INFECTION Mastery Level 4

A patient is suspected to have diverticulosis without symptoms of diverticulitis. What diagnostic test does the nurse anticipate educating the patient about prior to scheduling? Colonoscopy Barium enema Flexible sigmoidoscopy CT scan

Colonoscopy Diverticulosis is typically diagnosed by colonoscopy, which permits visualization of the extent of diverticular disease and biopsy of tissue to rule out other diseases. In the past, barium enema was the preferred diagnostic test, but it is now used less frequently than colonoscopy. CT with contrast agent is the diagnostic test of choice if the suspected diagnosis is divertiCULITIS (not diverticulosis); it can also reveal abscesses.

A patient diagnosed with acute primary HIV infection is in the clinic. What treatment should be initiated for this patient? Monotherapy protease inhibitor therapy Combination antiretroviral therapy Zidovudine therapy once daily Didanosine therapy once daily

Combination antiretroviral therapy People with acute primary HIV infection should be treated with combination antiretroviral therapy to suppress virus replication to levels below the limit of detection of sensitive plasma HIV RNA assays.

The nurse is educating a patient diagnosed with acute bacterial rhinosinusitis about interventions that may assist with symptom control. What should the nurse include in this information? (Select all that apply.) Take an over-the-counter nasal decongestant. Take an over-the-counter antihistamine. Ensure an adequate fluid intake. Increase the humidity in the home. Apply local heat to promote drainage.

Ensure an adequate fluid intake. Increase the humidity in the home. Apply local heat to promote drainage. The nurse instructs the patient about methods to promote drainage of the sinuses, including humidification of the air in the home, the use of warm compresses to relieve pressure, and increasing fluid intake. Hinkle pg 554

Culture of client's vaginal discharge reveals Gardnerella vaginalis. Which of the following would the nurse expect to assess? Foul, foamy discharge Thick, curdy, white discharge Fishy-smelling watery discharge Yellowish-white discharge

Fishy-smelling watery discharge Gardnerella vaginalis is associated with a gray-white, watery, fishy smelling vaginal discharge. The discharge associated with a candida infection is curdy white, thick and strong. Discharge due to Trichomonas vaginalis is yellow-white, foamy, and foul.

A client visits the clinic reporting a circular rash on the upper right arm. The rash is diagnosed as tinea corporis. For what type of infection does the nurse anticipate the client will be treated? Rickettsiae Protozoans Mycoplasma Fungus

Fungus One type of fungal infection is superficial (dermatophytoses), which affect the skin, hair, and nails; examples include tinea corporis, or ringworm, and tinea pedis, also known as athlete's foot. Rickettsiae, protozoans, and mycoplasma have different characteristics and transmission than fungus.

Which term refers most precisely to a localized skin infection of a single hair follicle? Furuncle Carbuncle Cheilitis Comedone

Furuncle Furuncles occur anywhere on the body but are most prevalent in areas subjected to irritation, pressure, friction, and excessive perspiration, such as the back of the neck, the axillae, or the buttocks. A carbuncle is a localized skin infection involving several hair follicles. Cheilitis refers to dry cracking at the corners of the mouth. Comedones are the primary lesions of acne, caused by sebum blockage in the hair follicle.

The nurse is caring for a preschooler. Which technique will the nurse apply as most effective in preventing hospital-acquired infections in this population? personal protective equipment standard precautions hand washing private hospital room

HAND WASHING is the single most important measure for preventing infection transmission. Personal protective equipment and using infection-control precautions are required for certain diseases, such as varicella, diphtheria, mumps, pertussis, measles, and meningitis. Standard precautions, which include hand washing, are guidelines for treating all clients as potentially infectious and protect the nurse and other clients from transmission, while hand washing specifically protects the client. A private room provides protection for high-risk clients and privacy for family members.

A nurse is caring for a patient who is being administered penicillin. What are the common adverse reactions to penicillin a nurse should assess for? Inflammation of the tongue and mouth Impaired oral mucous membranes Severe hypotension Sudden loss of consciousness

Inflammation of the tongue and mouth Some of the common adverse effects of penicillin are glossitis (inflammation of the tongue), stomatitis (inflammation of the mouth), and gastritis (inflammation of the stomach). Unless severe, the drug may be continued as prescribed and the nurse would intervene to help the patient manage the common adverse reactions. Impaired oral mucous membranes are signs of a fungal superinfection in the oral cavity, whereas severe hypotension and sudden loss of consciousness are signs of an anaphylactic shock; these are not common adverse effects of penicillin and require immediate medical attention.

Smallpox is considered a biological agent of warfare. Which of the following are correct statements about the virus that will direct responses? Select all that apply. It has an incubation period of 72 hours It is extremely contagious after appearance of a rash The rash appears one week after exposure A large amount of the virus is present in the saliva and pustules One form, variola major, has a 30% mortality rate

It is extremely contagious after appearance of a rash A large amount of the virus is present in the saliva and pustules One form, variola major, has a 30% mortality rate The incubation period for smallpox is 10 to 12 days. A flat, red-lesioned rash appears 2 to 3 days postexposure.

The nurse should monitor the client for which common side effects of erythromycin therapy? Headache and fever Urticaria and opthalmic drainage Nausea, vomiting, and diarrhea Shortness of breath and sore throat

Nausea, vomiting, diarrhea Gastrointestinal problems (e.g., nausea, vomiting, and diarrhea) are common side effects of erythromycin and other macrolides. Headache, fever, opthalmic drainage, uticaria, shortness of breath and sore throat are no common side effects.

If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? Use a clean technique during insertion Use a sterile technique to disconnect the catheter from the tubing to obtain urine specimens Place the catheter bag on the client's abdomen when moving the client Perform meticulous perineal care daily with soap and water

Perform meticulous perineal care daily with soap and water

The nurse obtains a health history from a client with a prosthetic heart valve and new symptoms of infective endocarditis. Which question by the nurse is most appropriate to ask? "Have you been to the dentist recently?" "Do you have a family history of endocarditis?" "Have you recently vacationed outside of the United States?" "Do you live with any domesticated animals in your home?"

"Have you been to the dentist recently?" Invasive procedures, particularly those involving mucosal surfaces (e.g., those involving manipulation of gingival tissue or periapical regions of teeth), can cause a bacteremia, which rarely lasts more than 15 minutes. However, if a client has any anatomic cardiac defects or implanted cardiac devices (e.g., prosthetic heart valve, pacemaker, implantable cardioverter defibrillator), bacteremia can cause bacterial endocarditis.

A nurse is teaching a client about the medication regimen surrounding fluoroquinolones. Which statement made by the client would indicate the need for additional education? "I will only drink enough water to swallow the drug." "I will take all of my antibiotics." "If I have trouble breathing, I will call 911." "I may have some abdominal pain with this medication."

"I will only drink enough water to swallow the drug." Clients taking fluoroquinilones should increase, not limit, their fluid intake. It is important that the client take all of the prescribed antibiotics and understand adverse reactions, such as abdominal pain. Difficulty breathing may indicate hypersensitivity and is an emergency.

A 9-year-old client is brought to the emergency department with a sutured wound with purulent drainage. The area around the wound is red and warm to the touch, and the child is febrile. The parents want to know the significance of the purulent drainage. What is the best response by the nurse? "The drainage contains enzymes that are necessary for wound healing." "Antibiotics cause the cells of the tissues to produce purulent drainage." "If a wound heals on the surface but infection remains, it will open and drain." "The drainage is an indication that the sutures were not tight enough."

"If a wound heals on the surface but infection remains, it will open and drain." Purulent drainage indicates an infection in situ. A wound may heal over the top, but when infection remains, the wound may reopen at the base and drain the discharge. A wound will continually reopen and drain purulent discharge until the infection is eradicated. It is not related to antibiotics or the ineffectiveness of the sutures.

The nurse is caring for a client diagnosed with genitourinary tuberculosis (TB). Which statement, made by the client, about genitourinary TB demonstrates an understanding? "It isn't infectious, and I can't pass it from one person to another." "I can't pass it sexually to my partner." "It's a late manifestation of respiratory tuberculosis." "It's an early manifestation of an autoimmune disorder."

"It's a late manifestation of respiratory tuberculosis." Genitourinary TB is usually a late manifestation of respiratory TB and can occur if the disease spreads through the bloodstream from the lungs. Bacillus in the urine is infectious, and urine would be handled cautiously. A condom would be used during sex to prevent spread of the infection.

A client is being treated for trichomoniasis. The client has received instructions about the prescribed drug therapy. The nurse determines that the client needs additional teaching when she states which of the following? "I might notice a metallic taste in my mouth while I'm taking the drug." "I need to avoid drinking any alcohol with this drug." "My partner will not need any treatment." "I need to take the medication three times a day for a week."

"My partner will not need any treatment." Trichomoniasis is treated with metronidazole. Both partners are treated and receive a one-time loading dose or smaller dose three times a day for a week. The client may experience a transient metallic taste when taking the drug. Client are strongly advised to abstain from alcohol when taking metronidazole because of a possible disulfiram-like reaction.

A client the nurse is caring for has developed a bladder infection while in the hospital. The client has had a Foley catheter for two weeks. The client's family asks you how the client got this infection. What would be the nurse's best response? "People in hospitals are often more susceptible to infections because they are already ill and they are exposed to germs while they are in the hospital." "People in hospitals sometimes exhibit signs of infections they had before being admitted." "Sometimes people in hospitals get exposed to microorganisms that their visitors bring in." "People in hospitals are surrounded by infectious agents, so they can get infections they didn't have before being admitted."

"People in hospitals are often more susceptible to infections because they are already ill and they are exposed to germs while they are in the hospital." Hospitalized clients are more susceptible to infections than well people because they are exposed to pathogens in the health care environment, may have incisions or invasive equipment (e.g., intravenous lines) that compromise skin integrity, or may be immunosuppressed from poor nutrition, their disease process, or its treatment. Although all answers are correct, the most complete answer is A.

The circulating nurse is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse? Remove the item from the sterile field. Mark the client's chart for future review of infections. Remove the entire sterile field from use. Ask another nurse to review the technique used.

Remove entire sterile field If any doubt exists about the maintenance of sterility, the field should be considered not sterile. Because the object in question was placed in the sterile field, the sterile field must be removed from use. Removing the individual item is not appropriate, as the entire field was potentially contaminated. Reviewing the client's chart at a later date does not decrease the chance of infection. Although another nurse could observe the technique used to put objects in a sterile field, it does not resolve the immediate concern.

A client with herpes simplex virus (HSV) encephalitis is receiving acyclovir. To ensure early intervention, the nurse monitors laboratory values and urine output for which type of adverse reactions? Musculoskeletal Integumentary Hepatic Renal

Renal Monitoring of blood chemistry test results and urinary output will alert the nurse to the presence of renal complications related to acyclovir therapy. Complications with the integumentary system will can be observed by the nurse; it is not necessary to review laboratory results or urine output for integumentary reactions. Urine output is not monitored for musculoskeletal or hepatic adverse reactions.

The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of 2 to 12 days. 20 to 30 days. 1 to 3 months. 3 to 6 months.

2 to 12 days. HSV-1 is transmitted primarily by direct contact with infected secretions. The time periods of 20 to 30 days, 1 to 3 months, and 3 to 6 months exceed the incubation period.

A patient was bitten by a tick 3 months ago and is now having muscle aches as well as joint pain and swelling. The patient is having difficulty with self care and requires assistance with activities of daily living (ADLs). What stage of Lyme disease does the nurse recognize the patient is in? Stage I Stage II Stage III Stage IV

Stage III Lyme disease has three stages. Stage I presents with a classic "bull's-eye" rash (i.e., erythema migrans) and flulike signs and symptoms that may include chills, fever, myalgia, fatigue, and headache. If antibiotics are not administered, stage II Lyme disease may present within 4 to 10 weeks following the tick bite and may manifest with joint pain, memory loss, poor motor coordination, and meningitis. Stage III can begin anywhere from weeks to more than a year after the bite and has serious long-term chronic sequelae, including arthritis, neuropathy, myalgia, and myocarditis.

The nurse is teaching a client about mastitis. Which statement should the nurse include in her teaching? The most common pathogen is group A beta-hemolytic streptococci. A breast abscess is a common complication of mastitis. Mastitis usually develops in both breasts of a breastfeeding client. Symptoms include fever, chills, malaise, and localized breast tenderness.

Symptoms include fever, chills, malaise, and localized breast tenderness. Mastitis is an infection of the breast characterized by flu-like symptoms, along with redness and tenderness in the breast. The most common causative agent is Staphylococcus aureus. Breast abscess is rarely a complication of mastitis if the client continues to empty the affected breast. Mastitis usually occurs in one breast, not bilaterally.

A 44-year-old homeless man presented to the emergency department with hemoptysis. The patient was diagnosed with tuberculosis (TB) after diagnostic testing and has just begun treatment with INH, pyrazinamide, and rifampin (Rifater). When providing patient education, what should the nurse emphasize? The rationale and technique for using incentive spirometry The correct use of a metered-dose inhaler (MDI) for bronchodilators The need to maintain good nutrition and adequate hydration The importance of adhering to the prescribed treatment regimen

The importance of adhering to the prescribed treatment regimen Successful treatment of TB is wholly dependent on the patient's conscientious adherence to treatment. Patient education relating to this fact is a priority over MDIs, incentive spirometry, or nutrition, although each may be necessary.

A client with HIV has recently completed a 7-day regimen of antibiotics. She reports vaginal itching and irritation. In addition, the client has a white, cheeselike vaginal discharge. Which condition is the client most likely experiencing? Vulvovaginal candidiasis Bacterial vaginosis Trichomonas vaginalis vaginitis Human papillomavirus

Vulvovaginal candidiasis Use of antibiotics decreases bacteria, thereby altering the natural protective organisms usually present in the vagina, which can lead to candidiasis overgrowth. Clinical manifestations include a vaginal discharge that causes pruritus; the discharge may be watery or thick but usually has a white, cheeselike appearance. Bacterial vaginosis does not produce local discomfort or pain. Discharge, if noticed, is heavier than normal and is gray to yellowish white. Most HPV infections are self-limiting and without symptoms.

Which procedure reduces the potential for infection primarily by addressing the portal of entry? Wiping down common areas with buffered bleach on a regular basis Wearing gloves when contact with blood or body fluids is anticipated Disposing of soiled clothing and bed linens in a dedicated receptacle Isolating clients who have antibiotic-resistant infections

Wearing gloves when contact with blood or body fluids is anticipated The wearing of gloves specifically blocks the portal of entry to the health care worker through the use of a physical barrier. Bleaching and cleaning as well as disposing of soiled linen eliminate the source of infection by killing microorganisms, and isolating clients similarly addresses a source by minimizing contact with uninfected persons.

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis? a painless genital ulcer that appeared about 3 weeks after unprotected sex copper-colored macules on the palms and soles that appeared after a brief fever patchy hair loss and red, broken skin involving the scalp, eyebrows, and beard areas one or more flat, wartlike papules in the genital area that are sensitive to touch

a painless genital ulcer that appeared about 3 weeks after unprotected sex A painless genital ulcer is a symptom of primary syphilis. Macules on the palms and soles after fever are indicative of secondary syphilis, as is patchy hair loss. Wartlike papules are indicative of genital warts.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: severe abdominal pain radiating to the shoulder. anorexia, nausea, and vomiting. eructation and constipation. abdominal ascites.

anorexia, nausea, and vomiting. Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection?

broad spectrum One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum anti-infectives are less likely to kill normal flora, although it is not impossible. A drug may be bactericidal, meaning it kills the pathogen; or bacteriostatic, meaning it prevents reproduction of the pathogen, but this is not related to superinfections.

In which clients is it most important to understand the importance of an annual Papanicolaou test? clients with a history of recurrent candidiasis clients with a pregnancy before age 20 clients infected with the human papillomavirus (HPV) clients with a long history of hormonal contraceptive use

clients infected with the human papillomavirus (HPV) HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of hormonal contraceptives do NOT increase the risk of cervical cancer.

The spirochete Leptospira is primarily transmitted to farmers by: an airborne mechanism. exposure to spores in the environment. direct contact with infected animals. a mosquito bite.

direct contact with infected animals. The pathogenic leptospires infect a wide variety of wild and domestic animals. Infected animals release the organisms into the environment through the urinary tract. Transmission to humans occurs by contact with infected animals or urine-contaminated surroundings. This spirochete is not transmitted by airborne, spores, or a fomite.

After teaching a group of students about the indications for use for aminoglycosides, the instructor determines that the teaching was successful when the students identify which type of infection as a primary indication? gram-negative infections gram-positive infections fungal infections viral infections

gram-negative infections Aminoglycosides are used primarily in the treatment of infections caused by gram-negative microorganisms. Aminoglycosides are not effective on gram-positive bacteria. Since aminoglycosides are antibacterial, they are not effective on fungal or viral infections.

A client with renal dysfunction of acute onset comes to the emergency department complaining of fatigue, oliguria, and coffee-colored urine. When obtaining the client's history to check for significant findings, the nurse should ask about: chronic, excessive acetaminophen use. recent streptococcal infection. childhood asthma. family history of pernicious anemia.

recent streptococcal infection. A skin or upper respiratory infection of streptococcal origin may lead to acute glomerulonephritis. Other infections that may be linked to renal dysfunction include infectious mononucleosis, mumps, measles, and cytomegalovirus. Chronic, excessive acetaminophen use isn't nephrotoxic, although it may be hepatotoxic. Childhood asthma and a family history of pernicious anemia aren't significant history findings for a client with renal dysfunction.

A nurse is caring for a client with a central venous catheter and notices redness and tenderness at the catheter insertion site. Which assessment finding would indicate possible systemic infection? temperature of 97.3 degrees Fahrenheit (36.3 degrees Celsius) blood pressure of 122/78 mm Hg respiratory rate of 32 breaths/minute heart rate of 55 beats/minute

respiratory rate of 32 breaths/minute Signs and symptoms of systemic infection may include central nervous system involvement, such as tachypnea, dizziness, and lethargy. An increased or decreased temperature and the infectious process associated with systemic infection would most likely cause tachycardia rather than bradycardia. Severe systemic infection would result in an extremely low blood pressure.

A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icteric period. The nurse would expect the client to manifest: severe pruritus and liver tenderness. severe anorexia. disappearance of jaundice. chills and fever.

severe pruritus and liver tenderness. Severe pruritus and liver tenderness are common during the icterus period. Chills, fever, and severe anorexia occur during the prodromal period. The disappearance of jaundice occurs in the convalescent phase. Icteric is basically the presentating/signs of jaundice, esp. in the sclera.

A nurse is speaking to a 62-year-old female client who has been started on sulfisoxazole, a sulfonamide antibiotic. The nurse should teach this client to contact the health care provider if the client experiences what adverse effect associated with the drug? polydipsia tachycardia skin rash or itching dizziness

skin rash or itching Clients taking sulfonamides should be instructed to contact the prescriber if they experience skin rash or itching. These symptoms may indicate a sulfonamide-induced allergic reaction and the need to change or stop the drug.

What are places with common outbreaks of scabies? Select all that apply. nursing homes military barracks prisons boarding schools child care centers Anywhere large groups of people are confined

All listed locations commonly experience outbreaks of scabies.

A nurse on your unit sustains a needlestick injury while caring for a client whose infectious status is unknown. What would be the best course of action for the nurse to follow? Avoid notifying the supervisor of the injury until the client's infectious status is confirmed. Avoid revealing the identity of the client or source of blood. Be tested for disease antibodies at appropriate intervals. Document the injury in writing after the client's infectious status is confirmed.

Be tested for disease antibodies at appropriate intervals. If a needlestick injury has occurred, the nurse should be tested for disease antibodies immediately and at appropriate intervals thereafter. The nurse should document the injury in writing immediately and should not wait until the client's infectious status is confirmed. The nurse should also notify the supervisor of the injury immediately and identify the person or source of blood, if possible.