Infectious Disease Med-Surge EAQ Level 1 & 2

CANCER nitrogen mustard as part of a drug protocol for cancer asks how this drug works in the body. the nurse considers the actions of nitrogen mustard, which include: Combining with DNA strands and interfering with cell replication

Alkylating agents, of which nitrogen mustard is one, combine with DNA strands and interfere with cell replication. Inhibiting the synthesis of purine and pyrimidine is the mechanism of action of antimetabolites. Antibiotics, not nitrogen mustard, used in cancer chemotherapy are believed to act by binding with DNA to interfere with RNA production.

A mother with the diagnosis of acquired immunodeficiency disease (AIDS) states that she has been caring for her baby even though she has not been feeling well. What important information should the nurse determine? 1 If she has kissed the baby 2 If the baby is breastfeeding 3 When the baby last received antibiotics 4 How long she has been caring for the baby

Epidemiologic evidence has identified breast milk as a source of human immunodeficiency virus (HIV) transmission. Kissing is not believed to transmit HIV. When the baby last received antibiotics is unrelated to transmission of HIV. HIV transmission does not occur from contact associated with caring for a newborn.

acute malaria. For which complication should the nurse monitor the client?

Fluid and electrolyte disturbances occur because of fever, profuse diaphoresis, vomiting, and diarrhea.

HIV or AID PT with an IV needing hook up, protection for RN is?

Gloves and Hand washing ONLY Mask and Gown when possible splash

routes of transmission of the human immunodeficiency virus (HIV). There is no risk of exposure to HIV when an individual: Makes a donation of a pint of whole blood

Equipment used in blood donation is disposable; the donor does not come into contact with anyone else's blood. Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact.

Which test result should a nurse review to determine if the antibiotic prescribed for the client will be effective? 1 Serologic test 2 Sensitivity test 3 Serum osmolality 4 Sedimentation rate

Infected body fluids are tested to determine the antibiotics to which the organism is particularly sensitive or resistant (sensitivity). The serologic test tests for antibody content. The serum osmolality test provides data about fluid and electrolyte balance. The erythrocyte sedimentation rate (ESR) is a nonspecific test for the presence of inflammation.

The significant other of a client who is dying of AIDS tells the nurse, "Life is not worth living without my partner." What should the nurse plan to do to help the significant other cope with the impending death? 1 Involve the significant other's support system.

Involving the support system will decrease the person's feelings of isolation. Anticipatory grieving does not involve psychotic thoughts. Suggesting a bereavement group to the significant other is premature. The concern is about loss and loneliness, not self-image.

A client is admitted to the hospital for general paresis as a complication of syphilis. Which therapy should the nurse anticipate will most likely be prescribed for this client? 1 Penicillin therapy 2 Major tranquilizers 3 Behavior modification 4 Electroconvulsive therapy

Massive doses of penicillin may limit central nervous system damage if treatment is started before neural deterioration from syphilis occurs. Tranquilizers are used to modify behavior, not to treat general paresis. Behavior, not paresis, is treated with behavior modification. Electroconvulsive therapy is used to treat certain psychiatric disorders.

physical examination and laboratory tests of a client with malaria. Important clinical indicators should the nurse be alert when reviewing data about this client? Hyperthermia, Oliguria, and Splenomegaly

A high fever (hyperthermia) results from the disease process. Parasites invade the erythrocytes, subsequently dividing and causing the cell to burst. The spleen enlarges from the sloughing of red blood cells. Oliguria, occurs in malaria-induced kidney failure.

A nurse is planning to provide discharge teaching to the family of a client with acquired immunodeficiency syndrome (AIDS). Which statement should the nurse include in the teaching plan? 1 "Wash used dishes in hot, soapy water." 2 "Let dishes soak in hot water for 24 hours before washing." 3 "You should boil the client's dishes for 30 minutes after use." 4 "Have the client eat from paper plates so they can be discarded."

A person cannot contract human immunodeficiency virus (HIV) by eating from dishes previously used by an individual with AIDS; routine care is adequate.

From HIV to AID how can it be stipulated that it has advanced?

AIDS is diagnosed when an individual with HIV develops one of the following: a CD4+ T lymphocyte level of less than 200 cells/µL, wasting syndrome, dementia, one of the listed opportunistic cancers (e.g., Kaposi sarcoma [KS], Burkitt lymphoma), or One of the listed opportunistic infections (e.g., Pneumocystis jiroveci pneumonia, Mycobacterium tuberculosis).

Malaria related Plasmodium Falciparum, with drug therapy can eliminated infection.

Quinine sulfate is used for malaria when the plasmodia are resistant to the less toxic chloroquine. However, a new strain of Plasmodium that is resistant to quinine must be treated with a combination of quinine (quick-acting), pyrimethamine, and sulfonamide (slow-acting) therapy. The aim of therapy is to eliminate, not control, the parasite.

A client with scleroderma reports having difficulty chewing and swallowing. What should the nurse recommend to safely facilitate eating? 1 Eat a mechanical soft diet 2 Liquefy food in a blender 3 Take frequent sips of water with meals 4 Use a local anesthetic mouthwash before eating

Scleroderma causes chronic hardening and shrinking of the connective tissues of any organ of the body, including the esophagus and face; a mechanical soft diet includes foods that limit the need to chew and are easier to swallow. Liquefied foods are difficult to swallow; esophageal peristalsis is decreased, and liquids are aspirated easily. Taking frequent sips of water with meals will not help; it is equally difficult to swallow solids and liquids, and aspiration may result.

A nurse observes that an unlicensed assistive personnel (UAP) did not use a bag impervious to liquid for contaminated linen from a client who is on contact precautions. The nurse's best way to handle this situation is to: 1 Place the linen in an appropriate bag 2 Write an incident report about the situation 3 Review transmission-based precautions with the UAP 4 Place an anecdotal summary of the behavior in the UAP's personnel record

Standard and contact precautions require specific handling of potentially infectious matter; therefore, the nursing assistant should be reminded that hospital policies concerning these precautions must be followed for personal protection and the protection of others before the mistake is made again. Placing the linen in an appropriate bag, writing an incident report about the situation, and placing an anecdotal summary of the behavior in the nursing assistant's personnel record can be done by the nursing assistant immediately after relearning appropriate precautions. Because no injury is evident, an incident report in the nursing assistant's personnel record is unnecessary. Because no injury is evident, documentation in the nursing assistant's personnel record is unnecessary.

The nurse teaches a group of clients that nutritional support of natural defense mechanisms indicates the need for a diet high in: 1 Essential fatty acids 2 Dietary cellulose and fiber 3 Tryptophan, an amino acid 4 Vitamins A, C, E, and selenium

Vitamins A, C, E, and selenium stimulate the immune system. The role of fatty acids in natural defense mechanisms is uncertain. Dietary cellulose and fiber have no known effect on natural defense mechanisms. Tryptophan has no known effect on natural defense mechanisms.

Clostridium Welchii (Clostridium Perfringen)

Which disease results when this organism enters a wound, causing crepitus? Gangrene C. welchii (C. perfringens) is a spore-forming bacterium that produces a toxin that decays muscle, releasing a gas; it is one of the major causative agents for gas gangrene. Clostridium tetani enters the body via puncture of the skin and affects the nervous system; gas gangrene does not occur with this organism. Anthrax disease is caused by Bacillus anthracis Clostridium botulinum contaminates food that is then ingested, causing botulism.

Pt Presents with a fever, headache, loss of appetite, and malaise. RN identifies raised red bumps on the client's arms and legs. A diagnosis of chickenpox is made. The client should be placed in a private room with what kind of precautions? 1 Contact precautions 2 Droplet precautions 3 Airborne precautions 4 No additional precautions other than standard precautions

According to The Centers for Disease Control and Prevention guidelines, airborne precautions apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route, including chickenpox. Chickenpox is transmitted from person to person by directly touching the blisters, saliva, or mucus of an infected person. The virus can also be transmitted through the air. Chickenpox can be spread indirectly by touching contaminated items freshly soiled, such as clothing, from an infected person.

The nurse is providing discharge instructions to a client who is recovering from an acute case of viral hepatitis. Which statement by the client indicates a need for further education? 1 "I will avoid alcohol." 2 "I will eat small frequent meals." 3 "I will take acetaminophen for pain rather than aspirin." 4 "I will eat foods high in carbohydrates, moderate in fats, and moderate in proteins."

Acetaminophen is damaging to the liver and is contraindicated in clients with hepatitis. Clients should avoid alcohol, eat small frequent meals, and eat foods high in carbohydrates and moderate in fats and protein.

active immunity occurs when: Protein substances are formed within the body to neutralize antigens

Active immunity occurs when the individual's cells produce antibodies in response to an agent or its products; these antibodies will destroy the agent (antigen) should it enter the body again. Antigens do not fight antibodies; they trigger antibody formation that in turn attacks the antigen.

A client developed acute herpes zoster and was treated with antiviral medication within 72 hours of the appearance of the rash. The client is reporting persistent pain one week later. What does the nurse identify as the cause of the posttherapeutic neuralgia? 1 Damage to the nerves 2 Untreated major depression 3 Scarring in the area of the rash 4 Continued presence of the skin rash

After the original infection has healed, the virus remains quiescent (DORMANT), or it may return. Posttherapetic neuralgia, which occurs in some individuals, results from damage to the nerves caused by the varicella-zoster virus; the neuralgia may last for months. Untreated major depression and scarring in the area of the rash are unrelated to posttherapeutic neuralgia. The rash does not cause posttherapeutic neuralgia.

A client with multiple myeloma who is receiving chemotherapy has a temperature of 102.2° F. The temperature was 99.2° F when it was taken six hours ago. A priority nursing intervention is to: 1 Administer the prescribed antipyretic and notify the primary health care provider 2 Obtain the respirations, pulse, and blood pressure; recheck the temperature in one hour 3 Assess the amount and color of urine; obtain a specimen for a urinalysis 4 Note the consistency of respiratory secretions and obtain a specimen for culture

Because an elevated temperature increases metabolic demands, the pyrexia must be treated immediately. The practitioner should be notified because this client is immunodeficient from both the disease and the chemotherapy. A search for the cause of the pyrexia then can be initiated. More vigorous intervention than obtaining the respirations, pulse, and blood pressure and rechecking the temperature in one hour is necessary. This client has a disease in which the immunoglobulins are ineffective and the therapy further suppresses the immune system. Assessing the amount and color of urine and obtaining a specimen for a urinalysis is not the immediate priority, although it is important because the cause of the pyrexia must be determined. Also the increased amount of calcium and urates in the urine can cause renal complications if dehydration occurs. Noting the consistency of respiratory secretions and obtaining a specimen for culture is not the priority, although important because respiratory tract infections are a common occurrence in clients with multiple myeloma.

When approaching homosexual clients who have acquired immunodeficiency syndrome (AIDS), it is most important for nurses to: Correct1 Establish a meaningful rapport with clients 2 Have a strong sense of their own sexual identity 3 Admit their own feelings of discomfort to the clients Incorrect4 Become aware of their own attitudes regarding homosexuality

Before nurses can help others, they must understand feelings about issues that may affect clients; establishing a meaningful rapport with clients is the first step toward providing nonjudgmental care. It should follow a self-assessment of attitudes, values, and beliefs. a nurse who feels uncomfortable should not be caring for the client in the first place.

Urine Catheter Care

Best way to reduce catheter associated urinary tract infections (CAUTIs) in long term indwelling catheters is to do what? Replace the catheter on a routine basis A biofilm made up of bacteria develops on long term indwelling catheters. The only way to eliminate this biofilm is to replace the catheter.

chronic hepatitis infection

C and D Hepatitis C and D generally develop into chronic hepatitis. Hepatitis A, B, and E are acute, self-limiting infections that resolve over time. They generally do not develop into chronic hepatitis.

A nurse is precepting a senior level nursing student. The preceptor knows the nursing student understands the concept of screening for sepsis when the student states: 1 "Sepsis mortality is affected greatly by treatments performed in the first 6 hours." 2 "Blood cultures are required to diagnosis sepsis." 3 "An oral temperature of 96.4 degrees F (35.8 C) is not an indicator of sepsis." 4 "A primary health care provider's prescription is required to screen for sepsis."

Studies have shown that if a bundle treatment is not done in the first 6 hours, the likelihood of survival dramatically decreases. Only in about 30% to 40% of the cases are blood cultures positive in septic clients. Hypothermia is as strong of a sepsis indicator as hyperthermia. The signs and symptoms of sepsis are indicative of many other diseases as well. If the health care team is not actively looking for sepsis, it will be missed. A sepsis screening is an assessment that the nurse can perform at any time. To perform the screening the nurse analyzes the vital signs, client history, and lab reports; synthesizes the findings to evaluate if the sepsis screening is negative or positive; and then notifies the primary health care provider of the findings.

A client is diagnosed with herpes genitalis. What should the nurse do to prevent cross-contamination? 1 Institute droplet precautions. 2 Arrange transfer to a private room 3 Wear a gown and gloves when giving direct care. 4 Close the door and wear a mask when in the room

The exudate from herpes virus type 2 is highly contagious; gown and gloves should be worn. A face shield should be worn if there is a potential for splashing of body fluids. The organism is not in respiratory tract secretions; the organism is present in the exudate from active lesions. Arranging transfer to a private room is unnecessary. Closing the door and wearing a mask when in the room is not necessary because herpes genitalis is not an airborne infectious disease.

Syphillis (Stages)

The incubation stage lasts two to six weeks; spirochetes proliferate at the entry site, and the individual is contagious. The primary stage lasts 8 to 12 weeks; the chancre is teeming with spirochetes, and the individual is contagious. The duration of the secondary stage is variable (about five years); skin and mucosal lesions contain spirochetes, and the individual is highly contagious. The tertiary stage is noncontagious; tertiary lesions contain only small numbers of treponemes.