Ch. 20

A 3-year-old boy presents to the emergency department. His parents report three days of fever, lethargy, and poor feeding intake. They report diarrhea and visible blood in his stool for the past day. During assessment by the RN, the patient is irritable and shows signs of moderate dehydration. The patient is admitted to the hospital for rehydration and gastrointestinal illness work up. 1. The patient's symptoms are most concerning for which of the following infectious organisms as the cause of acute diarrhea?

A. Shiga-toxin-producing Escherichia coli

A hospital is experiencing an outbreak of rotavirus. An RN on a pediatric surgical unit takes precautions to protect her patients from acquiring the disease. 3. The mother of an infected 18-month-old patient expresses concern that she may acquire rotavirus infection. Which of the following responses is most appropriate by the RN?

Adults may acquire rotavirus infection, but symptoms are generally mild.

A nurse is caring for an 18-month-old girl in the pediatric intensive care unit. She was admitted following three days of bloody diarrhea and fever. Her parents report she had fewer wet diapers than normal. She was admitted with hyperkalemia, as well as increased blood urea nitrogen (BUN) and creatinine levels, indicating acute renal failure. After further lab work, the toddler is diagnosed with hemolytic uremic syndrome (HUS), possibly caused by drinking unpasteurized milk. Which of the following clinical manifestations are diagnostic of HUS?

All of the choices are correct.

A hospital is experiencing an outbreak of rotavirus. An RN on a pediatric surgical unit takes precautions to protect her patients from acquiring the disease. 2. The occurrence of which of the following symptoms in an 18-month-old patient would cause concern for infection with rotavirus?

All of these choices are correct.

A nurse is caring for an 18-month-old girl in the pediatric intensive care unit. She was admitted following three days of bloody diarrhea and fever. Her parents report she had fewer wet diapers than normal. She was admitted with hyperkalemia, as well as increased blood urea nitrogen (BUN) and creatinine levels, indicating acute renal failure. After further lab work, the toddler is diagnosed with hemolytic uremic syndrome (HUS), possibly caused by drinking unpasteurized milk. The child's parents ask the nurse to explain why their child has not received antibiotics. Which of the following statements are true about the use of antibiotic therapy in HUS?

Antibiotics are of no help and may increase the pathology

Lisa, a 35-year-old mother of two, presents to a family practitioner's office in Maine. She is visibly shaken, but does not appear to be acutely ill in any way. You begin to take her vitals, and suddenly she shouts out: "Please, just take this from me!" You reach for the sandwich bag in her hand, which appears to contain a fecal sample. Upon closer inspection, you notice something in the sample that makes you quickly understand the woman's agitation. 1. Based upon all of the information obtained through specimen testing, along with the patient's history and symptoms, the pathogen is most likely:

B. Diphyllobothrium latum

Match the infectious agents to the description of the disease they cause to test your understanding of GI tract diseases. E. coli o157.h7

Bloody diarrhea with development of hemolytic uremic syndrome in 10% of patients

A 3-year-old boy presents to the emergency department. His parents report three days of fever, lethargy, and poor feeding intake. They report diarrhea and visible blood in his stool for the past day. During assessment by the RN, the patient is irritable and shows signs of moderate dehydration. The patient is admitted to the hospital for rehydration and gastrointestinal illness work up. 4. Three days later, the patient is started on dialysis. Which of the following is a serious complication of the patient's infection with the potential to cause kidney injury and renal failure?

Hemolytic uremic syndrome

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 2. In this case, if serologic tests had pointed to a related hepatitis virus in the patient's infection, which of the following would have been suspected?

Hepatitis E virus

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 2. According to information given in the case, which type of test was used to diagnose hepatitis A infection in the patient?

Immunologic

Select the correct descriptions of mumps, a gastrointestinal tract disease.

Inflammation of the salivary glands Humans are the only host for the virus

A 3-year-old boy presents to the emergency department. His parents report three days of fever, lethargy, and poor feeding intake. They report diarrhea and visible blood in his stool for the past day. During assessment by the RN, the patient is irritable and shows signs of moderate dehydration. The patient is admitted to the hospital for rehydration and gastrointestinal illness work up. 2. The RN collects the patient's history from the parents. Which of the following statements would raise concern for the potential that the patient has been infected with shiga-toxin-producing E. coli?

Ingestion of undercooked hot dog at county fair

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 1. Which of the following symptoms made the physician include hepatitis viruses in the differential diagnosis?

Jaundice

Match the infectious agents to the description of the disease they cause to test your understanding of GI tract diseases. Campylobacter jejuni

Most frequent cause of diarrhea resulting in watery stools, fever, vomiting, headaches, and severe abdominal pain

Your patient is a 4-year-old male. His mother reports that two days ago, he developed a runny nose, was very lethargic, and ran a fever. She assumed he was getting a cold or the flu but that morning she was alarmed at the swollen glands in his neck. He attends a community-run preschool, and on taking a history, she tells you that she usually takes him to a naturopathic practitioner. She tells you that he has not had any vaccines because she read that they cause autism. What disease is the child likely to have given the history and manifestations?

Mumps

T/F Evidence suggests that people with high numbers of the bacteria associated with periodontitis may also have increased rates of cardiovascular disease.

T

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 2. True or False: Based upon the data presented, there were four possible sources of hepatitis A contamination at this facility.

T

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 3. True or False: The patient could have protected herself from hepatitis A infection through vaccination before she traveled.

T

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 5. True or False: Pathogens acquired abroad may mimic common microbes associated with gastrointestinal illness in the United States, and this complicates the diagnostic process.

T

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 3. Based upon the data presented, what was the most likely source of hepatitis contamination at this facility?

The staff, as 60% were positive for hepatitis A infection.

Choose the statement that describes rotavirus infections to test your understanding of GI tract diseases.

The virus has an unusual double-stranded RNA genome.

Select all of the correct tissues that make up GALT to test your understanding of the defenses present in the gastrointestinal tract.

Tonsils and adenoids in the oral cavity Lymphoid tissues in the esophagus Peyer's patches in the small intestine Appendix

Match the infectious agents to the description of the disease they cause to test your understanding of GI tract diseases. Salmonella typhi

Typhoid fever characterized by progressive, invasive infection that leads to septicemia

Lisa, a 35-year-old mother of two, presents to a family practitioner's office in Maine. She is visibly shaken, but does not appear to be acutely ill in any way. You begin to take her vitals, and suddenly she shouts out: "Please, just take this from me!" You reach for the sandwich bag in her hand, which appears to contain a fecal sample. Upon closer inspection, you notice something in the sample that makes you quickly understand the woman's agitation. 2. Based upon this identification, what was the most likely mode of transmission of this pathogen?

Vehicle through contaminated food

Choose the best description of the normal microbiota of the oral cavity.

Very large, diverse population that includes bacteria, fungi, and protozoans

A hospital is experiencing an outbreak of rotavirus. An RN on a pediatric surgical unit takes precautions to protect her patients from acquiring the disease. 1. When assisting with care activities for a patient with rotavirus, the RN should observe all of the following standard precautions, except ________.

donning a mask

Your patient is a 4-year-old male. His mother reports that two days ago, he developed a runny nose, was very lethargic, and ran a fever. She assumed he was getting a cold or the flu but that morning she was alarmed at the swollen glands in his neck. He attends a community-run preschool, and on taking a history, she tells you that she usually takes him to a naturopathic practitioner. She tells you that he has not had any vaccines because she read that they cause autism. The major cytopathic effect caused by this agent is that ______.

infected cells have HN spikes in their membrane that bind to an uninfected cell and the two fuse, creating a syncytium

Lisa, a 35-year-old mother of two, presents to a family practitioner's office in Maine. She is visibly shaken, but does not appear to be acutely ill in any way. You begin to take her vitals, and suddenly she shouts out: "Please, just take this from me!" You reach for the sandwich bag in her hand, which appears to contain a fecal sample. Upon closer inspection, you notice something in the sample that makes you quickly understand the woman's agitation. 2. The oval structure visualized by bright field microscopic analysis of the patient's fecal sample is a(n) ______.

ovum (egg)

Lisa, a 35-year-old mother of two, presents to a family practitioner's office in Maine. She is visibly shaken, but does not appear to be acutely ill in any way. You begin to take her vitals, and suddenly she shouts out: "Please, just take this from me!" You reach for the sandwich bag in her hand, which appears to contain a fecal sample. Upon closer inspection, you notice something in the sample that makes you quickly understand the woman's agitation. 3. The box-like repeated structures seen through bright field microscopic analysis of the patient's fecal sample are ______.

proglottids

Lisa, a 35-year-old mother of two, presents to a family practitioner's office in Maine. She is visibly shaken, but does not appear to be acutely ill in any way. You begin to take her vitals, and suddenly she shouts out: "Please, just take this from me!" You reach for the sandwich bag in her hand, which appears to contain a fecal sample. Upon closer inspection, you notice something in the sample that makes you quickly understand the woman's agitation. 2. The patient could have avoided infection with this organism by

properly preparing the salmon they consumed.

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 4. In determining a diagnosis, it is important to consider _________.

the time of exposure to the pathogen and additional symptoms beyond fever

A nurse is caring for an 18-month-old girl in the pediatric intensive care unit. She was admitted following three days of bloody diarrhea and fever. Her parents report she had fewer wet diapers than normal. She was admitted with hyperkalemia, as well as increased blood urea nitrogen (BUN) and creatinine levels, indicating acute renal failure. After further lab work, the toddler is diagnosed with hemolytic uremic syndrome (HUS), possibly caused by drinking unpasteurized milk. The child's parents are noticeably distressed. They ask the nurse what could have been done to prevent their child from contracting this illness. Which of the following responses by the nurse is most appropriate?

While there are some individuals who advocate for health benefits of consuming unpasteurized milk, the risks of acquiring organisms such as pathogenic E. coli, Salmonella, Listeria, and Campylobacter, among others, outweighs any benefit.

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 1. Which of the following is a correct statement based upon information in the podcast?

You should inquire whether the patient took recommended preventative measures before traveling (i.e., vaccines, prophylactic drugs).

A 3-year-old boy presents to the emergency department. His parents report three days of fever, lethargy, and poor feeding intake. They report diarrhea and visible blood in his stool for the past day. During assessment by the RN, the patient is irritable and shows signs of moderate dehydration. The patient is admitted to the hospital for rehydration and gastrointestinal illness work up. 3. The RN expects all of the following to be ordered as treatment for this patient, except ________.

antibiotics

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 1. Based upon the data, what percentage of tomato samples were positive for hepatitis A virus?

1%

Lisa, a 35-year-old mother of two, presents to a family practitioner's office in Maine. She is visibly shaken, but does not appear to be acutely ill in any way. You begin to take her vitals, and suddenly she shouts out: "Please, just take this from me!" You reach for the sandwich bag in her hand, which appears to contain a fecal sample. Upon closer inspection, you notice something in the sample that makes you quickly understand the woman's agitation. 1. Which form of treatment should be administered to the patient at this time?

D. Praziquantel

Which of the following bacteria produces an enzyme that breaks down urea?

Helicobacter pylori

Select all of the accessory organs of the gastrointestinal system that add digestive fluids.

Salivary glands Gallbladder Pancreas

The normal biota of the GI tract is most diverse in the _______.

large intestine

Match the correct description with each type of hepatitis virus. Hep B

Enveloped DNA virus that is transmitted by blood contact and is associated with cirrhosis and hepatocellular carcinoma

Lisa, a 35-year-old mother of two, presents to a family practitioner's office in Maine. She is visibly shaken, but does not appear to be acutely ill in any way. You begin to take her vitals, and suddenly she shouts out: "Please, just take this from me!" You reach for the sandwich bag in her hand, which appears to contain a fecal sample. Upon closer inspection, you notice something in the sample that makes you quickly understand the woman's agitation. 1. Based upon these results, the pathogen appears to be a ______.

helminth

________, an increase in certain granular leukocytes, is a hallmark of helminthic infections.

Eosinophilia

Lisa, a 35-year-old mother of two, presents to a family practitioner's office in Maine. She is visibly shaken, but does not appear to be acutely ill in any way. You begin to take her vitals, and suddenly she shouts out: "Please, just take this from me!" You reach for the sandwich bag in her hand, which appears to contain a fecal sample. Upon closer inspection, you notice something in the sample that makes you quickly understand the woman's agitation. 3. True or False: The patient's condition is being caused by a prokaryotic organism.

F

T/F Bacteria appear transiently in the stomach as they travel through the GI tract, but there are no normal biota members associated with the stomach.

F

T/F Hepatitis C is known as the "silent epidemic" for more than 3.5 million Americans are infected with this virus; however, infection rates in the United States and abroad are decreasing due to the implementation of a successful vaccine.

F

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 2. True or False: Patients exhibiting fever after travel to malaria endemic areas should be tested for the parasite first before being treated for this disease.

F

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 3. True or False: The patient was treated with an antiviral drug specific for hepatitis A infection.

F

Match the correct description with each type of hepatitis virus. Hep E

Fecal-oral route of transmission and infection has no long-term consequences except in pregnant women

A hospital is experiencing an outbreak of rotavirus. An RN on a pediatric surgical unit takes precautions to protect her patients from acquiring the disease. 4. What treatment would the RN anticipate to be ordered for an infected 18-month-old patient?

Fluid and electrolyte replacement

Evaluate the statements below, and select those that correctly apply to food infections vs. food intoxications.

Foodborne infections can be caused by Salmonella enterica whereas food poisoning is often caused by Staphylococcus aureus. Foodborne infections typically have incubation periods of 12-36 hours, whereas food poisoning has a more rapid onset of between 1 and 6 hours. Bacillus cereus and Clostridium perfringens can cause food poisoning, as well as Staphylococcus aureus.

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 3. Based upon the information presented, which of the following is a correct pairing between risk factor and disease?

Fresh water consumption and schistosomiasis

While working as an ultrasound technician, I performed an abdominal ultrasound on a teenage girl who had been admitted to the hospital with nausea and vomiting. In an effort to distract my nervous patient, and also to elicit more information, I asked the patient to tell me about the symptoms that had led to her hospitalization. The patient related to me that she had recently traveled with her church youth group to Costa Rica in order to take part in an international fellowship conference. The patient had returned home to the United States three weeks ago. 1. Had the patient in the case also exhibited the sign of eosinophilia, which disease would have been implicated instead of hepatitis A infection?

Schistosomiasis

A nurse is caring for an 18-month-old girl in the pediatric intensive care unit. She was admitted following three days of bloody diarrhea and fever. Her parents report she had fewer wet diapers than normal. She was admitted with hyperkalemia, as well as increased blood urea nitrogen (BUN) and creatinine levels, indicating acute renal failure. After further lab work, the toddler is diagnosed with hemolytic uremic syndrome (HUS), possibly caused by drinking unpasteurized milk. Why does a patient with HUS present with bloody diarrhea?

Shiga toxin damages the gut lining, causing it to bleed

A nurse is caring for an 18-month-old girl in the pediatric intensive care unit. She was admitted following three days of bloody diarrhea and fever. Her parents report she had fewer wet diapers than normal. She was admitted with hyperkalemia, as well as increased blood urea nitrogen (BUN) and creatinine levels, indicating acute renal failure. After further lab work, the toddler is diagnosed with hemolytic uremic syndrome (HUS), possibly caused by drinking unpasteurized milk. What organism is the leading cause of HUS in the United States?

Shiga-toxin-producing Escherichia coli

Match the infectious agents to the description of the disease they cause to test your understanding of GI tract diseases. Shigella dysenteriae

Diarrhea containing blood and mucus from the GI tract

Match the infectious agents to the description of the disease they cause to test your understanding of GI tract diseases. Vibrio cholerae

Diarrhea described as rice water stools

Choose the statement that describes the best method of prevention of dental caries.

Dietary restriction of carbohydrates

Select all of the correct answers concerning the disease schistosomiasis to test your understanding of GI tract diseases caused by Schistosoma sp.

Chronic infection results in liver disease, splenomegaly, and hepatomegaly. Schistosomes are trematodes often referred to as blood flukes. Fluke cloaks itself with host proteins to evade the immune response.

Select all of the correct descriptions concerning the normal biota of the gastrointestinal tract.

Contains billions of microorganisms Provides a protective function Helps educate the immune system

Match the statement to the helminth it most accurately describes to test your understanding of GI tract infections caused by helminths. Enterobius verminicularis

Cycle A, pinworm, diagnosis by adhesive tape method

Match the statement to the helminth it most accurately describes to test your understanding of GI tract infections caused by helminths. Trichuris trichiura

Cycle A, whipworm, humans are sole host

Match the statement to the helminth it most accurately describes to test your understanding of GI tract infections caused by helminths. Diphyllobothrium latum

Cycle C, fish tapeworm, transmitted by sushi

Match the statement to the helminth it most accurately describes to test your understanding of GI tract infections caused by helminths. Taeria solium

Cycle C, pork tapeworm, acquired by ingestion of undercooked pork

Your patient is a 4-year-old male. His mother reports that two days ago, he developed a runny nose, was very lethargic, and ran a fever. She assumed he was getting a cold or the flu but that morning she was alarmed at the swollen glands in his neck. He attends a community-run preschool, and on taking a history, she tells you that she usually takes him to a naturopathic practitioner. She tells you that he has not had any vaccines because she read that they cause autism. What is the causative agent of the suspected disease?

Paramyxovirus

Match the correct description with each type of hepatitis virus. Hep C

RNA virus transmitted by blood contact and results in liver failure