs when normal gastrointestinal (GI) flora is destroyed (eg, antibiotic use). Clients with C difficile often have watery diarrhea, nausea, fever, and abdominal pain. Hypovolemia can easily develop through the loss of fluids and electrolytes in the stool, especially in infants and the elderly. Clients with hypovolemia from GI losses will often have hyponatremia, hypokalemia, and elevated blood urea nitrogen (BUN) (poor renal perfusion). This client has hyponatremia (normal, 135-145 mEq/L [135-145 mmol/L]), hypokalemia (normal, 3.5-5.0 mEq/L [3.5-5.0 mmol/L]), and an elevated BUN (normal, 6-20 mg/dL [2.1-7.1 mmol/L]). Hypovolemia can cause hypotension and renal failure, and electrolyte abnormalities can cause cardiac arrhythmias; therefore, these are priority to report. Fluid resuscitation and electrolyte replacement should be initiated promptly to prevent complications. (Option A) Normal blood gas levels are PO₂ 80-100 mm Hg (10.6-13.3 kPa), pCO₂ 35-45 mm Hg (4.7-6.0 kPa), and pH 7.35-7.45. This client has normal results, and these do not need to be reported. (Options C and D) Expected findings of pneumonia include fever, chills, fatigue, crackles, and sputum production. There is nothing to indicate that the client is having respiratory difficulty. Therefore, electrolyte imbalance is a priority. Educational objective: Severe watery diarrhea can lead to hypovolemia. Clients should be monitored for hyponatremia, hypokalemia, elevated blood urea nitrogen, and other electrolyte imbalances. These should be reported and treated immediately to avoid cardiac arrhythmias, hypotension, and renal failure.

Question 6

The nurse is answering questions at a hospital-sponsored health fair. What actions should the nurse encourage to help prevent contracting the West Nile virus? Select all that apply.

Accepted Answer

West Nile virus is a mosquito-borne disease (encephalitis) that occurs mainly during the summer months, especially during humid weather. Prevention focuses on avoiding mosquitoes and using an insect repellent. Prevention also includes wearing long sleeves, long pants, and light colors and avoiding outdoor activities at dawn and dusk when mosquitoes are most active (Options C and E). (Option A) Food and water precautions are emphasized for infectious diseases contracted through contaminated water or food, such as hepatitis A or typhoid (enteric) fever. (Option B) Limiting contact with infected pets is classic advice for avoiding ringworm, a superficial fungal skin infection. (Option D) Washing bedding in hot water is a classic instruction to help reduce allergies/asthma (eg, commonly from mites) or scabies (a contagious skin infection caused by mites). Educational objective: West Nile virus is transmitted by an infected mosquito bite. Prevention focuses on avoiding mosquitoes and using a mosquito repellent. Prevention also includes keeping arms and legs covered with light-colored clothing and avoiding outdoor activities at dawn and dusk.

Question 7

The nurse teaches a group of homeless community clients preventive measures related to transmission of hepatitis A. Which of these measures would the nurse teach as the priority precaution to prevent transmission?

Accepted Answer

The transmission of hepatitis A occurs most commonly through the fecal-oral route through poor hand hygiene and improper food handling by infected persons. It is seen primarily in developing countries. After infection, the hepatitis A virus reproduces in the liver and is secreted in bile. Therefore, hand hygiene (especially after toileting and before meals) is the most important intervention to reduce the occurrence of hepatitis A infection (Option D). Vaccination against hepatitis A is recommended for all children at age 1 and for adults at risk of contracting the virus (health care workers, men who have sex with men, drug users, those who travel to areas with a high prevalence, those with clotting disorders, and those with liver disease). (Options A and B) Hepatitis A is secreted in bile and is more often transmitted via the fecal-oral route. However, the virus can also be spread through needle sharing between intravenous drug users and unsafe sexual practices. These practices should be discouraged and hand hygiene encouraged as the most important intervention for prevention. (Option C) Vaccination is an important means of preventing infection. However, hygienic measures (eg, hand washing, sanitation, cleanliness, avoiding sharing personal items) are readily implemented by all clients regardless of means. Educational objective: Hepatitis A is spread via the fecal-oral route. Therefore, hygienic practices (eg, hand hygiene, sanitation) are the fastest and most readily available interventions available to prevent the spread of the hepatitis A virus. Needle sharing and unprotected sex should be discouraged, and all children age at least 1 year should receive the hepatitis A vaccine.

Question 8

The nurse plans discharge teaching for a client with active herpes lesions who has a new prescription for oral acyclovir and topical lidocaine.  What information will the nurse include in the teaching plan?

Accepted Answer

11ecbb05_c9f1_0820_b433_9d023560d85a_MD0009_00 Acyclovir (Zovirax), famciclovir, and valacyclovir are commonly used to treat herpes infection as they shorten the duration and severity of active lesions. Genital herpes is a sexually transmitted infection caused by a herpes simplex virus and is highly contagious, especially when lesions are active. It remains dormant in the body even when active lesions are healed. There is no cure for genital herpes; treatment is aimed at relieving symptoms and preventing the spread of infection. Touching the lesions and then rubbing or scratching another part of the body can spread the infection. Therefore, gloves should be used when applying topical antiviral or analgesic (eg, lidocaine) medications. (Option A) Herpetic lesions should be kept clean and dry. They can be cleansed with warm water and soap or other solutions. Bandages are not applied to the lesions. (Option B) There is no cure for herpes infection. Genital herpes often leads to local recurrence. Some clients may need long-term suppressive therapy. (Option C) During periods of active lesions, abstinence from sexual intercourse is indicated. Condoms should be used during periods of dormancy due to viral shedding. Educational objective: Clients should be taught to use gloves when applying topical medication to herpes lesions to avoid the spread of infection. There is no cure for genital herpes infection; recurrences are common. Complete abstinence from sexual intercourse is recommended when active lesions are present as barrier contraception alone is insufficient to prevent the spread of infection.

Question 9

The nurse assesses the site where a client received an intradermal purified protein derivative (ie, Mantoux) test 48 hours ago and notices a 16-mm area of induration. The client has no symptoms. Which action will the nurse take next?

Accepted Answer

The intradermal purified protein derivative (PPD) test, or Mantoux test, is administered to screen for tuberculosis (TB). The forearm is injected with 0.1 mL of the PPD, and the client returns in 48-72 hours to have the site assessed for induration (a raised area). Redness alone is not read as a positive response. An area of induration >15 mm is considered a positive response in any client (Option A). However, a positive PPD test does not mean that the client has active TB infection but rather that the client has been exposed to TB and has developed an immune response. Positive sputum cultures, chest x-rays, and the presence of symptoms confirm that the client has active disease(Option C). (Option B) A second injection is not needed when the client has a positive PPD. (Option D) Placing the client in airborne precautions before confirming the presence of active TB is premature. Only clients with active TB (eg, symptoms, positive chest x-ray or sputum stain/culture) require isolation. Educational objective: A positive purified protein derivative (ie, Mantoux) response alone does not indicate active tuberculosis (TB). Confirmation of active TB will be made by positive sputum samples, chest x-ray, and the presence of symptoms.

Question 10

A client is admitted to the hospital for evaluation of suspected pulmonary tuberculosis (TB). The nurse assesses for which characteristic presenting signs and symptoms associated with TB disease? Select all that apply.

Accepted Answer

Mycobacterium tuberculosis is a gram-positive, acid-fast bacillus that is transmitted through the airborne route. TB is usually (85%) pulmonary but can also be extrapulmonary (eg, meninges, genitourinary, bone and joints, gastrointestinal). TB, regardless of location, commonly presents with constitutional symptoms, including: Low-grade fever Night sweats Anorexia and weight loss Fatigue Additional symptoms depend on the location of the infection. Pulmonary tuberculosis typically includes: Cough Purulent or blood-tinged sputum Shortness of breath Dyspnea and hemoptysis are typically seen in the late stages. The classic manifestations of TB can be absent in immunocompromised clients and the elderly. (Option A) Dysuria is a symptom of extrapulmonary genitourinary TB. (Option B) Jaundice can be present in disseminated TB with liver involvement. It can also be a side effect associated with drugs used to treat pulmonary TB (eg, isoniazid). (Option C) Back pain indicates spinal TB. Educational objective: The characteristic signs and symptoms associated with pulmonary TB disease include cardinal (major) signs (eg, cough, sputum production, dyspnea) and constitutional (minor) signs (eg, anorexia, weight loss, fatigue, fever, night sweats).

Question 11

The nurse is caring for a client who had a laparoscopic cholecystectomy 3 days ago. The client's WBC count has increased from 11,200/mm³ (11.2 × 10⁹/L) to 14,600/mm³ (14.6 × 10⁹/L) over the last 24 hours. The nurse understands that which of the following assessment findings indicate potential infection? Select all that apply.

Accepted Answer

11ecbb05_c9f3_03f2_b433_838bb8616038_MD0009_00 Cholecystectomy (removal of the gallbladder) is performed through laparoscopic or open surgery. Signs of postoperative infection typically appear 3-7 days after surgery. Systemic signs may include fever, elevated WBC count, and fatigue. Some potential postoperative infections include: Pneumonia can occur when atelectasis (alveolar collapse) prevents clearing of secretions, promoting bacterial growth. Symptoms include cough with or without sputum, tachypnea, and shortness of breath. Postoperative incentive spirometry, ambulation, and cough/deep breathing exercises help keep alveoli open and prevent pneumonia (Option C). Surgical site infections present with localized redness, warmth, swelling, and purulent drainage. Proper wound care and sterile dressing changes help prevent infection (Options B and E). Urinary tract infections (UTIs), caused by the use of indwelling urinary catheters during surgery, can present with frequency, urgency, and dysuria. Prompt removal of catheters after surgery helps prevent UTIs. Peritonitis (peritoneal infection) presents with rebound tenderness, boardlike abdominal rigidity, and shallow breathing related to abdominal distension. Peritonitis may lead to sepsis and death if untreated (Option D). (Option A) Clients recovering from laparoscopic surgery may experience referred left shoulder pain during the first few postoperative days. This is due to diaphragmatic nerve irritation caused by the carbon dioxide used to inflate the abdomen during laparoscopic surgery. Educational objective: Some potential postoperative infections related to abdominal surgery include pneumonia, surgical site infection, and peritonitis. Signs of infection may include cough, tachypnea, and shortness of breath; warmth or redness around the incision; purulent incisional drainage; or rigid, painful abdomen.

Question 12

An elderly client has a 17-mm induration after a tuberculin skin test (TST). Based on this result, which statement is most accurate?

Accepted Answer

11ecbb05_c9ea_2a4d_b433_ade6f3f53eb0_MD0009_00 In a heathy client, an induration >15 mm indicates a positive TST; this means that the client was exposed to TB, developed antibodies to the disease, and has a TB infection. Additional tests are needed to determine if the client has latent TB infection (LTBI) or active TB disease. Clients with LTBI are asymptomatic and cannot transmit the microorganism to others. Clients with active TB disease usually are symptomatic and can transmit the microorganisms through the air. (Option A) The elderly have decreased immunity and may be unable to develop antibodies to react to the tuberculin; this can result in a false-negative TST reaction. (Option C) A positive reaction to TST means that the client is infected with TB bacteria. The infectious bacteria are concealed by the body's defense and do not lead to active TB disease in most individuals. When the client has a decreased immunity (eg, immunosuppression), bacteria cause an active TB disease. Additional diagnostic tests (eg, chest x-rays, bacteriologic sputum smear for acid-fast bacilli and culture) are needed to determine if this client has active TB disease. (Option D) A positive reaction indicates a TB infection only. Further evaluation and bacteriologic testing is necessary. If active TB is suspected before testing is completed, airborne transmission precautions will then be initiated. Educational objective: A positive reaction to TST means that a client was exposed to TB, developed antibodies, and now has a TB infection. Additional testing is needed to determine if a client has LTBI or active TB disease.

Question 13

The nurse is caring for a client in the acute phase of meningococcal meningitis. Which nursing actions should be included in the client's plan of care? Select all that apply.

Accepted Answer

Bacterial meningitis is an inflammation of the membranes that cover the brain and spinal cord and is caused by bacterial infection. Symptoms include headache, neck stiffness, nausea, vomiting, photophobia, fever, and altered mental status. The client with meningitis is at risk for seizure due to increased neuroirritability from fever and alterations in intracranial pressure. Bacterial meningitis is frequently caused by Neisseria meningitidis (meningococcus) in adults. Meningococcal meningitis is highly infectious and requires strict droplet isolation precautions (eg, surgical mask, private room, client masked during transport) (Options A and B). For clients with meningitis, a restful, reduced stimulus environment (eg, quiet, dimly lighted, cool temperature) promotes healing and reduces neuroirritability and seizure risk (Option E). The client should be on bed rest with the head of the bed elevated 10-30 degrees to promote venous return from the brain and reduce sudden changes in intracranial pressure (Option C). (Option D) Seizure precautions (eg, padded bed rails, oxygen and suction equipment at bedside) should be maintained for a client with meningitis. The client may require suction after a seizure has occurred, but nothing should be inserted into the client's mouth during a seizure, including a padded tongue blade, due to the risk of damaging the teeth or oral mucosa. Educational objective: Care for the client with meningococcal meningitis includes droplet isolation precautions, seizure precautions, reduced stimulus environment (eg, quiet, dimly lit), and bed rest with the head of the bed elevated between 10-30 degrees.

Question 14

The nurse reinforces teaching to a client with HIV during a follow-up clinic visit after being on antiretroviral drugs for the past 2 months. Which statement by the client indicates a need for further instruction?

Accepted Answer

Antiretroviral therapy (ART) is a medication regimen consisting of multiple drugs for managing and preventing progression of HIV infections. ART impairs viral replication at multiple points, which leads to decreased viral loads and increased CD4⁺ (ie, helper T) cell counts. multiple points When educating clients about ART, it is critical to explain that treatment is lifelong and requires strict adherence (Option A). Even clients with undetectable viral loads remain infected with HIV. The discontinuation of, or poor adherence to, ART results in the progression of HIV (which may lead to AIDS) and promotes viral drug resistance. (Option B) Clients with HIV who are sexually active are at increased risk for sexually transmitted infections (STIs). Regular testing (≥1 time annually) and treatment for STIs are recommended. (Option C) Latex or polyurethane barriers should be used during sex to prevent STI transmission, as nonbarrier contraception and natural skin condoms (eg, lambskin) offer poor protection against HIV and STI transmission. (Option D) IV drug use is a common source of HIV infection. Although abstinence from IV drugs is preferred, clients who continue to use them should be instructed to avoid sharing needles and receive information about needle and syringe exchange programs. Educational objective: Clients with HIV must be educated to strictly adhere to prescribed antiretroviral therapy to prevent disease progression. Clients with HIV who are sexually active should seek testing for sexually transmitted infections and use latex condoms/barriers during sex. Clients with HIV should use a needle exchange program if using IV drugs.

Question 15

A client with multidrug-resistant tuberculosis (MDR-TB) has a 1-month follow up visit after beginning medication therapy. The client states, "I've had really bad nausea and fatigue, but because my cough has already improved, I knew it would be alright to stop taking the medications." The nurse identifies which priority nursing diagnosis (ND) in this client's care plan?

Accepted Answer

Knowledge deficit is the lack of adequate information required for health recovery, maintenance, and promotion. The priority ND is knowledge deficit of the prescribed therapeutic regimen manifested by the client's verbalization of nonadherence to the prescribed MDR-TB therapy. Medication to treat MDR-TB usually must be taken for 6 to 9 months. The length of the treatment regiment, the cost and amount of medications that must be taken, and the unpleasant side effects all contribute to clients becoming nonadherent with treatment. If clients do not properly complete the entire medication regimen, they risk reactivating the MDR-TB disease, increasing the bacteria's drug-resistance, and spreading the disease to others. The medications cannot be discontinued until therapy is complete. (Option A) Activity intolerance is an insufficient physiological or psychological energy to complete daily activities. In this client, it is related to side effects of the medications and a deconditioned state and is manifested as fatigue or weakness. This is appropriate to include in the care plan but is not the priority ND. (Option B) Imbalanced nutrition, less than body requirements, is an insufficient intake of nutrients to meet metabolic needs. In this client, it is related to inability to ingest foods secondary to nausea, fatigue, and anorexia and is manifested by inadequate caloric intake and a loss of appetite. This is appropriate to include in the care plan but is not the priority ND. (Option D) In this client, nausea is related to medication side effects and is suggested by a verbal report of nausea and loss of appetite. It is appropriate to include this in the care plan but is not the priority ND. Educational objective: The ND, knowledge deficit of the prescribed therapeutic regimen, is appropriate in a client with MDR-TB who is nonadherent to the prescribed medication therapy. Nonadherence increases the risk for recurrence, development of drug-resistant organisms, and spread of TB disease to others.

Question 16

The camp nurse conducts a class for incoming summer counselors on prevention of tick bites and Lyme disease. Which instructions should the nurse include? Select all that apply.

Accepted Answer

11ecbb05_c9ef_a88f_b433_fb79688276c5_MD0009_00 Lyme disease develops after a bite from a deer tick infected with Borrelia burgdorferi. Clients initially develop flulike symptoms (eg, headache, fever, myalgia, fatigue). Many clients develop erythema migrans, a bull's-eye rash; however, it is not always present. Any of these symptoms should be reported immediately to a health care provider (Option D). The client will likely be prescribed antibiotics (eg, doxycycline, amoxicillin) to treat Lyme disease and prevent it from causing complications (eg, carditis, chronic arthritis, meningitis, facial paralysis). To prevent tick bites during outdoor activities, clients should: Apply an insect repellent spray that contains tick-repelling ingredients (eg, DEET, picaridin) (Option A) Avoid tall grass and thick underbrush, and hike only in the center of the trails (Option B) Avoid tall grass and thick underbrush, and hike only in the center of the trails (Option B) Wear long-sleeved shirts tucked into pants, long pants tucked into socks or boots, and closed-toed shoes (Option E) Wear long-sleeved shirts tucked into pants, long pants tucked into socks or boots, and closed-toed shoes (Option E) (Option C) Covering attached ticks with petroleum jelly or nail polish is a folk remedy that actually increases the chance of infection by keeping the tick on the skin. Ticks should be promptly removed using tweezers, being careful to grasp the tick close to the attachment site and not crush it during removal. Educational objective: Clients should be taught to prevent tick bites while hiking by using insect repellent; avoiding tall grass and thick underbrush; and wearing long-sleeved shirts, long pants, and closed-toed shoes. Ticks should be promptly removed with tweezers, keeping them intact. Flulike symptoms and a bull's-eye rash should be reported immediately to the health care provider.

Question 17

The public health nurse provides care for a client on a directly observed therapy (DOT) program to treat tuberculosis (TB). Which option best describes the care the nurse provides on this program?

Accepted Answer

TB is curable if the client completes the prescribed medication regimen. Noncompliance with the treatment plan is a major problem in treating TB due to the length of time drug therapy is required (usually about 6 months) and the associated unpleasant side effects. DOT is an effective patient-centered treatment strategy developed by the World Health Organization that increases compliance with drug therapy, prevents reinfection and the development of multi-drug resistant TB strains, and controls the spread of TB disease worldwide. The public health nurse provides and watches the client swallow every prescribed medication for at least the first 2 months of antitubercular medication therapy, preferably longer. Any designated person (ie, caregiver) can provide the medications and observe the client swallow them. This can take place in any designated area (eg, clinic, home, school, workplace). (Option A) The public health nurse follows the client throughout the treatment period until all sputum smears and cultures are normal, but not in the DOT program. (Option B) The public health nurse gives the client bus tokens or cab fare vouchers to attend scheduled clinic visits as incentives, but not in the DOT program. (Option D) The public health nurse screens all of the client's close contacts for possible infection and prophylactic treatment, but not in the DOT program. Educational objective: Directly observed therapy is a patient-centered treatment strategy, implemented by a health care worker or caregiver, to ensure adherence with drug therapy.

Question 18

The client with suspected active pulmonary tuberculosis (TB) has a positive tuberculin skin test (TST).  Which prescription from the health care provider does the nurse anticipate will confirm the diagnosis in this client?

Accepted Answer

Bacteriologic testing is performed in clients with suspected TB disease to confirm the diagnosis. A stained sputum smear is examined microscopically for the presence of Mycobacterium tuberculosis (tubercle bacillus), and a culture identifies the growth of the microorganisms. Collect an early morning sputum sterile specimen on 3 consecutive days for an acid-fast bacilli (AFB) smear and culture. Fluids and/or expectorants can be given at bedtime to help liquefy secretions. It is usually easier for clients to produce a specimen upon awakening as secretions collect in the airways during the night. (Option A) Blood cultures that identify microorganism in the blood are not usually obtained to confirm a diagnosis of TB. (Option B) Nose cultures are routinely performed to determine the presence of methicillin-resistant Staphylococcus aureus but are not performed to confirm a diagnosis of TB. (Option D) The QuantiFERON-TB blood test is performed to screen for TB and can be used as an alternate to the TST. The advantages it offers include the following: there are fewer false-positive results, only a single client visit is required, and results are available in 24 hours. However, it is more expensive. Educational objective: An AFB sputum culture and smear test are performed to detect the presence of M. tuberculosis and confirm a diagnosis of TB.

Question 19

The nurse is caring for a client diagnosed with influenza who has had high fever, muscle aches, headache, and sore throat for 36 hours. The health care provider prescribes ibuprofen and oseltamivir. Which of the following actions by the nurse are appropriate? Select all that apply.

Accepted Answer

Influenza (flu) is a contagious viral infection that affects the respiratory tract. Symptoms include fever, chills, severe muscle aches, headache, cough, sore throat, nasal congestion, and malaise. Influenza treatment includes rest, hydration, humidified air, and antipyretics/analgesics. Antiviral medications (eg, zanamivir [Relenza], oseltamivir [Tamiflu]) are given to clients with symptom onset within the last 48-72 hours. These medications inhibit viral reproduction and can shorten the duration of the illness. Annual vaccination is recommended to prevent influenza (Option D). To prevent spreading influenza, infected clients should be on droplet precautions (eg, surgical mask, private room), wear a mask when being transported out of the room, and be taught to cover the mouth and nose while coughing or sneezing (Options B and C). Hand hygiene should also be emphasized as the influenza virus can persist on unwashed hands and surfaces. (Option A) Oseltamivir is an appropriate antiviral medication for this client who reports onset of influenza symptoms 36 hours ago. (Option E) The influenza virus is spread via droplet transmission when infected persons cough or sneeze. Hospital personnel caring for clients with influenza should adhere to droplet precautions in addition to standard (universal) precautions. Educational objective: Clients hospitalized with influenza should be on droplet precautions, wear a mask during transport, be instructed to cover coughs and sneezes, and be assisted in performing hand hygiene frequently. Antiviral medications (eg, zanamivir [Relenza], oseltamivir [Tamiflu]) are most beneficial if given within 48-72 hours of symptom onset.

Question 20

The nurse assessing a client notices pearly white plaque-like lesions on the mouth mucosa. The nurse understands that which client is at highest risk for oral candidiasis?

Accepted Answer

Oropharyngeal candidiasis, or thrush (moniliasis), is an infection of the mucous membranes generally caused by the yeastlike fungus Candida albicans. The fungus causes pearly, "milk-curd" lesions on the oral or laryngeal mucosa that may bleed when removed. Immunosuppressed individuals such as those taking corticosteroid medications, clients undergoing chemotherapy or radiation, or clients with immune deficiency states (eg, AIDS) have an increased incidence. Clients receiving prolonged or high-dose antibiotic treatment are at increased risk as the normal microbial flora of the mouth is reduced, allowing other opportunistic infections to arise (Option B). Individuals with dentures and infants also commonly experience monilial infections. Treatment is antifungal medications (eg, nystatin) and proper oral hygiene. (Option A) Inhaled beta-2 agonists (eg, albuterol) do not increase the risk for fungal infections. However, individuals taking an inhaled corticosteroid (eg, budesonide, fluticasone) are at increased risk for oral candidiasis. To reduce this risk, the client should rinse the mouth after each inhaled dose and maintain good oral hygiene. (Options C and D) Proper oral hygiene and nutrition are important in prevention of oral candidiasis. However, the client with braces or poor hygiene and inadequate nutrition is at lower risk than one who is immunosuppressed or taking antibiotics. Educational objective: Immunosuppressed clients (eg, taking steroids, undergoing chemotherapy or radiation, with immunodeficient states) and those taking prolonged or high-dose antibiotics are at increased risk of oral candidiasis. Elderly clients with dentures are also at high risk. Infection is treated with antifungals (eg, nystatin) and proper oral hygiene.

Exam 1: Adult Health

A female client comes to the clinic with a suspected lower urinary tract infection; urinalysis confirms a diagnosis of cystitis. Which symptoms reported by the client would be most consistent with this condition? Select all that apply.

A 59-year-old client comes to the clinic due to a blistering, linear rash on the left chest. The client reports itching and pain around the rash. What is the priority question for the nurse to ask the client?

The spouse of an immunocompromised client is diagnosed with influenza virus infection. The spouse asks the office nurse how long contact with the client should be avoided to prevent the infection from spreading. What is the nurse's most appropriate response?

A home health nurse is giving an infection control presentation on pulmonary tuberculosis (TB) disease to a group of home health aides. Which statement made by a home health aide indicates an understanding about the mode of transmission of pulmonary TB?

The nurse is caring for a 76-year-old client newly admitted with pneumonia and Clostridium difficile infection. Which of the following would be priority to report to the health care provider?

The nurse is answering questions at a hospital-sponsored health fair. What actions should the nurse encourage to help prevent contracting the West Nile virus? Select all that apply.

The nurse teaches a group of homeless community clients preventive measures related to transmission of hepatitis A. Which of these measures would the nurse teach as the priority precaution to prevent transmission?

The nurse plans discharge teaching for a client with active herpes lesions who has a new prescription for oral acyclovir and topical lidocaine. What information will the nurse include in the teaching plan?

The nurse assesses the site where a client received an intradermal purified protein derivative (ie, Mantoux) test 48 hours ago and notices a 16-mm area of induration. The client has no symptoms. Which action will the nurse take next?

A client is admitted to the hospital for evaluation of suspected pulmonary tuberculosis (TB) . The nurse assesses for which characteristic presenting signs and symptoms associated with TB disease? Select all that apply.

An elderly client has a 17-mm induration after a tuberculin skin test (TST) . Based on this result, which statement is most accurate?

The nurse is caring for a client in the acute phase of meningococcal meningitis. Which nursing actions should be included in the client's plan of care? Select all that apply.

The nurse reinforces teaching to a client with HIV during a follow-up clinic visit after being on antiretroviral drugs for the past 2 months. Which statement by the client indicates a need for further instruction?

The camp nurse conducts a class for incoming summer counselors on prevention of tick bites and Lyme disease. Which instructions should the nurse include? Select all that apply.

The public health nurse provides care for a client on a directly observed therapy (DOT) program to treat tuberculosis (TB) . Which option best describes the care the nurse provides on this program?

The client with suspected active pulmonary tuberculosis (TB) has a positive tuberculin skin test (TST) . Which prescription from the health care provider does the nurse anticipate will confirm the diagnosis in this client?

The nurse is caring for a client diagnosed with influenza who has had high fever, muscle aches, headache, and sore throat for 36 hours. The health care provider prescribes ibuprofen and oseltamivir. Which of the following actions by the nurse are appropriate? Select all that apply.

The nurse assessing a client notices pearly white plaque-like lesions on the mouth mucosa. The nurse understands that which client is at highest risk for oral candidiasis?