Question 1

A patient has presented at the ED with copious diarrhea and accompanying signs of dehydration. During the patients health history, the nurse learns that the patient recently ate oysters from the Gulf of Mexico. The nurse should recognize the need to have the patients stool cultured for microorganisms associated with what disease?

Accepted Answer

In the U.S., cholera should be suspected in patients who have watery diarrhea after eating shellfish harvested from the Gulf of Mexico.

Question 2

A patient is alarmed that she has tested positive for MRSA following culture testing during her admission to the hospital. What should the nurse teach the patient about this diagnostic finding?

Accepted Answer

This patients testing results are indicative of colonization, which is not synonymous with infection. The test results are considered reliable, and would not be characterized as preliminary. Treatment is not normally prescribed for colonizations.

Question 3

A patients diagnostic testing revealed that he is colonized with vancomycin-resistantenterococcus (VRE). What change in the patients health status could precipitate an infection?

Accepted Answer

Colonization can progress to infection if there is a portal of entry by which bacteria can invade body
tissues. The use of vancomycin, or any other antibiotic, would not necessarily precipitate a VRE infection. Prolonged skin contact is similarly unlikely to cause infection, provided the skin remains intact.

Question 4

A clinic nurse is caring for a male patient diagnosed with gonorrhea who has been prescribed ceftriaxone and doxycycline. The patient asks why he is receiving two antibiotics. What is the nurses best response?

Accepted Answer

Because patients are often coinfected with both gonorrhea and chlamydia, the CDC recommends dual therapy even if only gonorrhea has been laboratory proven. Although the number of resistant strains of gonorrhea has increased, that is not the reason for use of combination antibiotic therapy. Dual therapy is prescribed to treat both gonorrhea and chlamydia, because many patients with gonorrhea have a coexisting chlamydial infection. This combination of antibiotics does not reduce the risk of reinfection or provide a faster cure.

Question 5

A student nurse completing a preceptorship is reviewing the use of standard precautions. Which of the following practices is most consistent with standard precautions?

Accepted Answer

Standard precautions are used to prevent contamination from blood and body fluids. Gloves are worn whenever exposure is possible, and hands should be washed after removing gloves. Needles are never recapped after use because this increases the risk of accidental needlesticks. Under ordinary circumstances, masks and gowns are not necessary for starting an IV line. Double-gloving is not a
recognized component of standard precautions.

Question 6

During a health education session, a participant asks the nurse how a vaccine can protect from future exposures to diseases against which she is vaccinated. What would be the nurses best response?

Accepted Answer

Vaccines are an antigen preparation that produces an antibody response in a human to protect him or her from future exposure to the vaccinated organism. A vaccine does not respond to an infection after it occurs; it does not act like an antibiotic and does not actively attack the microorganism.

Question 7

A 2-year-old is brought to the clinic by her mother who tells the nurse her daughter has diarrhea and the child is complaining of pain in her stomach. The mother says that the little girl had not eaten anything unusual, consuming homemade chicken strips and carrot sticks the evening prior. Which bacterial infection would the nurse suspect this little girl of contracting?

Accepted Answer

Annually in the United States, Salmonella species contaminate approximately 2.2 million eggs ( 1 in 20,000 eggs) and one in eight chickens raised as meat. Diarrhea with gastroenteritis is a common manifestation associated with Salmonella. Recent outbreaks of $E$. coli have been associated with ingestion of undercooked beef. Shigella spreads through the fecaloral route, with easy transmission from one person to another. People infected with Giardia lambliacontract the disease by drinking contaminated water.

Question 8

A public health nurse is teaching a mother about vaccinations prior to obtaining informed consent for her childs vaccination. What should the nurse cite as the most common adverse effect of vaccinations?

Accepted Answer

The most common adverse effects are an allergic reaction to the antigen or carrier solution and the occurrence of the actual disease (often in modified form) when live vaccine is used. Reactions to vaccines do not typically include sensitivity to the sun, nausea and vomiting, or joint pain.

Question 9

A mother brings her 12 month-old son into the clinic for his measles-mumps-rubella (MMR) vaccination. What would the clinic nurse advise the mother about the MMR vaccine?

Accepted Answer

Patients should be advised that fever, transient lymphadenopathy, or a hypersensitivity reaction might occur following an MMR vaccination. Reactions to an MMR do not include photophobia or hypothermia.

Question 10

An older adult patient tells the nurse that she had chicken pox as a child and is eager to be vaccinated against shingles. What should the nurse teach the patient about this vaccine?

Accepted Answer

Zostavax, a vaccine to reduce the risk of shingles, is recommended for people older than 60 years of age because it reduces the risk of shingles by approximately $50 \%$. It does not need to be preceded by childhood varicella vaccine. The vaccine consists of a single injection.

Question 11

The nurse educator is discussing emerging diseases with a group of nurses. The educator should cite what causes of emerging diseases? Select all that apply.

Accepted Answer

Many factors contribute to newly emerging or re-emerging infectious diseases. These include travel, globalization of food supply and central processing of food, population growth, increased urban crowding, population movements (e.g., those that result from war, famine, or man-made or natural disasters), ecologic changes, human behavior (e.g., risky sexual behavior, IV/injection drug use), antimicrobial resistance, and breakdown in public health measures. Not noted is an overall decline in human immunity.

Question 12

An older adult patient has been diagnosed with Legionella infection. When planning this patients care, the nurse should prioritize which of the following nursing actions?

Accepted Answer

The lungs are the principal organs of Legionella infection. The patient develops increasing pulmonary symptoms, including productive cough, dyspnea, and chest pain. Consequently, respiratory support is vital. Hemorrhage and skin breakdown are not central manifestations of the disease. Preservation of the patients airway is a priority over emotional support, even though this aspect of care is important.

Question 13

The nurse is caring for a patient with secondary syphilis. What intervention should the nurse institute when caring for this patient?

Accepted Answer

Lesions of primary and secondary syphilis may be highly infective. Gloves are worn when direct contact with lesions is likely, and hand hygiene is performed after gloves are removed. Isolation in a private room is not required. Corticosteroids antiviral medications are not indicated.

Question 14

A long-term care facility is the site of an outbreak of infectious diarrhea. The nurse educator has emphasized the importance of hand hygiene to staff members. The use of alcohol-based cleansers may be ineffective if the causative microorganism is identified as what?

Accepted Answer

The spore form of the bacterium C. difficile is resistant to alcohol and other hand disinfectants; therefore, the use of gloves and handwashing (soap and water for physical removal) are required when $C$. difficile has been identified. Each of the other listed microorganisms is susceptible to alcohol-based cleansers.

Question 15

The nurse is providing care for an older adult patient who has developed signs and symptoms ofCalicivirus (Norovirus). What assessment should the nurse prioritize when planning this patients care?

Accepted Answer

The vomiting and diarrhea that accompany Norovirus create a severe risk of fluid volume deficit. For this reason, assessments relating to fluid balance should be prioritized, even though each of the listed assessments should be included in the plan of care.

Question 16

The nurse who provides care at a wilderness camp is teaching staff members about measures that reduce campers and workers risks of developing Giardia infections. The nurse should emphasize which of the following practices?

Accepted Answer

Transmission of the protozoan Giardia lamblia occurs when food or drink is contaminated with viable cysts of the organism. People often become infected while traveling to endemic areas or by drinking contaminated water from mountain streams within the United States. Berries, mosquitoes, and ticks are not sources of this microorganism.

Question 17

A nurse is participating in a vaccination clinic at the local public health clinic. The nurse is describing the public health benefits of vaccinations to participants. Vaccine programs addressing which of the following diseases have been deemed successful? Select all that apply.

Accepted Answer

The most successful vaccine programs have been ones for the prevention of smallpox, measles, mumps, rubella, polio, diphtheria, pertussis, and tetanus. There is no vaccine for tuberculosis. Hepatitis is not counted as one of the most successful vaccination programs, because vaccination rates for hepatitis leave room for improvement.

Question 18

A public health nurse promoting the annual influenza vaccination is focusing health promotion efforts on the populations most vulnerable to death from influenza. The nurse should focus on which of the following groups?

Accepted Answer

Influenza vaccination is particularly beneficial in preventing death among older adults, especially those with compromised health status or those who live in institutional settings. It is recommended for children and adults, but carries the greatest reduction in morbidity and mortality in older adults.

Question 19

The nurse receives a phone call from a clinic patient who experienced fever and slight dyspnea several hours after receiving the pneumococcus vaccine. What is the nurses most appropriate action?

Accepted Answer

Nurses should ask adult vaccine recipients to provide information about any problems encountered after vaccination. As mandated by law, a Vaccine Adverse Event Reporting System (VAERS) form must be completed with the following information: type of vaccine received, timing of vaccination, onset of the adverse event, current illnesses or medication, history of adverse events after vaccination, and demographic information about the recipient. NSAIDs are not necessarily required and no evidence of distress warrants a call to 911 . This is not an expected response to vaccination.

Quiz 70: Management of Patients With Infectious Diseases