Chapter 14 Risk of Infectious and Communicable Diseases

17. Which criteria must be met to define a water-associated disease outbreak? A) Two or more people with laboratory-confirmed primary amebic meningoencephalitis B) Two or more cases of chemical poisoning if water quality data indicate contamination by the chemical C) Two or more people having experienced a similar illness after exposure to water D) Epidemiologic evidence implicating drinking water as the probable source of the illness

Ans: C Feedback: Two criteria must be met for an event to be defined as a water-associated disease outbreak. First, two or more people must have experienced a similar illness after exposure to water. Second, epidemiologic evidence must implicate recreational water (not drinking water) or volatilization of water-associated compounds into the air surrounding the water as the probable source of illness. Evidence of primary amebic meningoencephalitis and chemical poisoning are not required for confirmation of a water-associated disease outbreak.

11. Which agency has an electronic surveillance system for the early notification of community-based epidemics? A) Department of Health and Human Services B) Centers for Disease Control and Prevention C) World Health Organization D) Department of Defense

Ans: D Feedback: The Department of Defense (DoD) has an electronic surveillance system for the early notification of community-based epidemics (ESSENCE), which has been in operation since 2001 to detect infectious disease outbreaks. At the federal level, the Department of Health and Human Services (DHHS) is the U.S. public health infrastructure that develops policies to protect the nation's health. The Centers for Disease Control and Prevention (CDC) is a major DHHS agency that protects the nation's health by developing guidelines that promote health and quality of life by preventing and controlling disease, injury, and disability. The CDC is also a partner with the World Health Organization (WHO) through the Global Outbreak Alert and Response Network and the WHO Surveillance and Response system, which provide international epidemic alerts and responses.

6. A client with tuberculosis sneezes in the waiting room and infects several other clients who are sitting on the other side of the room. Which mechanism of transmission is involved in this case? A) Airborne B) Droplet C) Direct contact D) Indirect contact

Ans: A Feedback: Airborne transmission occurs when microorganisms are carried in the air in small particles, called droplet nuclei, at distances that exceed a few feet. Droplet transmission theoretically is a form of contact transmission; the mechanism of transfer of the pathogen to the host is quite distinct from either direct or indirect transmission. Therefore, droplet transmission is considered a separate route of transmission. Droplets are generated from the source person primarily during coughing, sneezing, or talking and are propelled a short distance (<3 feet) through the air and deposited on the conjunctivae, nasal mucosa, or mouth of another person. Direct contact occurs through direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person (or animal). Indirect contact involves contact of a susceptible host with a contaminated intermediate inanimate object, called a vehicle, such as a contaminated surgical instrument, needle, toy, soiled clothing, or bed linen.

4. In infectious disease epidemiology, just the presence of an infectious agent is not sufficient to produce an infectious disease. Which host factors determine whether a person is at risk for an infection or an infectious disease? (Select all that apply.) A) Age B) Sex C) Occupation D) Physical and emotional health E) Immune status

Ans: A, B, D, E Feedback: There are several host factors that determine whether a person is at risk for an infection or an infectious disease. These include age, sex, race, physical and emotional health, and immune status. Occupation is not a host factor.

19. Which factors place an individual at high risk for acquiring a sexually transmitted infection (STI)? (Select all that apply.) A) Having multiple sexual partners B) Using a condom during sex C) Having no other STIs D) Having a sexual partner who has had an STI E) Receiving a blood transfusion

Ans: A, D Feedback: Any person is in a high-risk group for STIs if they have multiple sexual partners, do not use a condom during sex, have other STIs, and/or have a sexual partner who has had an STD. Although once a risk for exposure to HIV, blood transfusions no longer place an individual at high risk for acquiring an STI.

10. Several levels of public health surveillance are necessary to protect the nation's health. At what level are healthcare providers and health facilities required to report certain infectious diseases? A) Local B) State C) Federal D) International

Ans: B Feedback: Local reporting mechanisms are community specific. At the state level, healthcare providers and health facilities are required to report certain infectious diseases to state health departments. At the federal level, the Department of Health and Human Services (DHHS) is the US public health infrastructure that develops policies to protect the nation's health. The Centers for Disease Control and Prevention (CDC) also is a partner with the World Health Organization (WHO) through the Global Outbreak Alert and Response Network and the WHO Surveillance and Response system, which provide international epidemic alerts and responses.

9. Person, place, and time characterize the description of an epidemiologic problem. Using knowledge of outbreak investigations, which occurs with propagated outbreaks? A)Same person or vehicle as the reservoir or means of transmission B) Infection transmitted from person to person over a short period of time C) Generating secondary infections with intervals between peaks that approximate the usual incubation period for the infection D) Generating tertiary infections following exposure to a primary case

Ans: C Feedback: A propagated outbreak is one where the infection is transmitted from person to person over a longer period of time than with a common source outbreak, and it can generate secondary infections with intervals between peaks that approximate the usual incubation period for the infection. A common source outbreak is one that has the same origin. Secondary infections are those that occur within the accepted incubation period following exposure to a primary case.

13. A client presents with severe diarrhea. The client tells the nurse that she went to a chicken roast at church the previous weekend. The nurse suspects a foodborne illness. Which cause of bacterial foodborne illness should the nurse most suspect in this case? A) Campylobacter B) Listeria monocytogenes C) Salmonella D) Escherichia coli O157:H7

Ans: A Feedback: Campylobacter is the most common cause of bacterial foodborne illness in the United States, and it is an important cause of diarrheal illness throughout the world regardless of people's age. Consumption of contaminated poultry is the most common source of Campylobacter infection, although undercooked meats, ground beef, pork, cheese, eggs, shellfish, unpasteurized milk, and direct exposure to pets and farm animals have been implicated. Other infectious organisms that commonly cause foodborne illnesses include noroviruses, Listeria monocytogenes, nontyphoid Salmonella, and E. coli O157:H7.

15. The client reports diarrhea, fever, and abdominal cramps 24 hours following exposure to raw eggs while cooking. An efficient and effective homemade oral rehydration solution is to stir: A) One level teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water B) Eight level teaspoons of salt and one level teaspoon of sugar into one quart or liter of clean drinking water C) One level teaspoon of salt and one level teaspoon of sugar into one quart or liter of clean drinking water D) Eight level teaspoons of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water

Ans: A Feedback: An efficient and effective homemade oral rehydration solution is to stir one level teaspoon of salt and eight level teaspoons of sugar into one quart or liter of clean drinking water or water that has been boiled and cooled.

8. Chloroquine-resistant malaria occurs in most of Africa, the Middle East, and Asia and all of the South Pacific islands. This type of disease occurrence is known as: A) Endemic B) Epidemic C) Pandemic D) Outbreak

Ans: A Feedback: An endemic disease, infection, or infectious agent occurs when it becomes prevalent within a population or geographic area. An epidemic or outbreak refers to a significant increase in an infection or infectious disease beyond the expected (endemic) level in a certain population and/or geographic area. A pandemic is an epidemic that generally spreads worldwide. The use of "outbreak" in this text is synonymous with epidemic.

20. A client wants to know the best way to avoid sexually transmitted infections (STIs). The nurse should mention: A) Abstinence B) Monogamous relationship with an infected partner C) Washing the genitals after sex D) Use of latex condoms

Ans: A Feedback: Other than abstinence, a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected is the best way to avoid STIs. Sexual partners should talk to each other about their STIs so that preventive action can be taken. Prevention of STI transmission does not include washing the genitals, urinating, or douching after sex. Latex condoms can reduce the risk of transmission but only when used consistently (every time) and correctly.

12. A client arrives on the unit, diagnosed with norovirus infection from eating shellfish. The client has been vomiting repeatedly and is now severely dehydrated. Which interventions are likely to be performed for this client? (Select all that apply.) A) Starting an intravenous line for fluid and electrolyte replacement B) Encouraging the client and the client's family to practice good handwashing C) Immediate disinfecting all potentially contaminated objects and surfaces D) Isolating the client until 12 hours after the client has been symptom free E) Administering a vaccination

Ans: A, B, C Feedback: Oral hydrating solutions should be given for attacks of norovirus, and in severe cases intravenous fluid and electrolyte replacement may be necessary. At the first signs of this acute gastroenteritis outbreak, good handwashing, thorough and immediate disinfection with appropriate solutions, and isolation of sick people until 72 hours, not 12 hours, after they are symptom free are critical. There is no vaccine currently for noroviruses.

3. Infectious agents are biological agents capable of producing an infection or infectious disease. Which are considered biological agents? (Select all that apply.) A) Fungi B) Fomites C) Bacteria D) Viruses E) Helminths

Ans: A, C, D, E Feedback: Infectious agents are biological agents capable of producing an infection or infectious disease and include bacteria, viruses, rickettsiae, fungi, protozoa, and helminths. Fomites are any substance that adheres to and transmits infectious materials. An infectious disease need not be contagious or communicable.

14. A client arrives at the clinic reporting diarrhea and flu-like symptoms. On questioning, the client tells the nurse about a family gathering she attended recently where she had some smoked seafood. Which foodborne illness should the nurse most suspect in this client? A) Campylobacter B) Listeria monocytogenes C) Salmonella D) Escherichia coli O157:H7

Ans: B Feedback: Nurses and other healthcare providers should suspect listeriosis in high-risk clients with a recent history of eating delicatessen food, soft cheeses, or smoked seafood who become ill with diarrhea and/or flu-like symptoms. Other infectious organisms that commonly cause foodborne illnesses include noroviruses, Listeria monocytogenes, nontyphoid Salmonella, and E. coli O157:H7. Campylobacter is the most common cause of bacterial foodborne illness in the United States, and it is an important cause of diarrheal illness throughout the world regardless of people's age.

2. A student nurse asks if an infectious disease is the same thing as a communicable disease. The nurse explains that an infectious disease is not necessarily a communicable disease. Which must a communicable disease have that an infectious disease does not have to have? (Select all that apply.) A) Pathogenic microorganism B) Portal of exit from the infected person C) Means of transmission D) Portal of entry to a susceptible host E) Organism that harbors the infectious agent

Ans: B, C, D Feedback: An infectious disease in a human host is one caused by the growth of pathogenic microorganisms in the body. For a disease to be communicable, or contagious, there must be a portal of exit from the infected person (or animal), a means of transmission, and a portal of entry to a susceptible host. Thus, an infectious disease need not be contagious, or communicable.

16. A client reports symptoms of severe abdominal cramps, bloody diarrhea, and vomiting after eating commercially packaged salad. The nurse suspects Escherichia coli O157:H7. The client asks about the average time of resolution of these symptoms. What time frame should the nurse provide? A) 3 to 5 days B) 5 to 7 days C) 7 to 10 days D) 12 to 14 days

Ans: C Feedback: Escherichia coli O157:H7, a deadly toxin-producing bacterium, produces symptoms of severe abdominal cramps, bloody and nonbloody diarrhea, and vomiting that generally resolve within 7 to 10 days.

21. A client presents with several ulcerative sores on his penis that are firm, round, and painless. He also has rough, reddish brown spots on his palms and the bottoms of his feet. He acknowledges that he is sexually active with multiple partners and is inconsistent in his use of a condom. Which sexually transmitted infection should the nurse most suspect in this client? A) Gonorrhea B) Chlamydia C) Syphilis D) Human papillomavirus

Ans: C Feedback: Syphilis is primarily indicated by ulcerative sores occurring mainly on the external genitals, vagina, anus, or in the rectum, although they can occur on the lips or in the mouth. The sore is usually firm, round, and painless. Rashes associated with secondary syphilis appear as rough, red, or reddish brown spots both on the palms of the hands and/or the bottoms of the feet. Infections with Neisseria gonorrhoeae, like those resulting from Chlamydia trachomatis, cause several clinical syndromes including urogenital, pharyngeal, and rectal infections in males and females, and conjunctivitis in adults and neonates. Chlamydia is known as a "silent" infection because most infected people are asymptomatic and lack abnormal physical examination findings. Men who are symptomatic typically have urethritis, with a mucoid or watery urethral discharge and dysuria. A minority of infected men develop epididymitis (with or without symptomatic urethritis), presenting with unilateral testicular pain, tenderness, and swelling. Human papillomavirus infections, if manifest, are primarily indicated by genital warts.

1. The nurse works with a female client who recently developed an infection of Staphylococcus aureus while in the hospital. In this case, S. aureus is which component in the chain of infection? A) Host B) Environmental reservoir C) Agent D) Portal

Ans: C Feedback: The agent, or the microbe that causes the disease, is the "what" of the epidemiologic triangle. The host, or the organism that is harboring the infectious agent, is the "who" of the triangle. The environment, which includes those external factors that cause or allow disease transmission, is the "where" of the triangle. Other necessary elements include a portal of exit from the host, environmental reservoirs, transmission, and a portal of entry to a new host.

5. When an infectious agent enters the host and begins to multiply, an infection occurs. The time between exposure to an infectious agent and the manifestation of symptoms in the host is known as: A) Carrier time B) Colonization C) Incubation period D) Latent period

Ans: C Feedback: The time between exposure to an infectious agent and the manifestation of symptoms in the host is called the incubation period. Asymptomatic people are carriers of a virus and can transmit the virus to others through percutaneous inoculation, exposure to mucous membranes, and sexual contact. When an infectious agent is present and there are no clinical signs of disease, colonization with the infectious agent is said to have occurred, and the infected person is capable of transmitting the agent. The latent period is the stage of a disease during which symptoms are hidden.

18. A 16-year-old client visits the community health clinic with concerns that she may have a sexually transmitted infection (STI). She asks whether STIs are treatable. STIs that are easily treated and curable include: (Select all that apply.) A) Human papillomavirus B) Herpes simplex C) Chlamydia D) Gonorrhea E) Syphilis

Ans: C, D, E Feedback: Infections caused by bacteria can be treated and usually cured with antibiotics, but those caused by viruses cannot be cured this way. Chlamydia, gonorrhea, syphilis—all bacterial—and trichomoniasis—parasitic are easily treated with antibiotics and cured if diagnosed early. Human papillomavirus and herpes simplex are viral infections that are not treatable.

7. The student-nurse discusses transmission that involves contact of a susceptible host with a vehicle. Based on the chain of infection links, which exemplifies a vehicle? A) Animals B) Insects C) Reptiles D) Water

Ans: D Feedback: Indirect contact involves contact of a susceptible host with a contaminated intermediate inanimate object, called a vehicle, such as a contaminated surgical instrument, needle, toy, soiled clothing, or bed linen. Vehicles also include food, water, and contaminated hands that are not washed. Indirect contact also includes vector transmission. Vectors are animal or insect carriers of infectious agents.