Chapter 14: HAIs, MRSA, Prevention of disease

The nurse is caring for a patient with active hepatitis C and recalls that the disease is spread by which route? Feces Semen Blood Inhalation

Blood Hepatitis C virus (HCV) is transmitted or spread when the blood from a HCV-infected person enters the bloodstream of someone who is not infected. Most commonly transmitted through needle sharing

The nurse is performing an assessment of a patient with acquired immunodeficiency syndrome (AIDS) and observes a whitish coating on the tongue and throat. Which fungus does the nurse suspect are causing the lesions?

Candida albicans Overgrowth of Candida albicans can cause candidiasis in the mouth (thrush), esophagus, intestines, and vagina.

The nurse is reviewing the laboratory reports for a patient with pneumonia who is resistant to penicillin G. The nurse anticipates that which medication will be prescribed? Cilastatin Ceftriaxone Vancomycin Meropenem

Ceftriaxone Streptococcus pneumonia causes pneumonia and is resistant to penicillin G. Ceftriaxone, or cefotaxime, is the preferred antibiotic.

are used to minimize the spread of pathogens that are acquired from direct or indirect contact, especially multi drug-resistant organisms (e.g. MRSA, VRE, CRE)

Contact precautions

A patient is infected with Enterococcus faecalis. The nurse identifies that which medications may be prescribed? Select all that apply. Daptomycin Gentamicin Oritavancin Vancomycin Streptomycin

Daptomycin & Oritavancin Daptomycin(Cubicin), linezolid (Zyvox), oritavancin (Orbactiv), and tigecycline (Tygacil) are the preferred treatments for Enterococcus faecalis. It is resistant to the drugs vancomycin, gentamicin, and streptomycin

What bacteria most commonly cause HAIs

E.coli, S. aureus, Enterbacter aerogenes

According to the Center for Disease Control (CDC) guidelines, which personal protective equipment will the nurse put on when assessing a patient who is on contact precautions for diarrhea caused by Clostridium difficile(select all that apply)? Mask Gown Gloves Shoe covers Eye protection

Gown & Gloves Because the nurse will have substantial contact with the patient and bedding when doing an assessment, gloves and gowns are needed

The nurse provides education for other staff members related to caring for a patient who is coughing up blood. The nurse instructs the staff to don which personal protective equipment (PPE)? Select all that apply. Gown Shoe covers Gloves Face mask Prescribed eyeglasses

Gowns, Gloves, and Face Mask

any disease caused by a fungus

Mycosis

Which patient exposure by the nurse is most likely to require postexposure prophylaxis when the patients human immunodeficiency virus (HIV) status is unknown? Needle stick with a needle and syringe used to draw blood Splash into the eyes when emptying a bedpan containing stool Contamination of open skin lesions with patient vaginal secretions Needle stick injury with a suture needle during a surgical procedure

Needle stick with a needle and syringe used to draw blood Puncture wounds are the most common means for workplace transmission of blood-borne diseases, and a needle with a hollow bore that had been contaminated with the patients blood would be a high-risk situation. The other situations described would be much less likely to result in transmission of the virus.

Is fever a reliable indicator of infection in older adults?

No, because many have lower core body temperatures and decreased immune responses. Suspicion of disease should typically begin if a patient demonstrates change the ability to perform daily activities or in cognitive function

Zoonosis is the spread of disease from animals to humans. Which is a clinical example of a zoonotic infection? Acute meningitis Tuberculosis bacterium (TB) Severe acute respiratory syndrome (SARS) Methicillin-resistant Staphylococcus aureus(MRSA)

Severe acute respiratory syndrome (SARS) SARS is an example of a zoonosis infection. In 2003, China experienced an outbreak of SARS linked to the civet cat, a small carnivorous mammal found throughout Asia and Africa.

precautions used for patients known to be infected with highly transmissible diseases. Include airborne, droplet, and contact precautions

Transmission based precuations

The nurse plans a presentation for community members about how to decrease the risk for antibiotic- resistant infections. Which information will the nurse include in the teaching plan (select all that apply)? Continue taking antibiotics until all the medication is gone. Antibiotics may sometimes be prescribed to prevent infection. Unused antibiotics that are more than a year old should be discarded. Antibiotics are effective in treating influenza associated with high fevers. Hand washing is effective in preventing many viral and bacterial infections.

Continue taking antibiotics until all the medication is gone. Antibiotics may sometimes be prescribed to prevent infection. Hand washing is effective in preventing many viral and bacterial infections. All prescribed doses of antibiotics should be taken. In some situations, such as before surgery, antibiotics are prescribed to prevent infection. There should not be any leftover antibiotics because all prescribed doses should be taken. However, if there are leftover antibiotics, they should be discarded immediately because the number left will not be enough to treat a future infection

Precautions used for TB and Rubeola

Airborne Precautions

are used if the organism can cause infection over long distances when suspended in the air (e.g. TB, Rubeola)

Airborne precautions

A patient reports burning, frequency, and painful urination. The nurse suspects that the patient is experiencing a urinary tract infection that is caused by which bacteria? Escherichia coli Helicobacter pylori Streptococcus faecalis Haemophilus influenzae

Escherichia coli Escherichia coli is a common cause of urinary tract infections, especially in women because the bacteria is normally found in the colon. When the person contaminates the urethra with the bacteria, it causes urinary tract infections

A young adult female patient who is human immunodeficiency virus (HIV)-positive has a new prescription for efavirenz (Sustiva). Which information is most important to include in the medication teaching plan? Driving is allowed when starting this medication. Report any bizarre dreams to the health care provider. Continue to use contraception while on this medication. Take this medication in the morning on an empty stomach.

Continue to use contraception while on this medication. Efavirenz can cause fetal anomalies and should not be used in patients who may be pregnant. The drug should not be used during pregnancy because large doses could cause fetal anomalies. Once-a-day doses should be taken at bedtime (at least initially) to help patients cope with the side effects that include dizziness and confusion. Patients should be cautioned about driving when starting this drug. Patients should be informed that many people who use the drug have reported vivid and sometimes bizarre dreams.

are used to minimize contact with pathogen that spread through the air at close contact and that affect the respiratory system or mucous membranes (e.g, influenza, pertussis

Droplet precautions

The nurse is traveling to an underdeveloped country in which dengue fever is a concern. The nurse recognizes that which virus causes the disease? Ebola virus Hantavirus Flavivirus West Nile virus

Flavivirus Flavivirus causes dengue fever.

infections that are acquired as a result of exposure to microorganisms in a health care setting

Health care-associated infections (HAIs)

A pregnant woman with a history of asymptomatic chronic human immunodeficiency virus (HIV) infection is seen at the clinic. The patient states, I am very nervous about making my baby sick. Which information will the nurse include when teaching the patient? The antiretroviral medications used to treat HIV infection are teratogenic. Most infants born to HIV-positive mothers are not infected with the virus. Because she is at an early stage of HIV infection, the infant will not contract HIV. It is likely that her newborn will become infected with HIV unless she uses antiretroviral therapy (ART).

Most infants born to HIV-positive mothers are not infected with the virus. Only 25% of infants born to HIV-positive mothers develop HIV infection, even when the mother does not use ART during pregnancy. The percentage drops to 2% when ART is used. Perinatal transmission can occur at any stage of HIV infection (although it is less likely to occur when the viral load is lower). ART can safely be used in pregnancy, although some ART drugs should be avoided.

A patient with a positive rapid antibody test result for human immunodeficiency virus (HIV) is anxious and does not appear to hear what the nurse is saying. What action by the nurse is most important at this time? Teach the patient about the medications available for treatment. Inform the patient how to protect sexual and needle-sharing partners. Remind the patient about the need to return for retesting to verify the results. Ask the patient to notify individuals who have had risky contact with the patient.

Remind the patient about the need to return for retesting to verify the results. After an initial positive antibody test, the next step is retesting to confirm the results. A patient who is anxious is not likely to be able to take in new information or be willing to disclose information about HIV status of other individuals.

The nurse provides education for a group of nursing students about preventing transmission of contagious infection. Which infections that are airborne and require transmission-based precautions does the nurse include in the teaching? Select all that apply. Cholera Rubeola Influenza Pertussis Tuberculosis (TB)

Rubeola & Tuberculosis (TB) Transmission-based precautions include airborne precautions, droplet precautions, and contact precautions. Tuberculosis and rubeola are contagious diseases, and the organism can cause infection over long distances when suspended in the air.

precautions designed for all patients in hospital and health care facilities. Applies to mucous membranes, non-intact skin blood, all body fluids, secretions, and excretions.

Standard precautions

A patient with a bacterial infection is receiving penicillin G. After reviewing the patient's laboratory report, the nurse anticipates that the prescription will be changed to either ceftriaxone or cefotaxime. Which microorganism did the nurse likely find in the report? Enterococcus faecalis Staphylococcus aureus Staphylococcus epidermidis Streptococcus pneumoniae

Streptococcus pneumoniae Streptococcus pneumoniae is a gram-positive bacterium and is resistant to penicillin G. Ceftriaxone or cefotaxime can be used to treat infections caused by Streptococcus pneumoniae because these medications act by inhibiting the bacterial cell wall synthesis.

Pts at higher risk for HAIs?

Surgical and immunocompromised patients are at highest risk

The nurse performs an assessment on a patient and notes a large chancre on the penis that the patient states is painless. The patient is suspected of being infected with Treponema pallidum. Which diagnosis does the nurse anticipate? Syphilis Gonorrhea Chlamydia Genital warts

Syphilis Syphilis is caused by Treponema pallidum, a disease-causing bacterium

A patient with phlebitis due to prolonged IV cannulation develops a fever, chills, and an elevated white blood cell count. Blood cultures are drawn and reveal Staphylococcus aureus. Of which type of infection is this an example? Systemic Localized Contained Community-acquired

Systemic An infection that spreads throughout the body, often via blood, is termed a systemic infection. A small, contained infection, such as an abscess on the foot, is a localized infection.

A patient who has a positive test for human immunodeficiency virus (HIV) antibodies is admitted to the hospital with Pneumocystis jiroveci pneumonia (PCP) and a CD4+ T-cell count of less than 200 cells/mL. Based on diagnostic criteria established by the Centers for Disease Control and Prevention (CDC), which statement by the nurse is correct? The patient meets the criteria for a diagnosis of an acute HIV infection. The patient will be diagnosed with asymptomatic chronic HIV infection. The patient has developed acquired immunodeficiency syndrome (AIDS). The patient will develop symptomatic chronic HIV infection in less than a year.

The patient has developed acquired immunodeficiency syndrome (AIDS). Development of PCP meets the diagnostic criterion for AIDS. The other responses indicate earlier stages of HIV infection than is indicated by the PCP infection

The nurse is caring for a patient who is suspected of having a fungal infection on the groin area. Which organisms does the nurse determine could be causing the rash? Select all that apply. Trichophyton Microsporum Epidermophyton Coccidioides immitis Aspergillus fumigatus

Trichophyton Microsporum Epidermophyton Trichophyton, Microsporum, and Epidermophyton are fungal organisms that affect the skin.

Which diseases does the nursing instructor include when educating a group of nursing students about infections caused by Mycobacteria? Select all that apply. Tetanus Typhoid fever Tuberculosis Hansen's disease Toxic shock syndrome

Tuberculosis & Hansen's disease Mycobacterium lepraecauses leprosy, or Hansen's disease. Mycobacterium tuberculosiscauses tuberculosis of the lungs via inhalation of infected droplets.