Infectious Disease

A nurse is teaching a client about drug therapy against Plasmodium falciparum. What information should the nurse include in the teaching plan?

The infection generally can be eliminated. Rationale: 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. Reinfestation can occur with a different species or strain of Plasmodium. The immunity is permanent if drug therapy is successful.

Isoniazid (INH) is prescribed as a prophylactic measure for a client whose spouse has active tuberculosis (TB). What statements by the client indicate that there is a need for further teaching? Select all that apply.

"I sometimes allow our children to sleep in our bed at night.",,"I know I also have tuberculosis because the skin test was positive.", ,"I'll be skipping the wine but enjoying the cheese at my neighbor's party." Rationale: The children are at an increased risk because the client's spouse has TB; the children should be screened as members of the household. The positive skin test indicates that the client has been exposed to the bacilli and developed antibodies, not necessarily the disease itself; further diagnostic studies are indicated. Both wine and aged cheese contain tyramine and histamine, which when taken concurrently with INH can cause headache, flushing, and a drop in blood pressure; these should be avoided when taking INH. Pyridoxine (vitamin B6) should be taken to prevent neuritis, which is associated with INH. The prophylactic drug therapy will be continued for 6 to 12 months.

The nurse is providing discharge teaching to a client with acquired immunodeficiency syndrome (AIDS) whose white blood cell count (WBC) is low. Which statement indicates a need for further education? Select all that apply.

"I will eat at least one piece of fresh fruit every day.", "I will walk at the mall twice a week to keep up my strength." Rationale: When a client with AIDS has a low WBC, it is necessary to avoid possible sources of infection. Raw fruit and vegetables should be avoided, as should large gatherings of people who might be ill. When the WBC is low, the client should avoid changing the litter box, and cups and glasses should not be reused. The client should rinse his/her toothbrush in bleach weekly and then rise out the bleach with hot water. Hands should be washed with an antimicrobial soap before eating and drinking, after touching a pet, after using the toilet, and after shaking hands with anyone.

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:

"Sepsis mortality is affected greatly by treatments performed in the first 6 hours." Rationale: 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. However, typically health care team members miss this symptom. 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 who experiences anorexia and fatigue develops jaundice. A diagnosis of hepatitis A is made. The client's spouse and adult children who still live at home ask whether they should receive gamma globulin. Which is the most appropriate response by the nurse?

"You should call your primary healthcare provider immediately about getting gamma globulin." Rationale: Gamma globulin provides passive immunity to hepatitis type A if given to household or sexual contacts within two weeks of exposure. Gamma globulin may provide some protection; contact, not droplet, precautions should be followed. Gamma globulin provides passive immunity for hepatitis type A, not type B. Gamma globulin provides some protection; the hepatitis type A virus is found in the stools of infected individuals before the onset of symptoms and during the first few days of illness.

A client who is to receive nitrogen mustard as part of a drug protocol for cancer asks how this drug works in the body. Before responding in language the client can understand, the nurse considers the actions of nitrogen mustard, which include:

Combining with DNA strands and interfering with cell replication Rationale: Alkylating agents, of which nitrogen mustard is one, combine with DNA strands and interfere with cell replication. Some chemotherapeutic drugs are believed to act by interfering with cellular protein synthesis, but nitrogen mustard does not. 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.

What is the primary focus of nursing care for a client admitted with tetanus caused by a puncture wound?

Decreasing external stimuli Rationale: The slightest stimulation can set off a wave of severe, painful muscle spasms involving the whole body. Nerve impulses cross the myoneural junction and stimulate muscle contraction caused by exotoxins produced by Clostridium tetani. Monitoring urinary output is not a major nursing concern for clients with tetanus. Body alignment is not an important consideration for clients with tetanus. Oral intake of fluids may not be possible because of excessive secretions and laryngospasms.

A client with acquired immunodeficiency syndrome (AIDS) is receiving a treatment protocol that includes a protease inhibitor. When assessing the client's response to this drug, which common side effect should the nurse expect?

Diarrhea Rationale: Diarrhea, nausea, and vomiting are common side effects; clients should take these medications with a meal or light snack. These drugs may cause hyperglycemia, not hypoglycemia. Circumoral (perioral), not peripheral, paresthesias may occur with protease inhibitors; peripheral paresthesias may occur with nucleoside reverse transcriptase inhibitors. Seeing yellow halos around lights does not occur with protease inhibitors; it may occur with digoxin toxicity.

The nurse is caring for a client with sepsis, who is hemodynamically stable. The client is complaining of abdominal pain. Which of these primary health care provider prescriptions should the nurse do FIRST?

Draw peripheral blood cultures Rationale: This question requires the learner to recall the priority treatments for clients with sepsis. Mortality in septic clients increases by 7.6% for every hour an antibiotic is delayed. Because this client is hemodynamically stable, the priority is to draw the blood cultures so the antibiotic can be initiated as soon as possible. Administering the antibiotic before obtaining blood cultures could mask the infection, delaying appropriate treatment. Taking the client to x-ray before obtaining the blood cultures would delay antibiotic initiation.

An older adult, who alternately lives in a homeless shelter and on the street, is brought to the emergency department by friends. The client has a fever, night sweats, and a blood-tinged productive cough. The health care provider suspects that the client has tuberculosis and prescribes a purified protein derivate (PPD) test, chest x-ray, and sputum culture. Place these interventions in the order that they should be performed.

Institute airborne precautions.,Have a chest x-ray performed., Perform a PPD intradermal skin test, Obtain a sputum specimen., Notify the Department of Health. Rationale: Tuberculosis is transmitted via microorganisms that travel with air currents. The client should be placed in a room that has at least six exchanges of air per hour and is ventilated to the outside. Care givers should wear a high-efficiency particulate air respirator. A chest x-ray study is the quickest way to determine the presence of suspicious lesions in the lung. A PPD test can be read in 48 to 72 hours. A positive culture may not develop for 3 to 6 weeks. The Department of Health should be notified when the diagnosis of tuberculosis is confirmed.

What clinical manifestations does a nurse expect a client with systemic lupus erythematosus (SLE) most likely to exhibit? Select all that apply.

Joint pain, facial rash, Pericarditis Rationale: SLE is a chronic, autoimmune disease that affects connective tissue; joint pain is common. A butterfly rash is characteristic of SLE. Pericarditis is the most common cardiac indicator of SLE. Weight loss, not gain, is a classic sign of SLE because of gastrointestinal effects. Renal impairment with SLE may cause hypertension, not hypotension

The nursing staff has a team conference on acquired immunodeficiency syndrome (AIDS) and discusses the routes of transmission of the human immunodeficiency virus (HIV). The discussion reveals that there is no risk of exposure to HIV when an individual:

Makes a donation of a pint of whole blood Rationale: Equipment used in blood donation is disposable; the donor does not come into contact with anyone else's blood. The risk depends on the spouse's previous behavior. 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. An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus.

A client is suspected of having rabies after being bitten by a raccoon. For which clinical indicators should the nurse assess the client? Select all that apply.

Nuchal rigidity, Pharyngeal spasm Rationale: Rabies, an acute infectious disease affecting the central nervous system (CNS), causes stiffness of the back of the neck (nuchal rigidity). Painful pharyngeal spasms when swallowing or even looking at water are responsible for the use of the term hydrophobia to refer to rabies. The CNS is affected; diarrhea is not a concern. Memory is not affected by this disease. Urinary stasis is not an expected problem; catheterization can be employed if necessary.

A client, who has been living in another country for 10 years, is undergoing diagnostic testing to identify the causative organisms of the infection that has been acquired. When caring for this client, the nurse recalls that active immunity occurs when:

Protein substances are formed within the body to neutralize antigens Rationale: 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. Antigens are foreign substances that enter the body and trigger antibody formation. Sensitized lymphocytes do not act as antibodies.

A nurse is caring for a client with a negative-pressure wound treatment device. What should the nurse explain to the client about how this system helps prevent a wound infection?

Removes excess fluid Rationale: Removing excess fluid reduces bacterial load and excess fluid, which is a medium in which organisms grow; these results help prevent a wound infection. The dressing is a vapor-permeable dressing, not a nonpermeable dressing; this vapor-permeable dressing supports gas exchange, thereby reducing growth of anaerobic organisms that flourish in an occlusive oxygen-depleted environment. Promoting circulation facilitates healing; this does not prevent infection. Constant or intermittent suction alters the cytoskeleton of cells in the wound bed, which in turn accelerates the rate of cell activity, increasing fibrogenesis and formation of granulation tissue (fibrin, collagen, and tiny blood vessels); this does not prevent infection.

The nurse understands that the 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 Rationale: A biofilm made up of bacteria develops on long term indwelling catheters. The only way to eliminate this biofilm is to replace the catheter. The efficacy of cranberry tablets in decreasing the frequency of urinary tract infections has not be established. Catheter care is external and may not eliminate the biofilm. Antibiotic therapy may increase the growth of microbes within the biofilm.

A client is admitted with the diagnosis of tetanus. For which clinical indicators should the nurse assess the client? Select all that apply.

Restlessness, Muscular rigidity, Respiratory tract spasms, Spastic voluntary muscle contractions Rationale: Toxins from bacilli invade nervous tissue, causing restlessness. Toxins from bacilli invade nervous tissue, causing muscle spasms and muscular rigidity. Toxins from the bacillus invade nervous tissue; respiratory spasms may result in respiratory failure. Toxins from bacilli invade nervous tissue, causing spastic contraction of voluntary muscles. Tetanus causes spasms of facial muscles, resulting in a grotesque grinning expression (risus sardonicus) and spasms of masticatory muscles (trismus), not atony of facial muscles.