Infection Review PREP U ( NUR2 TEST 2)
Clients with which medical history will have an increased risk for developing urinary tract infections? Select all that apply. a. Urinary obstruction b. Elderly c. Prostate disease d. Not sexually active e. A premenopausal woman f. Neurogenic disorders
a, b, c, f There is an increased risk for UTIs in persons with urinary obstruction and reflux, in people with neurogenic disorders that impair bladder emptying, in women who are sexually active, in postmenopausal women, in men with diseases of the prostate, and in older adults (elderly).
A nurse would implement droplet precautions for a client with which condition? Select all that apply. a. Mumps b. Pertussis c. Ebola virus d. Scabies e. Parvovirus B 19
a, b, e Disorders requiring droplet precautions include pertussis, mumps, and parvovirus B 19. Scabies and viral hemorrhagic infections such as Ebola would require contact precautions.
A client is in the acute care facility for the administration of intravenous (IV) antibiotics to treat bacterial pneumonia. The client begins to have severe diarrhea 3 days after the IV antibiotics with abdominal cramping and pain. What does the nurse suspect the client has developed due to the antibiotic use? a. An allergic reaction to the antibiotic b. A helminth infection c. Pseudomembranous colitis d. Food poisoning
a. When a client is taking an antibiotic, a superinfection can result from overgrowth of microorganisms not affected by the drug. This can lead to a serious inflammation of the colon called pseudomembranous colitis accompanied by potentially life-threatening diarrhea. The nurse should report fever, abdominal cramps, and severe diarrhea immediately. The other choices are not related to the use of the antibiotics.
A 72-year-old female clinic patient is started on trimethoprim-sulfamethoxazole for treatment of a urinary tract infection. Prior to administering this drug, the nurse should assess the patient for which of the following conditions? a. Asthma b. Hypertension c. Renal impairment d. Diabetes mellitus
c. Sulfonamides should be used cautiously in patients with renal impairment.
What is the best rationale for health care providers receiving the influenza vaccination on a yearly basis? a. To eventually eradicate the influenza virus in the United States b. To prevent the emergence of drug-resistant strains of the influenza virus c. To decrease nurses' susceptibility to healthcare-associated infections d. To decrease risk of transmission to vulnerable clients
d. To reduce the chance of transmission to vulnerable clients, health care workers are advised to obtain influenza vaccinations. The vaccine will not decrease nurses' risks of developing health care-associated infections, eradicate the influenza virus, or decrease the risk of developing new strains of the influenza virus.
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? a. Shows damage to the kidneys b. If risk for chronic pyelonephritis is likely c. Reveals causative microorganisms d. Detects calculi, cysts, or tumors
d. Urinary obstruction is the most common cause of pyelonephritis in the older adult. A KUB may reveal obstructions such as calculi, cysts, or tumors. KUB is not indicated for detection of impaired renal function or reveal increased risk for chronic form of the disorder. Urine cultures will reveal causative microorganisms present in the urine.
Which are characteristics of resident flora? Select all that apply. a. They provide a type of natural immunity. b. They do not compete with disease-producing microorganisms. c. They do not cause harm to the body. d. They live on nonsterile areas of the body.
a, c, d Characteristics of resident flora include living on nonsterile areas of the body; not causing harm to the body; providing a type of natural immunity. Not competing with disease producing microorganisms is not a characteristic of resident flora.
A fomite is a/an: a. tick-like ectoparasite. b. infection transfer agent. c. natural antibiotic. d. natural disinfectant.
b. Inanimate objects that carry an infectious agent are known as fomites.
A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following? a. Through the bloodstream (hematogenous spread) b. By ascending infection (transurethral) c. Due to a fistula (direct extension) d. The result of urethra abrasion (sexual intercourse)
b. The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.
The nurse educator is discussing emerging diseases with a group of nurses. The educator should cite what causes of emerging diseases? Select all that apply. a. Use of extended-spectrum antibiotics b. Increased global travel c. Progressive weakening of human immune systems d. Population movements e. Globalization of food supplies
a, b, d, e Many factors contribute to newly emerging or re-emerging infectious diseases. These include travel, globalization of food supply and central processing of food, population growth, increased urban crowding, population movements (e.g., those that result from war, famine, or man-made or natural disasters), ecologic changes, human behavior (e.g., risky sexual behavior, IV/injection drug use), antimicrobial resistance, and breakdown in public health measures. Not noted is an overall decline in human immunity.
Everyone in the family except the mother currently has influenza. What should the nurse tell the mother are appropriate measures to avoid this infection? Select all that apply. a. Frequent hand washing b. Sterilization c. Avoid close contact with family members d. Immunization
a, c, d Immunization, frequent hand washing, and avoiding close contact with family members are appropriate measures to avoid influenza. Sterilization is not an appropriate measure for influenza.
A client who developed acute pyelonephritis asks the nurse what may have caused the infection. Which information will be included in the nurse's response? Select all that apply. a. Escherichia coli is the causative agent in about 80% of cases. b. Severe hypertension often is a contributing factor in the progress of the disease. c. Outflow obstruction, catheterization, and urinary instrumentation cause the complicated, acute form. d. Urinary reflux is the most common cause. e. Acute pyelonephritis is caused by bacterial infection.
a, c, e Acute pyelonephritis is an acute suppurative inflammation of the kidney caused by bacterial infection. Escherichia coli is the causative agent in about 80% of cases, also Enterobacteriaceae, Pseudomonas species, group B Streptococcus, Staphylococcus, and enterococci. Factors that contribute to the development of complicated acute pyelonephritis are outflow obstruction, catheterization and urinary instrumentation, vesicoureteral reflux, pregnancy, and neurogenic bladder. Reflux is the most common cause of chronic pyelonephritis. Severe hypertension is a contributing factor in the progression of chronic pyelonephritis.
What is the term for parasitic relationships between microorganisms and the human body in which the human body is harmed? a. Infectious disease b. Commensal disease c. Communicable disease d. Mutual disease
a. A parasitic relationship is one in which only the infecting organism benefits from the relationship and the host either gains nothing from the relationship or sustains injury from the interaction. If the host sustains injury or pathologic damage in response to a parasitic infection, the process is called an infectious disease. Mutual and commensal relationships do not harm the human body. Communicable diseases can be passed from one human to another; they are not parasitic.
A nurse is interviewing a client with fever, myalgia, headache, and lethargy. Which question is most important for the nurse to ask related to identifying the cause of these symptoms and the possible need for quarantining the client? a. Have you or any family members traveled outside the country recently? b. Did you receive an influenza vaccine this season? c. Are these symptoms similar to an illness you have had in the past? d. Have you been exposed to anyone who has not been vaccinated recently?
a. The client is presenting with the nonspecific symptoms of viral illness. Due to the global market and the ease of international travel, there is increasing risk for global pandemics. Knowing if the client has recently visited certain countries could help identify the most likely viruses to which the client may have been exposed. Being vaccinated for local influenzas is not a guarantee the client has or does not have this, or another, virus. Being exposed to an unvaccinated person is only relevant if that person is infectious; because many viral illnesses present with similar symptoms, this question is not helpful. Having had a virus in the past reduces the likelihood that the client is ill with that same virus.
There are two criteria that have to be met in order for a diagnosis of an infectious disease to occur. What are these two criteria? a. Recovery of probable pathogen and documentation of signs and symptoms compatible with an infectious process. b. Identification by microscopic appearance and Gram stain reaction c. Propagation of a microorganism outside the body and testing to see what destroys it. d. Serology and an antibody titer specific to the serology
a. The diagnosis of an infectious disease requires two criteria: (a) the recovery of a probable pathogen or evidence of its presence from the infected sites of a diseased host, and (b) accurate documentation of clinical signs and symptoms compatible with an infectious process. Culture and sensitivity are the growing of microorganisms outside the body and the testing to see what kills it. Identifying a microorganism by microscopic appearance and Gram stain reaction are not the criteria for diagnosis. Serology, an indirect means of identifying infectious agents by measuring serum antibodies in the diseased host, and the quantification of those antibodies (an antibody titer) are not criteria for diagnosis.
The bacteria that line the gut of a human help maintain normal gut health and provide essential nutrients. This type of relationship is: a. mutualistic. b. commensal. c. parasitic. d. saprophytic.
a. The term mutualism is applied to an interaction in which the microorganism and the host both derive benefits from the interaction. Commensalism is a relationship where the organism receives benefit at no harm to the host. A parasite is an organism that derives benefits from its biologic relationship with another organism with the potential of causing harm.
A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? a. Limit the use of indwelling urinary catheters. b. Administer prophylactic antibiotics as prescribed. c. Toilet residents who are immobile on a scheduled basis. d. Encourage frequent mobility and repositioning.
a. When indwelling catheters are used, the risk of UTI increases dramatically. Limiting their use significantly reduces an older adult's risk of developing a UTI. Regular toileting promotes continence, but has only an indirect effect on the risk of UTIs. Prophylactic antibiotics are not normally given. Mobility does not have a direct effect on UTI risk.
A nurse is caring for a child who was admitted to the pediatric unit with infectious diarrhea. The nurse should be alert to what assessment finding as an indicator of dehydration? a. Weak pulse b. Fever c. Diaphoresis d. Labile BP
a. Assessment of dehydration includes evaluation of thirst, oral mucous membrane dryness, sunken eyes, a weakened pulse, and loss of skin turgor. Diaphoresis, labile BP, and fever are not characteristic signs and symptoms of dehydration.
A client has a concentration of S. aureus located on his skin. The client is not showing signs of increased temperature, redness, or pain at the site. The nurse is aware that this is a sign of a microorganism at which of the following stages? a. Colonization b. Infection c. Bacteremia d. Disease
a. Colonization refers to the presence of microorganisms without host interference or interaction. Infection is a condition in which the host interacts physiologically and immunologically with a microorganism. Disease is the decline in wellness of a host due to infection. Bacteremia is a condition of bacteria in the blood.
A nurse is assessing a client who may be in the early stages of dehydration. Early manifestations of dehydration include: a. thirst or irritability. b. increased heart rate with hypotension. c. sunken eyeballs and poor skin turgor. d. coma or seizures.
a. 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.
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? a. The infection is being transmitted by healthcare personnel. b. The visitors brought the disease into the unit. c. The clients are in too small an area, so they pass around diseases. d. The clients don't wash their hands after going to the bathroom.
a. 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.
A client diagnosed with influenza is admitted to the hospital. Which transmission-based precautions should the nurse initiate? a. Droplet b. Airborne c. Neutropenic d. Contact
a. 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.
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? a. Mode of transmission b. Susceptible host c. Portal of entry d. Agent
a. 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 discharging a 4-year-old boy from the emergency department. The boy was seen for an insect bite that became swollen and reddened and warm and painful to touch. The client's vital signs are all within normal range for age. While giving discharge instructions to the client's father, he asks why the child is not going to get antibiotics for the infected insect bite. What would be your best response? a. "This is a local inflammatory response to the insect bite; it is not an infection so antibiotics will not help." b. "In children who are previously healthy, inflammation and infections usually resolve without the need for drugs." c. "I'll make sure the doctor is made aware that you'd like your son to have a course of antibiotics." d. "Infection is not the same as inflammation. What your son has is inflammation."
a. Regardless of the cause, a general sequence of events occurs in the local inflammatory response. This sequence involves changes in the microcirculation, including vasodilation, increased vascular permeability, and leukocytic cellular infiltration. As these changes take place, five cardinal signs of inflammation are produced: redness, heat, swelling, pain, and loss of function. Infections do not always resolve spontaneously. The nurse should teach the patient's father about the reasons that antibiotics are unnecessary rather than simply deferring to the physician.
When assessing a client with infectious diarrhea, which of the following would lead the nurse to suspect that the client is experiencing severe dehydration? a. Rapid, thready pulse b. Dry oral mucous membranes c. Increased thirst d. Sunken eyes
a. Severe dehydration is manifested by signs of shock such as rapid, thready pulse, cyanosis, cold extremities, rapid breathing, lethargy, and coma. Dry oral mucous membranes and increased thirst suggest mild dehydration. These findings along with sunken eyes suggest moderate dehydration.
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? a. Chemistry studies b. Microbiology report c. MRI report d. The complete blood count (CBC)
b. 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.
A client reports nausea, vomiting, and diarrhea for 5 days. The nurse assesses the mucous membranes as pale and dry. The client has sunken eyes with the following vital signs: pulse 122 and thready, respirations 23, blood pressure 78/55, temperature 101.8°F oral. Which is the priority nursing intervention? a. Request an order from the physician for IV rehydration therapy. b. Initiate oral rehydration therapy at 100 mL/kg of oral rehydration solution over 4 hours. c. Assess vital signs every 15 minutes. d. Obtain stool specimen for analysis.
a. The client is demonstrating hemodynamic instability that could lead to shock; therefore IV rehydration therapy is indicated. Oral rehydration therapy can begin once the client becomes hemodynamically stable. Although it is appropriate for the nurse to take vital signs frequently, the client needs fluid replacement and that need should be addressed first. Stool specimens can be obtain once the client is hemodynamically stable.
A nurse advises a client with recurring UTIs to drink large amounts of water. What normal protective action is the nurse telling the client to utilize? a. Increase washout of urine b. Decrease acidity of urine c. Increase immune availability d. Thin mucus to prevent bacterial adherence
a. The normal flow of urine functions to wash bacteria from the urinary tract. If a client is not drinking enough, urine can become stagnant and promote infection. Increased consumption of water will increase the washout. Water has no effect on acidity, consistency of mucus, or immune function.
Which of the following is the most common site of a nosocomial infection? a. Urinary tract b. Respiratory tract c. Gastrointestinal tract d. Skin
a. The urinary tract is the most common site of nosocomial infection, accounting for greater than 3% of the total number reported by hospitals each year.
A female client has been prescribed a course of antibiotics for the treatment of a UTI. When providing health education for the client, the nurse should address what topic? a. The risk of developing a vaginal yeast infection as a consequence of antibiotic therapy b. The need to expect a heavy menstrual period following the course of antibiotics c. The risk of developing antibiotic resistance after the course of antibiotics d. The need to undergo a series of three urine cultures after the antibiotics have been completed
a. Yeast vaginitis occurs in many clients treated with antimicrobial agents that affect vaginal flora. Antibiotics do not affect menstrual periods and serial urine cultures are not normally necessary. Resistance is normally a result of failing to complete a prescribed course of antibiotics.
An adult client in the ICU has a central venous catheter in place. Over the past 24 hours, the client has developed signs and symptoms that are suggestive of a central line associated bloodstream infection (CLABSI). What aspect of the client's care may have increased susceptibility to CLABSI? a. The client was treated for vancomycin-resistant enterococcus (VRE) during a previous admission. b. The client's central line was placed in the femoral vein. c. The client had blood cultures drawn from the central line. d. The client has received antibiotics and IV fluids through the same line.
b In adult clients, the femoral site should be avoided in order to reduce the risk of CLABSI. Drawing blood cultures, receiving treatment for VRE, and receiving fluids and drugs through the same line are not known to increase the risk for CLABSI.
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. a. fomites b. portal of entry c. susceptible host d. infectious agent e. virulence
b, c, d 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.
The nurse is providing an education program to reduce the incidence of infection currently on the rise in the community. What areas should the nurse focus on when presenting this program? (Select all that apply.) a. Swimming in the community pool b. Immunization programs c. Regulated health practices d. The use of antibiotics to prevent infections e. Sanitation techniques
b, c, e Methods of infection prevention include sanitation techniques (e.g., water purification, disposal of sewage and other potentially infectious materials), regulated health practices (e.g., the handling, storage, packaging, and preparation of food by institutions), and immunization programs.
The nurse is reviewing the medical records of several patients who have been diagnosed with the following infections: Patient A: Mumps Patient B: Respiratory syncytial virus Patient C: Tuberculosis Patient D: Impetigo Patient E: Scabies The nurse would implement contact precautions for which patients? Select all that apply. a. Patient C b. Patient D c. Patient B d. Patient A e. Patient E
b, c, e 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 nurse is counseling a client about risk factors for yeast infections. Which should the nurse list as a risk factor for an overgrowth of Candida albicans? Select all that apply. a. Core body temperature of 37°C (98.6°F) b. Decrease in amount of bacterial flora c. Recent exposure to a person with athlete's foot d. Antibiotic therapy e. Impaired immune system
b, d, e Systemic mycoses are serious fungal infections of deep tissues and, by definition, are caused by organisms capable of growth at 37°C (98.6°F). Yeasts such as Candida albicans are commensal flora of the skin, mucous membranes, and gastrointestinal tract and are capable of growth at a wider range of temperatures. Intact immune mechanisms and competition for nutrients provided by the bacterial flora normally keep colonizing fungi in check. Alterations in either of these components by disease states or antibiotic therapy can upset the balance, permitting fungal overgrowth and setting the stage for opportunistic infections.
Infectious agents produce products or substances called virulence factors that make it easier for them to cause disease. Which of these are virulence factors? Select all that apply. a. Prodromal factors b. Invasive factors c. Evasive factors d. Adhesion factors e. Toxins
b,c,d,e Virulence factors are substances or products generated by infectious agents that enhance their ability to cause disease. Although the number and type of microbial products that fit this description are numerous, they can generally be grouped into four categories: toxins, adhesion factors, evasive factors, and invasive factors. Prodromal means occurring first or prior to a specific event. It is not a virulence factor.
When administering aminoglycosides, the nurse must be aware of which of the following adverse reactions? a. Glaucoma and renal failure b. Ototoxicity and nephrotoxicity c. Hypoglycemia and hyperglycemia d. Liver necrosis, or hepatic failure
b. After parenteral administration, aminoglycosides are widely distributed in extracellular fluid and reach therapeutic levels in blood, urine, bone, inflamed joints, and pleural and ascitic fluids. They accumulate in high concentrations in the proximal renal tubules of the kidney leading to acute tubular necrosis. This damage to the kidney is termed nephrotoxicity. They also accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and the vestibular apparatus. This damage to the inner ear is termed ototoxicity.
Which of the following describes host interaction with an organism? a. Infectious disease b. Infection c. Reservoir d. Colonization
b. 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.
The nurse is providing care for an older adult client who has developed signs and symptoms of Calicivirus (Norovirus). What assessment should the nurse prioritize when planning this client's care? a. Respiratory status b. Fluid intake and output c. Pain d. Deep tendon reflexes and neurological status
b. The vomiting and diarrhea that accompany Norovirus create a severe risk of fluid volume deficit. For this reason, assessments relating to fluid balance should be prioritized, even though each of the listed assessments should be included in the plan of care.
Following a knee replacement, a client develops an infection at the site. After months of unsuccessful anti-infective therapy, the surgeon removed the implant. What explanation can the nurse provide when the client asks why the anti-infective therapy did not work? a. Microbes are becoming more resistant to antibiotic therapy. b. Organisms on a colonized implant produce a self-protecting biofilm. c. The knee replacement may have been contaminated at the factory. d. Toxins in the organism have damaged the new joint implant.
b. If infected, artificial heart valves, joint replacements, and other implanted medical devices can become colonized. The infecting organism produces a matrix of cells and capsular material that prevents the infection from being cleared from the body. At that point, the implant must be removed to clear the infection.
A client is taking a vacation in a foreign country. The nurse teaches the client about giardiasis, a common traveler's infection. Which statement should be included in the teaching plan? a. Avoid close contact with other passengers while flying on an airplane. b. Avoid eating food and drinking beverages that might be contaminated. c. Avoid swimming in the coastal waters of the foreign country. d. Complete the necessary inoculations before traveling out of the country.
b. Protozoa are unicellular animals with a complete complement of eukaryotic cellular machinery, including a well-defined nucleus and organelles. Most are saprophytes, but a few have adapted to the accommodations of the human environment and produce a variety of diseases, including malaria, amebic dysentery, and giardiasis. Protozoan infections can be passed directly from host to host as through sexual contact, indirectly through contaminated water or food, or by way of an arthropod vector.
Which objective symptom of a UTI is most common in older adults, especially those with dementia? a. Incontinence b. Change in cognitive functioning c. Hematuria d. Back pain
b. The most common objective finding is a change in cognitive functioning, especially in those with dementia, because these clients usually exhibit even more profound cognitive changes with the onset of a UTI. Incontinence, hematuria, and back pain are not the most common presenting objective symptoms.
The nurse who teaches a client about preventing recurrent urinary tract infections would include which statement? a. Take tub baths instead of showers. b. Void immediately after sexual intercourse. c. Increase intake of coffee, tea, and colas. d. Void every 5 hours during the day.
b. Voiding flushes the urethra, expelling contaminants. Showers are encouraged, rather than tub baths, because bacteria in the bath water may enter the urethra. Coffee, tea, colas, alcohol, and other fluids that are urinary tract irritants should be avoided. The client should be encouraged to void every 2 to 3 hours during the day and completely empty the bladder.
A nurse is giving discharge instructions for a client who was diagnosed with acute pyelonephritis 3 days previously. Which instruction is important for the nurse to discuss when teaching the client? a. The client will require bed rest at home for 7 days. b. It is important that the client take the prescribed antibiotic for the duration of the prescription. c. Because the client received antibiotics in the hospital, there are no further medications required. d. Restrict fluid intake to 1 L/day.
b. Acute pyelonephritis is treated with appropriate antimicrobial drugs and may also require intravenous hydration. Unless obstruction or other complications in the client occur, the symptoms usually disappear within several days. Treatment with an appropriate antimicrobial agent usually is continued for 10-14 days.
A client with a sacral pressure ulcer has had a urinary catheter inserted. As a result of this new intervention, the nurse should prioritize what nursing diagnosis in the client's plan of care? a. Impaired physical mobility related to presence of an indwelling urinary catheter b. Risk for infection related to presence of an indwelling urinary catheter c. Toileting self-care deficit related to urinary catheterization d. Disturbed body image related to urinary catheterization
b. Catheters create a high risk for UTIs. Because of this acute physiologic threat, the client's risk for infection is usually prioritized over functional and psychosocial diagnoses.
A middle-aged woman is admitted with acute pyelonephritis. Which assessment finding correlates with this diagnosis? a. systemic infection b. Flank pain, dysuria, and nausea/vomiting c. scarring and deformation of the renal calyces and pelvis d. poorly controlled hypertension
b. Manifestations of acute pyelonephritis include pain, frequency, urgency, dysuria, nausea, and vomiting. Chronic rather than acute pyelonephritis is often caused by hypertension, while most cases are caused by ascending bacteria, not systemic infections. Scarring is more commonly a result of chronic pyelonephritis.
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? a. "Colonization and infection are interchangeable terms used to describe a bacterial invasion." b. "Colonization becomes infection when the host and organism interact." c. "Both colonization and infection require treatment with different antibiotics." d. "Colonization results in symptoms such as redness and swelling, infection results in fever."
b. 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.
A nurse implements aseptic technique as a means to break the chain of infection at which element? a. Reservoir b. Portal of entry c. Portal of exit d. Means of transmission
b. 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.
A nurse is preparing to administer a client's scheduled dose of subcutaneous heparin. To reduce the risk of needlestick injury, the nurse should perform what action? a. Recap the needle immediately before leaving the room. b. Avoid recapping the needle before disposing of it. c. Wear gloves when administering the injection. d. Recap the needle before leaving the bedside.
b. Used needles should not be recapped. Instead, they are placed directly into puncture-resistant containers near the place where they are used. Gloves do not prevent needlestick injuries.
A gerontologic nurse is assessing a client who has numerous comorbid health problems. What assessment findings should prompt the nurse to suspect a UTI? Select all that apply. a. Food cravings b. Insatiable thirst c. New onset of confusion d. Fever e. Upper abdominal pain
c, d Early symptoms of UTI in older adults include burning, urgency, and fever. Some patients develop incontinence and delirium with the onset of a UTI. Food cravings, increased thirst, and upper abdominal pain necessitate further assessment and intervention, but none are directly suggestive of a UTI.
A woman reports to the nurse that she has developed a yeast infection. The woman does not understand how she could get a yeast infection since she has been on antibiotics for a urinary tract infection. What is the rationale for this client's complaint? a. Yeast grows well when exposed to sugar, which is found as a carrier substance in most antibiotics. b. Antibiotics allow yeast to access sterile environments in the body. c. Destroying one type of resident flora (bacteria) can allow overproliferation of another competing type (yeast). d. Yeast prefers a warm, moist, and dark environment, such as that present in the female perineum.
c. Yeast are commensal flora of the skin, mucous membranes, and gastrointestinal tract and are capable of growth at a wider range of temperatures. Intact immune mechanisms and competition for nutrients provided by the bacterial flora normally keep colonizing fungi in check. Alterations in either of these components by disease states or antibiotic therapy can upset the balance, permitting fungal overgrowth and setting the stage for opportunistic infections.
Acute pyelonephritis is a result of: a. Viral infection b. Chronic reflux c. Bacterial infection d. Renal failure
c. Acute pyelonephritis represents a bacterial infection of the upper urinary tract, specifically the kidney parenchyma and renal pelvis. Gram-negative bacteria, including Escherichia coli and Proteus, Klebsiella, Enterobacter, and Pseudomonas species, are the common causative agents. Staphylococcus species and Streptococcus faecalis may also cause pyelonephritis, but they are uncommon.
A client's diagnostic testing revealed that he is colonized with vancomycin-resistant enterococcus (VRE). What change in the client's health status could precipitate an infection? a. Treatment of a concurrent infection using vancomycin b. Use of a narrow-spectrum antibiotic c. Development of a skin break d. Persistent contact of the bacteria with skin surfaces
c. Colonization can progress to infection if there is a portal of entry by which bacteria can invade body tissues. The use of vancomycin, or any other antibiotic, would not necessarily precipitate a VRE infection. Prolonged skin contact is similarly unlikely to cause infection, provided the skin remains intact.
Which term is used to describe microorganisms present in a host without host interference or interaction? a. Infection b. Normal flora c. Colonization d. Reservoir
c. 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.
The nurse is caring for several older clients. For which client would the nurse be especially alert for signs and symptoms of pyelonephritis? a. A client with acute renal failure b. A client with a urinary tumor c. A client with urinary obstruction d. A female client with preexisting chronic glomerulonephritis
c. The client with urinary obstruction is at the highest risk of developing pyelonephritis because a urinary obstruction is the most common cause of pyelonephritis in older adults. Acute glomerulonephritis usually occurs in older adults with preexisting chronic glomerulonephritis. Older clients with acute renal failure or urinary tumor are not at high risk for developing pyelonephritis.
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? a. Document the reaction to the previous immunization. b. Obtain further history regarding the reaction and immunization. c. Withhold the immunization. d. Administer the Tdap as ordered.
c. 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.
An 8-year-old female is diagnosed with a third urinary tract infection (UTI) this calendar year. For what condition is it most important for the nurse to advocate assessment? a. Goodpasture syndrome b. Nephrotic syndrome c. Vesicoureteral reflux d. Autosomal dominant polycystic kidney disease
c. Vesicoureteral reflux is associated with UTIs and therefore should be investigated. While ascending UTIs in autosomal dominant polycystic kidney disease can cause complications with the cysts in this condition, it is less associated with UTIs than vesicoureteral reflux. Nephrotic syndrome involves the loss of proteins in the urine and is not associated with UTI development. Goodpasture syndrome is an autoimmune cause of glomerulonephritis and does not present as a UTI.
Which individual is at the highest risk of developing a urinary tract infection (UTI)? a. A 60-year-old man with a history of cardiovascular disease who is recovering in hospital from a coronary artery bypass graft b. A 38-year-old man with high urine output due to antidiuretic hormone insufficiency c. A 30-year-old woman with poorly controlled diabetes mellitus d. A 66-year-old man undergoing dialysis for the treatment of chronic renal failure secondary to hypertension
c. Young women as well as persons with diabetes are at high risk of UTIs. Neither postsurgical recovery nor renal failure are necessarily direct risks for UTI development, and high urine output would decrease rather than increase UTI risk.
A nurse is preparing to insert a peripheral intravenous access device into the arm of a client. When preparing the skin for insertion, which of the following should the nurse use to prevent possible health-care associated bloodstream infections? a. Normal saline b. Alcohol c. Chlorhexidine d. Povidone-iodine
c. Although povidone-iodine or alcohol may be used, the preferred agent to clean the skin prior to insertion of an intravenous device is chlorhexidine. Normal saline would not be appropriate.
A female client's most recent urinalysis results are suggestive of bacteriuria. When assessing this client, the nurse's data analysis should be informed by what principle? a. Urine contains varying levels of healthy bacterial flora. b. A diagnosis of bacteriuria requires three consecutive positive results. c. Urine samples are frequently contaminated by bacteria normally present in the urethral area. d. Most UTIs in female clients are caused by viruses and do not cause obvious symptoms.
c. Because urine samples (especially in women) are commonly contaminated by the bacteria normally present in the urethral area, a bacterial count exceeding 105 colonies/mL of clean-catch, midstream urine is the measure that distinguishes true bacteriuria from contamination. A diagnosis does not require three consecutive positive results and urine does not contain a normal flora in the absence of a UTI. Most UTIs have a bacterial etiology.
A nurse is assessing a client with diarrheal disease and determines that the condition has most likely resulted from a parasitic infection. Which of the following would be a potential cause? Select all that apply. a. Shigella b. Salmonella c. E. coli d. Giardia e. Cryptosporidium
d, e Parasitic infections associated with diarrhea include Giardia, cryptosporidium, and entamoeba histolytica. E. coli, salmonella, and shigella are bacterial causes of diarrhea.
The nurse is teaching a health class about UTIs to a group of older adults. What characteristic of UTIs should the nurse cite? a. Men over age 65 are equally prone to UTIs as women, but are more often asymptomatic. b. Men of all ages are less prone to UTIs, but typically experience more severe symptoms. c. The prevalence of UTIs in men cannot be reliably measured, as men generally do not report UTIs. d. The prevalence of UTIs in men older than 50 years of age approaches that of women in the same age group.
d. The antibacterial activity of the prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging. The prevalence of infection in men older than 50 years of age approaches that of women in the same age group. Men are not more likely to be asymptomatic and are not known to be reluctant to report UTIs.
A client is ordered to receive a fluoroquinolone, ciprofloxacin, to treat a bacterial infection. The nurse instructs the client to monitor for which potentially dangerous side effect associated with fluoroquinolone therapy? a. Renal failure b. High fevers c. Photophobia and phototoxicity d. Tendon rupture
d. Fluoroquinolones such as ciprofloxacin inhibit DNA synthesis and can have side effects such as gastrointestinal irritation and tendon rupture.
A cytotechnologist is examining a blood sample. Which must be identified for a diagnosis of infectious disease? a. Positive serology b. Genomic sequences c. Detection of pathogenic metabolites d. Recovery of probable pathogen
d. The recovery of the pathogen and signs of the infection are the criteria necessary for diagnosis of an infectious disease. Genomics, serology, and pathogenic metabolite detection are techniques the cytotechnologist could use to recover the pathogen.
A client was unaware that intestinal flora are beneficial, stating, "I thought all bacteria were bad." Which is the nurse's most accurate response? a. "Any organism capable of supporting the nutritional and physical growth requirements of another is called a host." b. "There's a parasitic relationship by which the bacteria benefits but there's a minimal effect on the host's health." c. "An interaction such as this is called commensalism: The colonizing bacteria acquire nutritional needs and shelter, and the host is able to keep their numbers under control." d. "The term 'mutualism' is applied to an interaction in which the microorganism and the host both derive benefits from the interaction."
d. The relationship between host (human) and bacteria that colonize the gut is a mutualistic relationship. The bacteria digest and synthesize nutrients that we cannot digest. With commensalism there is no net benefit or loss, such as is seen in a parasitic relationship; the host is separate from the bacteria.
A parent asks the nurse what signs and symptoms a child would display if the child had a urinary tract infection. Which is the best response by the nurse? a. The same symptoms as an adult. b. The child's immune system is weak so he or she will not have foul-smelling urine. c. The child will not have a fever. d. The child does not present with typical symptoms
d. Unlike adults, children frequently do not present with the typical signs of a UTI. A urinary tract infection should be suspected when the child presents with a fever that has no other cause. The parents should be educated to report any abnormal colored or cloudy urine because this is also an early indication of a urinary tract infection.
A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis? a. Acute renal failure b. Renal cell carcinoma c. Renal calculi d. Acute pyelonephritis
d. Acute pyelonephritis tends to present with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in the loin area of the back that is unilateral or bilateral. Lower urinary tract symptoms, including dysuria, frequency, and urgency also are common. There may be significant malaise, and the person usually looks and feels ill. Nausea and vomiting may occur along with abdominal pain. Cancer, kidney stones, and acute renal failure have different presentations.
The nurse educator identifies the student understands the function of normal flora in the human body when the student makes which statement? a. Normal flora includes the bacteria that cause sexually transmitted infections in humans. b. Normal flora fight infection by working to engulf invading pathogens. c. Normal flora becomes the cause of illness when the body perceives threat of foreign bacteria. d. Normal flora compete with potential pathogens and work symbiotically with the host.
d. Bacteria found throughout the body usually provide beneficial normal flora to compete with potential pathogens, to facilitate digestion, or to work in other ways symbiotically with the host. Normal flora does not engulf invading pathogens, an immune system reaction enlists the white blood cells to migrate to the site of the infection to do this work. Bacteria causing sexually transmitted infections are not part of the normal flora that exist in the various reservoirs of the body. Normal flora is not the cause of illness during a bacterial infection, it is when the normal flora have lost the ability to compete with the invading pathogen when a person becomes ill.
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection? a. Use clean technique during insertion b. Use sterile technique to disconnect the catheter from the tubing to obtain urine specimens c. Place the catheter bag on the client's abdomen when moving the client d. Perform meticulous perineal care daily with soap and water
d. Cleanliness of the area will reduce potential for infection. Strict aseptic technique must be used when inserting a urinary bladder catheter. The nurse must maintain a closed system and use the catheter's port to obtain specimens. The catheter bag must never be placed on the client's abdomen unless it is clamped because it may cause urine to flow back from the tubing into the bladder.
Acute postinfectious glomerulonephritis, as its name implies, follows an acute infection somewhere else in the body. What is the most common cause of acute postinfectious glomerulonephritis? a. E. coli b. S. aureus c. P. aeruginosa d. Group A β-hemolytic streptococci
d. Group A β-hemolytic streptococci have the ability to seed from one area of the body to another. One area it seeds to is the kidney, where it causes acute postinfectious glomerulonephritis. Other organisms can cause acute postinfectious glomerulonephritis, but they are not the most common cause of the disease.
A child has been brought to an urgent care clinic. The parents state that the child is "not making water." When taking a history, the nurse learns the child had a sore throat about 1 week ago but seems to have gotten over it. "We [parents] only had to give antibiotics for 3 days for the throat to be better." The nurse should suspect the child has developed: a. nephrotic syndrome. b. kidney stones. c. acute renal failure. d. acute postinfectious glomerulonephritis.
d. The classic case of poststreptococcal glomerulonephritis follows a streptococcal infection by approximately 7 to 12 days: the time needed for the development of antibodies. The primary infection usually involves the pharynx (pharyngitis), but can also result from a skin infection (impetigo). Oliguria, which develops as the GFR decreases, is one of the first symptoms.
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: a. the client's infection may be caused by droplet transmission. b. enteric precautions can be discontinued. c. the client requires an antiviral agent. d. enteric precautions must be continued.
d. The nurse must continue enteric precautions for a client with gastroenteritis caused by the Norwalk virus because this virus is transmitted by the fecal-oral route. No safe and effective antiviral agent is available specifically for treating viral gastroenteritis. The Norwalk virus isn't transmitted by droplets.
