Chapter 15: Infection
The nurse plans a presentation for community members about how to decrease the risk for antibiotic-resistant infections. Which information will the nurse include in the teaching plan? (Select all that apply.) a. Antibiotics may sometimes be prescribed to prevent infection. b. Continue taking antibiotics until all of the prescription is gone. c. Unused antibiotics from previous illnesses should be discarded. d. Antibiotics are effective in treating influenza associated with high fevers. e. Hand washing is effective in preventing many viral and bacterial infections.
ANS: A, B, C, E In some situations, such as before surgery, antibiotics are prescribed to prevent infection. All prescribed doses of antibiotics should be taken. There should not be any leftover antibiotics because all prescribed doses should be taken. However, if there are leftover antibiotics, they should be discarded at once because the number left will not be enough to treat a future infection. Hand washing is considered the single most effective action in decreasing infection transmission. Antibiotics are ineffective in treating viral infections such as influenza.
The registered nurse (RN) is caring for a patient who is living with HIV and admitted with tuberculosis. Which task can the RN delegate to assistive personnel (AP)? a. Teach the patient how to dispose of tissues with respiratory secretions. b. Stock the patient's room with the necessary personal protective equipment. c. Interview the patient to obtain the names of family members and close contacts. d. Tell the patient's family members the reason for the use of airborne precautions.
ANS: B A patient diagnosed with tuberculosis would be placed on airborne precautions. Because all health care workers are taught about the various types of infection precautions used in the hospital, the UAP can safely stock the room with personal protective equipment. Obtaining contact information and patient teaching are higher-level skills that require RN education and scope of practice.
According to the Center for Disease Control and Prevention (CDC) guidelines, which personal protective equipment will the nurse put on before assessing a patient who is on contact precautions for Clostridium difficile diarrhea? (Select all that apply.) a. Mask b. Gown c. Gloves d. Shoe covers e. Eye protection
ANS: B, C Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed. Eye protection and masks are needed for patients in contact precautions only when spraying or splashing is anticipated. Shoe covers are not recommended in the CDC guidelines.
A patient treated for human immunodeficiency virus (HIV) infection for 6 years has developed fat redistribution to the trunk with wasting of the arms, legs, and face. Which recommendation would the nurse provide? a. Consider the benefits of daily exercise. b. Review foods that are higher in protein. c. Discuss a change in antiretroviral therapy. d. Talk about treatment with antifungal agents.
ANS: C A frequent intervention for metabolic disorders is a change in antiretroviral therapy (ART).Treatment with antifungal agents would not be appropriate because there is no indication of fungal infection. Changes in diet or exercise have not proven helpful for this problem.
A patient informed of a positive rapid screening test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. Which action by the nurse is most important at this time? a. Inform the patient about the available treatments. b. Teach the patient how to manage a possible drug regimen. c. Remind the patient to return for retesting to verify the results. d. Ask the patient to identify those persons who had intimate contact.
ANS: C After an initial positive antibody test result, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about the HIV status of other individuals.
The nurse is caring for a patient who is living with human immunodeficiency virus (HIV) and taking antiretroviral therapy (ART). Which information is most important for the nurse to address when planning care? a. The patient reports feeling ―constantly tired.‖ b. The patient reports having no side effects from the medications. c. The patient is unable to explain the effects of atorvastatin (Lipitor). d. The patient reports missing doses of tenofovir AF/emtricitabine (Descovy).
ANS: D Because missing doses of ART can lead to drug resistance, this patient statement indicates the need for interventions such as teaching or changes in the drug scheduling. Fatigue is a common side effect of ART. The nurse should discuss medication actions and side effects with the patient, but this is not as important as addressing the skipped doses of Descovy.
The nurse prepares to administer the following medications to a hospitalized patient with human immunodeficiency (HIV) infection. Which medication is most important to administer at the scheduled time? a. Nystatin tablet b. Oral acyclovir (Zovirax) c. Aerosolized pentamidine (NebuPent) d. Oral tenofovir AF/emtricitabine/bictegravir (Biktarvy)
ANS: D It is important that antiretrovirals be taken at the prescribed time every day to avoid developing drug-resistant HIV. The other medications would also be given as close as possible to the correct time, but they are not as essential to receive at the same time every day.
A patient with human immunodeficiency virus (HIV) infection has developed Cryptosporidium parvum infection. Which expected outcome would the nurse include in the plan of care? a. The patient will be free from injury. b. The patient will receive immunizations. c. The patient will have adequate oxygenation. d. The patient will maintain intact perineal skin.
ANS: D The major manifestation of C. parvum infection is loose, watery stools, which would increase the risk for perineal skin breakdown. The other outcomes would be appropriate for other complications (e.g., pneumonia, dementia, influenza) associated with HIV infection.
To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review? a. Viral load b. Rapid HIV antibody c. Enzyme immunoassay d. Immunofluorescence assay
ANS: A The effectiveness of ART is measured by the decrease in the amount of virus detectable in the blood. The other tests are used to detect HIV antibodies, which remain positive even with effective ART.
The nurse is advising a patient who was exposed 4 days ago to human immunodeficiency virus (HIV) through unprotected sexual intercourse. The patient's antigen-antibody test has just been reported as negative for HIV. Which information would the nurse give to this patient a. ―You will need to be retested in 2 weeks.‖ b. ―You do not need to fear infecting others.‖ c. ―We won't know for about 10 years if you have HIV infection.‖ d. ―With no symptoms and this negative test, you do not have HIV.‖
ANS: A HIV screening tests detect HIV-specific antibodies or antigens. However, there may be a delay between infection and the time a screening test is able to detect HIV. The typical ―window period‖ for antigen-antibody combination assays is approximately 3 weeks. It would be best practice to have the patient return for repeat testing in approximately 2 weeks. It is not known based on this information whether the patient is infected with HIV or can infect others.
A patient who uses injectable illegal drugs asks the nurse how to prevent acquired immunodeficiency syndrome (AIDS). Which response by the nurse would be most useful in preventing human immunodeficiency virus (HIV) infection? a. ―Consider a needle and syringe exchange program.‖ b. ―Ask those who share equipment to be tested for HIV.‖ c. ―Clean your drug injection equipment before each use.‖ d. ―Avoid sexual intercourse when using injectable drugs.‖
ANS: A Participation in needle and syringe-exchange programs has been shown to decrease and control the rate of HIV infection. Cleaning drug equipment before use also reduces risk, but it might not be consistently practiced. HIV antibodies do not appear for several weeks to months after exposure, so testing drug users would not be very effective in reducing risk for HIV exposure. HIV can be transmitted through both intercourse and injection.
Which infection control actions would the nurse include in the use of standard precautions? a. Gloving before wiping pink sputum off the bedrail b. Gowning prior to delivering a food tray to a patient c. Masking before interviewing a patient about health history d. Applying goggles before helping a patient to ambulate in the hall
ANS: A Standard precautions apply to (1) blood; (2) all body fluids, secretions, and excretions; (3) non-intact skin; and (4) mucous membranes. Standard precautions are designed to reduce the risk for transmission of microorganisms in hospitals. They should be applied to all patients regardless of diagnosis or presumed infection status. Transmission-based precautions are used for patients known to be or suspected of being infected with highly transmissible or epidemiologically important pathogens that require additional precautions to interrupt transmission and prevent infection. Transmission-based precautions include airborne precautions, droplet precautions, and contact precautions.
Eight years after seroconversion, a patient with human immunodeficiency virus infection has a CD4+ cell count of 800/L and an undetectable viral load. Which intervention would the nurse include in the plan of care? a. Encourage adequate nutrition, exercise, and sleep. b. Teach about the side effects of antiretroviral agents. c. Explain opportunistic infections and antibiotic prophylaxis. d. Monitor symptoms of acquired immunodeficiency syndrome (AIDS).
ANS: A The CD4+ level for this patient is in the normal range, indicating that the patient is the stage of asymptomatic chronic infection when the body is able to produce enough CD4+ cells to maintain a normal CD4+ count. Maintaining healthy lifestyle behaviors is an important goal in this stage. AIDS and increased incidence of opportunistic infections typically develop when the CD4+ count is much lower than normal. Although the initiation of ART is highly individual, it would not be likely that a patient with a normal CD4+ level would receive ART.
An older adult who takes medications for coronary artery disease and hypertension is newly diagnosed with HIV infection and is starting antiretroviral therapy. Which information will the nurse include in patient teaching? a. Many drugs interact with antiretroviral medications. b. HIV infections progress more rapidly in older adults. c. Less frequent CD4+ level monitoring is needed in older adults. d. Hospice care is available for patients with terminal HIV infection.
ANS: A The nurse will teach the patient about potential interactions between antiretrovirals and the medications that the patient is using for chronic health problems. Treatment and monitoring of HIV infection is not affected by age. A patient beginning early ART is not a candidate for hospice. Progression of HIV is not affected by age although it may be affected by chronic disease.
The nurse is caring for a patient living with asymptomatic chronic HIV infection. Which prophylactic measures will the nurse include in the plan of care? (Select all that apply.) a. Hepatitis B vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Trimethoprim-sulfamethoxazole e. Varicella zoster immune globulin
ANS: A, B, C Asymptomatic chronic HIV infection is a stage between acute HIV infection and a diagnosis of symptomatic chronic HIV infection. Although called asymptomatic, symptoms (e.g., fatigue, headache, low-grade fever, night sweats) often occur. Prevention of other infections is an important intervention in patients who are living with HIV, and these vaccines are recommended as soon as the HIV infection is diagnosed. Antibiotics and immune globulin are used to prevent and treat infections that occur later in the course of the disease when the CD4+ counts have dropped or when infection has occurred.
A group of seniors who experienced the COVID-19 pandemic asks the nurse to speak about preventing illness during future respiratory epidemics. Which information would the nurse include? (Select all that apply.) a. Frequent handwashing is effective in preventing transmission of many infectious diseases. b. Receiving a vaccine, when available, can prevent or modulate specific infectious illnesses. c. Older adults can eliminate the risk of respiratory infection through health-related behaviors. d. Maintaining general health through regular activity and good nutrition helps prevent infections. e. Avoiding large crowds during periods of high transmission limits exposure to infectious disease.
ANS: A, B, D, E Handwashing, vaccines, good general health, and avoiding crowds can decrease the risk of contracting a contagious respiratory illness. Older adults are susceptible to infection due to age-related changes in immune function and the frequent presence of comorbidities: following infection prevention behavior guidelines reduces the risk for all age groups, but does not eliminate the risk of contracting an infectious disease.
In which ways would the nurse identify that individuals locally and globally may be at risk for contracting new or remerging infectious diseases? (Select all that apply.) a. Biologic warfare b. Low population density c. Direct contact with animals d. Development of antibiotic resistance strains e. Changes in characteristics of known diseases
ANS: A, C, D, E Emerging infectious diseases can originate from unknown sources, from contact with animals, changes in known diseases, or biologic warfare. COVID-19 (caused by SARS-CoV-2), Ebola virus, and Chikungunya are examples of emerging infections. Other emerging infections occur when a previously treatable organism develops resistance to antibiotics, such as carbapenum-resistant enterobacteriaceae (CRE). Some diseases thought to be under control, such as TB, measles, and pertussis, have reemerged. Factors such as global travel, population density, encroachment into new environments, antibiotic misuse, lack of immunizations, and bioterrorism have increased the risk for widespread distribution of these infections.
A pregnant woman with asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, ―I am very nervous about making my baby sick.‖ Which information will the nurse include when teaching the patient? a. The antiretroviral medications used to treat HIV infection are teratogenic. b. Most infants born to HIV-positive mothers are not infected with the virus. c. Because it is an early stage of HIV infection, the infant will not contract HIV. d. Her newborn will be born with HIV unless she uses antiretroviral therapy (ART).
ANS: B Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 1% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.
Which patient would benefit from education about HIV preexposure prophylaxis (PrEP)? a. A 23-yr-old woman living with HIV infection b. A 52-yr-old recently single woman just diagnosed with chlamydia c. A 33-yr-old hospice worker who received a needle stick injury 3 hours ago d. A 60-yr-old male in a monogamous relationship with an uninfected partner
ANS: B Preexposure prophylaxis (PrEP) is used to prevent HIV infection. Persons who would be good candidates for PrEP include individuals with a recent diagnosis of an STI and those with more than one partner. Individuals who are not on PrEP but who have a recent high-risk exposure (such as a needle stick) would be better candidates for postexposure prophylaxis (PEP). A person in a monogamous relationship with an HIV-uninfected partner is considered low-risk for HIV infection.
A patient who is diagnosed with acquired immunodeficiency syndrome (AIDS) tells the nurse, I feel obsessed with morbid thoughts about dying.‖ Which response by the nurse is appropriate? a. ―Thinking about dying will not improve the course of AIDS.‖ b. ―Do you think that taking an antidepressant might be helpful?‖ c. ―Can you tell me more about the thoughts that you are having?‖ d. ―It is important to focus on the good things about your life now.‖
ANS: C More assessment of the patient's psychosocial status is needed before taking any other action. The statements, ―Thinking about dying will not improve the course of AIDS‖ and ―It is important to focus on the good things in life‖ or suggesting an antidepressant discourage the patient from sharing any further information with the nurse and decrease the nurse's ability to develop a trusting relationship with the patient.
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV) infection. Which action would the nurse take? a. Instruct the patient to apply ice to the neck. b. Tell the patient a secondary infection is present. c. Explain to the patient that this is an expected finding. d. Request that an antibiotic be prescribed for the patient.
ANS: C Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Lymphadenopathy is common with acute HIV infection and is therefore not likely to represent an additional infection. Ice will not decrease the swelling in persistent generalized lymphadenopathy.
Which exposure by the nurse is most likely to require postexposure prophylaxis when the patient's human immunodeficiency virus (HIV) status is unknown? a. Bite to the arm that does not result in open skin. b. Splash into the eyes while emptying a bedpan containing stool. c. Needle stick with a needle and syringe used for a venipuncture. d. Contamination of open skin lesions with patient vaginal secretions.
ANS: C Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patient's blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.
The nurse designs a program to decrease the incidence of human immunodeficiency virus (HIV) infection in the adolescent and young adult populations. Which information would the nurse assign as the highest priority for these populations? a. Methods to prevent perinatal HIV transmission b. Ways to sterilize needles used by injectable drug users c. Prevention of HIV transmission between sexual partners d. Means to prevent transmission through blood transfusions
ANS: C Sexual transmission is the most common way that HIV is transmitted. The nurse should also provide teaching about perinatal transmission, needle sterilization, and blood transfusion, but the rate of HIV infection associated with these situations is lower.
Which nursing action will be most useful in assisting a young adult to adhere to a newlyprescribed antiretroviral therapy (ART) regimen? a. Give the patient detailed information about possible medication side effects. b. Remind the patient of the importance of taking the medications as scheduled. c. Help the patient develop a schedule to decide when the drugs would be taken. d. Encourage the patient to join a support group for adults who are HIV positive
ANS: C The best approach to improve adherence is to learn about important activities in the patient's life and adjust the ART around those activities. The other actions are also useful, but they will not improve adherence as much as individualizing the ART to the patient's schedule.
Which patient who has arrived at the human immunodeficiency virus (HIV) clinic would the nurse assess first? a. Patient whose rapid HIV-antibody test is positive. b. Patient whose latest CD4+ count has dropped to 250/L. c. Patient who has had 10 liquid stools in the last 24 hours. d. Patient who has nausea from prescribed antiretroviral drugs
ANS: C The nurse should assess the patient who has diarrhea for dehydration and hypovolemia. The other patients also will require assessment and possible interventions, but do not require immediate action to prevent complications such as hypovolemia and shock.
A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ count of less than 200 cells/mL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which interpretation is correct? a. ―The patient meets the criteria for a diagnosis of acute HIV infection.‖ b. ―The patient will be diagnosed with asymptomatic chronic HIV infection.‖ c. ―The patient will likely develop symptomatic HIV infection within 1 year.‖ d. ―The patient has developed acquired immunodeficiency syndrome (AIDS)
ANS: D Development of PCP meets the diagnostic criteria for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection.
A patient is diagnosed with both human immunodeficiency virus (HIV) and active tuberculosis (TB) disease. Which information obtained by the nurse is most important to communicate to the health care provider? a. The Mantoux test had an induration of 7 mm. b. The chest x-ray showed infiltrates in the lower lobes. c. The patient has a cough that is productive of blood-tinged mucus. d. The patient is being treated with antiretrovirals for HIV infection
ANS: D Drug interactions can occur between the antiretrovirals used to treat HIV infection and the medications used to treat TB. The other data are expected in a patient with HIV and TB.
A patient who is human immunodeficiency virus (HIV)-infected has a CD4+ cell count of 400/L. Which factor is most important for the nurse to determine before the initiation of antiretroviral therapy (ART) for this patient? a. CD4+ cell count b. How the patient obtained HIV c. Patient's tolerance for potential medication side effects d. Patient's ability to follow a complex medication regimen
ANS: D Drug resistance develops quickly unless the patient takes ART medications on a strict, regular schedule. In addition, drug resistance endangers both the patient and community. The other information is also important to consider, but patients who are unable to manage and follow a complex drug treatment regimen should not be considered for ART.
Which action should the nurse take before administering gentamicin (Garamycin) to a patient with a wound infection? a. Ask the patient about any nausea. b. Obtain the patient's oral temperature. c. Change the prescribed wet-to-dry dressings. d. Review the patient's serum creatinine results
ANS: D Gentamicin is nephrotoxic and can cause renal failure as reflected in the patient's serum creatinine. Monitoring the patient's temperature before gentamicin administration is not necessary. Nausea is not a common side effect of IV gentamicin. There is no need to change the dressing before gentamicin administration.