Ch 66: Infectious Diseases
A public health nurse is teaching a mother about vaccinations prior to obtaining informed consent for her child's vaccination. What should the nurse cite as the most common adverse effect of vaccinations?
Allergic reactions to the antigen or carrier solution Explanation: The most common adverse effects are an allergic reaction to the antigen or carrier solution and the occurrence of the actual disease (often in modified form) when live vaccine is used. Reactions to vaccines do not typically include sensitivity to the sun, nausea and vomiting, or joint pain.
The nurse is providing education to a client who has been diagnosed with chlamydia. The client will begin treatment with azithromycin today. Which teaching point should the nurse reinforce with this client?
"Abstain from any sexual activity for 1 week after the antibiotic is complete." Explanation: Client counseling includes abstinence for 1 week after treatment, in addition to the completion of the partner's treatment. Although handwashing is an important aspect of preventing the spread of infection, the nurse must emphasize prevention of chlamydia through the normal route of transmission of this infection, which is sexually. Coinfection with chlamydia often occurs in clients infected with gonorrhea. Chlamydia and gonorrhea are caused by bacteria that are transmitted during sexual relations. Both chlamydia and gonorrhea infections frequently do not cause symptoms in women and thus are often referred to as "silent" related to clinical presentation. It is important to retest women 3 months' posttreatment, due to the possibility of reinfection.
A 28-year-old sexually active male presented to a clinic because he was concerned about a round, painless sore on the shaft of his penis that had appeared 2 days prior to his visit. The nurse practitioner recognized the lesion as a "chancre," an indicator of primary syphilis. The nurse should tell the patient:
"An antibiotic injection is the best treatment since the lesion has just occurred." Explanation: An untreated chancre will usually resolve within 2 months, but a generalized infection will occur as the microorganisms spread from the original site. A rash will occur in 2 to 8 weeks after the chancre. A single dose of penicillin G benzathine is the medication of choice for early syphilis.
The nurse educator, who is teaching a class on sexually transmitted infections, recognizes that teaching has been effective when students indicate which statement is true about the difference between colonization and infection?
"Colonization becomes infection when the host and organism interact." Explanation: The term colonization is used to describe microorganisms present without host interference or interaction. Infection indicates a host interaction with an organism. Organisms reported in microbiology test results often reflect colonization rather than infection. Clinical evidence of redness, heat, and pain and laboratory evidence of white blood cells on the wound specimen smear suggest infection. In this situation, the host identifies the staphylococci as foreign. Infection is recognized by the host reaction (manifested by signs and symptoms) and by laboratory-based evidence of white blood cell reaction and microbiologic organism identification. Colonization does not require treatment with antibiotics because the host has not experienced physiological consequences from the presence of colonization. Infection may require treatment with antibiotics due to the severity of the host reaction.
The nurse is instructing the family on home care of a client with shingles. The family member asks whether their teenage children should stay in a different room. What is the best response by the nurse?
"Have they had chickenpox or the varicella vaccine?" Explanation: To answer the question correctly, the nurse needs to know whether the children have had chickenpox or received the varicella vaccine. If the children have been vaccinated or had the disease, then they are immune and no precautions are needed. If the children have not been vaccinated for chickenpox nor had the disease, it would be best to maintain distance. Shingles is contagious. Even though the client may be in pain, this should not guide the nurse's response.
The nurse has been teaching a client with genital herpes how to care for the lesions. Which of the following statements by the client indicates that she needs additional instruction?
"I'll wear occlusive underwear to prevent transmission of the virus." Explanation: The client should wear loose cotton underwear to promote cleanliness and dryness in the genital area. Sitz baths can promote cleanliness and decrease inflammation in the area. Lesions may be cleaned gently with soap and patted dry carefully with a towel; the client should avoid touching the lesions and then touching any other part of the body. Drinking plenty of fluids is advised to decrease dysuria, which accompanies genital herpes.
The nurse is seeing a client who came into the sexual health clinic after discovering condylomata along her labia. The client states, "This makes no sense, I don't even know who I got this from and I have been so careful!" What is the nurse's best response?
"It sounds like you are feeling angry. Let's talk more about human papillomavirus (HPV) and strategies to stay healthy while you are being treated." Explanation: In many cases, clients are angry about having warts from HPV and do not know who infected them because the incubation period can be long and partners may have no symptoms. Acknowledging emotional distress that occurs when a sexually transmitted infection is diagnosed and providing support and facts are important nursing actions. The client in this case is clearly feeling angry and overwhelmed. The nurse should first provide empathy and help the client focus on information regarding treatment in a solution focused way. Discussing the number of sexual partners and risk factors is important in prevention; however, given the client's emotional state the alternative responses would not be helpful and supportive. In addition, to inform the client that if a condom was used the virus cannot be transmitted is incorrect. Transmission can also occur through skin-on-skin contact in areas not covered by condoms.
The nurse is giving an educational talk to a local parent-teacher association. A parent asks how he can help his family avoid community-acquired infections. What would be the nurse's best response to help prevent and control community-acquired infections?
"Make sure your family has all their childhood immunizations." Explanation: To help prevent and control community-acquired infections, nurses should encourage childhood immunizations. Vaccines stimulate the body to produce antibodies against a specific disease organism. The immunization of children protects children as well as adults who may not have developed sufficient immunity. Following a proper diet and exercise regimen and going for regular checkups are important, but these measures do not help prevent or control community-acquired infections. Smoking cessation does not reduce the risk of such infections either.
A nurse is caring for a male client with gonorrhea who's receiving ceftriaxone (Rocephin) and doxycycline (Vibramycin). The client asks the nurse why he's receiving two antibiotics. How should the nurse respond?
"Many people infected with gonorrhea are infected with chlamydia as well." Explanation: Treatment for gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin (Zithromax) is also ordered. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.
The nurse is caring for a client who has just been diagnosed with chlamydia and is very upset. The client says, "I don't understand this. The person I had sex with did not have any symptoms at all. How could I have known?" What is the best response by the nurse to this client?
"Many people with chlamydia won't have symptoms for up to 3 weeks after being infected." Explanation: As many as 75% of infected women and 25% of infected men are symptom free. It may take 1-3 weeks for symptoms to appear. Whether in passion or not, if symptoms are present, an individual would be able to see them. It is true that a condom would help decrease the incidence of an STI but the nurse should not try to condemn or judge the client with the STI. Knowing a client's sexual history is important but it does not answer the question that the client posed?
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." Explanation: 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.
An adolescent informs the school nurse that she is afraid of contracting an STI but her boyfriend does not want to use condoms. What is the best response by the nurse?
"The use of condoms is one of the best ways to reduce the risk of acquiring an STI." Explanation: The use of condoms to provide a protective barrier from transmission of STI related organisms has been broadly promoted, especially since the recognition of HIV/AIDS. At first referred to as a method to ensure safe sex, the use of condoms has been shown to reduce but not eliminate the risk of transmission of HIV and other STIs.
The nurse is meeting with the mother of an 11-year-old girl to provide decision making support and education regarding human papillomavirus (HPV) vaccination. The mother states, "I am confused about why my 11 year old needs to be protected from a sexually transmitted infection. She is so young and not sexually active. Why does she need the vaccination now?" What is the nurse's best response?
"The vaccination helps to prevent cervical cancer in adult women. It works better if she has it before she becomes sexually active. Let's talk about some of the concerns you have about the vaccination" Explanation: When counseling clients regarding the HPV vaccination, it is important to use supportive communication to help reduce the client's anxiety and help them make the best decision for his or her health. The nurse should provide facts about the benefits of vaccination along with the potential long term consequences of abstaining from vaccination. The nurse should be careful when stating the child will be "protected from sexually transmitted infections." The HPV vaccination only protect against infections caused by HPV and the primary purpose of the vaccination is to prevent the development of certain cancers related to the infection. Telling the mother her daughter is at risk for ectopic pregnancy and infertility is ineffective because the nurse has not yet discussed the possible consequences of a HPV infections. The nurse is not communicating in a manner that would reduced the mother's anxiety. The response may be perceived as accusatory and judgmental. By telling the mother if she waits to vaccinate her daughter until she is 15 years old, the nurse is providing incorrect information. Children between the ages of 9 and 14 require fewer doses of the vaccination that children 15 and older up to 26 years of age.
The nurse is teaching students about the West Nile virus. Which statement by the nurse is accurate?
"There is no treatment for West Nile virus infection." Explanation: Clients with West Nile virus are supported by fluid replacement, airway management, and standard nursing care while the client has meningitis symptoms. The incubation period (from mosquito bite until the onset of symptoms) is between 3 and 14 days. Most human infections are asymptomatic. When symptoms are present, headache and fever are most frequently reported. Less than 1% of those infected develop more severe illness, including meningitis. Birds are the natural reservoir for the virus. Mosquitoes become infected when feeding on birds and can transmit the virus to animals and humans.
The nurse is caring for a client who asks, "I heard the nurse tell my doctor I have adnexal tenderness. What does that mean?" The client has also been experiencing fever and loss of appetite. How should the nurse respond?
"This means the internal body parts surrounding your uterus are also sore. Knowing this helps confirm that you have pelvic inflammatory disease and now you can be given the correct treatment." Explanation: The minimal criteria for diagnosis of pelvic inflammatory disease and the prescribed treatment include one, or more, of the following: uterine tenderness, adnexal tenderness (adnexa are the "appendages" of the uterus, namely the ovaries, fallopian tubes, and ligaments that hold the uterus in place), and cervical motion tenderness. Other symptoms include fever, general malaise, anorexia, nausea, headache, and, possibly, vomiting. Adnexal tenderness is not related to the adrenal glands. The nurse would be incorrect in responding to the client with this explanation. When client's report the cardinal symptoms of pelvic inflammatory disease, it is important to conduct pregnancy testing and ectopic pregnancy can be one of the consequences of this infection; however, this is not the correct response to the client's question. It is also incorrect to inform the client that ectopic pregnancy leads to infertility. Although there is a correlation between the two, the nurse cannot make such a conclusive statement to the client. Adnexal tenderness is not a symptom of bacterial vaginosis.
A client comes to the emergency department reporting severe diarrhea. The client is pale with dry mucous membranes and poor skin turgor. The nurse would suspect Escherichia coli (E. coli) as the potential cause when the client states which of the following?
"Yesterday for lunch, I ate a hamburger that was on the rare side." Explanation: Escherichia coli infection is often associated with the ingestion of undercooked ground beef, which should be cooked until the meat is no longer pink and the juices run clear. Salmonella is associated with undercooked eggs and chicken. Campylobacter also is commonly associated with improperly cooked or stored chicken. Drinking contaminated water from a mountain spring is associated with Giardia lamblia infection.
The nurse is providing education to a client who has been diagnosed with trichomoniasis. When providing information about metronidazole, what should the nurse be certain to include?
"You will need to avoid alcohol during treatment and for 3 days after the medication is complete." Explanation: The client should be advised to avoid alcohol for the duration of treatment with metronidazole and for 3 days after it is complete. Test of cure is not required after treatment with metronidazole for trichomoniasis. Nursing education on abstaining from sexual activity until both partners are treated is imperative. The most effective treatment for trichomoniasis is metronidazole or tinidazole. Trichomoniasis is the most common curable sexually transmitted infection.
A child is brought to the emergency department by his parents. The child has been experiencing significant diarrhea over the past 36 hours. Further evaluation reveals infectious diarrhea with moderate dehydration. The physician orders oral rehydration solution, 100 mL/kg over the next 4 hours. The child weighs 77 lbs. How much would the nurse expect to administer?
3500 Explanation: The child weighs 77 pounds, which is equivalent to 35 kg. The order is for 100 mL per kilogram; multiplying 100 by 35 kg equals 3500 mL. The nurse would administer this amount to the child over 4 hours.
The usual incubation period (from infection to first symptom) for hepatitis B is
45 to 160 days. Explanation: Hepatitis B is responsible for more than 200 deaths of healthcare workers annually. The incubation period for hepatitis B is 45 to 160 days. The incubation period for hepatitis A is 15 to 50 days; for gonorrhea, 2 to 7 days. The incubation for the Sin Nombre virus is unclear.
Which of the following medications are used to suppress viral load of the HSV-2 infection?
Acyclovir (Zovirax) Explanation: With Herpes simplex virus 2 (HSV-2), the antiviral agents acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir) are recommended to suppress the viral load and decrease recurrence and shedding. Flagyl and Cleocin are not used for this purpose.
A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority?
Acute pain related to the development of the genital lesions Explanation: Although deficient knowledge, ineffective coping, and hyperthermia are possible nursing diagnoses, the priority would be acute pain because the initial infection is usually very painful and lasts about 1 week.
A nurse is having a yearly employee tuberculin skin test. Which skin test results would indicate a positive result?
An induration of 12mm Explanation: The size of the induration, not including the surrounding area of erythema, is measured in millimeters. The measurement determines whether the reaction is significant. For example, a tuberculin skin test is test is considered positive if the induration is 10 mm or greater in persons with no known risk factors for TB; smaller measurements are significant in certain risk groups, such as immunocompromised clients. The other answers are not indicative of positive results.
A client is admitted with bacterial meningitis. Which hospital room is the best choice for this client?
An isolation room three doors from the nurses' station Explanation: A client with bacterial meningitis should be kept in isolation for at least 24 hours after admission and, during the initial acute phase, should be as close to the nurses' station as possible to allow maximal observation. Placing the client in a room with a client who has viral meningitis may cause harm to both clients because the organisms causing viral and bacterial meningitis differ; either client may contract the other's disease. Immunity to bacterial meningitis can't be acquired; therefore, a client who previously had bacterial meningitis shouldn't be put at risk by rooming with a client who has just been diagnosed with this disease.
To confirm a diagnosis of syphilis, the nurse would identify the gram-negative bacteria, Treponema palladium, on the laboratory report. The nurse knows that this bacteria is classified among:
Spirochetes Explanation: Direct identification of the spirochete bacteria obtained from the chancre lesion of primary syphilis is used for a positive diagnosis
Which of the following is the medication of choice for early syphilis?
Penicillin G benzathine Explanation: A single dose of penicillin G benzathine intramuscular injection is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration. Patients who are allergic to penicillin are usually treated with doxycycline or tetracycline. Rocephin is not the medication of choice for syphilis.
A family will be staying in a cabin by a lake and, upon arriving, observes rodent droppings on the floor in the kitchen. What is the best way for the family to clean up in order to avoid contracting hantavirus from the feces?
Apply a bleach solution prior to sweeping or vacuuming the floor. Explanation: Prevention of infection by the hantavirus requires strategies to reduce human contact with rodents and their droppings. Brooms and vacuum cleaners should be used with caution; areas that may emit dust while being cleaned should be first dampened with a bleach solution to reduce viral contaminants and the potential for dust dispersion.
A client is diagnosed with Legionnaire's disease. The nurse anticipates which medication to be prescribed?
Azithromycin Explanation: Azithromycin or a fluoroquinolone such as moxifloxacin, is the drug of choice for treating Legionnaire's disease. Trimethoprim sulfate may be used to treat pertussis. Ceftriaxone may be used to treat gonorrhea. Penicillin G benzathine is the drug of choice for treating syphilis.
A 47-year-old male client presented to the medical unit and the health care team suspects tuberculosis (TB). The nurse is admitting the client to a reverse isolation room. QuantiFERON testing and chest x-ray are pending. Urinalysis results are negative. No other testing was performed prior to admission to isolation. The client denies any chest pain, shortness of breath (SOB), or respiratory difficulty. The client presents with productive yellow sputum.
Based on the provided assessment status, the nurse should utilize airborne precautions to prevent exposure and sputum to collect specimens for additional testing. A client admitted with suspected tuberculosis (TB) should be placed in a reverse isolation room. Because diagnostic testing is pending, the nurse should limit exposure of the staff to the client and provide a safe therapeutic environment. Additional testing/collection of specimens may be needed to further isolate pathology. Because TB is spread through the respiratory tract, the client should be placed on airborne precautions. Because the client has productive sputum, a specimen should be collected to identify pathological organisms. Tuberculosis is not spread through droplets and contact precautions are used for infectious diseases that can be transmitted through direct contact and/or within the client's environment. Sterile technique is not indicated as part of the precautions used to prevent transmission of TB. Because the urinalysis results were normal, there is no further need to obtain an additional urine specimen. A rapid plasma reagin (RPR) test is used to detect syphilis. There is no clinical indication that the client has a sexually transmitted infection (STI); therefore, this action is not needed.
The nurse is discussing childhood immunization recommendations with a pediatric patient's parent. Where would the nurse find the most current information on this topic?
CDC Explanation: The standard recommended immunization schedules are revised by the CDC (2013a) as epidemiologic evidence warrants.
The nurse educator is teaching a group of nursing students about the physiologic manifestations of tertiary syphilis. The students respond correctly by stating which major organ systems are identified as the most affected by tertiary syphilis?
Cardiovascular and neurological Explanation: The most common complications of untreated syphilis manifest as aortitis (inflammation of the aorta) and neurosyphilis and are evidenced by dementia, psychosis, paresis, stroke, or meningitis.
The nurse is instructing a health class on the proper use of a male condom. Place the steps of using a condom in the proper order. Use all options.
Check the expiration date of the condom. Obtain an erection. Unroll the condom over the penis leaving a ½-inch space at the top. Roll the condom up to the tip of the penis pinching the top. Dispose of the used condom. Explanation: The correct method to use a male a condom is to begin by making sure that the condom is not passed the expiration date. After the male obtains an erection, the user unrolls the condom over the penis, leaving a ½-inch space at the top of the condom for the semen. After orgasm, the user rolls the condom up to the tip of the penis, pinching the top where the semen is contained. Then, the user disposes of the used condom.
The nurse is caring for a group of clients at a public health clinic. Which sexually transmitted disease would the nurse focus the client education on curative goals?
Chlamydia Explanation: Chlamydia is the most common and fast spreading bacteria. Because it is a bacteria, with proper treatment, chlamydia is able to be cured. Sexually transmitted diseases that are viruses, such as HIV, HPV, and herpes, can lay dormant in the body thus being difficult to treat.
The nurse is providing care to a client who has been diagnosed with gonorrhea. The nurse also prepares the client for treatment of which of the following?
Chlamydia Explanation: Co-infection with chlamydia often occurs in clients infected with gonorrhea. Therefore, the nurse would expect the client to receive treatment for both of these diseases. Human immunodeficiency virus, syphilis, and herpes simplex are not commonly associated with gonorrhea.
A long-term care facility is the site of an outbreak of infectious diarrhea. The nurse educator has emphasized the importance of hand hygiene to staff members. The use of alcohol-based cleansers may be ineffective if the causative microorganism is identified as what?
Clostridium difficile Explanation: The spore form of the bacterium C. difficile is resistant to alcohol and other hand disinfectants; therefore, the use of gloves and handwashing (soap and water for physical removal) are required when C. difficile has been identified. Each of the other listed microorganisms is susceptible to alcohol-based cleansers.
A nurse would anticipate instituting contact precautions for a client with which of the following?
Clostridium difficile infection Explanation: Contact precautions would be appropriate for a client with an infection due to Clostridium difficile. Airborne precautions are appropriate for clients with measles or varicella. Droplet precautions are appropriate for clients with mumps.
Which term is used to describe microorganisms present in a host without host interference or interaction?
Colonization Explanation: Colonization is used to describe microorganisms present without host interference or interaction. Infection indicates a host interaction with an organism. Reservoir is any person, plant, animal, substance, or location that provides living conditions for microorganisms and that enables further dispersal of the organism. Normal flora is persistent nonpathogenic organisms colonizing a host.
Which of the following describes microorganisms present without host interference or interaction?
Colonization Explanation: The term colonization is used to describe microorganisms present without host interference or interaction. Infection indicates a host interaction with an organism. Infectious disease is the state in which the infected host displays a decline in wellness due to the infection. Reservoir is the term used for any person, plant, animal, substance, or location that provides nourishment for microorganisms and enables further dispersal of the organisms.
A nurse who provides care in a busy ED is in contact with hundreds of clients each year. The nurse has a responsibility to receive what vaccine?
Hepatitis B vaccine Explanation: Nurses should recognize their personal responsibility to receive the hepatitis B vaccine and an annual influenza vaccine to reduce potential transmission to themselves and vulnerable client groups. HPV is not a threat because it is sexually transmitted. No vaccines are available against C. difficile and S. aureus.
The nurse recognizes what groups of people are at an increased risk for infection? Select all that apply.
Debilitated clients Older adults Clients with impaired skin Explanation: Certain people are at increased risk for infection because their defenses are compromised in one or more ways. For example, older adults, premature infants, malnourished and debilitated clients, clients receiving immunosuppressive agents, and clients with impaired skin, bone marrow suppression, or disorders of the immune system are especially susceptible to virulent and nonvirulent strains of microorganisms. Clients with pancreatic disease and adolescents are not at higher risk for infections.
A male client comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention?
Discharge from the penis and burning during urination Explanation: Signs and symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are a sign of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.
The nurse is caring for a patient with a meningococcus infection. What type of precautions should be used for this patient?
Droplet Explanation: Droplet precautions are used for organisms such as influenza or meningococcus that can be transmitted by close contact with respiratory or pharyngeal secretions.
A client diagnosed with influenza is admitted to the hospital. Which transmission-based precautions should the nurse initiate?
Droplet Explanation: Influenza is transmitted via droplets; therefore, the nurse should initiate droplet precautions. Tuberculosis and varicella would qualify for airborne precautions. Contact precautions are used for organisms that are transmitted by skin-to-skin contact. Neutropenic (or reverse) precautions are used for immunosuppressed clients.
Patients who have had pelvic inflammatory disease (PID) are prone to which of the following complications?
Ectopic pregnancy Explanation: All patients who have had PID need to be informed of the signs and symptoms of ectopic pregnancy because they are prone to this complication. Other complications include bacteremia with septic shock and thrombophlebitis with possible embolization. Patients who have PID are not prone to inguinal lymphadenopathy
A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STIs." How should the nurse proceed? Select all that apply.
Educate the client about why it's important to inform sexual contacts so they can receive treatment. Inform the health department that this client contracted a chlamydia infection. Explanation: Gonorrhea and chlamydia are reportable communicable diseases. The nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The department of health should contact the sexual contacts, not the nurse. Doing nothing for the client is judgmental; everyone is entitled to healthcare regardless of health habits.
A client who is blind is admitted for treatment of gastroenteritis. What does the nurse recognize as the highest priority for this client?
Fluid volume deficit Explanation: Because the client has gastroenteritis and is probably dehydrated, the client's fluid volume takes highest priority. A sensory deficit such as blindness puts the client at risk for injury from the environment; however, a potential problem doesn't take highest priority. Although the client's tolerance for activity and mobility also may be relevant, these don't take precedence over the client's dehydration.
A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?
Foul-smelling discharge from the penis Explanation: Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.
After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment?
Genital herpes Explanation: Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.
A client is hospitalized with a Clostridium difficile infection. Which of the following would the nurse include when providing care to this client?
Gloves and gowns for all client contact Explanation: Care of a client with C. difficile infection requires contact precautions with the use of gowns and gloves for all client contact. These spores are resistant to alcohol; therefore, the nurse needs to use soap and water to wash the hands. Bleach-based solutions and cleaning products are preferred for clean-ups.
A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), the physician orders diagnostic testing of the vaginal discharge. Which STD must be reported to the public health department?
Gonorrhea Explanation: Gonorrhea must be reported to the public health department. Bacterial vaginitis, genital herpes, and HPV aren't reportable diseases.
The nurse observes a nursing assistant leave the room of client diagnosed with Clostridium difficile infection without washing hands. Which is the priority action by the nurse?
Have the nursing assistant wash hands with soap and water. Explanation: Although all actions listed are appropriate, the priority nursing action is to ensure that the nursing assistant washes their hands with soap and water. Allowing nursing assistants to continue with their job without washing their hands could lead to the nursing assistant infecting other clients with whom they come in contact. The potential for health care-associated acquisition is increased because the spore is relatively resistant to disinfectants and can be spread via the hands of healthcare providers.
Which of the following sexually transmitted infections (STIs) could be transmitted perinatally?
Herpes simplex Explanation: Herpes simplex and syphilis can be transmitted perinatally and sexually. Chlamydia, gonorrhea, and trichomoniasis are transmitted sexually.
The nurse is instructing an adolescent female who is not sexually active on potential vaccinations available. Which vaccination would the nurse state that decreases the risk of cervical can
Human papilloma viral (HPV) Explanation: Human papilloma viral (HPV) infection is the most commonly transmitted sexual disease in the United States. A strain of this infection can cause cervical cancer. An HPV vaccine is available to both females and males. For females, the vaccine decreases the risk of cervical cancer and genital warts. For males, the vaccine decreases the risk of genital warts and anal cancers. Hepatitis B vaccine protects against a liver disease. Herpes zoster is the vaccine for shingles. The meningococcal vaccine protects against several diseases including meningitis.
The nurse is instructing an adolescent female who is not sexually active on potential vaccinations available. Which vaccination would the nurse state that decreases the risk of cervical cancer?
Human papilloma viral (HPV) Explanation: Human papilloma viral (HPV) infection is the most commonly transmitted sexual disease in the United States. A strain of this infection can cause cervical cancer. An HPV vaccine is available to both females and males. For females, the vaccine decreases the risk of cervical cancer and genital warts. For males, the vaccine decreases the risk of genital warts and anal cancers. Hepatitis B vaccine protects against a liver disease. Herpes zoster is the vaccine for shingles. The meningococcal vaccine protects against several diseases including meningitis.
A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata?
Human papilloma virus Explanation: Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Hemophilus ducreyi bacillus is the cause of chancroid.
Which of the following is the most common sexually transmitted infection (STI) among young, sexually active people?
Human papillomavirus (HPV) Explanation: HPV infection is the most common STI among young, sexually active people. Millions of Americans are infected with HPV, many unaware that they carry the virus.
A client who has developed a painless penile ulcer is diagnosed with syphilis. What treatment would physician prescribe?
IV penicillin G; single dose Explanation: This client has primary syphilis. A single dose of parenterally administered penicillin G is used to treat primary and secondary syphilis.
The nurse is caring for a client with genital herpes experiencing a reoccurrence. Which nursing diagnosis would be the priority?
Impaired Skin Integrity Explanation: The priority nursing diagnosis focuses on the Impaired Skin Integrity. Interventions would include nursing instruction on the care of the skin to prevent further infection to self and others. The nurse would also focus on the management of the disease. Because this is a reoccurrence, Knowledge Deficit is not a priority. Psychosocial nursing diagnoses are not a priority at this time unless other data suggests.
Which of the following describes host interaction with an organism?
Infection Explanation: Infection indicates a host interaction with an organism. The term colonization is used to describe microorganisms present without host interference or interaction. Infectious disease is the state in which the infected host displays a decline in wellness due to the infection. Reservoir is the term used for any person, plant, animal, substance, or location that provides nourishment for microorganisms and enables further dispersal of the organisms.
A patient has developed chickenpox and asks the nurse what the incubation period would be. What should the nurse inform the patient?
It is 10 to 21 days. Explanation: The incubation period for varicella zoster, the virus that causes chickenpox, is about 2 weeks (range, 10 to 21 days).
The clinical manifestations of primary syphilis can be diagnostic. Select all the symptoms consistent with this diagnosis.
It occurs 2 to 3 weeks after initial inoculation with the organism a painless lesion forms at the site of infection the lesion resolves in 2 months. Explanation: The presence of a rash occurs with secondary syphilis. Primary syphilis has no rash.
The nurse recognizes the client is in which stage of syphilis when the client has no signs or symptoms of syphilis?
Latency Explanation: Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. A period of latency occurs when the infected person has no signs or symptoms of syphilis. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.
Which stage or period of syphilis occurs when the infected person has no signs or symptoms of syphilis?
Latency Explanation: Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. A period of latency occurs when the infected person has no signs or symptoms of syphilis. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.
The nurse is trying to determine if a patient admitted to the hospital the previous day has a bacterial wound infection. What laboratory study should the nurse review to obtain this information?
Microbiology report Explanation: The primary source of information about most bacterial infections is the microbiology laboratory report, which should be viewed as a tool to be used along with clinical indicators to determine if a patient is colonized, infected, or diseased.
The nurse places a client in isolation. Isolation techniques have the potential to break the chain of infection by interfering with what component of the chain of infection?
Mode of transmission Explanation: Isolation techniques attempt to break the chain of infection by interfering with the transmission mode. These techniques do not directly affect the agent, host, or portal of entry.
The nurse is seeing a client in the community health clinic who reports finding "sores" in the mouth. On assessment, the nurse notes the lesions appear flat, flesh colored and papillary. What should the nurse do next?
Obtain a health history that includes inquiring about sexual health practices Explanation: The most common strains of HPV, 6 and 11, usually cause condylomata (genital warts) on the female and male genitalia and can be found in the mouth. Often these lesions are visible, flesh-colored, flat, verrucous, or papillary. The nurse should first obtain a further health history including sexual health practices that would help determine if further investigation for HPV is needed. Because the client has only told the nurse about the lesions and no other symptoms at this point, the informing the client that the lesion is consistent with the HPV infection would be premature. Further assessment and diagnostic testing is warranted. A colposcopy is a diagnostic biopsy performed on females to check for any cellular changes or dysplasia (changes in cervical cells). Lesions associated HSV and HPV are unique in characteristics. HSV lesions are painful and, although the nurse may be correct in suggested blood work for HSV, it is important that a complete health history with sexual health practices be discussed to ensure accurate assessment of the client's needs.
The nurse is caring for a client who has acquired immunodeficiency disease (AIDS) and has developed oral thrush. What type of infection is the nurse aware that has developed due to the immunocompromised state of the client?
Opportunistic Explanation: An opportunistic or superinfection occurs among immunocompromised hosts. Examples would be yeast infections in the mouth, bladder infections, gastroenteritis, and Pneumocystis carinii. An acute infection has a sudden onset with serious and sometimes life-threatening manifestations. A chronic infection is an extended infection that resists treatment. A secondary infection is a complication of some other disease process that occurred first.
Which can be used for rehydration therapy for diarrheal disorders?
Oral rehydration salts (ORS) Explanation: An ORS solution may be used for rehydration therapy for diarrheal disorders. Foods that are high in simple sugars, such as undiluted apple juice or gelatin, should be avoided. Sports drinks do not replace fluid losses correctly and should not be used.
Symptoms of pelvic infection usually begin with which of the following?
Pain Explanation: Symptoms of pelvic infection usually begin with vaginal discharge, dyspareunia (painful sexual intercourse), lower abdominal pelvic pain, and tenderness that occur after menses. Other symptoms include fever, general malaise, anorexia, nausea, headache, and possibly vomiting.
The nurse is reviewing the medical records of several patients who have been diagnosed with the following infections:Patient A: MumpsPatient B: Respiratory syncytial virusPatient C: TuberculosisPatient D: ImpetigoPatient E: Scabies
Patient B,D,E Explanation: The nurse would implement contact precautions for the patients with respiratory syncytial virus, impetigo, and scabies. Droplet precautions are used for mumps; airborne precautions are used for tuberculosis.
A client is diagnosed with early latent syphilis of unknown duration. Which medication treatment will the nurse expect to be prescribed for this client?
Penicillin G benzathine, three intramuscular injections at 1-week intervals Explanation: Treatment of all stages of syphilis is the administration of antibiotic medications. Clients with late latent or latent syphilis of unknown duration should receive three injections of penicillin G benzathine at 1-week intervals. Penicillin G benzathine is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration. It is given by intramuscular injection at a single session. Clients who are allergic to penicillin are usually treated with doxycycline. Zithromax is not used to treat syphilis.
A nurse would implement droplet precautions for a client with which condition? Select all that apply.
Pertussis Mumps Parvovirus B 19 Explanation: Disorders requiring droplet precautions include pertussis, mumps, and parvovirus B 19. Scabies and viral hemorrhagic infections such as Ebola would require contact precautions.
A nurse implements aseptic technique as a means to break the chain of infection at which element?
Portal of entry Explanation: The use of aseptic technique interrupts the chain of infection at the portal of entry. Employee health, environmental sanitation, and disinfection and sterilization interfere with the reservoir element. Hand hygiene, control of secretions, and excretions and proper trash and waste disposal interfere with the portal of exit. Isolation, proper food handling, airflow control, standard precautions, sterilization, and hand hygiene interfere with the means of transmission.
The nurse has received several laboratory studies back at the clinic. Which of these results should be reported to the local health department?
Positive gonorrhea Explanation: Gonorrhea and chlamydia are reportable communicable diseases. In any healthcare facility, a mechanism should be in place to ensure that all diagnosed patients are reported to the local public health department to ensure follow-up of the patient. The public health department also is responsible for interviewing the patient to identify sexual contacts so that contact notification and screening can be initiated.
The nurse is working in the labor and delivery suite when a client with active herpes simplex virus type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care will the nurse prepare for?
Prepare for a cesarean section. Explanation: The nurse is most accurate to prepare for a cesarean section because the mother has an active lesion and does not want to transmit the virus to the newborn. Antibiotic therapy, at this time, does not prevent the transmission of the infection. A full assessment is always completed on the newborn and is not an adjustment in the plan of care. Antibacterial ointment is not placed on the mother's lesions.
A client in the clinic is diagnosed with diarrhea caused by a Campylobacter species. Which instruction should the nurse provide to prevent further episodes?
Properly store and cook meat. Explanation: Campylobacter infection is caused by consuming undercooked or raw meat. Proper storage and cooking of meat will prevent further episodes of Campylobacter infection. The client should also be told to prepare meat separately from other foods, including the use of utensils. Giardia lamblia diarrhea is caused by drinking contaminated water. Shigella infection is transmitted via the fecal-oral route, so handwashing after going to the bathroom would help prevent the illness. Salmonella infections are usually caused by consuming raw eggs; they also can be transmitted via produce.
When a disease infects a host a portal of entry is needed for an organism to gain access. What has been identified as the usual portal of entry for tuberculosis?
Respiratory system Explanation: The portal of entry for M. tuberculosis is through the respiratory tract.
A 2-year-old is brought to the clinic by her mother who tells the nurse her daughter has diarrhea and the child is complaining of pain in her stomach. The mother says that the little girl had not eaten anything unusual, consuming homemade chicken strips and carrot sticks the evening prior. Which bacterial infection would the nurse suspect this little girl of contracting?
Salmonella Explanation: Annually in the United States, Salmonella species contaminate approximately 2.2 million eggs (1 in 20,000 eggs) and one in eight chickens raised as meat. Diarrhea with gastroenteritis is a common manifestation associated with Salmonella. Recent outbreaks of E. coli have been associated with ingestion of undercooked beef. Shigella spreads through the fecal-oral route, with easy transmission from one person to another. People infected with Giardia lamblia contract the disease by drinking contaminated water.
After discussing the vaccine available for human papillomavirus with the mother of a 12-year-old female client, the mother agrees to have her daughter immunized. It is July when the nurse administers the first dose. The nurse would instruct the mother to bring the girl in for her second dose at which time?
September Explanation: The vaccine for human papillomavirus is given in three intramuscular doses, with the initial dose followed by a second dose in 2 months, and a third dose in 6 months after the first dose. For this girl, the second dose would be given 2 months after July, which would be September.
Which organism is responsible for impetigo?
Staphylococcus aureus Explanation: S. aureus and Streptococcus pyogenes are the organisms responsible for impetigo. H. capsulatum is responsible for histoplasmosis. B. anthracis is responsible for anthrax. C. difficile is responsible for some diarrheal diseases.
Painless chancres or ulcerated lesions are associated with which systemic disease?
Syphilis Explanation: Syphilis is manifested by a painless chancres or ulcerated lesions. Psoriasis is exhibited by plaques with scales. Kaposi sarcoma are cutaneous lesions that are blue-red or dark brown in color. Urticaria is wheals or hives due to infection or allergic reactions.
Painless chancres are associated with which systemic disease?
Syphilis Explanation: Syphilis is manifested by a painless chancres. Psoriasis is exhibited by plaques with scales. Kaposi sarcomas are cutaneous lesions that are blue-red or dark brown in color. Urticaria is wheals or hives due to infection or allergic reactions.
An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported?
Syphilis Explanation: The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDs. Genital herpes, hepatitis B, venereal warts (condyloma acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law.
A client is suspected of sepsis from a postsurgical incision infection. What characteristic of sepsis would the nurse recognize? Select all that apply.
Temperature of 102F Heart rate of 120 beats/minute Respiratory rate of 24 breaths/minute
Which statement reflects what is known about the Ebola virus?
The diagnosis should be considered in a client who has a febrile, hemorrhagic illness after traveling to Asia or Africa. Explanation: The diagnosis should be considered in a client who has a febrile, hemorrhagic illness after traveling to Asia or Africa, or who has handled animals or animal carcasses from those parts of the world. Antibiotic therapy, such as penicillin, would not be effective for the treatment of viruses. Treatment must be largely supportive maintenance of the circulatory and respiratory systems. The infected client likely would need ventilator and dialysis support through the acute phases of illness. The viruses are usually spread by exposure to blood or other body fluid, insect bite, and mucous membrane exposure. Symptoms include fever, rash, and encephalitis, which progress rapidly to profound hemorrhage, organ destruction, and shock.
You work on a long-term care unit. In the last two weeks more than half the clients on your unit have been diagnosed with gastroenteritis. What is the most likely reason?
The infection is being transmitted by healthcare personnel. Explanation: Healthcare personnel are in frequent and direct contact with many clients who harbor various microorganisms; the risk for transmitting pathogenic microorganisms between clients is high.
After attending a conference at a hotel for several days, a patient is having symptoms suspected of being related to Legionnaires' disease. When making a bed assignment for this patient, how should the assignment be made?
The patient can be placed in a semiprivate room because the disease is not transmitted from person to person. Explanation: Isolation is not required because Legionella is not transmitted between humans.
Nursing students are reviewing information about infectious diseases and events associated with infection. Students demonstrate understanding of the information when they identify the incubation period as which of the following?
Time between exposure and onset of symptoms Explanation: The incubation period is time between contact or exposure and the development of the first signs and symptoms. The presence of microorganisms without the host interacting with them is called colonization. The state in which the host displays a decrease in wellness characterizes an infectious disease. The process of the host shedding the microorganisms to another reflects the mode of exit.
The nurse is caring for a client with secondary syphilis. What intervention should the nurse institute when caring for this client?
Wear gloves if contact with lesions is possible. Explanation: Lesions of primary and secondary syphilis may be highly infective. Gloves are worn when direct contact with lesions is likely, and hand hygiene is performed after gloves are removed. Isolation in a private room is not required. Corticosteroids antiviral medications are not indicated.
When developing a teaching plan for a client with syphilis, which of the following would be most important to include?
With proper treatment, the disease can eventually be cured. Explanation: For a client with syphilis, proper treatment will improve the symptoms of skin lesions and other sequelae of infection, with serology eventually reflecting a cure. Typically, early syphilis or early latent syphilis is treated with a one-time intramuscular dose of penicillin G benzathine; three injections at one week intervals are used for clients with late latent or latent syphilis of unknown duration. Condoms significantly reduce the risk of transmission of syphilis and other sexually transmitted infections. Sexual contact is avoided until previous or current partners have been treated.
The nurse is scheduled to administer tetanus, diphtheria, and pertussis (Tdap) vaccine to a client at the clinic. The client states, "I had a reaction the last time I got an immunization." What action should the nurse take first?
Withhold the immunization. Explanation: The nurse should withhold the immunization until a further investigation of the type of reaction and immunization received is completed. Clients who have had serious reactions or encephalopathy after receiving the pertussis vaccine should not receive the vaccine again. The client may suffer a severe reaction if the Tdap is administered without investigation. Documentation of the reaction cannot happen until the nurse receives further information.
How often should women diagnosed with human papillomavirus (HPV) have Pap smears?
Yearly Explanation: Women with HPV should have annual Pap smears because of the potential of HPV to cause dysplasia.
Which of the following nursing instructions is most important for the nurse to emphasize to the client with a new HSV-2 diagnosis?
You must inform all sexual partners. Explanation: The spread of the infection could quickly multiple if the client's sexual partners are infected and continue to spread the virus to others; thus, it is most important to emphasize that all sexual partners must be informed. All of the other options are correct but not most important.
During flu season, a nurse is teaching clients about the chain of infection. What components are considered "links" in this chain? Select all that apply.
infectious agent portal of entry susceptible host Explanation: The six components involved in the transmission of microorganisms are described as the chain of infection. All components in the chain of infection must be present to transmit an infectious disease from one human or animal to a susceptible host: an infectious agent, an appropriate reservoir, exit route, means of transmission, portal of entry, and susceptible host.
Which statement holds true? Untreated genital warts:
may resolve on their own, remain unchanged, or increase in size or number. Explanation: Untreated genital warts do not lead to AIDS. Untreated genital warts may resolve on their own, remain unchanged, or increase in size or number. They may lead to cervical or other pelvic reproductive types of cancer.
Flu and cold season offers excellent examples of physiologic reflexes to ward off illness. One problem is that an effective mechanical defense for one person can complete a link in the chain of infection for someone else. To which link is the above referring?
means of transmission Explanation: As a person sneezes or coughs, if he or she does not cover his or her mouth and nose, the airborne microbes can be spread to others, finding a susceptible host. Covering up when coughing or sneezing is vital protection against infection. The reservoir refers to the environment in which the infectious agent can survive and reproduce. Portal of entry refers to the route by which the infectious agent escapes from the environment in which it lives and reproduces. Infectious agent refers to the agent that has the power to produce disease.
The six elements necessary for infection include a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and
mode of entry into the host. Explanation: The six elements necessary for infection are a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and a mode of entry into, not a mode of exit from, the host.
A client suspected of having chlamydia is to undergo testing to confirm the infection. Which test would the nurse anticipate as being ordered?
nucleic acid amplification test (NAAT) Explanation: Nucleic acid amplification tests (NAAT) are most sensitive for the detection of chlamydia. The Gram stain best identifies gonorrhea from the male urethra. VDRL and RPR are used to detect syphilis.
An 82-year-old client is admitted to the hospital with a diagnosis of pneumonia. The nurse learns that the client lives alone and hasn't been eating or drinking properly. When assessing the client for dehydration, the nurse would expect to find:
tachycardia. Explanation: With an extracellular fluid or plasma volume deficit, compensatory mechanisms stimulate the heart, causing an increase in heart rate. Distended jugular veins and hypertension may be signs of fluid volume overload. Body temperature may be elevated with dehydration. Blood pressure, in particular systolic blood pressure, falls with dehydration, and orthostatic hypotension may occur.
A nurse is assessing a client who may be in the early stages of dehydration. Early manifestations of dehydration include:
thirst or irritability. Explanation: Early signs and symptoms of dehydration include thirst, irritability, dry mucous membranes, and dizziness. Coma, seizures, sunken eyeballs, poor skin turgor, and increased heart rate with hypotension are all later signs.
