3101 skills: Chap. 29 Infection EAQ's

3. Perform hand-hygiene practices. 4. Use gloves when assessing the wound. 5. Use appropriate, personal protective equipment. Rationale Proper hand-hygiene practices are important to control the spread of infection to other sites or other patients. The nurse should use gloves when assessing the wound to prevent cross contamination of the wound and her hand. The nurse should use appropriate, personal protective equipment (PPE) when assessing the wound to prevent the microorganisms from spreading. Calling a senior nurse may be considered only if there is additional assistance required. Waiting for the laboratory results is not required to perform an assessment. p. 445

A patient who had a hysterectomy 10 days ago has come for a follow-up visit. The patient is experiencing pain and itching at the incision site. The nurse suspects a wound infection and performs an assessment for confirmation. When assessing this patient, what actions should the nurse perform to reduce the spread of infection? Select all that apply. 1. Call for a senior nurse. 2. Wait for the laboratory results. 3. Perform hand-hygiene practices. 4. Use gloves when assessing the wound. 5. Use appropriate, personal protective equipment.

1. Pain 2. Redness 4. Tenderness Rationale Pain is an important finding in wound infection because it is due to inflammation. Redness is commonly seen in wounds that are infected. Tenderness is observed in a wound infection due to localized swelling and inflammation. The infected wound appears red; it does not appear pale. The skin around the infected wound is warm to the touch. Study Tip: Sometimes learning a fun fact can help you memorize information, such as the signs of inflammation. The cardinal signs of inflammation as established by early Greek and Roman physicians are the four ors: rubor (redness), calor (heat [think calorie]), dolor (pain), and tumor (swelling). p. 446

A patient who had undergone a hysterectomy 10 days ago came for a follow-up visit. The patient notices purulent drainage at the incision site. The nurse suspects wound infection and performs assessment for confirmation. Which clinical findings would the nurse evaluate? Select all that apply. 1. Pain 2. Redness 3. Paleness 4. Tenderness 5. Cold sensation

2. Clostridium difficile Rationale Clostridium difficile is a common spore-forming bacterium that causes antibiotic-induced diarrhea. Bacteroides fragilis are normal flora of the human colon that may cause infections when displaced into the bloodstream or tissues near the site of injury or surgery. Staphylococcus aureus can cause wound infection and pneumonia. Legionella pneumophila can grow in 25-degree to 42-degree water. This microorganism may not cause antibiotic-induced diarrhea. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options . p. 444

A patient who is on antibiotic therapy visits the primary health care provider with severe diarrhea. The primary health care provider diagnoses the patient with antibiotic-induced diarrhea. Which microorganism causes antibiotic-induced diarrhea? 1. Bacteroides fragilis 2. Clostridium difficile 3. Staphylococcus aureus 4. Legionella pneumophila

2. Asperigillas 5. Clostridium tetani Rationale Microorganisms responsible for exogenous infections include Aspergillus and Clostridium tetani. Endogenous infections occur when the body's normal floras are altered. Yeast, streptococci, and staphylococci can cause endogenous infections. p. 448

A patient who underwent bariatric surgery complains of serous exudate at the site of surgery. The primary health care provider diagnoses the patient with a health care-associated infection. Which microorganisms can cause exogenous infections? Select all that apply. 1. Yeast 2. Asperigillas 3. Streptococcus 4. Staphylococcus 5. Clostridium tetani

1. Provide adequate rest 2. Provide adequate nutrition Rationale Patients who require attentive care are provided with supportive therapy, which includes providing adequate rest and nutrition to the patient to improve the patient's defense mechanisms against infections. Maintaining proper hand hygiene, monitoring the patient's response to drug therapy, and the usage of standard precautions while handling patients during therapy are general responsibilities of the nurse while caring for a patient with exogenous or endogenous infections. p. 445

A patient with a urinary tract infection is hospitalized due to severe discomfort. The primary health care provider advises the nurse to provide supportive therapy to the patient. Which actions of the nurse are included when providing supportive therapy? Select all that apply. 1. Provide adequate rest 2. Provide adequate nutrition 3. Maintain proper hand hygiene 4. Monitor the patient's response to drug therapy 5. Use standard precautions during therapy

1. "The incubation period for mumps is 1 to 5 days." Rationale The average incubation period for mumps is 16 to 18 days, but can range from 12-25 days. The recovery of the patient is noticed during the convalescence stage of malaria. Acute infections are noticed during the illness stage. Group A beta-hemolytic Streptococcus causes strep throat manifested by a sore throat, pain, and swelling. Herpetic whitlow is the infection caused by the herpes simplex virus. The nonspecific signs and symptoms, such as itching and tingling, develop during the prodromal stage at the site before the appearance of the lesions. p. 446

A registered nurse is teaching a student nurse about the various stages of infections. Which statement made by the student nurse indicates a need for additional teaching? 1. "The incubation period for mumps is 1 to 5 days." 2. "The acute symptoms of malaria will disappear during the convalescence stage." 3. "Group A beta-hemolytic Streptococcus causes a sore throat, pain, and swelling at the illness stage." 4. "Herpes simplex at the prodromal stage begins with itching at the site before the lesion appears."

4. Normal flora may cause disease when residing in their usual area of the body. Rationale Normal flora do not usually cause disease when they reside in their usual area of the body. Normal flora exist in large numbers in the large intestine without causing any illness. These flora maintain a sensitive balance with other microorganisms to prevent infection. A person normally excretes trillions of microbes daily through the intestines. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking; look for key words; (2) Read each answer thoroughly and see if it completely covers the material asked by the question; (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 448

A registered nurse teaches a nursing student about normal flora. Which statement of the nursing student indicates a need for further learning? 1. Normal flora of the large intestine exist in large numbers. 2. Normal flora maintain a sensitive balance with other microbes. 3. A healthy person excretes trillions of microbes daily through the intestines. 4. Normal flora may cause disease when residing in their usual area of the body.

4. In a patient with a urinary tract infection, organisms exit through drainage tubes. 5. The influenza virus is released from the body through the mucous membranes. Rationale When a patient has a urinary tract infection, microorganisms exit during urination. The influenza virus is released from the body through the respiratory tract when a patient sneezes or coughs. The skin is considered as a portal of exit because any break in skin integrity allows pathogens to exit the body and is exhibited by the presence of purulent drainage. The hepatitis B virus can exit from wounds, venipuncture sites, and bloody stools. Gastrointestinal portals of exit include emesis, bowel elimination, and drainage of bile via surgical wounds or drainage tubes. p. 445

A registered nurse teaches a nursing student about the portal of exit of different organisms. Which statement made by the nursing student indicates a need for further learning? Select all that apply. 1. The skin is considered a portal of exit. 2. The hepatitis B virus can exit through blood. 3. Gastrointestinal portals of exit include emesis and drainage tubes. 4. In a patient with a urinary tract infection, organisms exit through drainage tubes. 5. The influenza virus is released from the body through the mucous membranes.

2. Prodromal stage Rationale The prodromal stage is the time interval of onset of nonspecific symptoms to more specific symptoms. During this stage, microbes grow and multiply and the patient is capable of spreading the disease to others. The illness stage is the time interval when a patient manifests signs and symptoms specific to the type of infection. The incubation period is the time interval between the entrance of a pathogen into the body and the appearance of the first symptoms. The convalescence stage is the time interval when acute symptoms of infection disappear. p. 446

During which stage is a patient capable of spreading a disease because microorganisms are growing and multiplying? 1. Illness stage 2. Prodromal stage 3. Incubation period 4. Convalescence stage

Patient A Rationale Iron levels are decreased; in patients with chronic infection as microorganisms utilize iron for DNA synthesis, generation of energy, and carrying oxygen. Normal serum levels of iron are in the range of 50 to 175 mcg/dL. Normal levels of eosinophils are in the range of 1% to 4%, and increased levels indicate infection in patients. Therefore, an eosinophil percentage of 2% indicates a normal finding. The normal range of a white blood cell count is 5000 to 10,000/mm 3, and it is elevated during infection. A white blood cell level of 6000/mm 3 indicates normal findings. The normal percentage of neutrophils in the blood is 55% to 70%, and elevated levels indicate infection. Therefore, a neutrophil level of 60% indicates a normal finding. p. 451

The nurse is reviewing the laboratory reports of four patients. Which lab finding indicates chronic or existing infection? Patient A: the total iron level in the blood is 30mcg/100 dl Patient B: the percentage of eosinophils in the blood is 2% Patient C: WBC count is 6000/mm3 Patient D: the percentage of neutrophils in the blood is 60%

1. It provides a barrier to microorganisms. 2. It helps in removing organisms when they adhere to outer layers of the skin. 3. It contains fatty acids that have an antibacterial action. Rationale The multilayered surface of the skin acts as a barrier against microorganisms. The periodic shedding of outer layers of the skin helps in removing organisms that adhere to the outer layers of the skin. The sebum secreted from the skin glands contains fatty acids that have antibacterial action. The skin does not help in washing away particles containing microorganisms or have microbial-inhibiting action. Saliva in the oral cavity helps to perform these actions. p. 447

The nurse is teaching a group of nursing students about the normal defense mechanisms of the body against infections. Which statements are true about the skin as a primary defense against infections? Select all that apply. 1. It provides a barrier to microorganisms. 2. It helps in removing organisms when they adhere to outer layers of the skin. 3. It contains fatty acids that have an antibacterial action. 4. It helps in washing away particles containing microorganisms. 5. It contains microbial inhibitors.

4. White blood cells Rationale A break in the integrity of the skin and mucous membranes may allow pathogens to exit the body, which may be exhibited by the presence of a purulent drainage. This purulent discharge contains white blood cells and bacteria. Serous exudates may contain serum. Platelets may not be present in any exudates. Sanguineous exudates may contain red blood cells. p. 446

The nurse suspects the exit of an infectious organism through a purulent skin discharge. What would be the components of this discharge? 1. Serum 2. Platelets 3. Red blood cells 4. White blood cells

1. A patient who underwent bronchoscopy 2. A patient who receives broad-spectrum antibiotics 3. A patient who has an indwelling urinary catheter 4. A patient who suffers from diabetes mellitus Rationale Bronchoscopy bypasses the natural defenses of the body and predisposes the patient to HAIs. Broad-spectrum antibiotics suppress the normal flora and promote growth of resistant strains of microorganisms. An indwelling urinary catheter bypasses the natural defenses and also serves as a port of entry for microorganisms. Diabetes mellitus suppresses the body's immunity and increases the risk of HAIs. Fever does not affect the natural defense mechanism, and therefore does not increase the risk of HAIs. p. 448

The nurse works in a hospital. The nurse understands that health care-associated infections (HAIs) are difficult to treat. Which patient may be at increased risk of developing an HAI? Select all that apply. 1. A patient who underwent bronchoscopy 2. A patient who receives broad-spectrum antibiotics 3. A patient who has an indwelling urinary catheter 4. A patient who suffers from diabetes mellitus 5. A patient who has a fever

3. Ensure a closed, urinary catheter drainage system. 4. Change the IV access site if inflamed. 5. Use aseptic technique when suctioning the airway. Rationale A closed urinary catheter drainage system helps to contain microorganisms and prevent the spread of infection. An IV access site should be changed as soon as signs of inflammation appear. Inflammation can lead to infection. Microorganisms can be introduced into the airway if aseptic technique is not followed for suctioning. Repeated catheter irrigation may increase the risk for contracting an infection because irrigation bypasses the normal defenses of the body. Adding drug additives to IV fluids also increases the risk of infections. pp. 447-448

The nurse works in a hospital. What precautions are necessary to help prevent health care-associated infections? Select all that apply. 1. Frequently irrigate urinary catheters. 2. Insert drug additives to IV fluids. 3. Ensure a closed, urinary catheter drainage system. 4. Change the IV access site if inflamed. 5. Use aseptic technique when suctioning the airway.

3. Organic matter Rationale Clostridium perfringens causes gas gangrene; it thrives mostly on organic matter. Some bacterial forms, such as spores, live on a water surface for long periods of time. Aerobic organisms such as Staphylococcus aureus require oxygen for survival and multiplication sufficient to cause disease. Escherichia coli consumes undigested food in the bowel. p. 443

What is the major reservoir of the microbe that causes gas gangrene? 1. Water 2. Oxygen 3. Organic matter 4. Undigested food in the bowel

1. Illness stage Rationale The illness stage is the interval in which the patient manifests signs and symptoms specific to a type of infection. (For instance, strep throat is manifested by sore throat, pain, and swelling). The incubation period is the interval between the entrance of a pathogen into the body and the appearance of the first symptoms. The prodromal stage is the interval from the onset of nonspecific signs and symptoms (such as a low-grade fever or fatigue) to more specific symptoms. Convalescence is the interval in which acute symptoms of infection disappear. Study Tip: To remember the meaning of prodromal, remember that pro means "first" or "in front of." The prodromal stage happens first, before the appearance of symptoms. p. 446

What is the name of the interval when a patient manifests signs and symptoms specific to a type of infection? 1. Illness stage 2. Convalescence 3. Prodromal stage 4. Incubation period

2. Respiratory tract Rationale The influenza virus is released from the body via the respiratory tract when an infected person sneezes or coughs. Organisms that cause communicable disease such as Hepatitis B and HIV exit from wounds and bloody stool. Organisms such as Neisseria gonorrheae and HIV exit through the reproductive tract during sexual contact. Any break in the skin and mucous membranes allows pathogens to exit the body; the influenza virus does not exit through the skin. p. 444

What is the portal of exit of the influenza virus? 1. Blood 2. Respiratory tract 3. Reproductive tract 4. Skin and mucous membrane Rationale The influenza virus is released from the body via the respiratory tract when an infected person sneezes or coughs. Organisms that cause communicable disease such as Hepatitis B and HIV exit from wounds and bloody stool. Organisms such as Neisseria gonorrheae and HIV exit through the reproductive tract during sexual contact. Any break in the skin and mucous membranes allows pathogens to exit the body; the influenza virus does not exit through the skin. p. 444

3. droplet 5. airborne Rationale If a patient is not isolated, he or she may spread a tuberculosis infection through droplet nuclei and airborne particles during coughing, sneezing and talking. Infections such as human immunodeficiency virus (HIV) are transmitted through indirect contact, such as needles. Malaria may be transmitted through vectors such as mosquitoes. Vehicles such as blood may transmit infection such hepatitis B, HIV, and hepatitis C. pp. 444-445

What would be the mode of transmission if a patient suspected of having tuberculosis is not isolated? Select all that apply. 1. Indirect 2. Vectors 3. Droplet 4. Vehicles 5. Airborne

4. hep b virus Rationale Vehicles such as blood may transmit the hepatitis B virus. Chickenpox, scarlet fever, and tuberculosis can be transmitted through the air or droplet nuclei. p. 445

Which disease can be transmitted when a nurse is drawing blood from a patient with an infection? 1. Chickenpox 2. Scarlet fever 3. Tuberculosis 4. Hepatitis B virus

4. Hepatitis C virus Rationale Hepatitis C virus (HCV) is a communicable disease that can be asymptomatic. Viral meningitis and pneumonia have a low or no risk for transmission and are not considered communicable diseases. Tuberculosis is a communicable and symptomatic disease. p. 443

Which disease is a communicable disease that can be asymptomatic? 1. Meningitis 2. Pneumonia 3. Tuberculosis 4. Hepatitis C virus

1. Bacteria growing in a pH of 3.0 Rationale Most bacteria prefer an environment within a pH range of 5.0 to 7.0. Therefore, bacterial growth may be prevented in a pH of 3.0. Bacteria grow vigorously in dark environments such as under dressings and within body cavities. Most bacteria require water or moisture for survival. Therefore, bacteria can grow in a moist surgical wound. Bacteria can grow vigorously if the temperature is 38° C because most bacteria grow in an ideal temperature that ranges from 20° to 43° C. p. 444

Which environment would limit the growth of bacteria? 1. Bacteria growing in a pH of 3.0 2. Bacteria growing under dressings 3. Bacteria growing in a moist surgical wound 4. Bacteria growing in at a temperature of 38° C

3. Excessive bathing Rationale Excessive bathing can remove sebum present in the skin, which increases the risk of infections. Abrasions can provide an entrance for microbial infections on the skin. Dehydration can cause infections in the oral cavity. Improper hand washing can cause infections because many microorganisms remain on the skin. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies. p. 447

Which factor can alter the defense mechanism of sebum? 1. Abrasions 2. Dehydration 3. Excessive bathing 4. Improper hand washing technique

4. Clostridium perfringens Rationale Clostridium perfringens causes gas gangrene. Escherichia coli causes gastroenteritis and urinary tract infection. Neisseria gonorrhoeae causes gonorrhea and pelvic inflammatory disease. Staphylococcus aureus causes wound infection and pneumonia. p. 443

Which microorganism causes gas gangrene? 1. Escherichia coli 2. Neisseria gonorrheae 3. Staphylococcus aureus 4. Clostridium perfringens

3. Neisseria gonorrhea Rationale Neisseria gonorrhea exits through a man's urethral meatus or a woman's vaginal canal during sexual contact. Ebolavirus is transmitted through blood or body fluids. Clostridium difficile causes antibiotic-induced diarrhea. Legionella pneumophila grows only at certain temperatures. p. 445

Which microorganism exits through a man's urethral meatus during sexual contact? 1. Ebolavirus 2. Clostridium difficile 3. Neisseria gonorrhea 4. Legionella pneumophila

4. Salmonella Rationale The microorganisms associated with an exogenous infection are those that do not exist as normal flora in humans such as salmonella. Staphylococci, enterococci, and streptococci are responsible for endogenous infection and exist as normal flora in an individual. Test-Taking Tip: Remember Latin and Greek word parts. For this question, the prefix exo means "out" or "outside." That is the clue that exogenous means an infection from a microorganism that is not part of the normal flora in humans. p. 448

Which microorganism is associated with an exogenous infection? 1. Staphylococci 2. Enterococci 3. Streptococci 4. Salmonella

3. A patient with pneumonia 5. A patient with viral meningitis Rationale A patient with pneumonia and a patient with viral meningitis are at a low risk of disease transmission. A patient with Ebola, a patient with influenza, and a patient with chickenpox are at a high risk of disease transmission because these conditions can spread through direct contact. p. 443

Which patients are at a low risk of disease transmission? Select all that apply. 1. A patient with Ebola 2. A patient with influenza 3. A patient with pneumonia 4. A patient with chickenpox 5. A patient with viral meningitis

3. The illness stage is the time interval when the patient has signs and symptoms specific to the infection type. Rationale The illness stage is the time interval when patient manifests signs and symptoms specific to the type of infection. The convalescence stage is the time interval when acute symptoms of infection disappear. During the prodromal stage, the onset of nonspecific signs and symptoms to more specific symptoms occur. The incubation period is the time interval between the entrance of a pathogen into the body and the appearance of the first symptoms. p. 446

Which statement is true regarding the illness stage of an infection? 1. The illness stage is the time interval when acute symptoms of infection disappear. 2. The illness stage is the time interval from the onset of nonspecific symptoms to more specific symptoms. 3. The illness stage is the time interval when the patient has signs and symptoms specific to the infection type. 4. The illness stage is the time interval between the entrance of the pathogen into the body and the appearance of the first symptoms.

1. The costs of health care-associated infections are reimbursed. Rationale The costs of health care-associated infections (HAIs) are not reimbursed; therefore, the prevention of HAIs plays an important role in the managed care of health care systems. HAIs can increase the cost of health care because they increase infections in patients. The invasive procedure involved, the therapies received, and the length of hospitalization can influence the risk of HAIs in patients. HAIs can be caused by invasive procedures performed during the delivery of health services in a health care facility. Test-Taking Tip: Sometimes reading a question in the middle or toward the end of an exam may trigger your memory with the answer or provide an important clue to an earlier question. p. 447

Which statement regarding health care-associated infections requires correction? 1. The costs of health care-associated infections are reimbursed. 2. Health care-associated infections can significantly increase the cost of health care. 3. The length of hospitalization influences the risk of health care-associated infections. 4. Health care-associated infections result from the delivery of health services in a healthcare facility.

1. Vasodilation occurs at the site of injury. Rationale Vasodilation occurs at the site of injury resulting in excessive blood loss at the site. The immediate response to a cellular injury is an acute inflammation. Increased blood flow at the site of inflammation leads to redness and warmth at the site of inflammation. The cellular response involves white blood cells at the site of inflammation. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 446

Which statement regarding vascular and cellular responses is true? 1. Vasodilation occurs at the site of injury. 2. Chronic inflammation is an immediate response to cellular injury. 3. Increased blood flow leads to coldness at the site of inflammation. 4. The cellular response involves red blood cells at the site of infection.

1. Repeated irrigation of the catheter 3. Improper specimen collection technique Rationale Health-care associated infections result from the delivery of health services in a health care facility. Repeated catheter irrigations or improper specimen collection techniques can cause urinary tract infections. The use of contaminated antiseptic solutions may cause surgical or traumatic wounds. The improper care of the intravenous (IV) insertion site may affect the patient's bloodstream. Improper disposal of respiratory exudates may cause respiratory tract infection. p. 448

While caring for a patient with testicular cancer in a health care setting, the nurse observes that the patient develops a urinary tract infection. Which actions of the nurse could be responsible for the development of this health care-associated infection? Select all that apply. 1. Repeated irrigation of the catheter 2. The use of a contaminated antiseptic solution 3. Improper specimen collection technique 4. Improper care of the intravenous (IV) insertion site 5. Improper disposal of respiratory exudates

2. Streptococcus (beta-hemolytic group A) Rationale Streptococcus (beta-hemolytic group A) organisms that cause throat infection can spread to other systems as well. The oropharynx, skin, and perianal areas are the reservoirs of this organism. It causes rheumatic fever in patients who are susceptible. Streptococcus (beta-hemolytic group B), Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus do not cause rheumatic fever. Study Tip: The value of a throat culture for Streptococcus (beta-hemolytic group A) goes far beyond a sore throat. To help you remember which beta-hemolytic group is so dangerous, consider that if you knew the correct answer to this question, you would get an "A" in Streptococcus! p. 444

A 10-year-old patient with symptoms of a throat infection develops rheumatic fever. What could be the possible causative organism for the throat infection and rheumatic fever in this patient? 1. Staphylococcus aureus 2. Streptococcus (beta-hemolytic group A) 3. Streptococcus (beta-hemolytic group B) 4. Methicillin-resistant Staphylococcus aureus

1. The use of antibiotics Rationale The patient currently has diarrhea related to Clostridium difficile. Clostridium difficile is an organism that is increased in proportion to beneficial microorganisms by taking antibiotics. (The resulting diarrhea is known as antibiotic-induced diarrhea.) Therefore, the most likely reason for this particular patient's current complaints of diarrhea is the use of antibiotics. If a patient in a hospital setting acquires Clostridium difficile and has not been on antibiotics, the diarrhea is most likely due to cross contamination from another patient. A secondary viral infection could be a reason for diarrhea but not the most likely reason in this situation. Because the patient has a history of irritable bowel syndrome, which can cause diarrhea as well, it could also be a reason. However, Clostridium difficile is a more likely cause given that the patient is currently infected with it. Clostridium difficile is an anaerobic bacterium that thrives where little or no free oxygen is available. Aerobic bacteria require oxygen to survive and are not the cause of this patient's diarrhea. pp. 446-447, 460

A 30-year-old patient with a history of irritable bowel syndrome complains of diarrhea. The nurse finds that the patient is infected with Clostridium difficile and is on appropriate treatment. What could be the most likely reason for the patient's current complaints of diarrhea? 1. The use of antibiotics 2. Secondary viral infection 3. Irritable bowel syndrome 4. Aerobic bacteria

1. Swelling 2. Redness 3. Pain Rationale The local manifestations of inflammation include swelling, redness, and pain. These manifestations are caused by protective vascular reactions that help to combat inflammation. Anorexia and vomiting are systemic manifestations of inflammation. pp. 450-451

A 47-year-old patient has arrived at the clinic after accidentally cutting his forearm with a pair of scissors. Which clinical manifestations would the nurse expect to indicate a local inflammation? Select all that apply. 1. Swelling 2. Redness 3. Pain 4. Anorexia 5. Vomiting

1. Infection caused by Aspergillus Rationale Exogenous infections are caused by microorganisms found outside the individual such as Aspergillus, Salmonella and Clostridium tetani. Therefore, a patient infected with Aspergillus is considered to have an exogenous infection. Endogenous infections are caused by organisms such as Streptococci or Enterococci. Infections caused by a bronchoscopy or the administration of broad spectrum antibiotics are iatrogenic infections. p. 448

A 65-year-old patient is undergoing treatment for chronic bronchitis and develops a health care-associated exogenous infection. What could be the reason for this condition? 1. Infection caused by Aspergillus 2. Infection caused by Streptococci 3. Infection caused during bronchoscopy 4. Infection caused by broad spectrum antibiotics

4. Both symptomatic and asymptomatic patients can transmit the virus. Rationale Hepatitis C is a communicable disease. A person with or without symptoms can transmit the virus. It is present in blood and body fluids. It can be spread through sexual contact but not through the fecal-oral route. p. 444

A community nurse is conducting an awareness program for sex workers and community members with substance abuse problems. What should the nurse tell the attendees about prevention of the spread of the hepatitis C virus? 1. A symptomatic patient cannot transmit hepatitis C. 2. Hepatitis C can be transmitted through the fecal-oral route. 3. Only symptomatic patients can transmit the virus. 4. Both symptomatic and asymptomatic patients can transmit the virus.

3. It obstructs the normal flushing action of urine flow. Rationale The presence of a catheter in the urethra breaches the natural defenses of the body . The reflux of microorganisms up the catheter lumen from the drainage bag or backflow of urine in the tubing increases the risk of infection. A catheter can help in keeping an incontinent patient's skin dry, but that normally does not lead to a urinary tract infection. The catheter can become caught up in the linens or with other equipment, but that does not cause a urinary tract infection. A patient with a catheter is producing urine and urinating; thus the patient is staying hydrated and still urinating. p. 448

A patient has an indwelling urinary catheter. Why does an indwelling urinary catheter present a risk for urinary tract infection? 1. It keeps an incontinent patient's skin dry. 2. It can get caught in the linens or equipment. 3. It obstructs the normal flushing action of urine flow. 4. It allows the patient to remain hydrated without having to urinate.

2. Iatrogenic infection Rationale Iatrogenic infections are caused by an invasive diagnostic or therapeutic procedure. Patients who underwent a bronchoscopy and are treated with broad-spectrum antibiotics are at a greater risk of developing this type of infection. The use of broad-spectrum antibiotics for the treatment of infection may cause a suprainfection. An exogenous infection is caused by organisms that are found outside of an individual. Endogenous infections occur when a patient receives broad-spectrum antibiotics that alter the normal flora. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses. p. 448

A patient is diagnosed with a bronchial airway obstruction after performing a bronchoscopy. Which type of infection may the patient contract after performing the test? 1. Suprainfection 2. Iatrogenic infection 3. Exogenous infection 4. Endogenous infection

3. Droplet 4. Airborne 5. Direct contact Rationale Varicella zoster is the organism that causes chickenpox. Infection spreads by the airborne route, by the droplet nuclei, and by direct contact. Vector transmissions, such as mosquito and louse bites, do not cause chickenpox. Vehicles, such as contaminated items, water, and blood, do not cause chickenpox. p. 445

A patient is suspected of having chickenpox. What are the modes of transmission of the organism that causes this infection? Select all that apply. 1. Vector 2. Vehicle 3. Droplet 4. Airborne 5. Direct contact

3. Prodromal stage Rationale The prodromal stage is the interval from onset of nonspecific signs and symptoms to more specific symptoms. During this stage, microorganisms grow and multiply and the patient may be capable of spreading the disease to others. Therefore, the patient may be in an isolation room to reduce the spread of infection. The illness stage is the interval when a patient manifests signs and symptoms that are specific to a type of infection. The convalescence stage is the interval when acute symptoms of an infection disappear. The incubation period is the first stage of the infection process; it is the Interval between the entrance of the pathogen into the body and the appearance of the first symptoms. Test-Taking Tip: Make certain that the answer you select is reasonable under ordinary circumstances and that the action can be carried out in the given situation. p. 446

A patient reporting itching and tingling arrives at the hospital. The nurse suspects a herpes simplex infection and keeps the patient in an isolation room. What would be the patient's stage of infection? 1. Illness stage 2. Convalescence 3. Prodromal stage 4. Incubation period

1. Illness stage Rationale The interval when a patient manifests signs and symptoms (such as a sore throat and pain while swallowing) that are specific to a type of infection is the illness stage. Convalescence is the interval when acute symptoms of infection disappear. The prodromal stage is the interval from the onset of nonspecific signs and symptoms to more specific symptoms. The incubation period is the first stage of the infection process. It is the interval between the entrance of a pathogen into body and the appearance of the first symptoms. p. 446

A patient reporting sore throat and pain while swallowing arrives at the hospital. The laboratory reports revealed the presence of beta-hemolytic group A streptococcus. What would be the patient's stage of infection? 1. Illness stage 2. Convalescence 3. Prodromal stage 4. Incubation period

2. Administer antibiotics. 4. Provide adequate nutrition. 5. Monitor response to drug therapy. Rationale Antibiotics should be administered to control the wound infection. Adequate nutrition is a supportive therapy, which helps in wound healing and recovery from infection. The response to drug therapy should be monitored to plan further management. Reducing water intake is not advisable; instead adequate water intake should be encouraged. Administration of anxiolytics is only considered for anxious patients and not for wound infection. p. 445

A patient who had a hysterectomy 10 days ago has come for a follow-up visit. The patient is experiencing pain and itching at the incision site. After assessment, the health care provider suspects the incision site is infected. Which interventions would help control infection? Select all that apply. 1. Reduce water intake. 2. Administer antibiotics. 3. Administer anxiolytics. 4. Provide adequate nutrition. 5. Monitor response to drug therapy.

1. Saliva 2. Sebum 3. Flora in the vagina 5. Macrophages in the respiratory tract Rationale Smoking can result in poor oral hygiene and dehydration in the patient. Saliva contains microbial inhibitors, such as lysozyme, which plays an important role in the defense mechanism. However, poor oral hygiene and dehydration may alter this defense mechanism. Excessive bathing may result in the removal of the skin's sebum layer. Sebum is one of the skin's defense mechanisms; it contains fatty acid and kills some bacteria. Oral contraceptives and antibiotics disrupt the normal flora present in the vagina. Smoking affects macrophages and the cilia lining the upper airway, which play a crucial role in defending against microorganisms entering the body through the airway. The shedding of the outer layers of skin cells removes surface microorganisms from the body. Irregular, but not excessive, bathing can result in a failure to shed outer layers of skin cells. Smoking and excessive bathing do not affect any defense mechanisms related to the eyes. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking and look for key words, (2) Read each answer thoroughly and see if it completely covers the material asked by the question, and (3) Narrow the choices by immediately eliminating answers you know are incorrect. p. 447

The nurse finds that a patient is a chain smoker and bathes more than five times a day. On assessing medical reports, the nurse finds that the patient is on contraceptive therapy. Based on the nurse's findings, which of the patient's body defense mechanisms may weaken? Select all that apply. 1. Saliva 2. Sebum 3. Flora in the vagina 4. Tearing and blinking of the eyes 5. Macrophages in the respiratory tract 6. Shedding of the outer layer of skin cells

1. Bacteria 2. Neutrophils 3. Monocytes 4. White blood cells Rationale Accumulation of fluid, dead tissue cells, and WBCs form a purulent exudate at the site of inflammation. Exudate may be serous (clear, like plasma), sanguineous (containing red blood cells), or purulent (containing white blood cells and bacteria). Neutrophils and monocytes are types of white blood cells, and as such, can be components of purulent exudate. Red blood cells are not part of purulent exudate. p. 446

The nurse is caring for a patient 24 hours status post abdominal surgery. Upon examination, the nurse notes that a purulent exudate has formed at the incision site. Which cellular components make up purulent exudate? Select all that apply. 1. Bacteria 2. Neutrophils 3. Monocytes 4. White blood cells 5. Red blood cells

1. An infectious agent 3. The source of pathogen growth 5. A susceptible host Rationale An infectious agent is the main pathogen or infection-causing organism that spreads through the chain of infection . The source for pathogen growth is the reservoir where the pathogens can multiply, survive, and wait until they are transferred to a susceptible host. A susceptible host is the element in the chain of infection that receives the pathogens and is in a favorable condition for their growth and transmission. A vaccine schedule is the plan of immunization and is not an element in the chain of infection. A clean surrounding is an ideal situation to prevent the spread of pathogens and is not an element in the chain of infection. Test-Taking Tip: The computerized NCLEX ® exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. p. 443

The nurse is caring for a patient who has a respiratory infection. The nurse understands that an infection occurs in a cycle and involves several elements. What are the elements in the chain of infection? Select all that apply. 1. An infectious agent 2. A vaccine schedule 3. The source of pathogen growth 4. A clean surrounding 5. A susceptible host

1. Eating thawed meat that is partially cooked 4. Removing a contaminated wound dressing by oneself Rationale A partially cooked, thawed piece of meat is more likely to cause infection because frozen meat is typically stored for a longer time, and partially cooked meat can transmit certain infections. Also, the wound dressing may have bacteria and removing the dressing by oneself can cause infection. Airborne infection may spread while sneezing; hence sneezes should be covered. Washing hands after using the toilet and covering foods with lids are some of the measures to prevent infection. Test-Taking Tip: Careful reading of this question ensures that you see the word discouraged and not automatically read encouraged when it is not there.

The nurse is educating a patient on how to prevent the spread of infections. Which patient habits should be discouraged to prevent infections? Select all that apply. 1. Eating thawed meat that is partially cooked 2. Covering the mouth or nose when coughing or sneezing 3. Washing hands after using the toilet 4. Removing a contaminated wound dressing by oneself 5. Covering food with lids to avoid flies p. 445

3.IV fluid 4. Food 5. Water Rationale Infections from vehicle transmissions are transmitted through IV fluids, food, and water. These act to help the microorganisms spread from one person to another. Mosquitoes and flies are vectors and can spread infection through external and internal transmission. p. 445

The nurse is learning about various modes of infection transmission. What are the sources for vehicle transmission of infection? Select all that apply. 1. Mosquitoes 2. Flies 3.IV fluid 4. Food 5. Water

3. "The virus can be spread to another person by contact with body fluids." Rationale The primary routes of HIV infection are associated with contact of HIV-infected body fluids such as blood or semen, blood transfusions, sharing of infected needles, and needle-stick injuries. The virus spreads through sexual contact and does not spread through feces. The virus does not cause Rocky Mountain spotted fever, which is caused by Rickettsia rickettsii. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. pp. 444-445

The nurse is planning discharge instructions for a patient diagnosed with human immunodeficiency virus (HIV). Which statement made by the patient would indicate effective teaching? 1. "The virus cannot spread through sexual contact." 2. "The virus can spread through feces only when I have symptoms of the disease." 3. "The virus can be spread to another person by contact with body fluids." 4. "The virus can cause Rocky Mountain spotted fever."