MedSurg Infectious Disease

A client is diagnosed with gastroenteritis. What does the nurse determine is the basic intention underlying the unique dietary management for this client? 1. Provide optimal amounts of all important nutrients. 2. Increase the amount of bulk and roughage in the diet. 3. Eliminate chemical, mechanical, and thermal irritation. 4. Promote psychologic support by offering a wide variety of foods.

3 Irritation of the mucosa may cause increased bleeding or perforation and therefore should be avoided. All clients' diets should be nutritionally balanced; this is not specific to this client's problem. Bulk and roughage may irritate the mucosa and should be decreased. Psychologic support is not the primary goal; efforts should be made to include foods that are psychologically beneficial but eliminate foods that are irritating to the mucosa.

A client, who has been living in another country for 10 years, is undergoing diagnostic testing to identify the causative organisms of the infection that has been acquired. When caring for this client, the nurse recalls that active immunity occurs when: 1. Protein antigens are formed in the blood to fight invading antibodies 2. Protein substances are formed within the body to neutralize antigens 3. Blood antigens are aided by phagocytes in defending the body against pathogens 3. Sensitized lymphocytes from an immune donor act as antibodies against invading pathogens

2 Active immunity occurs when the individual's cells produce antibodies in response to an agent or its products; these antibodies will destroy the agent (antigen) should it enter the body again. Antigens do not fight antibodies; they trigger antibody formation that in turn attacks the antigen. Antigens are foreign substances that enter the body and trigger antibody formation. Sensitized lymphocytes do not act as antibodies.

The nurse understands that the best way to reduce catheter associated urinary tract infections (CAUTIs) in long term indwelling catheters is to do what? 1. Replace the catheter on a routine basis 2. Administer cranberry tablets three times a day 3. Perform catheter care twice a day 4. Administer prophylactic antibiotics twice a day for the duration of the catheter placement

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

A client who experiences anorexia and fatigue develops jaundice. A diagnosis of hepatitis A is made. The client's spouse and adult children who still live at home ask whether they should receive gamma globulin. Which is the most appropriate response by the nurse? 1. "Gamma globulin is unnecessary as long as you follow droplet precautions." 2. "You should call your primary healthcare provider immediately about getting gamma globulin." 3. "Gamma globulin provides passive immunity for hepatitis B, not hepatitis A." 4. "Your family member's type of hepatitis is no longer communicable and gamma globulin is not required."

2 Gamma globulin provides passive immunity to hepatitis type A if given to household or sexual contacts within two weeks of exposure. Gamma globulin may provide some protection; contact, not droplet, precautions should be followed. Gamma globulin provides passive immunity for hepatitis type A, not type B. Gamma globulin provides some protection; the hepatitis type A virus is found in the stools of infected individuals before the onset of symptoms and during the first few days of illness.

A tuberculin skin test with purified protein derivative (PPD) tuberculin is performed as part of a routine physical examination. The nurse instructs the client to make an appointment so the test can be read in: 1. 12 hours 2. 24-48 hours 3. 48-72 hours 4. 1 week

3 It takes 48-72 hours for antibodies to respond to the antigen and form an indurated area. The results of tuberculosis skin tests that are not read within this timeframe will not be accurate.

A nurse is teaching a client about drug therapy against Plasmodium falciparum. What information should the nurse include in the teaching plan? 1. The infection can be controlled. 2. Immunity will prevent reinfestation. 3. The infection generally can be eliminated. 4. Immunity from the original infection is temporary.

3 Quinine sulfate is used for malaria when the plasmodia are resistant to the less toxic chloroquine. However, a new strain of Plasmodium that is resistant to quinine must be treated with a combination of quinine (quick-acting), pyrimethamine, and sulfonamide (slow-acting) therapy. The aim of therapy is to eliminate, not control, the parasite. Reinfestation can occur with a different species or strain of Plasmodium. The immunity is permanent if drug therapy is successful.

A client with a recent history of sinusitis develops meningitis and demonstrates a positive Brudzinski sign. The priority nursing care is: 1. Controlling intracranial pressure 2. Adding pads to the side of the bed 3. Administering prescribed antibiotics 4. Hydrating the client with hypotonic saline

3 The Brudzinski sign (when the neck is flexed while in the supine position, flexion of the hips occurs) indicates bacterial meningitis, a complication of sinusitis; the client's greatest need is a regimen of antibiotics, to which the causative agent is sensitive. Bacterial meningitis causes increased intracranial pressure and it is important for the nurse to monitor for manifestations of increased intracranial pressure; however, in this circumstance, it is not the priority. Because of the risk for seizures in bacterial meningitis, padded side rails are an important nursing intervention; however, this intervention does not have priority over instituting the appropriate antibiotic therapy to eradicate the cause of the meningitis. The data do not indicate a need for a hypotonic solution for hydrating the client.

A nurse working in the health services center of a college is reviewing the vaccination records of a young adult who plans to enroll. Which immunizations are required to meet admission criteria according to the American Academy of Pediatrics? 1. One dose of diphtheria toxoid, oral poliomyelitis, live measles, live rubella, and mumps vaccines. 2. Two doses of diphtheria toxoid, oral poliomyelitis vaccine, and one dose of live measles, live rubella, and mumps vaccine. 3. Three doses of diphtheria toxoid and oral poliomyelitis vaccine, and one dose of live measles, live rubella, and mumps vaccine. 4. Three doses of diphtheria toxoid vaccine, two doses of oral poliomyelitis vaccine, and one dose of live measles, live rubella, and mumps vaccine.

3 Three doses of diphtheria toxoid and oral poliomyelitis vaccine, and one dose of live measles, live rubella, and mumps vaccine is the schedule for active immunization as recommended by the American Academy of Pediatrics. One dose of diphtheria toxoid, oral poliomyelitis, live measles, live rubella, and mumps vaccines does not follow the schedule for active immunization as recommended by the American Academy of Pediatrics. Two doses of diphtheria toxoid, oral poliomyelitis vaccine, and one dose of live measles, live rubella, and mumps vaccine does not follow the schedule for active immunization as recommended by the American Academy of Pediatrics. Three doses of diphtheria toxoid vaccine, two doses of oral poliomyelitis vaccine, and one dose of live measles, live rubella, and mumps vaccine does not follow the schedule for active immunization as recommended by the American Academy of Pediatrics.

A nurse is reviewing the physical examination and laboratory tests of a client with malaria. For which important clinical indicators should the nurse be alert when reviewing data about this client? Select all that apply. 1. Polyuria 2. Leukopenia 3. Hyperthermia 4. Splenomegaly 5. Erythrocytosis

3, 4 A high fever (hyperthermia) results from the disease process. Parasites invade the erythrocytes, subsequently dividing and causing the cell to burst. The spleen enlarges from the sloughing of red blood cells. Oliguria, not polyuria, occurs in malaria-induced kidney failure. Leukopenia does not occur. Erythrocytosis does not occur.

The registered nurse determines that the new graduate understands the type(s) of hepatitis that generally develop into a chronic hepatitis infection if the graduate identifies which of the following? Select all that apply 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D 5. Hepatitis E

3, 4 Hepatitis C and D generally develop into chronic hepatitis. Hepatitis A, B, and E are acute, self-limiting infections that resolve over time. They generally do not develop into chronic hepatitis. A small percentage of clients with hepatitis B do not develop immunity and can become carriers of the disease.

Isoniazid (INH) is prescribed as a prophylactic measure for a client whose spouse has active tuberculosis (TB). What statements by the client indicate that there is a need for further teaching? Select all that apply. 1. "I plan to start taking vitamin B6 (NesTrex) with breakfast." 2. "I'll still be taking this drug six months from now." 3. "I sometimes allow our children to sleep in our bed at night." 4. "I know I also have tuberculosis because the skin test was positive." 5. "I'll be skipping the wine but enjoying the cheese at my neighbor's party."

3, 4, 5 The children are at an increased risk because the client's spouse has TB; the children should be screened as members of the household. The positive skin test indicates that the client has been exposed to the bacilli and developed antibodies, not necessarily the disease itself; further diagnostic studies are indicated. Both wine and aged cheese contain tyramine and histamine, which when taken concurrently with INH can cause headache, flushing, and a drop in blood pressure; these should be avoided when taking INH. Pyridoxine (vitamin B6) should be taken to prevent neuritis, which is associated with INH. The prophylactic drug therapy will be continued for 6 to 12 months.

A client who is to receive nitrogen mustard as part of a drug protocol for cancer asks how this drug works in the body. Before responding in language the client can understand, the nurse considers the actions of nitrogen mustard, which include: 1. Interference of the cellular protein synthesis 2. Inhibition of the synthesis of purine and pyrimidine 3. Binding with DNA to interfere with RNA production 4. Combining with DNA strands and interfering with cell replication

4 Alkylating agents, of which nitrogen mustard is one, combine with DNA strands and interfere with cell replication. Some chemotherapeutic drugs are believed to act by interfering with cellular protein synthesis, but nitrogen mustard does not. Inhibiting the synthesis of purine and pyrimidine is the mechanism of action of antimetabolites. Antibiotics, not nitrogen mustard, used in cancer chemotherapy are believed to act by binding with DNA to interfere with RNA production.

Which action should the nurse take when caring for a client with malaria? 1. Institute seizure precautions. 2. Prepare for blood transfusions. 3. Maintain isolation precautions. 4. Provide nutrition between paroxysms.

4 Maintaining adequate nutritional and fluid balance is essential to life and must be accomplished during periods when intestinal motility is not excessive so that absorption can occur. Although shaking chills may occur, seizures generally do not occur. Blood transfusions are not used in the treatment of malaria. Maintaining isolation precautions is unnecessary; infection can occur only through direct serum contact or a bite from an infected Anopheles mosquito.

The nurse is caring for a client with sepsis, who is hemodynamically stable. The client is complaining of abdominal pain. Which of these primary health care provider prescriptions should the nurse do FIRST? 1. Administer 1 L intravenous bolus of Ringers Lactate over 30 minutes 2. Administer levofloxacin (Levaquin) 500 mg intravenously over 30 minutes 3. Take the client to x-ray for an abdominal computed tomography (CT) scan 4. Draw peripheral blood cultures

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