INFECTION Mastery Level 7
The nurse is providing education to a postpartal woman who has developed a uterine infection. Which statement by the woman indicates that further instruction is needed? "I will change my perineal pad regularly to remove the infected drainage." "I will take frequent walks around my home to promote drainage." "When I am sleeping or lying in bed, I should lie flat on my back." "If my abdomen becomes firm, or if I don't urinate as much, I need to call the doctor."
"When I am sleeping or lying in bed, I should lie flat on my back." With a uterine infection, the client needs to be in a semi-Fowler position to facilitate drainage and prevent the infection from spreading. Changing the perineal pads regularly, walking to promote drainage, and contacting the doctor if her uterus becomes rigid or she notes a decrease in urinary output are all correct actions.
What medications are classified as echinocandin antifungals? (Select all that apply.) Anidulafungin Voriconazole Caspofungin Micafungin Terbinafine
Anidulafungin Caspofungin Micafungin Antifungals in the echinocandin group include anidulafungin, caspofungin, and micafungin. The other two are azoles.
A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis? Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy. Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease. Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection. Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.
Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease. The treatment of choice for Trichomonas vaginalis is oral metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment and eradication of the infection is possible with treatment.
Michael, 25 years old, has had mitral valve regurgitation since age four, after having rheumatic fever. Michael is planning to go to his dentist to have his teeth cleaned. Because of Michael's history he will need to take antibiotics in conjunction with this procedure to prevent bacteremia. Which class of antibiotics will Michael most likely receive if he has no allergies? Vancomycin Penicillin Cephalosporin Tetracycline
Penicillin Penicillin G may also be used as prophylaxis in special patient populations to prevent bacterial endocarditis prior to procedures likely to produce temporary bacteremia, such as dental procedures. These patients include those with prosthetic heart valves, mitral valve prolapse, most congenital heart diseases, and acquired valvular heart disease. It may also be used as prophylaxis in patients with recurrent rheumatic fever or rheumatic heart disease.
Your client is being treated for streptococcal pharyngitis and is NPO. Her health care provider has ordered Penicillin G to be given IM. She wants to know why she cannot take her medications via an oral route. Your best response is: Penicillin G is inactivated by gastric acid, therefore it is only given IM or IV. Penicillin G is inactivated by gastric acid, therefore it is only given IM. Penicillin G can be given orally but requires higher doses. Penicillin G is no longer used for this problem.
Penicillin G is inactivated by gastric acid, therefore it is only given IM or IV. Penicillin G is not effective orally because it is inactivated by gastric acid. Several preparations of penicillin G are available for intravenous (IV) and intramuscular (IM) administration; however, it is important to note that the IV and IM forms of Penicillin G can not be used interchangeably.
The nurse is monitoring a client's postoperative course after an appendectomy. The nurse's assessment reveals that the client has vomited, has abdominal tenderness and rigidity, and has tachycardia. The nurse reports to the physician that the client has signs/symptoms of which complication? Peritonitis Pelvic abscess Ileus Hemorrhage
Peritonitis The nurse should report to the physician that the client has signs/symptoms of peritonitis. Signs/symptoms of a pelvic abscess include anorexia, chills, fever, diaphoresis, and diarrhea. Signs/symptoms of an ileus include absent bowel sounds, nausea, and abdominal distention. Signs/symptoms of hemorrhage include tachycardia, hypotension, anxiety, and bleeding.
What type of lesion are pus-filled?
Pustules
An 11-year-old girl comes into the healthcare provider's office stating dysuria. The nurse suspects a urinary tract infection. Which findings on the laboratory report is consistent with a urinary tract infection? WBCs: 20 per high-power field pH 7.8 Ketones: positive Glucose: positive
WBCs: 20 per high-power field Urinary tract infections are more common in school-aged girls than in school-aged boys. A normal urinalysis would show less than 5 WBCs per high-power field. An elevated WBC count of 20 is an indication of bacteria and urinary tract infection. The normal range of urinary pH is 4.6 to 8.0. The presence of glucose or ketones in the urine does not indicate a urinary tract infection, but may indicate diabetes mellitus.
What type of lesion is defined as an elevated mass with transient, irregular borders?
Wheals
A nurse is caring for an older adult client with tuberculosis. The client has been prescribed ethambutol. Which adverse reactions of ethambutol should the nurse assess for? optic neuritis hypersensitivity epigastric distress vertigo
optic neuritis The nurse should assess for optic neuritis as it is one of the more severe reactions of ethambutol. Hypersensitivity and epigastric distress are adverse reactions associated with isoniazid. Vertigo is an adverse reaction of rifampin.
A client has been on sulfonamide therapy for the last six weeks. What client report may cause the health care provider to discontinue the sulfonamide? 10 lb weight loss Loose stools for the last two days Unable to eat spicy foods Decreased appetite
10 lb weight loss GI side effects with sulfonamide therapy may be mild, such as decreased appetite, inability to eat spicy foods (due to stomatitis), or loose stools for two days. But the drug may need to be discontinued for more serious problems such as pronounced weight loss.
What type of lesion is defined as circumscribed, elevated, palpable masses that contain serous fluid and are less than 0.5 cm in diameter.
Vesicles (herpes zoster)
A client who is taking phenazopyridine for urinary analgesia along with nitrofurantoin calls the clinic to report that her sclera appears yellowish. What is the nurse's best response to this client? "Come immediately to the clinic to be checked for hepatitis." "Stop taking the nitrofurantoin and the health care provider will prescribe another medication." "This is an expected side effect of this medication and is not alarming." "This is a result of the urinary tract infection and will go away once you have completed your anti-infective."
"This is an expected side effect of this medication and is not alarming." Phenazopyridine may cause a yellowish discoloration of the skin or sclera. It is not related to the nitrofurantoin, does not indicate the development of hepatitis, and is not a result of the urinary tract infection.
A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago A client who ambulates in the hallway every 4 hours A client with a nasogastric tube A client who is receiving acetaminophen (Tylenol) for pain
A client with a nasogastric tube Nasogastric, orogastric, and endotracheal tubes increase the risk of pneumonia because of the risk of aspiration from improperly placed tubes. Frequent oral hygiene and checking tube placement help prevent aspiration and pneumonia. Although a client who smokes is at increased risk for pneumonia, the risk decreases if the client has stopped smoking. Ambulation helps prevent pneumonia. A client who receives opioids, not acetaminophen, has a risk of developing pneumonia because respiratory depression may occur.
A nurse is providing health teaching to the parents of a 2-year-old child who has been diagnosed with benign febrile seizures. What is the most important information for the nurse to give the parents about this disorder? Benign febrile seizures will result in a developmental delay for the child. This diagnosis often progresses to one of epilepsy. The seizures will continue throughout the child's life. A respiratory or ear infection is usually present.
A respiratory or ear infection is usually present. An underlying infectious process is often a stimulating factor that triggers the febrile seizures. Parents should be aware of and instructed in how to treat a febrile child. The other options are not accurate in their presentation of febrile seizures.
A patient with TB has been admitted to a health care facility. When providing instructions for the patient teaching related to antitubercular drugs, which instructions should the nurse provide in order to avoid complications in the patient's GI tract? Double the dose if earlier dose is missed. Take prescribed Pyrazinamide without regard to food. Take prescribed Ethambutol with food. Avoid the consumption of alcohol.
Avoid the consumption of alcohol. The nurse should instruct the patient to avoid the consumption of alcohol since alcoholism compounds patient's difficulties and complicates the general condition of the patient's gastrointestinal tract. The nurse should instruct the patient to take the prescribed dose of Ethambutol without regard to food and to take the prescribed Pyrazinamide along with food. The nurse should instruct the patient to avoid doubling the dose in case the earlier dose was missed.
A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which medical diagnosis listed below may be associated with these clinical manifestations? Rocky mountain spotted fever Lyme disease Encephalitis Spinal infection
Encephalitis Encephalitis represents a generalized infection of the parenchyma of the brain or spinal cord. A virus, such as West Nile virus, usually causes encephalitis, although it may be caused by bacteria, fungi, and other organisms. Encephalitis is characterized by fever, headache, and nuchal rigidity. However, more often, people also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma. Rocky mountain spotted fever is a tickborne disease caused by the bacterium Rickettsia rickettsii and usually begins with a sudden onset of fever and headache. A rash may occur 2 to 5 days after fever onset. Lyme disease is also a tickborne disease. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. As the disease progresses, the client develops bouts of severe joint pain and swelling of the joint. Neurologic problems may occur weeks, months, or even years after the infection and may include inflammation of the membranes surrounding your brain (meningitis). Spinal infections can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, and meningitis.
A patient who has been on penicillin therapy for several days has developed inflamed oral mucous membranes and swelling in the tongue and the gums. The primary health care provider has diagnosed it as a fungal superinfection of the oral cavity resulting in impaired oral mucous membranes. Which of the following interventions should the nurse perform? Inspect mouth and gums regularly. Instruct patient to avoid brushing teeth. Offer patient a liquid diet. Instruct the patient to gargle every two hours.
Inspect mouth and gums regularly. The nurse should regularly inspect the patient's mouth and gums to assess the patient's progress. The nurse should instruct the patient to use a soft-bristled toothbrush. The patient need not follow a liquid diet; a nonirritating soft diet can be recommended. Gargling every two hours may not help relieve the symptoms and may even aggravate the existing condition.
What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids? Purulent otitis media Infectious otitis media Serous otitis media Sterile otitis media
Serous otitis media Serous otitis media, a collection of pathogen-free fluid behind the tympanic membrane, results from irritation associated with respiratory allergies and enlarged adenoids. The other options are distractors for this question. Purulent otitis media usually results from the spread of microorganisms from the eustachian tube to the middle ear during upper respiratory infections.
A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply. The incubation period for this virus is up to 4 months. There is a 70% chance that jaundice will occur. Transmission of the virus is possible with oral-anal contact during sex. Typically there is a spontaneous recovery. There is a 50% risk that cirrhosis will develop.
There is a 70% chance that jaundice will occur. Transmission of the virus is possible with oral-anal contact during sex. Typically there is a spontaneous recovery. The incubation period for hepatitis A is 15 to 50 days, with an average of 28 days. The risk of cirrhosis occurs with hepatitis B.
A young pregnant patient with intestinal amebiasis is prescribed a tetracycline. Which can be an adverse effect of the drug? Yellow-gray-brown discoloration of the teeth Toxic effects to the developing fetus Increase in the blood pressure Bacterial overgrowth of nonsusceptible organisms
Toxic effects to the developing fetus There is a possibility of toxic effects to the developing fetus if the patient takes tetracycline drugs during pregnancy. Tetracyclines may cause permanent yellow-gray-brown discoloration of the teeth in children younger than 9 years of age. Tetracyclines do not cause an increase in the blood pressure. Only prolonged or repeated therapy of tetracyclines may result in bacterial or fungal overgrowth of nonsusceptible organisms.
The patient wants to be prescribed an anti-infective drug for the flu. The nurse understands that anti-infective medications would not be useful against which biologic agents? Bacteria Fungi Mycoplasmas Viruses
Viruses Viruses are among the smallest living organisms known and survive as parasites of the living cells they invade. Viruses infect specific cells. Through a complex mechanism, viruses replicate within cells and then invade other cells, where they continue to replicate. As the body mounts an immune response to eliminate the viruses, cells harboring the viruses can be injured in the process. Typically, an inflammatory response and immune reaction are the body's physiologic responses to viral infection. Anti-infective medications are not typically effective against viruses.