Med surg. Chapter 71

A client is admitted with bacterial meningitis. Which hospital room is the best choice for this client?

An isolation room three doors from the nurses' station

You are a school nurse teaching a health class about the chain of infection in the transmission of sexually transmitted diseases (STDs). A student asks you which part of the chain of infection can be missing when transmission occurs. What would be your best answer?

"All parts of the chain of infection have to be present for the disease to be passed to another human."

The nurse is caring for a patient diagnose with severe acute respiratory syndrome (SARS). A family member asks what causes SARS. Which of the following responses by the nurse is accurate?

"Coronavirus"

The nurse is instructing the family on home care of a patient with shingles. The family member asks if their teenage children should stay in a different room. What is the best response by the nurse?

"Have they had chickenpox or the varicella vaccine?"

Which statement made by a client with a chlamydial infection indicates understanding of the potential complications?

"I need to treat this infection so it doesn't spread into my pelvis because I want to have children some day."

A nurse is assessing a woman with vaginal discharge. The nurse suspects bacterial vaginosis when the client states which of the following?

"I noticed a strange fishy odor during my period."

A client is diagnosed with a viral illness and requests an antibiotic to "cure" his illness. When the request is refused by the physician, the client states to the nurse, "I will never get better."What is the best response by the nurse?

"Prescribing antibiotics for a viral infection may result in drug-resistant bacteria."

A nurse is teaching personal hygiene care techniques to a client with genital herpes. Which statement by the client indicates the teaching has been effective?

"I will wear loose cotton underwear."

The nurse has been teaching a client with genital herpes how to care for the lesions. Which of the following statements by the client indicates that she needs additional instruction?

"I'll wear occlusive underwear to prevent transmission of the virus."

A pregnant patient asks the nurse if it is all right for her take the varicella immunization for entrance into nursing school. What is the best response by the nurse?

"It is not recommended that pregnant women take the live virus. You should wait until after your child is born."

The nurse is giving an educational talk to a local parent-teacher association. A parent asks how he can help his family avoid community-acquired infections. What would be the nurse's best response to help prevent and control community-acquired infections?

"Make sure your family has all their childhood immunizations."

A client you are caring for has developed a bladder infection while in the hospital. The client has had a Foley catheter for two weeks. The client's family asks you how the client got this infection. What would be your best response?

"People in hospitals are often more susceptible to infections because they are already ill and they are exposed to germs while they are in the hospital."

A 36-year-old patient is in the clinic for an annual physical. The patient asks the nurse "should I get a flu shot." Which of the following is the best response by the nurse?

"The flu shot is recommended for people over 6 months of age."

An adolescent informs the school nurse that she is afraid of contracting an STI but her boyfriend does not want to use condoms. What is the best response by the nurse?

"The use of condoms is one of the best ways to reduce the risk of acquiring an STI."

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 vesicles and pustules have crusted."

The nurse is caring for a client with an abscess on his back. The nurse observes purulent drainage coming from the abscess. What type of specimen does the nurse anticipate the physician will order to determine the type of bacteria present in the exudate?

A culture

Which of the following medications are used to suppress viral load of the HSV-2 infection?

Acyclovir (Zovirax)

A nurse is having a yearly employee tuberculin skin test. Which skin test results would indicate a positive result?

An induration of 12mm

You are caring for a client with an impaired immune system. You are concerned about the client acquiring a nosocomial infection. What intervention would help nurses control nosocomial infections?

Apply principles of medical and surgical asepsis.

The nurse observes a physician leave the room of a patient in isolation for Clostridium difficile (C. difficile). The physician uses the alcohol-based hand sanitizer hanging on the wall to wash her hands and leaves the door open. Which of the following actions should the nurse take?

Ask the physician to wash her hands with soap and water.

A client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client's history and physical findings, the physician suspects legionnaires' disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What's the drug of choice for treating legionnaires' disease?

Azithromycin (Zithromax)

The six elements necessary for infection include a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, in addition to which of the following?

Mode of entry to host

Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually transmitted infection, gonorrhea. What would contribute to her ignorance of her condition?

Being asymptomatic

The nurse is providing care to a client who has been diagnosed with gonorrhea. The nurse also prepares the client for treatment of which of the following?

Chlamydia

In which group is it most important for the client to understand the importance of an annual Papanicolaou test?

Clients infected with the human papillomavirus (HPV)

A nurse would anticipate instituting contact precautions for a client with which of the following?

Clostridium difficile infection

Which of the following terms refers to a state of microorganisms being present within a host without causing host interference or interaction?

Colonization

The nurse is providing discharge instructions to a female client following inpatient therapy for a gonorrhea infection. The client is being discharged on doxycycline (Vibramycin) for 7 days. Which nursing instruction is essential for a therapeutic outcome?

Complete all prescribed medication.

The following outcome appears on the plan of care for a client with genital herpes: "Client demonstrates knowledge about measures to reduce the risk of transmission and recurrences." Which of the following, if reported by the client, would support achievement of this outcome?

Consistently uses condoms with sexual activity

Which of the following is the most effective treatment for trichomoniasis?

Metronidazole (Flagyl)

Which of the following is the gold standard for herpes simplex virus (HSV) diagnosis?

Culture

Symptoms of pelvic infection usually begin with which of the following?

Dyspareunia

A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?

Foul-smelling discharge from the penis

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment?

Genital herpes

A client is hospitalized with a Clostridium difficile infection. Which of the following would the nurse include when providing care to this client?

Gloves and gowns for all client contact

The infection control nurse collects data that indicates an increase in the number of clients in the hospital with multidrug-resistant infections. What priority education should healthcare providers receive?

Hand hygiene

Which of the following sexually transmitted infections (STIs) could be transmitted perinatally?

Herpes simplex

The nurse is admitting a patient with severe diarrhea. What is the most important element of assessment for this patient?

Hydration status

The nurse is caring for a client with genital herpes experiencing a reoccurrence. Which nursing diagnosis would be the priority?

Impaired Skin Integrity

Which intervention should a nurse perform after administering an injection of penicillin to a patient with an infection?

Make the patient wait at least 30 minutes before leaving the health care facility.

When assessing a client with suspected pertussis, which of the following would the nurse most likely find?

Paroxysmal cough

Which of the following is the medication of choice for early syphilis?

Penicillin G benzathine

A client with influenza is admitted to an acute care facility. The nurse monitors the client closely for complications. What is the most common complication of influenza?

Pneumonia

The nurse is working in the labor and delivery suite when a client with active herpes simplex virus type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care will the nurse prepare for?

Prepare for a cesarean section.

A patient comes to the clinic with complaints of a painless sore on her lip 2 weeks after she had oral sex with her boyfriend. The nurse observes a chancre on the lips and the physician orders testing for syphilis. If results are positive, what is the likely stage the patient is in?

Primary

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?

Pseudomembranous colitis

A patient complains of nausea, vomiting, and diarrhea for 5 days. The nurse assesses the mucous membranes to be pale and dry. The patient has sunken eyes with the following vital signs: pulse 122 and thready, respirations 23, blood pressure 78/55, temperature 101.8°F oral. Which of the following is the priority nursing intervention?

Request an order from the physician for IV rehydration therapy.

Which organism is responsible for impetigo?

Staphylococcus aureus

Painless chancre lesions are associated with which systemic disease?

Syphilis

A client with a Staphylococcus aureus infection present in a sacral pressure ulcer has received treatment with three courses of antibiotics without eliminating the infection. What does the nurse understand has occurred with the client?

The client has a multidrug-resistant strain of bacteria.

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?

The infection is being transmitted by healthcare personnel.

When a hospitalized patient is in contact precautions, which of the following responses is necessary?

The patient should be placed in a private room when possible.

How often should women diagnosed with human papillomavirus (HPV) have Pap smears?

Yearly

Which of the following nursing instructions is most important for the nurse to emphasize to the client with a new HSV-2 diagnosis?

You must inform all sexual partners.

A college student comes to the campus health care center complaining of headache, malaise, and a sore throat that has worsened over the past 10 days. The nurse measures a temperature of 102.6° F (39.2° C) and finds an enlarged spleen and liver and exudative tonsillitis. Laboratory tests reveal a leukocyte count of 20,000/mm3, antibodies to Epstein-Barr virus, and abnormal liver function tests. These findings suggest:

infectious mononucleosis.

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:

the importance of informing his partners of the disease.

A client is diagnosed with shigellosis. The nurse teaches the client and family how the disease is transmitted and treated and discusses the need for enteric precautions. The nurse should explain that enteric precautions must be maintained:

until three fecal cultures are negative for Shigella.

You are teaching a pathophysiology class to pre-nursing students. Today you are teaching about infection. What groups of people would you tell the students are at increased risk for infection? (Mark all that apply.)

• Debilitated clients • Older adults • Clients with impaired skin

The clinical manifestations of primary syphilis can be diagnostic. Select all the symptoms consistent with this diagnosis.

• It occurs 2 to 3 weeks after initial inoculation with the organism • a painless lesion forms at the site of infection • the lesion resolves in 2 months.

A client is suspected of sepsis from a postsurgical incision infection. What characteristic of sepsis would the nurse recognize? Select all that apply.

• Temperature of 102°F • Heart rate of 120 beats/minute • Respiratory rate of 24 breaths/minute