Infection
A parent at an educational session on sexually transmitted infections (STIs) asks the nurse if there are vaccines available to prevent STIs. What is the nurse's best response?
Vaccine-preventable STIs can be effectively prevented through preexposure vaccination. Vaccines are under development or are undergoing clinical trials for certain STIs, including HIV and HSV. The only vaccines currently available are for prevention of HAV, HBV, and HPV infection. Vaccination efforts focus largely on integrating the use of these available vaccines into STI prevention and treatment activities.
You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia?
encourage fluid intake
A client with gastroenteritis is admitted to an acute care facility and presents with severe dehydration and electrolyte imbalances. Diagnostic tests reveal the Norwalk virus as the cause of gastroenteritis. Based on this information, the nurse knows that:
enteric precautions should be continued
The nurse is caring for a client with AIDS who has developed cytomegalovirus (CMV). The nurse anticipates the health care provider will order which drug to treat this client?
gancyclovir
An 80-year-old client is diagnosed with latent tuberculosis infection. What is a risk for the elderly population when being treated with INH?
hepatoxocitiy
Which STI could be transmitted perinatally?
herpes simplex virus and syphillis
In which condition present in the client should macrolides be used with caution?
liver dysfunction
A client in the emergency department is diagnosed with a communicable disease. When complications of the disease are discovered, the client is admitted to the hospital and placed in respiratory isolation. Which infection warrants airborne isolation?
measels
A nurse is accessing an implanted vascular access port. What action will the nurse take first in maintaining sterile technique?
perform hand hygeine
The herpes simplex virus type 1 (HSV-1), which produces a cold sore (fever blister), has an incubation period of
2-12 days
Which nursing diagnosis takes highest priority for a client with a compound fracture?
A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection.
Which condition is an example of wound healing by secondary intention?
An infected burn of the arm
A nurse is caring for a client who asks why she has been prescribed posaconazole following kidney transplantation. The nurse responds that posaconazole is used as prophylaxis to prevent:
Aspergillus infection.
A nurse is reviewing a client's medical history. Which factor indicates the client is at risk for candidiasis?
Because corticosteroids decrease host defense, they increase the risk of candidiasis. Candidiasis is rare before menarche and after menopause.
A nurse is examining a client's scalp for evidence of lice. The nurse should pay particular attention to which part of the scalp?
Behind the ears
In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?`
In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.
A client has been diagnosed with osteomyelitis and has been prescribed clindamycin, a narrow spectrum antibiotic. When planning this client's care, the nurse should understand that:
Narrow spectrum antibiotics are appropriate when the identity of the microorganism is known or strongly suspected.
A nurse is assessing vital signs for a postpartum client 48 hours after birth. The vital signs are: T 101.2° F; (38.4° C) HR 82 beats/min.; RR 18 breaths/min.; BP 125/78 mm Hg. How will the nurse interpret the vital signs?
Temperatures elevated above 100.4° F (38° C) 24 hours after birth are indicative of possible infection.
Which type of yeast infection is manifested by white, cheeselike discharge?
The discharge of candidiasis may be watery or thick, but has a white, cheeselike appearance. The other disorders do not have a cheeselike appearance.
The nurse is caring for a client admitted with a diagnosis of bacterial pharyngitis. The nurse anticipates the client will be ordered which medication?
The treatment of choice for bacterial pharyngitis is penicillin.
The parent of a child diagnosed with chickenpox asks when the child can go to play group again. What is the best response by the nurse?
When the lesions have crusted, the client is no longer contagious to others. The child remains contagious when the rash is present, and if the fever occurs as the rash is progressing.
The nurse is caring for a 26-year-old patient who has been diagnosed with roundworms. The patient is prescribed pyrantel. What adverse effect would the nurse inform the patient about?
abdominal pain or discomfort
Which of the following is an inappropriate nursing action by the surgical nurse?
gloves over artificial nails - artificial nails are not allowed due to increased infection
A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus?
he ELISA test will be positive in infants of HIV-infected mothers because of trans-placentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate in detecting true HIV infection in infants and toddlers than the polymerase chain reaction (PCR)
A client became ill with an influenza virus several days ago. Today, the client describes being free of symptoms. What component of the immune system will be predominant today?
supressor T-cells
he nurse teaches the client who demonstrates herpes zoster (shingles) that
the infection results from reactivation of the chickenpox virus
The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following?
Clinical manifestations of peritonitis include abdominal pain and distention, absence of bowel sounds, nausea and vomiting, fever, changes in vital signs.
The nurse is caring for a client who has recurrent sinusitis. Which consideration could the nurse suggest to best decrease the frequency of infections?
OTC decongestant
Before the nurse administers a prescribed anti-infective agent to a client, the nurse should confirm that what action has been performed?
culture testing
The client has been taking her antibiotic for five days. She tells the nurse that she is now experiencing vaginal itching and discharge. The nurse suspects what has occurred?
The client is experiencing a vaginal yeast superinfection related to the use of antibiotics.
An older adult client is being evaluated for suspected pyelonephritis and is ordered kidney, ureter, and bladder (KUB) x-ray. The nurse understands the significance of this order is related to which rationale?
Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors
A patient with cancer who developed neutropenia several days ago has consequently been placed in a single-bed room that has positive pressure. His daughter has just come to visit her father after arriving from her home in another state and has asked you for his room number. You notice that the daughter has reddened eyes, sniffles, and a dry cough. What instruction should you provide to the daughter?
"Even though it might be difficult, it's best for your father's health if you get well before visiting him in person, since he's so vulnerable right now."
A nursing assistant is caring for a client with Clostridium difficile diarrhea and asks the charge nurse, "How can I keep from catching this from the client?" The nurse reminds the nursing assistant to wash her hands and to ensure that the client is placed:
C. difficile can be transmitted from person to person by hands or waste containers such as a bedpan. A nurse who is in direct contact with the client should practice contact isolation, which includes wearing gloves and a gown
The client has been taking levofloxacin IV since admission 12 hours ago for a urinary tract infection. The nurse assesses the client's temperature at 99.8ºF. What is the nurse's best response?
Continue to monitor VS. The provider should be notified if the client's temperature is greater than 101ºF. The nurse cannot discontinue or administer additional doses without a provider's order. The body's normal defense to infection is an elevated temp until it reaches 101 degrees.
A school-age client is experiencing severe itching in both hands that is worse at night. On inspection, the nurse notes gray-brown burrows with epidermal curved ridges and follicular papules. Which nursing diagnosis should the nurse use to plan care for this client?
The client is demonstrating signs and symptoms of scabies, which include gray-brown burrows, epidermal curved or linear ridges, and follicular papules. The nursing diagnosis most appropriate for this client is impaired skin integrity related to the presence of invasive parasites and the development of pruritus.
The nurse planning to insert an indwelling urinary catheter into a client should utilize which technique?
Surgical asepsis, also known as sterile technique, is utilized to keep objects and areas free from microorganisms when performing surgery and procedures such as insertion of an indwelling urinary catheter or IV catheter
A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?
The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI.
Gary is a construction worker who is diagnosed with leprosy and is prescribed rifampin. Gary is married, an alcoholic, and wears contact lenses. At the time of initiating the therapy, the nurse should inform the client:
wear glasses
A nurse is caring for a client who had an aortic balloon valvuloplasty. The nurse should inspect the surgical insertion site closely for which complication(s)?
bleeding and infection
A college student is admitted to the emergency room to be evaluated for aseptic meningitis. The nurse knows that the most serious infecting organism (34% mortality rate) is:
Streptococcus pneumoniae
Painless chancres are associated with which systemic disease?
Syphilis
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?
With a uterine infection, the client needs to be in a semi-Fowler position to facilitate drainage and prevent the infection from spreading.
A client with fungal encephalitis receiving amphotericin B reports fever, chills, and body aches. The nurse knows that these symptoms
may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin.
A group of nursing students and their professor are engaged in a service learning project and will be caring for clients in Haiti. What medication should be administered to prevent the development of malaria?
Chloroquine phosphate is administered to prevent malaria when traveling to the countries where malaria is a risk because of infected mosquitoes
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.
causative organism/infectious agents, reservoir, mode of exit, route of transmission, susceptible host, mode of entry
A nurse is obtaining a prenatal history from a client who's 8 weeks pregnant. To help determine whether the client is at risk for a TORCH infection, the nurse should ask which question?
do you have any cats at home? Toxoplasmosis is transmitted through feces of infected cats (which may occur when emptying a litter box), through ingesting raw meat, or through contact with raw meat followed by improper hand washing
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 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.
A nurse is caring for a 39-year-old client who is taking INH, rifampin, and pyrazinamide. The client reports that her urine is red. What is the most likely cause of this discoloration?
adverse affect of rifampin
When discussing diseases of the middle ear, the nursing instructor distinguishes the different types of otitis media. What generally causes purulent otitis media?
upper respiratory infections