Community Chapter 15
D) Takes immunosuppressants Feedback: In many people who have latent TB infection, the Mycobacterium tuberculosis bacteria remain inactive for a lifetime without causing active TB disease. But in other people, especially those who have weak immune systems, the bacteria become active and cause TB disease. Working two jobs, vacationing in South America, and cooking food would not put one with a latent TB infection at greater risk for contracting active TB disease.
14.Four employees at a local restaurant have positive purified protein derivative (PPD) tuberculin skin tests and have been diagnosed with latent tuberculosis (TB) infection. Which employee would be at the greatest risk for contracting active TB disease? A) Works two jobs B) Vacations in South America C) Cooks the food D) Takes immunosuppressants
B) Genetic changes make the flu virus resistant to the flu shot from year to year. Feedback: As microbes reproduce, genetic changes may result in pathogens that are immunologically distinct from their parental strains. For example, antigenic drift, the slow and progressive genetic changes that take place in DNA and RNA as organisms replicate in multiple hosts, causes changes in influenza viruses each year. These frequent changes that result from antigenic drift mean that there is a new seasonal influenza vaccine each year. The flu is caused by the influenza virus, not bacteria, so antibiotics would not be appropriate for treatment. One does not need to be protected from all strains of the flu virus, only the ones prevalent in the client's area at the present time. Vaccination shots typically last for years, not for 3 to 6 months.
1. The clinic clients respond negatively to the need for a yearly flu shot. They ask why the medical communities don't just create one shot that will last for several years. Which explanation should the nurse give? A) Genetic changes in the bacteria that cause the flu require a rotating course of antibiotics. B) Genetic changes make the flu virus resistant to the flu shot from year to year. C) There is more than one strain of the flu virus and you must be protected from all of them. D) The shots last only for 3 to 6 months and must be renewed on a yearly basis.
A) 12-room unit with negative air pressure units Feedback: For an outbreak of H5N1, place the client in an airborne isolation room (AIR). Such rooms should have monitored negative air pressure in relation to the corridor, with 6 to 12 air changes per hour (ACH), and exhaust air directly outside or have recirculated air filtered by a high-efficiency particulate air (HEPA) filter. If an AIR is unavailable, a portable HEPA filter should be used to augment the number of ACH. Use a fit-tested respirator, at least as protective as a National Institute of Occupational Safety and Health (NIOSH)-approved disposable N-95 filtering face piece respirator, when entering the room (DHHS, 2006). The Centers for Disease Control and Prevention (CDC) has recommended nonpharmaceutical community interventions that use social distancing strategies to reduce contact between people.
10.The nurse is responsible for the construction of an isolation unit during an H5N1 outbreak. The unit is designated for only those clients with a confirmed diagnosis of H5N1. Which unit would be easily adapted to client needs? A) 12 -room unit with negative air pressure units B) 15 -room unit with a portable supply of PPEs C) 8 -room unit with four code carts D) 12 -room unit with four to six air changes per hour
B) Avoid contact with mosquitoes D) Eliminate standing water Feedback: WNV virus is not transmitted from person to person but from mosquito to person. No isolation precautions are indicated other than standard precautions. The Centers for Disease Control and Prevention (CDC) guidelines emphasize avian, animal, mosquito, and human WNV surveillance, along with control and elimination of mosquito breeding sites such as standing water in flowerpots, buckets, and old tires. The CDC recommends using an insect repellent such as DEET (N, N-diethyl-m-toluamide) or picaridin when outdoors, following the directions on the package. Because mosquitoes are most active at dusk and dawn, in addition to an insect repellent, people should wear long sleeves and pants when outdoors during these hours. Screens on windows and doors will keep mosquitoes out.
11.Ten documented cases of West Nile virus (WNV) have occurred recently in the community. To reduce the transmission of the virus, the nurse should educate the members of the community to: (Select all that apply.) A) Avoid contact with birds B) Avoid contact with mosquitoes C) Avoid those with a confirmed diagnosis D) Eliminate standing water E) Avoid exposure to the environment during the daylight hours
D) "A history of a tick bite is not required." Feedback: Exposure to Lyme disease is defined as having spent time (less than or equal to 30 days before onset of the initial skin lesion) in wooded, brushy, or grassy areas (i.e., potential tick habitats) in a county in which Lyme disease is endemic. A history of tick bite is not required. A county in which the disease is endemic is one in which at least two confirmed cases have been previously acquired or in which established populations of a known tick vector are infected with Borrelia burgdorferi. Those who are outdoors should do a final, full-body tick check at the end of the day (not once a week) for adults, children, and pets.
12.The client is diagnosed with Lyme disease. He states that he is not a hiker and does not remember being bitten by a tick. As part of the education plan, the nurse should state: A) "You must have been bitten by a tick and didn't recognize it as such." B) "Did you spend time in a brushy or grassy area in the last 90 days?" C) "Conduct a full -body tick check once a week during the summer." D) "A history of a tick bite is not required."
D) Animals roaming in the fair grounds Feedback: Recent cases of hemolytic-uremic syndrome (HUS) have been associated with outbreaks of E. coli O157:H7 infections, which were apparently caused by contact with animals in public settings, including fairs, farm tours, and petting zoos. Experience from these and previous outbreaks underscores the necessity for adequate control measures to reduce zoonotic transmission. The Centers for Disease Control and Prevention has developed standardized recommendations for public health officials, veterinarians, animal exhibitors, and visitors to animal exhibits; it established that hand washing is the single most important prevention step for reducing the risk for disease transmission. Other critical recommendations for venues with animals are the inclusion of transition areas between animal and nonanimal areas (e.g., where food is sold) and proper care and management of animals in public settings. Use of a gas barbecue, use of wood instead of charcoal to cook meat, and improperly cleaned cooking tools are not associated with E. coli infection.
13.The nurse admits a client to the hospital with the diagnosis of Escherichia coli O157:H7. The client is dehydrated and febrile. During the history phase of the admission, the client states that he doesn't know how he could have gotten sick at the local county fair—the hamburger he bought was well done. Upon further discussion, the nurse suspects the transmission may have occurred because of: A) Use of a gas barbecue B) Improper cleaning of the cooking tools C) Use of wood instead of charcoal to cook the meat D) Animals roaming in the fair grounds
C) Is HIV positive Feedback: Active TB infection is characterized by a chronic productive cough, low-grade fever, night sweats, and weight loss, along with a positive purified protein derivative (PPD) tuberculin skin test result. People with active TB are contagious. However, certain people who are anergic (lack an immune response to an antigen) may not have a positive PPD (e.g., persons with HIV). Having visited Central America recently, recovering from jet lag, and working in a factory setting would not produce a false negative result on the tuberculin skin test.
15.The nurse assesses a client in the local neighborhood clinic. He exhibits signs and symptoms of tuberculosis (TB) yet has a negative tuberculin skin test result. The nurse suspects that the physician may further test the client because he: A) Visited Central America recently B) Is recovering from jet lag C) Is HIV positive D) Works in a factory setting
A) Social service support B) Housing assistance E) Treatment enablers Feedback: Programs using DOT as the central element in a comprehensive, client-centered approach to case management (enhanced DOT) have higher rates of treatment completion than less intensive strategies. Each client's management plan should be individualized to incorporate measures that facilitate adherence to the drug regimen. Such measures may include, for example, social service support, treatment incentives and enablers, housing assistance, referral for treatment of substance abuse, and coordination of TB services with those of other providers. There is no need to hospitalize a person solely because he or she is infectious. Outclients should be instructed to remain at home, without visitors, until they are no longer thought to be infectious. However, such isolation is not a method to ensure compliance with the drug regimen but an infection control measure.
16.The nurse is responsible for the directly observed therapy (DOT) program in the community. Which represent the best methods to ensure compliance with clients' drug regimens? (Select all that apply.) A) Social service support B) Housing assistance C) Hospitalization D) Isolation until treatment complete E) Treatment enablers
A) Concentration of infectious droplet nuclei in the air B) Duration of exposure to the infected person C) Proximity to the infected person Feedback: The probability that a person who is exposed to Mycobacterium tuberculosis will become infected depends primarily on the concentration of infectious droplet nuclei in the air and the duration of exposure to a person with infectious TB disease. The closer the proximity and the longer the duration of exposure, the higher the risk of becoming infected. Close contacts are people who share the same air space in a household or other enclosed environment for a prolonged period (days or weeks, not minutes or hours) with a person with pulmonary TB disease. A suspected TB client is a person in whom a diagnosis of TB disease is being considered, whether anti-TB treatment has been started. People generally should not continue to be suspected of having TB for more than 3 months. The use of safety gloves and physical exertion on the job do not affect the probability of infection
17.As the occupational health nurse in a factory finds that five employees out of 30 have positive tuberculin skin test results. One employee on the 3 -to -11 shift has been diagnosed with active tuberculosis (TB). She asks if this means that the whole factory has been exposed. The nurse replies that the probability of infection depends upon: (Select all that apply.) A) Concentration of infectious droplet nuclei in the air B) Duration of exposure to the infected person C) Proximity to the infected person D) The use of safety gloves by employees E) Physical exertion required in the job
C) 6-mm induration Feedback: All high- and medium-priority contacts who do not have a documented previous positive tuberculin skin test result or previous TB disease should receive a baseline purified protein derivative (PPD) tuberculin skin test. The reaction to the intracutaneously injected PPD tuberculin skin test is the classic example of a delayed (cellular) hypersensitivity reaction, which induces induration. Induration of ≥ 5 mm is considered a positive result in people who have an initial induration of 0 mm.
18.A man who lives in a homeless shelter is diagnosed with active tuberculosis (TB). The shelter keeps a list of those who are assigned beds, and the majority of those sleeping there are regulars. Which finding would indicate a positive tuberculin skin test result using a two -step process? A) 4 -mm induration B) 2 -mm induration C) 6 -mm induration D) 3 -mm induration
B) Tuberculosis guidelines require testing of an entire healthcare setting. Feedback: The 2005 tuberculosis (TB) infection control guidelines emphasize actions to maintain momentum and expertise needed to avert another TB resurgence and to eliminate the lingering threat to healthcare personnel, which is mainly from clients or others with unsuspected and undiagnosed infectious TB disease. A sample recommendation is that the term "tuberculin skin tests" be used rather than purified protein derivative. The scope of settings in which the guidelines apply has been broadened to include laboratories and additional outclient and nontraditional healthcare settings. These recommendations also apply to an entire healthcare setting rather than to areas within a setting.
19.Each employee in a small community hospital is informed that he or she needs a tuberculin skin test and of the date that the test is due. The kitchen employees tell the nurse that they don't need the test and never had to have it before. The nurse should respond with: A) The test does not need to be given if you do not have client contact. B) Tuberculosis guidelines require testing of an entire healthcare setting. C) The test will not hurt; we won't fire you if you test positive. D) The tuberculosis guidelines state kitchen workers are at risk.
B) Develop improved defenses against reinfection Feedback: Three stages of microbial adaptation and change occur over varying periods of time. During stage I, an epidemic occurs. The microbes enter a "virgin" population where hosts have no prior exposure to the organism and have few defenses. This leads to further spread in the population. Ultimately, survivors are usually left with improved defenses against reinfection. During stage II, the infection becomes endemic or continuously present in a geographic area or population of people. Routine childhood diseases are an example of such infections. During stage III, symbiosis is possible. Further adaptation occurs, resulting in mutual tolerance and sometimes mutual benefit for both the microorganism and the host. This is the preferred outcome.
2.Nursing students in an enclosed classroom begin to become ill with a gastrointestinal illness. The public health department Page 63 identifies this occurrence as an emerging epidemic and isolates the population that is ill. According to microbial adaptation, those who survive the illness will then do which of the following? A) Recover with adaptive organism reintroduction into the environment B) Develop improved defenses against reinfection C) Become hosts to the organism, which is symbiotic in nature D) Become carriers of the infection, ultimately leading to an epidemic
A) Genetic and biological B) Physical/environmental D) Ecological E) Social, political, and economic Feedback: There are four types of interrelated and overlapping microbe-human interactions that can lead to emerging/reemerging infectious diseases: (1) genetic and biological; (2) physical/environmental; (3) ecological; and (4) social, political, and economic. Spiritual and psychological are not types of interactions leading to infectious diseases
20.A nurse is studying the Institute of Medicine's convergence model to learn how four types of interrelated and overlapping microbe -human interactions can lead to emerging/reemerging infectious diseases. These four types of interactions are: (Select all that apply.) A) Genetic and biological B) Physical/environmental C) Spiritual and psychological D) Ecological E) Social, political, and economic
A) Fluid-resistant gown B) Gloves D) Mask E) Goggles Feedback: When entering the room of a client with or suspected EVD, all healthcare providers should wear PPE, including a fluid-resistant gown, gloves, mask, and face shield/goggles (CDC, Infection prevention and control recommendations for hospitalized clients with known or suspected Ebola in U.S. hospitals). A respirator is not necessary.
21.The nurse prepares to enter the room of a client with suspected Ebola virus disease (EVD). Which pieces of personal protective equipment (PPE) should the nurse wear? (Select all that apply.) A) Fluid -resistant gown B) Gloves C) Respirator D) Mask E) Goggles
B) The unexposed population is not likely to contract the illness Feedback: If a substantial proportion of people in a population are not susceptible to a communicable disease, the few people who are susceptible are not likely to be exposed and contract the illness. This is a process called herd immunity.
3.Three years after exposure to a virulent form of the flu, a population faces the same flu strain. The public health department recognizes that there are members of the population who have not been exposed to the flu strain. Which is most likely to happen? A) The unexposed population will contract Page 64 the illness B) The unexposed population is not likely to contract the illness C) The unexposed population will contract the illness and reinfect others D) The flu will reach epidemic proportions and both populations will become ill
A) Temperature C) Precipitation D) Humidity Feedback: Many infectious diseases have characteristic geographic distributions and seasonal variations. Probably the most common is the influenza virus, which peaks each fall and winter. Factors such as temperature, precipitation, and humidity affect the life cycle of many disease pathogens and their vectors, and consequently they can affect disease outbreaks. Geology, or the types of rocks present in the area, and the amount of daylight are not likely to affect the life cycle of disease pathogens and their vectors.
4.Which environmental factors are likely to affect the life cycle of disease pathogens and their vectors and thus disease outbreaks? (Select all that apply.) A) Temperature B) Geology C) Precipitation D) Humidity E) Amount of daylight
A) Poor hygiene C) Poor sanitation Feedback: Urban life, with malnutrition, overcrowding, and poor sanitation, enhances the major pathways for transmission of infectious disease. The forced dislocation of large groups of people and migration of such groups of people from rural areas to cities can be accompanied by a breakdown of public health measures, leading to poor hygiene. These have often been factors in disease emergence. Decreased socialization, decreased viral load, and increased violence would not tend to increase the likelihood of disease emergence.
5.Tent communities are constructed in a rural community by the American Red Cross after a disaster. Because of overcrowding, surrounding states create accommodations for the displaced and homeless. The survivors are accommodated in the cities of four Southern states. Which factors may increase the possibility of disease emergence in the cities? (Select all that apply.) A) Poor hygiene B) Decreased socialization C) Poor sanitation D) Decreased viral load E) Increased violence
C) Adaptation Feedback: Microbial adaptation and change in response to the overuse of antibiotics and consequent accumulation in the environment will cause the rapid evolution of resistant pathogens. MRSA is not associated with microbes being rejected, assimilated, or stagnant.
6.An 80-year-old client is being treated for chronic urinary tract infections. She has received multiple antibiotics in the past 6 months. The physician orders a urine culture. The results of the urine culture are as follows: Staphylococcus aureus >100,000 colonies and demonstrated resistance to sulfamethoxazole and trimethoprim (Bactrim), penicillin, methicillin, and erythromycin. The client is diagnosed with methicillin -resistant Staphylococcus aureus (MRSA) on the basis of the findings of her urine test. Based on the client's history, a cause of the MRSA might be microbial: A) Rejection B) Assimilation C) Adaptation D) Stagnation
B) Enhanced infection control measures Feedback: The main lessons learned from SARS , the first new infectious disease to emerge in the 21st century, were that (1) astute healthcare providers are likely to be the key to early detection and reporting of initial cases of SARS-coronavirus disease, (2) containment of disease requires the diligent application of enhanced infection control measures at the national and local levels, the same measures that will defeat SARS should it reemerge, and (3) control of an emerging infection necessitates swift action by healthcare providers as well as an adequate public health infrastructure. Prophylactic antibiotics would not be effective against a virus. Use of alcohol cleansers would not be as effective as full, enhanced infection control measures. Reporting clusters to the Centers for Disease Control and Prevention can help in the early detection of the disease, but in and of itself will not help contain it.
7.The community health nurse works in a region where severe acute respiratory syndrome (SARS) has just been reintroduced into the environment. Which measure is imperative for the nurse to take to prevent spread of the disease? A) Prophylactic antibiotics B) Enhanced infection control measures C) Use of alcohol cleansers D) Report of clusters to the Centers for Disease Control and Prevention
B) Respiratory hygiene C) Hand hygiene D) Droplet precautions for visitors in contact Feedback: To prevent the transmission of all respiratory infections, respiratory hygiene/cough etiquette measures should be implemented at the first point of contact with a potentially infected person and should be incorporated into standard precautions. This includes covering the nose and mouth when coughing or sneezing, using tissues to contain respiratory secretions and disposing of them in the nearest waste receptacle after use, and hand hygiene (e.g., handwashing with nonantimicrobial soap and water, an alcohol-based hand rub, or an antiseptic hand wash) after having contact with respiratory secretions and contaminated objects/materials. In addition to standard precautions, all individuals, including visitors and healthcare providers, in contact with clients with an acute respiratory infection should use droplet precautions, which include wearing a surgical mask when in close contact (i.e., within approximately 3 feet) and on entering the room of the client. The 2013 World Health Organization guidelines for a suspected or confirmed case of MERS-CoV infection called for placing the client in a single isolation room with equal or greater than 12 air exchanges per hour, not quarantining infected families in their homes. Contact precautions are only needed when contact with blood, body fluids, secretions, or nonintact skin is anticipated.
8.There is an outbreak of Middle East respiratory syndrome coronavirus (MERS -CoV) in the community. The nurse is responsible for the dissemination of the education plan adopted by the public health department. Key components of the plan should include: (Select all that apply.) A) Quarantining infected families in their homes B) Respiratory hygiene C) Hand hygiene D) Droplet precautions for visitors in contact with affected clients E) Contact precautions for all cases
D) Antigenic shift Feedback: The H5N1 virus can improve its transmissibility among humans by two mechanisms. The first is antigenic shift, a "reassortment" event, in which genetic material is exchanged between human and avian viruses during coinfection of a human or an animal such as a pig. Reassortment could result in a fully transmissible pandemic virus, which could rapidly spread throughout the world. The second mechanism is a more gradual process of antigenic drift, an adaptive mutation, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans. Nearly all of the human infections with H5N1, which are the largest documented since its emergence in humans in 1997, were a result of people having direct or close contact with infected poultry or contaminated surfaces, but not a result of consuming chicken. An increase in incidence of autoimmune diseases, which involve one's own immune system attacking the body, is not related to the spread of avian influenza and would not lead to a pandemic. The avian flu is already transmitted primarily in a zoonotic manner, so any shift in transmission would be to human-to-human transmission, which would be more likely to cause a pandemic than zoonotic transmission.
9.International health experts indicate that the avian flu is the virus most likely to cause the next pandemic. What may improve its transmissibility to the public? A) Increase in consumption of chicken B) Increase in autoimmune disease incidence C) Shift to zoonotic transmission D) Antigenic shift