Community Chapter 8: Communicable Diseases

26. Which of the following persons is probably most at risk for an infectious disease? a. A member of the janitorial staff who cleans floors and equipment in the hospital b. An adult male who is a firefighter and a trained paramedic c. The family nurse practitioner who sees private clients for health teaching d. The nurse who is a first assistant to the physician in the operating room

ANS: A Although persons in all the options might be exposed to blood-borne pathogens, three of the four are trained professionals who probably understand how to protect themselves. The Occupational Safety and Health Administration (OSHA) requires employers to provide health workers with yearly in-service education on infectious disease control. The janitorial staff member presumably has less education about infectious disease and thus may be less likely to understand the principles behind avoiding exposure to blood-borne pathogens. DIF: Cognitive Level: Analysis REF: p. 211

10. A man had a viral upper respiratory tract infection and was seen by a family nurse practitioner (FNP). The FNP gave the man both verbal and written information about over-the-counter drugs to control symptoms. However, the patient insisted upon a prescription for an antibiotic. Which of the following would be the most appropriate response from the FNP? a. "Antibiotics won't be helpful in treating this infection, but they may allow bacteria that will be immune to antibiotics to develop, putting you at high risk for getting sicker." b. "I'll write you a prescription for a special new research drug that works wonders with viral respiratory infections." Then the FNP writes a prescription for a placebo. c. "I'm the expert. I'll decide when you need an antibiotic. And you do not need one." d. "Of course; I always try to meet the needs of my clients. Which antibiotic do you find works best for you?"

ANS: A Antibiotics should be used prudently to reduce the emergence of drug-resistant strains. Drug-resistant strains are a threat to everyone. However, it is important for the provider to recognize the client's desire to receive an antibiotic and to educate the client about why an antibiotic is not the most appropriate choice at this time. DIF: Cognitive Level: Analysis REF: p. 195

5. Which of the following statements concerning infectious diseases in the United States today is true? a. They account for 25% of all physician visits and are still a major cause of death. b. They are not a community/public health problem in the United States. c. They are a major source of morbidity in the world, but not in the United States. d. They are rarely fatal in the United States.

ANS: A Infectious diseases are a major cause of death in many nonindustrialized countries. Even in the United States, infectious diseases are responsible for 25% of all visits to physicians and remain a leading cause of death. DIF: Cognitive Level: Comprehension REF: p. 192

27. A nurse had just accepted a position but was required to complete some laboratory tests before actually beginning employment. Which of the following test results might be controversial? a. Hepatitis B antibody titer b. Human immunodeficiency virus (HIV) test c. Mantoux test for tuberculosis exposure d. Urine test for drug use

ANS: B All the tests are for problems that can be treated, except HIV infection, which has no cure. Furthermore, if positive test results become known, the nurse could suffer discrimination and social isolation. Mandating such a test is controversial. DIF: Cognitive Level: Application REF: p. 223

17. Which of the following is a major ethical and legal issue for all community/public health care professionals? a. Ensuring total compliance by clients to their treatment regimens b. Balancing individual autonomy against community protection c. Providing home care versus insisting that the client come to the clinic d. Allowing human immunodeficiency virus (HIV) carriers, even if licensed professionals, to be employed within health care agencies

ANS: B An ongoing problem is the right of individuals to remain autonomous versus the community's right to not be exposed to contagious diseases unnecessarily. HIV-positive professionals can work in health care agencies with certain precautions. DIF: Cognitive Level: Comprehension REF: p. 201

12. For what infection are health care professionals particularly at risk? a. Drug-resistant Salmonella infection b. Hepatitis B virus (HBV) c. Multidrug-resistant tuberculosis (MDR-TB) d. Sexually transmitted diseases (STDs), including acquired immune deficiency syndrome (AIDS)

ANS: B Blood-borne pathogens are an occupational risk for health care workers. Scrupulous adherence to universal precautions reduces that risk. DIF: Cognitive Level: Knowledge REF: p. 195 | p. 207

25. An elderly man saw a flyer about a free influenza immunization clinic at the senior citizens' center. Which of the following would be his best choice of action? a. Attending the free immunization clinic to say hello to his social contacts b. Bringing his elderly wife and both receive the influenza immunization c. Realizing that at his advanced age, he's already immune to influenza, and so he does not need to attend the clinic d. Recalling that he and his spouse received an influenza vaccine last year, and so they already have immunity

ANS: B Each year the influenza vaccine is reformulated to represent the strains that will most probably cause problems during the coming year. Hence, the elderly man should bring his wife, and both should be immunized against this year's strains of flu. DIF: Cognitive Level: Application REF: p. 209

20. Which of the following is an example of indirect transmission? a. The backpacker refilled his water container from a faucet in the park labeled "potable water." b. The biologist decided to set up his living quarters in one of the dusty caves, which he first swept out. c. The nursing assistant first put on a pair of gloves and then picked up the soiled dressing. d. The waiter went to the rest room, scrubbed his hands, and then returned to serving the meal.

ANS: B Indirect contact involves passive transmission from contaminated water, dust, or objects. Hantavirus, for example, is inhaled from dust containing rodent feces. DIF: Cognitive Level: Application REF: p. 205

16. Which of the following populations within the hospital should be the focus of infection control when a nurse is trying to decrease the rate of nosocomial infections? a. The staff working in the operating room and the emergency department, where open wounds are frequent b. The clients with indwelling portals of entry, such as Hickman catheters c. The cleaning/maintenance personnel, who must maintain high standards of cleanliness in the hospital d. The visitors coming into the facility, who are bringing outside organisms into the hospital

ANS: B Infections can occur rapidly when there is easy internal access to the body, as seen with central venous pressure catheters, intracranial pressure monitors, and respiratory nebulizers. DIF: Cognitive Level: Analysis REF: p. 201

19. Which of the following definitions of pathogenicity is accurate? a. How easily the agent can mutate to a form that can survive b. How invasive and virulent the organism is c. How much of the agent must be present to produce an illness d. How specific the host must be for the organism to thrive

ANS: B Pathogenicity reflects invasiveness, or how easily the organism can affect more body systems, and virulence, which is how much morbidity and mortality the organism can cause. DIF: Cognitive Level: Knowledge REF: pp. 204-205

30. Why have several states begun to require human immunodeficiency virus (HIV) testing for all incarcerated prisoners? a. As a literal "captive audience," prisoners are a group in which treatment can be enforced. b. Risk for infection is nearly five times higher among prisoners than in the general population. c. There can be no stigma or discrimination, inasmuch as all prisoners are equal before the law. d. This will help protect the public when prisoners are released because if the infection is diagnosed, it can then be treated.

ANS: B Prisoners have a rate of infection nearly five times higher than that among the general public. Many prisons are crowded, and so prisoners are also at high risk for infection. Social justice would imply treatment of this high-risk group. DIF: Cognitive Level: Comprehension REF: p. 225

1. What was one of the first public health measures legislated by the U.S. federal government? a. Funding local government provision of safe water b. Using the power to impose quarantine c. Requiring pasteurization of all milk d. Regulating disposal of waste (garbage and feces)

ANS: B Quarantine was the first measure used on a federal level to restrict spread of infectious diseases. DIF: Cognitive Level: Knowledge REF: p. 191

11. Which of the following persons would be most at risk for contracting an infectious disease? a. The woman who has been taking antituberculosis medication for 3 months b. The elderly woman who recently emigrated with her family from Asia c. A full-time nurse at the local public health clinic d. A volunteer nurse aide at the sexually transmitted disease clinic

ANS: B The elderly emigrant who has two risk factors (age and emigration status) would be the most vulnerable. DIF: Cognitive Level: Analysis REF: pp. 195-196

9. Which of the following groups is most at risk today for an outbreak of pneumococcal pneumonia? a. Adolescents who have not yet received their booster shots b. Persons older than 65 who live in nursing homes and other extended-care facilities c. Elementary school children who have not been immunized d. Young adults who have never been exposed to the agent before

ANS: B The outbreaks in chronic care facilities were determined to be the result of failure to vaccinate at-risk populations, particularly persons older than 65 who live in or visit community settings with many older adults. Because the majority of deaths caused by pneumococcal disease and influenza occur in persons older than 65, nurses should make an effort to ensure that such vaccinations are routinely administered in institutions that serve the older adult population. DIF: Cognitive Level: Comprehension REF: p. 194

22. For the past 3 months, the nurse has been exchanging new needles for used needles at a homeless shelter frequented by drug users. How might the nurse know whether his or her time and effort were effective? a. More people came each night with used needles, asking to exchange them. b. The local health department reported a downward trend in newly diagnosed human immunodeficiency virus (HIV) infection. c. Persons who stayed at the shelter frequently expressed appreciation to the nurse. d. The staff of the homeless shelter stated that they had been serving fewer clients.

ANS: B The study of diseases over time provides valuable information. Trends are useful for recognizing epidemics and for examining the impact of intervention programs. DIF: Cognitive Level: Application REF: pp. 205-206

1. Which of the following is a major reason behind the continued increase in the incidence of tuberculosis? (Select all that apply.) a. Concern over privacy means that many cases of infection are not identified. b. Infectious agents are becoming drug-resistant and are not as susceptible to treatment. c. Many persons are unwilling to name their contacts to public health nurses. d. People are becoming very complacent about practicing good hygiene. e. The environment in the United States is becoming increasingly dangerous. f. Infected persons are not always compliant with the long, costly treatment regimen.

ANS: B, F The incidence of tuberculosis and other infectious diseases is rising because of less success with standard antibiotic therapies. Drug-resistant infections are becoming more widespread. Multidrug-resistant tuberculosis strains developed as clients with tuberculosis became less compliant with their drug therapy. These strains necessitate longer, more costly treatment. DIF: Cognitive Level: Comprehension REF: p. 228

6. Which of the following contributed to several measles epidemics in the 1990s? a. People had stopped getting immunizations for measles and other diseases. b. The measles vaccine was no longer effective against the agent because the virus had mutated. c. The measles vaccine did not provide lifetime immunity. d. Thousands of ineffective contaminated vaccine doses had unknowingly been injected.

ANS: C Although it had been believed that measles immunity lasted for a lifetime, it clearly did not, and one to two booster doses are now recommended for continued protection against measles. DIF: Cognitive Level: Knowledge REF: p. 194

7. Which of the following is the reason for mumps outbreaks among young adults? a. People had stopped getting immunizations for mumps and other diseases. b. The mumps vaccine is no longer effective against the agent because the virus had mutated. c. The mumps vaccine does not provide lifetime immunity. d. Thousands of ineffective contaminated vaccine doses had unknowingly been injected.

ANS: C Although it had been believed that the mumps vaccine given in two doses conveyed lifetime immunity, it clearly did not, and a third dose is now recommended for persons at high risk for exposure to mumps. DIF: Cognitive Level: Comprehension REF: p. 194

18. A community/public health nurse is beginning an investigation of a communicable disease. What is the first action that the nurse will take? a. Diagnose the disease, ask patients to name contacts, and then find those contacts. b. Diagnose the problem, treat it, and then interview the client. c. Identify the disease, isolate the causative agent, and determine the method of transmission. d. Use the media to share symptoms and causes and then have professionals available to answer telephone calls, being sure to obtain names of infected persons.

ANS: C In accordance with epidemiologic principles, communicable disease investigation involves five steps: identifying the disease, isolating the causative agent, determining the method of transmission, establishing the susceptibility of the populations at risk, and estimating the effect on the population. DIF: Cognitive Level: Application REF: p. 202

13. Why, after each hike, did the nurse insist on the scouts checking each other for ticks? a. Ticks can carry noroviruses, which are then easily spread from person to person. b. Ticks can carry hantavirus, which is 30% to 40% fatal. c. Ticks can carry Lyme disease, which is the most common vector-borne disease in the United States. d. Ticks can carry West Nile virus, which causes disease that is currently considered an epidemic.

ANS: C Lyme disease is the most common vector-borne disease in the United States. The vector (carrier) is a tick infested with a spirochete. It is crucial to promptly remove any attached ticks. Noroviruses are transmitted through contaminated food and water and account for most cases of nonbacterial gastroenteritis. Hantavirus does have a significant fatality rate, but it is spread through exposure to aerosol secretions and excretions from rodents. West Nile virus is becoming an increasing problem in the United States, but it is spread by infected mosquitoes. DIF: Cognitive Level: Application REF: p. 197

15. Which of the following persons would be most likely to experience illness? a. The young woman who has just passed the National Council Licensure Examination (NCLEX) and is beginning employment b. The middle-aged man who, along with a wife and oldest child, works at a relative's restaurant c. The young woman whose first child has just been enrolled in daycare d. A middle-aged woman who cares for her elderly mother and father in their home when not at work as a receptionist

ANS: C None of the persons mentioned in the options seems to be in a high-risk aggregate such as infants, undernourished elderly persons, individuals with chronic disease, or immunosuppressed individuals. However, young preschool children spend a lot of time in groups and often bring illnesses home to their caregiver. DIF: Cognitive Level: Analysis REF: pp. 199-200

23. Who is responsible for providing immunizations and direct care services? a. The U.S. Department of Health and Human Services b. The Centers for Disease Control and Prevention c. The local health department d. The state health department

ANS: C Such tasks are the responsibility of the local boards of health. The Centers for Disease Control and Prevention offers financial assistance for many programs aimed at the control of infectious disease. The majority of the functions of the U.S. Department of Health and Human Services involve indirect care, including health planning and resource development, research, health care financing, and regulatory oversight. The state health departments provide or fund direct client services for select populations; they are the central force in maintaining public health. DIF: Cognitive Level: Knowledge REF: p. 206

29. A nurse is preparing a health presentation for a local daycare facility about preventing the spread of illness. Which of the following is the most important intervention to include? a. Checking with the local public health department regarding current epidemics or precautions b. Eating correctly, exercising every day, and getting adequate sleep c. Performing frequent hand-washing with soap and water, especially before eating or touching the face d. Visiting a health care provider once a year for scheduled screenings

ANS: C To prevent infections, the most effective primary prevention measure is frequent hand-washing with soap and water. DIF: Cognitive Level: Application REF: p. 227

8. A mother wanted her child vaccinated against measles. When she read the "benefits and risks" sheet, she changed her mind. Her child was the only one in the class who did not get immunized. What is the probable risk of her child getting measles in elementary school? a. Fairly high, as there is no way to prevent being exposed to measles during childhood b. Fairly low, as measles usually hits in late adolescence now c. Low, as most of the child's playmates have been immunized d. Very high without the protection of immunization

ANS: C Vaccination of 90% of susceptible groups provides substantial protection. Consequently, if the susceptible child was the only one not immunized, there is no one-at least at the school-who could pass on an infection to that child. DIF: Cognitive Level: Application REF: p. 194

14. People are fearful of the West Nile virus. Which of the following statements could a nurse truthfully say to them? a. "You should avoid forested areas to protect yourself." b. "Don't touch any dead birds or other small animals." c. "Wear insect repellent because the disease is spread by infected mosquitoes." d. "The disease is present in only isolated areas of the United States."

ANS: C West Nile virus is spread over a wide geographic area, and the disease is considered an epidemic. Because it is spread by infected mosquitoes, people should consider using insect repellent. DIF: Cognitive Level: Application REF: p. 199

21. Which of the following situations represents an accurate example of passive immunity? a. The nurse who has received three doses of hepatitis B vaccine b. The parents who took their child to a neighbor's house to expose the child to the mumps c. The adult who received three doses of live antigen polio vaccine d. The newborn who had not yet received any immunizations

ANS: D All examples are of active immunity except for the newborn, who has passive immunity from the mother. DIF: Cognitive Level: Application REF: p. 205

24. Which of the following examples best represents effective primary prevention? a. Attending a free community screening b. Engaging in breast self-examination (women) or testicular self-examination (men) c. Following up on any positive screening test d. Immunization according to the recommended schedule

ANS: D All of the other options are secondary measures for diagnosis and treatment. Immunizations are a type of primary prevention. DIF: Cognitive Level: Application REF: p. 207

3. In what way are antibiotics important in reducing the spread of communicable diseases? a. They help keep the environment free of the infectious agent. b. They help the host resist the infection. c. The kill the entire infectious agent upon contact with it. d. They reduce the time during which the disease is contagious in the infected person.

ANS: D Antibiotics have many effects, but they reduce the spread of communicable diseases by decreasing the time during which an infected host can spread a disease. DIF: Cognitive Level: Knowledge REF: p. 192

2. What scientific criteria were developed by Jacob Henle to link an organism to its specific disease? a. Give samples of the organism to three different researchers and see whether all three researchers can grow it successfully. b. Grow the organism on the diseased tissue and then see whether, when spread on normal tissue, the organism continues to grow. c. Identify microorganisms under a microscope and grow them on the tissue that the disease usually infects. d. Identify the organism, isolate the organism, and see if the organism produces disease.

ANS: D Henle's three criteria to link an organism to its specific disease were to identify the organism, isolate it, and use it to generate disease. DIF: Cognitive Level: Knowledge REF: p. 191

31. The nurse works in a sexually transmitted disease (STD) clinic. A young woman has tested positive for two STDs and has named a particular man as her only recent contact. Which of the following actions would represent an error by the nurse? a. Upon telephoning the man, the nurse shared that he had been named as a contact and he needed to come in and be tested. b. When the man came to the STD clinic, he was interviewed, including being asked if he had ever used drugs for recreational purposes. c. When the man was found to test positive for an STD, he was interviewed regarding contacts and asked whether he wished to discuss the problem with his wife or if he wanted the nurse to talk to his wife. d. When the man was not home, the nurse told another person who answered the phone that the STD clinic had called and to please have the man call this number.

ANS: D In finding and interviewing possible STD contacts, it is important that the nurse leave only a name and a phone number but no other information. DIF: Cognitive Level: Analysis REF: p. 227

4. Which of the following actions have had the most success in protecting the public's health? a. Creation of effective broad-spectrum antibiotics b. National immunization campaigns to protect children c. Growth of hospitals and medical and nursing schools in the twentieth century d. Safe water and sewage systems, as well as milk pasteurization

ANS: D Public health practices such as safe water, safe disposal of sewage, and pasteurization of milk have created safer environmental conditions that are primarily responsible for health protection. Other chapters (such as Chapter 5, "International Health") stress that safe water and sewage disposal are among the most important health protection measures that can be taken. DIF: Cognitive Level: Comprehension REF: p. 192

28. A young man had a test for human immunodeficiency virus (HIV) performed on an anonymous basis. When he tried to determine the results of the test, he was asked to come in to the public health department to get the results. Which of the following assumptions is correct? a. The laboratory results were inconclusive, and the test must be repeated. b. The test result came back negative, but he will be asked for a donation. c. The test result came back positive, and the staff want to support him emotionally when this information is shared with him. d. The staff want to counsel him on safer sex practices regardless of the test results.

ANS: D The young man cannot assume anything regarding the test results, although if they are positive, the staff will be supportive. Most programs require persons tested to obtain the results in person in order to provide an additional opportunity to engage in counseling and health education. DIF: Cognitive Level: Application REF: pp. 226-227