Chapter 34, 35, 36

34.16 Pathogenicity is different than virulence in that pathogenicity can: a. Cause a disease when pathogens are present. b. Lead to the ability of organisms to cause infection. c. Disrupt cell lining. d. Kill pathogens.

Answer B Lead to the ability of organisms to cause infection. Rationale: A. Virulence can cause a disease to be present, even in small numbers. B. Pathogenicity can lead to an organism's causing an infection. C. Cell lining is not disrupted in this process. D. Bactericidal ability leads to killing pathogens.

35.11 The female client has a fungal infection and will receive griseofulvin (Fulvicin). What assessment data is critical for the nurse to collect prior to administering this medication? 1. The client's height and weight 2. The type of diet the client is eating 3. The type of birth control the client is using 4. The amount of fat in the client's diet

Answer: 3 The type of birth control the client is using Rationale: Griseofulvin (Fulvicin) is a Pregnancy Category C drug, which means there isn't any data to indicate it is safe to take during pregnancy. The client's height and weight are not significant. The type of diet the client consumes is not significant.

34.11 The client receives an injection of penicillin G benzathine (Bicillin LA) in the outpatient clinic. What is a priority nursing action by the nurse prior to administering this injection? 1. Inform the client she will need to wait for 30 minutes before leaving the clinic. 2. Ask the client if she has ever had an allergic reaction to penicillin. 3. Have the client lie down and assess vital signs before she leaves. 4. Tell the client she will need to have someone drive her home.

Answer: 1 Rationale: It is important for the client to wait for 30 minutes before leaving the clinic because the client may not know whether or not she is allergic to penicillin. Asking about a penicillin allergy is important, but the client could still have an allergic reaction if she has not received previous doses of penicillin. There is no reason for the client to lie down and the nurse does not need to assess vital signs unless an allergy is suspected. There is no reason for the client to have someone drive her home.

35.9 The client receives metronidizole (Flagyl) for treatment of a vaginal yeast infection. What does the best medication education by the nurse include? 1. Do not drink alcohol with this medication. 2. Drink at least 2,000 mL of fluid with this medication. 3. Do not take this medication with milk or milk products. 4. Eat at least two cups of yogurt daily while on this medication.

Answer: 1 Rationale: The interaction of metronidizole (Flagyl) and alcohol causes an Antabuse-like reaction, i.e., severe nausea, vomiting, and abdominal pain. Pushing fluids is not necessary. There is no interaction with this medication and milk or milk products. There is no need to consume yogurt while on this medication.

36.14 The nurse accidentally sticks herself with a needle after starting an intravenous (IV) line on a client with acquired immune deficiency syndrome (AIDS). The nurse tells the supervisor about the accident. What is the best initial response by the supervisor to decrease anxiety in the nurse? 1. "Fortunately, the chances of you contracting human immunodeficiency virus (HIV) after the stick are very small." 2. "If you are started on medications soon, it will decrease the severity of the disease." 3. "Workers compensation will cover the cost of your illness and medications." 4. "Did you use the hospital protocols for starting intravenous (IV) lines on a client with acquired immune deficiency syndrome (AIDS)?"

Answer: 1 "Fortunately, the chances of you contracting human immunodeficiency virus (HIV) after the stick are very small." Rationale: There have been only about 56 cases of client-to-healthcare worker transmission; the risk is very small. The risk of transmission of human immunodeficiency virus (HIV) from client-to-healthcare worker is very small, and telling the nurse to start on medication, will not reduce anxiety. If the nurse did contract human immunodeficiency virus (HIV), workers compensation would cover the cost, but the risk of human immunodeficiency virus (HIV) transmission is small and this response will not reduce anxiety. Asking the nurse if she used protocols is very non-therapeutic at this point, and will most likely increase anxiety.

36.12 The nurse does health teaching with a client who has acquired immune deficiency syndrome (AIDS) and who has been started on antiviral medications. The nurse recognizes teaching has been effective when the client makes which statement? 1. "I will still need to take precautions to avoid spreading the virus to others." 2. "I will need to be on a high-calorie diet to enhance the effect of the medication." 3. "I will need to limit my travel to avoid people with other infections." 4. "I will not be able to continue working at my high-stress job anymore."

Answer: 1 "I will still need to take precautions to avoid spreading the virus to others." Rationale: Precautions are still necessary to avoid spreading the virus to others. A well-balanced diet is the best diet for a client with acquired immune deficiency syndrome (AIDS). There is no need to limit travel at this point. A high-stress job is not ideal, but at this point the client doesn't need to stop working.

35.13 The client has a fungal infection of the toenails and receives oral terbinafine (Lamisil). The client asks the nurse how a pill will heal his nail infection. What is the best response by the nurse? 1. "The medication accumulates in your nail beds and is there for many months." 2. "The medication should be combined with a topical agent to increase effectiveness." 3. "The medication works by destroying circulating fungi in your blood." 4. "The medication works by destroying toxins excreted by the fungi in your nails."

Answer: 1 "The medication accumulates in your nail beds and is there for many months." Rationale: Terbinafine (Lamisil) is an oral agent that has the advantage of accumulating in nail beds, allowing it to remain active many months after therapy is discontinued. Terbinafine (Lamisil) does not need to be combined with a topical agent. Terbinafine (Lamisil) does not destroy circulating fungi in the blood. Terbinafine (Lamisil) does not destroy toxins excreted by fungi.

35.2 The client has had malaria for many years. He asks the nurse why medications might not cure his illness when there are several drugs available. What is the best response by the nurse? 1. "When cysts occur late in the disease, the parasite is too resistant for medications to be effective." 2. "When erythrocytes rupture, the parasites are too numerous for medications to be effective." 3. "Once the parasite starts multiplying in your liver, medications are usually ineffective." 4. "Late in the illness, the immune system is too overwhelmed for medications to be effective."

Answer: 1 "When cysts occur late in the disease, the parasite is too resistant for medications to be effective." Rationale: When cysts occur inside the host, the parasite is often resistant to pharmacotherapy. Erythrocytes rupture early in the course of the illness, and medications are more effective at this stage The parasites begin multiplying in the liver in the earliest stage of the illness when medications are most effective. Late in the illness, medications are often ineffective because the parasites are in cysts, not because the immune system is overwhelmed.

36.3 The client receives zidovudine (Retrovir) for treatment of human immunodeficiency virus (HIV) infection. Which assessment data indicates an adverse reaction to zidovudine (Retrovir)? 1. Decreased white blood count (WBC) 2. Enlarged lymph nodes 3. Fever 4. Edema

Answer: 1 Decreased white blood count (WBC) Rationale: Bone marrow suppression is a common adverse effect of zidovudine (Retrovir), and decreased white blood cells (WBCs) are indicative of bone marrow suppression. Enlarged lymph nodes are not an adverse effect of zidovudine (Retrovir). Fever is the result of infection, not the use of zidovudine (Retrovir). Edema is not an adverse effect of zidovudine (Retrovir).

34.7 The client comes to the emergency department with a fever of 104° F. What will the best plan of the nurse include? 1. Plan to obtain blood cultures 2. Plan to obtain a complete blood count (CBC) test 3. Plan to obtain a sterile urine specimen 4. Plan to obtain liver and renal function tests

Answer: 1 Plan to obtain blood cultures Rationale: A high fever is usually indicative of a systemic infection. Blood cultures are the best way of identifying the causative organism. Blood cultures, not a complete blood count (CBC), are the best way of identifying the causative organism. Blood cultures, not sterile urine samples, are the best way of identifying the causative organism. Blood cultures, not liver and renal function tests, are the best way of identifying the causative organism.

35.3 The nurse plans to provide health promotion to a group of business travelers who are going to travel to Africa. What will the best teaching plan of the nurse include? 1. Plan to take antimalarial drugs prophylactically. 2. Plan to take antibiotics prophylactically. 3. Plan to take protease inhibitors prophylactically. 4. Plan to receive immunizations for malaria.

Answer: 1 Plan to take antimalarial drugs prophylactically. Rationale: Taking antimalarial drugs prophylactically is recommended when traveling to countries where malaria is found. Antibiotics are not necessary for travel into many countries. Protease inhibitors for viral infections are not recommended. To date, there are no effective immunizations against malaria.

36.9 The nurse teaches clients with acquired immune deficiency syndrome (AIDS) about the importance of taking their medications as prescribed. What does the nurse recognize as the primary factor for medication noncompliance in the acquired immune deficiency syndrome (AIDS) population? 1. The necessity of having to take multiple medications throughout the day 2. The difficulty with availability of medications to treat acquired immune deficiency syndrome (AIDS). 3. The unpleasant side effects that are associated with the medications 4. A lack of understanding for the reason to take the medications

Answer: 1 The necessity of having to take multiple medications throughout the day Rationale: Multiple medications are required throughout the day. The higher the number of medications taken daily equates with a higher noncompliance rate. Medications are generally available for clients with acquired immune deficiency syndrome (AIDS) today. Most clients with acquired immune deficiency syndrome (AIDS) recognize the importance of taking medications in spite of side effects. A lack of understanding could be a factor, but it is the schedule of taking multiple drugs that leads to noncompliance.

35.12 The client is noncompliant with taking medications to prevent malaria prior to an overseas business trip. What will the best assessment of the nurse reveal? 1. The side effects of vomiting and diarrhea were too uncomfortable. 2. The medication dosing was too frequent for the client to tolerate. 3. The cost of the medications was too high for the client's budget. 4. The taste of the various tablets was really too offensive to the client.

Answer: 1 The side effects of vomiting and diarrhea were too uncomfortable. Rationale: Side effects, such as vomiting and diarrhea, can be severe after taking the medication. Usually the dosing is once weekly; it is not too frequent for a client to tolerate. The cost of the medication is not a factor, generic forms are available. The medication is not coated, but the taste is not a significant factor.

34.2 The student nurse asks the nursing instructor for help with her microbiology class. The student is studying bacteria. What does the best plan of the nursing instructor include? Select all that apply. 1. Spherical-shaped bacteria are called cocci. 2. Gram-staining is one way to identify bacteria. 3. E-coli are gram-negative bacteria. 4. Bacteria are either aerobic or anaerobic. 5. Bacteria are multicellular organisms.

Answer: 1, 2, 3 Rationale: Spherical-shaped bacteria are called cocci. Gram-staining is one way to identify bacteria. E-coli are gram-negative bacteria. Some organisms have the ability to change their metabolism and survive in either aerobic or anaerobic conditions. Bacteria are single cell organisms.

36.1 The nurse educates clients with acquired immune deficiency syndrome (AIDS) about the nature of viruses. The nurse evaluates that learning has occurred when the clients make which response(s). Select all that apply. 1. "Viruses are nonliving particles." 2. "Viruses are intracellular parasites." 3. "A virion is a mature virus." 4. "The structure of viruses is complex." 5. "Viruses can infect plants as well as animals."

Answer: 1, 2, 3, 5 Rationale: Viruses are nonliving agents that infect bacteria, plants, and animals. Viruses must use intracellular machinery to replicate, so are called intracellular parasites. A mature infective particle is called a virion. Viruses can infect plants as well as animals. The structure of viruses is quite primitive compared to the simplest cell.

36.6 The nurse plans to teach a client with human immunodeficiency virus (HIV) infection about zidovudine (Retrovir). What will the best plan of the nurse include? Select all that apply. 1. Zidovudine (Retrovir) will need to be stopped if bone marrow depression occurs. 2. Zidovudine (Retrovir) therapy frequently results in the development of anemia. 3. Zidovudine (Retrovir) prevents spread of the virus through sexual contact. 4. Zidovudine (Retrovir) will slow the disease, but not cure it. 5. Zidovudine (Retrovir) was the first drug developed to treat acquired immune deficiency syndrome (AIDS)

Answer: 1, 2, 4, 5 Rationale: Stopping zidovudine (Retrovir) if bone marrow depression occurs allows the bone marrow time to recover. Treatment with zidovudine (Retrovir) frequently results in anemia. The drug only slows the disease; it will not cure it. Zidovudine (Retrovir) was the first drug developed to treat AIDS. Zidovudine (Retrovir) will slow the progression of the disease; it will not prevent its transmission.

35.1 The nursing instructor teaches the student nurses about fungal infections. The nursing instructor evaluates learning has occurred when the student nurses make which statement(s)? Select all that apply. 1. "Systemic infections require oral medications that have serious adverse effects." 2. "Systemic infections are much more common than superficial infections." 3. "Newer medications can be used for superficial as well as systemic infections." 4. "Superficial infections are considered more benign than systemic infections. 5. "Superficial infections are more difficult to treat than systemic infections."

Answer: 1, 3, 4 Rationale: Systemic infections often require aggressive oral or parenteral medications that produce more adverse effects than the topical agents. Some of the newer antifungal agents may be used for either superficial or systemic infections. Superficial infections are relatively benign; systemic infections can be life threatening. Systemic infections are less, not more common than superficial infections. Superficial infections are less difficult, not more difficult, to treat than systemic infections.

34.1 The nurse plans to teach the client with acquired immune deficiency syndrome (AIDS) about bacterial infec¬tions. Which statement describes the best plan of the nurse? Select all that apply. 1. "Pathogenicity means the bacteria can cause an infection." 2. "Pathogens are divided into two classes, bacteria and viruses." 3. "If just a few bacteria make you sick, this is virulence." 4. "Actually, most bacteria will not harm us." 5. "Most bacteria have developed antibiotic resistance."

Answer: 1, 3, 4 Rationale: The ability of an organism to cause infection is called pathogenicity. A highly virulent microbe is one that can produce disease when present in minute numbers. Only a few dozen pathogens commonly cause disease in humans; most are harmless. Human pathogens include viruses, bacteria, fungi, unicellular organisms, and multicellular animals. Antibiotic resistance is a problem; however only a few, not most, bacteria have not developed it.

35.8 The client receives amphotericin B (Fungizone) for histoplasmosis. What does the best assessment of the nurse include? Select all that apply. 1. Serum creatinine 2. Serum glucose 3. Serum sodium 4. Blood urea nitrogen 5. Serum amylase

Answer: 1, 4 Rationale: Amphotericin B (Fungizone) is nephrotoxic, so serum creatinine and blood urea nitrogen should be monitored. Amphotericin B (Fungizone) does not affect serum glucose. Amphotericin B (Fungizone) does not affect serum sodium. Amphotericin B (Fungizone) does not affect serum amylase.

36.2 The client asks the nurse why there aren't better drugs for human immunodeficiency virus (HIV) infection when so much money is spent on research. What is the best response by the nurse? 1. "Developing new drugs is difficult because people think acquired immune deficiency syndrome (AIDS) is a "gay" disease." 2. "Developing new drugs is difficult because the virus mutates so readily." 3. "Developing new drugs is difficult because we still do not understand the virus." 4. "Developing new drugs is difficult because we still do not have enough money."

Answer: 2 "Developing new drugs is difficult because the virus mutates so readily." Rationale: Antiviral pharmacotherapy can be extremely challenging because of the rapid mutation rate of viruses, which can quickly render drugs ineffective. Most people recognize human immunodeficiency virus (HIV) infection as a heterosexual, not homosexual, disease. After more then 20 years of research, the virus is mostly understood. More money is spent on human immunodeficiency virus (HIV) infection research than just about any other illness.

35.6 The client has scalp ringworm and is being treated with econazole (Spectazole). What are the best discharge instructions by the nurse? 1. "Wash your head at least three times a day for 2 weeks." 2. "Do not share any towels with family members." 3. "Avoid meat and high protein foods with this medication." 4. "Comb the medication into your hair and cover with a towel."

Answer: 2 "Do not share any towels with family members." Rationale: Ringworm can be spread by contact with articles such as towels that are used by the affected person. Washing the head three times a day is excessive and unnecessary while taking econazole (Spectazole). There is no reason to restrict protein. The medication is left on the head for 15 minutes, and then washed out.

35.5 The nurse does medication education for the client with histoplasmosis who receives ketoconazole (Nizoral). The nurse evaluates learning has occurred when the client makes which statement? 1. "I should take this medication with milk or antacids to decrease GI upset." 2. "I could develop nausea, vomiting, and abdominal pain with this medication." 3. "I cannot take this medication longer than 10 days." 4. "I could develop resistance to this medication if I take if too often."

Answer: 2 "I could develop nausea, vomiting, and abdominal pain with this medication." Rationale: Nausea, vomiting and abdominal pain are common side effects of ketoconazole (Nizoral). Taking ketoconazole (Nizoral) with milk or antacids will decrease its absorption. Ketoconazole (Nizoral) is often used for longer than 10 days. Organisms, not people, develop resistance; this is not a likely occurrence anyway.

35.10 The client is being treated for pinworms with mebendazole (Vermox). The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement? 1. "I need to have three negative stool cultures before I am cured." 2. "I may expel worms for three days after I finish the medication." 3. "I must avoid aspirin while I am on this medication." 4. "I need high-fiber foods to help with passage of the worms."

Answer: 2 "I may expel worms for three days after I finish the medication." Rationale: It can take up to 3 days for all the worms to be eliminated from the GI system. Stool cultures are not necessary. There is no interaction between mebendazole (Vermox) and aspirin. Diet will not impact the passage of worms.

34.13 The client is prescribed amoxicillin (Amoxil) for 10 days to treat strep throat. After 5 days, the client tells the nurse he plans to stop the medication because he feels better. What is the best response by the nurse? 1. "You should get another throat culture to see if the infection is gone." 2. "If you stop the medicine early, this could result in damage to your heart." 3. "If you stop the medicine early, this could result in resistance to the antibiotic." 4. "You should get another throat culture if your symptoms return."

Answer: 2 "If you stop the medicine early, this could result in damage to your heart." Rationale: If all the medication is not taken, remaining organisms could become resistant, and strep infections can damage heart valves. Another throat culture is inappropriate; the client must finish the medication. Stopping the medicine early can result in resistance to the antibiotic, but the client may not care about this unless he can see how it directly affects him. Another throat culture is inappropriate; the client must finish the medication.

34.10 The client receives multiple drugs for treatment of tuberculosis. The nurse teaches the client the rationale for multiple drug treatment, and evaluates learning as effective when the client makes which statement? 1. "Treatment for tuberculosis is complex, and multiple drugs must be continued for as long as I am contagious." 2. "Multiple drugs are necessary because the bacteria are likely to develop resistance to just one drug." 3. "Multiple drug treatment is necessary for me to be able to develop immunity to tuberculosis." 4. "Current research indicates that the most effective way to treat tuberculosis is with multiple drugs."

Answer: 2 "Multiple drugs are necessary because the bacteria are likely to develop resistance to just one drug." Rationale: Tuberculosis bacilli are likely to develop resistance to one drug, so multiple drugs must be used. Treatment must be continued long after the client is no longer contagious. Clients cannot develop immunity to bacterial infections. Current research does support multiple drug treatment, but this does not explain the rationale for this to the client.

34.6 The nurse works in infection control and teaches a class to staff nurses about the ways that resistance to antibiotics can occur. The nurse evaluates that learning has occurred when the nurses make which statement? 1. "Resistance to antibiotics can occur by the prophylactic use of them for pre-operative clients." 2. "Resistance to antibiotics can occur by the common use of them for nosocomial infections." 3. "Resistance to antibiotics can occur when physicians prescribe too many of them for elderly clients." 4. "Resistance to antibiotics can occur when physicians prescribe too many of them for children with ear infections."

Answer: 2 "Resistance to antibiotics can occur by the common use of them for nosocomial infections." Rationale: The organisms that cause nosocomial infections have most likely been treated with antibiotics, and are the most likely organisms to develop resistance to antibiotics. The prophylactic use of antibiotics does not promote antibiotic resistance. The use of antibiotics by physicians with elderly clients does not promote antibiotic resistance. The use of antibiotics by physicians for children with ear infections does not promote antibiotic resistance.

34.3 The client tells the nurse that the doctor told him his antibiotic did not kill his infection, but just slowed its growth. The client is anxious. What is the best response by the nurse to decrease the client's anxiety? 1. "This is okay because your infection is not really that serious." 2. "This is okay because your body will help kill the infection too." 3. "This is okay because your doctor is an infectious disease specialist." 4. "This is okay because your blood work is being monitored daily."

Answer: 2 "This is okay because your body will help kill the infection too." Rationale: Some drugs do not kill the bacteria, but instead slow their growth and depend on the body's natural defenses to dispose of the microorganisms. These drugs which slow the growth of bacteria are called bacteriostatic. Telling a client with an infection that the infection is not serious will increase anxiety because to the client, all infections are serious. Telling the client that the doctor is a specialist does not answer the question and will increase anxiety. Telling the client that blood work is being monitored does not answer the question and will increase anxiety.

36.11 The client with acquired immune deficiency syndrome (AIDS) asks the nurse why he must take so many medications. What is the best response by the nurse? 1. "To provide you with the most effective treatment for your illness." 2. "To decrease the possibility of the virus developing resistance to the medications." 3. "Because the earlier we start multiple medications the better for you." 4. "Research has shown single medications to be ineffective."

Answer: 2 "To decrease the possibility of the virus developing resistance to the medications." Rationale: Decreasing the possibility of resistance is the key; single drugs can be effective, but viral resistance is a problem. Multiple medications will provide the best treatment, but this is not as good an answer as avoiding drug resistance. It is debatable if multiple drugs should be used early in the course of the disease. Single medications can be effective, but drug resistance is more likely the reason.

35.7 The client receives nystatin (Nilstat) for a fungal infection in the mouth. The nurse plans to do medication education prior to discharge. What will the best plan of the nurse include? 1. Take the oral suspension with a straw to prevent tooth discoloration. 2. Dissolve the oral tablet in your mouth and then swallow it. 3. Crush the oral tablet, mix it with orange juice, and then swallow it. 4. Swallow the oral tablet whole without chewing or crushing it.

Answer: 2 Dissolve the oral tablet in your mouth and then swallow it. Rationale: Dissolving the tablet in the mouth allows contact of the medication with the organisms causing the infection. The medication does not cause tooth discoloration. The medication must remain in the mouth as long as possible, so it should not be crushed and mixed with liquids. The medication must remain in the mouth as long as possible, so it should not be swallowed whole.

35.4 The nurse works in infection control at a large hospital. Which client does the nurse recognize as being at greatest risk of acquiring a fungal infection? 1. The client with anemia who is pregnant with triplets 2. The client with malignant melanoma who is receiving chemotherapy 3. The client with severe burns over 20% of the body 4. The adolescent client with a fractured femur from an auto accident

Answer: 2 The client with malignant melanoma who is receiving chemotherapy Rationale: Chemotherapy suppresses the immune system; clients with a suppressed immune system are at highest risk. The pregnant client with anemia is not at risk. The client with burns is at risk, but will not acquire the infection if infection control procedures are followed. The adolescent with a fractured femur is not at risk.

34.12 The client comes to the emergency department complaining of a sore throat. He has white patches on his tonsils, and he has swollen cervical lymph nodes. What will the best plan of the nurse include? 1. Plan to obtain blood cultures 2. Plan to administer a broad-spectrum antibiotic 3. Plan to obtain a throat culture 4. Plan to administer a narrow-spectrum antibiotic

Answer: 3 Rationale: A throat culture is necessary to identify the causative organism and initiate the best antibiotic treatment. Blood cultures are not necessary at this point because the infection is in the throat; it is not systemic. A broad-spectrum antibiotic is commonly ordered, but a throat culture should be obtained first. Initial therapy with a narrow-spectrum antibiotic is too specific without knowing the causative organism.

34.15 The physician orders cefepime (Maxipime) for a client. What is a priority question for the nurse to ask the client prior to administration of this drug? 1. "Are you pregnant?" 2. "Are you breast-feeding?" 3. "Are you allergic to penicillin?" 4. "Are you allergic to tetracycline?"

Answer: 3 "Are you allergic to penicillin?" Rationale: Cephalosporins are contraindicated in clients who have experienced a severe allergic reaction to penicillin. Cefepime (Maxipime) is a Pregnancy Category B drug, and is safe for use during pregnancy. Cefepime (Maxipime) is a Pregnancy Category B drug, and is safe to use while breast-feeding. Cephalosporins are contraindicated in clients who have experienced a severe allergic reaction to penicillin, not tetracycline.

35.14 The client receives oral nystatin (Mycostatin) suspension for an oral candidiasis infection. She tells the nurse she cannot continue to "swish and swallow" because her nausea is too great. What is the best response by the nurse? 1. "You can take a phenergan suppository before the nystatin (Mycostatin)." 2. "Try drinking a 7-Up after you swallow the medication." 3. "It is all right to swish the medication and then spit it out." 4. "I will ask your doctor if a pill form can be substituted."

Answer: 3 "It is all right to swish the medication and then spit it out." Rationale: If GI side effects are disturbing, the client may swish the medication and then spit it out. A phenergan suppository is not necessary. Drinking a 7-Up is not necessary. Substituting a tablet form is not necessary.

34.4 The nurse works on an infectious disease unit. What is the best understanding of the nurse about the major role of the nurse on this unit? 1. Monitoring liver and renal function tests. 2. Ensuring that all antibiotic medications are given on time. 3. Educating the client about the illness and antibiotic therapy. 4. Ensuring that everyone entering the clients' rooms wash their hands.

Answer: 3 Educating the client about the illness and antibiotic therapy. Rationale: Nurses have many roles on an infectious disease unit. The role of the nurse that will best optimize client outcomes includes education about the illness and education about precisely following the antibiotic protocol. Monitoring liver and renal function tests is important, but if the client is not well educated, treatment may not be successful. Giving antibiotics on time is very important, but the client is likely to continue antibiotics at home and must be educated about the protocol. Ensuring that anyone entering a client's room washes their hands is the best way to prevent nosocomial infections, but does not mean the individual client's treatment will be successful.

36.4 The client receives acyclovir (Zovirax) for treatment of genital herpes. What is a priority assessment by the nurse? 1. Respiratory distress 2. Thrombocytopenia 3. Increased serum creatinine 4. Auditory and visual hallucinations

Answer: 3 Increased serum creatinine Rationale: Acyclovir (Zovirax) is nephrotoxic, so serum creatinine should be monitored. Kidney failure, not respiratory distress, is an adverse effect of acyclovir (Zovirax). Kidney failure, not bone marrow suppression, is an adverse effect of acyclovir (Zovirax). Kidney failure, not auditory and visual hallucinations, is an adverse effect of acyclovir (Zovirax).

34.8 The client receives gentamicin (Garamycin) intravenous (IV) in the clinical setting. What is a priority nursing action? 1. Place the client on isolation precautions 2. Draw daily blood chemistries 3. Monitor the client for hearing loss 4. Increase the fluids for the client during therapy

Answer: 3 Monitor the client for hearing loss Rationale: Aminoglycocides are ototoxic drugs, and the client should be monitored for hearing loss. Isolation is determined by the causative organism, not the drug used for treatment. Serum levels of the drug are indicated, but not blood chemistries. Increasing fluids during therapy is not indicated.

36.10 The client has just begun highly active antiretroviral therapy (HAART) therapy for the treatment of acquired immune deficiency syndrome (AIDS). Which teaching point is a priority for this client? 1. The goal of highly active antiretroviral therapy (HAART) therapy is to reduce plasma human immunodeficiency virus (HIV) ribonucleic acid (RNA) to the lowest possible level. 2. Knowing which medications target which phases of the human immunodeficiency virus (HIV) replication cycle. 3. Taking medications as scheduled is vital to successful treatment. 4. Medications must be taken for three years after viral load is not measurable.

Answer: 3 Taking medications as scheduled is vital to successful treatment. Rationale: Taking medicines, as scheduled, is vital to maintain adequate treatment and prevent resistance to the medication. The goal of highly active antiretroviral therapy (HAART) is to reduce plasma human immunodeficiency virus (HIV), but this is not as important as medication compliance. The client may be interested in knowing which medications target which phases of the human immunodeficiency virus (HIV) ribonucleic acid (RNA) reproduction cycle, but this is not as important as medication compliance. Medications must be continued for the lifetime of the client.

36.13 The client has acquired immune deficiency syndrome (AIDS) and has just learned she is pregnant. She tearfully asks the nurse if her baby will die of acquired immune deficiency syndrome (AIDS). What is the best outcome for this client? 1. The client will take penciclovir (Denavir) as prescribed. 2. The client will take indinavir (Crixivan) as prescribed. 3. The client will take zidovudine (Retrovir) as prescribed. 4. The client will take tipranavir (Aptivus) as prescribed.

Answer: 3 The client will take zidovudine (Retrovir) as prescribed. Rationale: A regime of oral zidovudine (Retrovir) will decrease the possibility of mother-to-baby transmission by 70%. Zidovudine (Retrovir), not penciclovir (Denavir), will decrease the possibility of mother-to-baby transmission by 70%. Zidovudine (Retrovir), not indinavir (Crixivan), will decrease the possibility of mother-to-baby transmission by 70%. Zidovudine (Retrovir), not tipranavir (Aptivus), will decrease the possibility of mother-to-baby transmission by 70%.

36.8 The nurse provides care for clients with acquired immune deficiency syndrome (AIDS). Which laboratory test is the best indicator of effective treatment with antiviral medications? 1. T4 lymphocyte count 2. CD4 count 3. Viral load 4. Absolute neutrophil count

Answer: 3 Viral load Rationale: The viral load is an actual count of viral presence, and is the best test. The viral load, not a T4 lymphocyte count, is the best test. The viral load, not a CD4 count, is the best test. The viral load, not an absolute neutrophil count, is the best test.

34.14 The physician orders penicillin for a female client who has a sinus infection. What is a priority question to ask the client prior to administering the medication? 1. "Are you pregnant?" 2. "Are you breast-feeding?" 3. "Do you plan to become pregnant?" 4. "Are you taking birth control pills?"

Answer: 4 "Are you taking birth control pills?" Rationale: Penicillin can cause birth control pills to lose their effectiveness. Penicillin is a Pregnancy Category B drug, and is safe to take if a client is pregnant. Penicillin is a Pregnancy Category B drug, and is safe to take if a client is breast-feeding. Penicillin is a Pregnancy Category B drug, and is safe to take if a client plans to become pregnant.

35.15 The client receives terbinafine (Lamisil) as treatment for a fungal infection of the toenails. What is an important assessment question for the nurse to ask? 1. "How do you clean and clip your toenails?" 2. "Do you have diabetes mellitus?" 3. "Are you HIV-positive?" 4. "What analgesic do you take for headaches?"

Answer: 4 "What analgesic do you take for headaches?" Rationale: Clients must be instructed not to use acetaminophen (Tylenol) while receiving terbinafine (Lamisil), because terbinafine (Lamisil) is hepatotoxic and so is acetaminophen (Tylenol) in large enough quantities. How the client cleans and clips his toenails is not significant. Terbinafine (Lamisil) does not affect glucose levels. Terbinafine (Lamisil) is not contraindicated for a client who is HIV-positive.

34.5 The client receives multiple antibiotics to treat a serious infection. What will the priority assessment of the client by the nurse include? 1. Assessing blood cultures for the presence of bacteria 2. Assessing renal and liver function tests 3. Assessing whether or not the client has adequate food and fluid intake 4. Assessing for diarrhea, and difficult or painful urination

Answer: 4 Assessing for diarrhea, and difficult or painful urination Rationale: A superinfection occurs when microorganisms normally present in the body, host flora, are destroyed by antibiotic therapy. A superinfection can be lethal and should be suspected if a new infection appears while the client is receiving antibiotics. Signs of superinfection commonly include diarrhea, difficult or painful urination, and abnormal vaginal discharges. Assessing blood cultures is important, but not as important as assessing for superinfections. Assessing renal and liver function tests is very important, but not as important as assessing for superinfections. Assessing food and fluid intake is very important, but not as important as assessing for superinfections.

36.7 The physician orders amantadine (Symmetrel) for a client with influenza. Which part of the client's health history would the nurse report to the physician prior to administering amantadine (Symmetrel)? 1. Allergy to shellfish 2. Diabetes mellitus 3. Chronic obstructive pulmonary disease (COPD). 4. Epilepsy

Answer: 4 Epilepsy Rationale: Amantadine (Symmetrel) is associated with seizures, and should not be administered to a client with epilepsy. An allergy to shellfish is not a contraindication to the use of amantadine (Symmetrel). Diabetes mellitus is not a contraindication to the use of amantadine (Symmetrel). Chronic obstructive pulmonary disease (COPD) is an indication for amantadine (Symmetrel) because influenza could be fatal in this client.

34.9 The client has MRSA and receives vancomycin (Vancocin) intravenously (IV). The nurse assesses an upper body rash and decreased urine output. What is the nurse's priority action? 1. Obtain a stat X-ray, and notify the physician. 2. Obtain a sterile urine specimen, and notify the physician. 3. Administer an antihistamine, and notify the physician. 4. Hold the next dose of vancomycin (Vancocin), and notify the physician.

Answer: 4 Hold the next dose of vancomycin (Vancocin), and notify the physician. Rationale: Upper body rash and decreased urine output are most likely symptoms of vancomycin (Vancocin) toxicity, so the medication should be held and the physician notified. There is no reason to obtain a chest x-ray. The client's symptoms are most likely not due to a urinary tract infection, so a sterile urine specimen is not indicated. An antihistamine would help if the problem was an allergy, but an allergy would not cause a decrease in urine output.

36.15 The client receives delavirdine (Rescriptor) as treatment for acquired immune deficiency syndrome (AIDS). The nurse assesses the client for which serious adverse effect? 1. Bone marrow suppression 2. Cardiac arrest 3. Seizures 4. Rash

Answer: 4 Rash Rationale: A serious adverse effect of delavirdine (Rescriptor) is Stevens-Johnson rash, which can be life threatening. Stevens-Johnson rash, not bone marrow suppression, is an adverse effect of delavirdine (Rescriptor). Stevens-Johnson rash, not cardiac arrest, is an adverse effect of delavirdine (Rescriptor). Stevens-Johnson rash, not seizures, is an adverse effect of delavirdine (Rescriptor).

36.5 The client receives acyclovir (Zovirax) as treatment for herpes simplex type 1 virus (genital herpes). What is the best, expected outcome for this client? 1. The client will prevent a reoccurrence of infection in the affected area. 2. The client will report a decrease in the number of lesions in the affected area. 3. The client will identify the names of sexual contacts in the past month. 4. The client will report decreased pain using the approved pain scale.

Answer: 4 The client will report decreased pain using the approved pain scale. Rationale: Pain is a major problem associated with this infection; the best outcome is decreased pain. It is not possible to prevent a reoccurrence of herpes simplex type 1 virus. Decreased lesions are not an outcome of treatment with acyclovir (Zovirax). It is not necessary to provide the names of sexual contacts, and this is not related to acyclovir (Zovirax).

36.19 Which of the following laboratory tests best evaluates HIV disease? a. CD4 count b. Complete blood count c. Platelets d. Liver function studies

Answer: A CD4 count Rationale: A. CD4 count best determines the progress of the disease. B. Complete blood count can be used, but does not assess the progress. C. Platelets are not indicated. D. Liver function studies can be used, but do not assess the progress.

34.23 Following surgery, a client is placed on cefotaxine (Claforan). The assessment for possible adverse effects should include observing for: a. Diarrhea. b. Tachycardia. c. Constipation. d. Headache.

Answer: A Diarrhea. Rationale: A. Diarrhea is a frequent adverse effect of cephalosporins. B. Tachycardia is not an adverse effect. C. Diarrhea, not constipation, is a common problem. D. Headache is not an adverse effect.

34.18 Discharge planning for the client prescribed tetracycline will include which of the following? a. Do not take the medication with milk. b. Decrease the amount of vitamins. c. Take the medication with antacids. d. Take the medication with iron supplements.

Answer: A Do not take the medication with milk. Rationale: A. Tetracycline effectiveness can be decreased by using milk products. B. It is not necessary to decrease vitamins. C. Antacids can decrease the effectiveness of tetracycline. D. Iron can decrease the effectiveness of tetracycline.

35.22 A client is receiving amphotericin B. The nurse will reinforce teaching by telling the client that he should watch for: a. Fever and chills. b. Headache. c. Constipation. d. Heartburn.

Answer: A Fever and chills. Rationale: A. Fever and chills are the important adverse effect to teach to clients taking amphotericin B. This could be related to an allergic response. B. Headache is not common. C. Constipation is not an adverse effect. D. Heartburn is not an adverse effect.

35.21 The mechanism of action of systemic antifungal agents is: a. Interfere with the synthesis of ergosterol in the fungal cell membrane. b. Bind to steroids in the fungal cell membrane. c. Bind to toxic levels of parasite in the red blood cells. d. Kill fungal growth.

Answer: A Interfere with the synthesis of ergosterol in the fungal cell membrane. Rationale: A. Systemic antifungal agents interfere with the synthesis of ergosterol in the fungal cell membrane, causing them to become permeable. B. Superficial fungal agents bind to sterols in the fungal cell membrane, allowing leakage of contents. C. Antiprotozoal drugs bind to toxic levels of parasite in the red blood cells. D. None of the these agents will kill the fungal growth.

35.20 The drug that most likely will be used for treatment of Trichomonas vaginalis is: a. Metronidazole (Flagyl). b. Praziquantel (Biltricide). c. Suramin (Germanin). d. Pyrimethamine (Daraprim).

Answer: A Metronidazole (Flagyl). Rationale: A. Metronidazole is the drug of choice for both giardiasis and trichomoniasis due to Trichomonas vaginalis. B. Praziquantel (Biltricide) is an anthelmintic effective against flatworms. C. Suramin (Germanin) is used for African sleeping sickness. D. Pyrimethamine (Daraprim) is an antimalarial drug.

36.20 The nurse is caring for a client receiving mesylate (Fortovase). The nurse would observe for adverse effects of: a. Nausea. b. Dizziness. c. Increased urinary output. d. Constipation.

Answer: A Nausea. Rationale: A. Nausea is a common adverse effect of mesylate (Fortovase), a protease inhibitor, and is used in combination with other drugs. B. Dizziness is not an adverse effect that could occur while receiving mesylate (Fortovase). C. Increased urinary output is not an adverse effect. D. Diarrhea, not constipation, is a common adverse effect with mesylate (Fortovase).

36.22 The nurse is preparing to discharge a client on an antiretroviral agent. Which of the following should the nurse include? a. Practice good handwashing. b. Take your blood pressure daily. c. Take your pulse daily. d. Weigh yourself daily.

Answer: A Practice good handwashing. Rationale: A. Handwashing is a technique the client and family members can use to control infection. B. Taking a blood pressure daily temperature is not necessary. C. Taking the pulse is not necessary. D. Daily weight is not necessary.

35.16 Superficial fungal infections differ from systemic fungal infections in that superficial fungal infections: a. Are less common. b. Affect hair and skin. c. Affect internal organs. d. Can be fatal.

Answer: B Affect hair and skin. Rationale: A. Systemic fungal infections are less common than are superficial ones. B. Superficial fungal infections affect hair, skin, nails, and mucous membranes. C. Systemic fungal infections affect internal organs. D. Systemic fungal infections can be fatal.

34.20 Which of the following laboratory tests will be performed to determine whether a specific bacterium is resistant to a specific drug? a. Complete blood count b. Culture and sensitivity test c. Urinalysis d. Blood urea nitrogen

Answer: B Culture and sensitivity test Rationale: A. Complete blood count would not determine the specific drug for the specific organism. B. Culture and sensitivity is the examination for a specific organism, and can determine the correct medication. C. Urinalysis would not determine the specific drug for the specific organism. D. Blood urea nitrogen would not determine the specific drug for the specific organism.

34.19 The nurse is caring for a client receiving gentamicin IV. The nurse would observe for adverse effects of: a. Diarrhea. b. Ototoxicity. c. Increased urinary output. d. Nausea.

Answer: B Ototoxicity. Rationale: A. Diarrhea is not a common adverse effect of gentamicin. B. Ototoxicity is an adverse effect that could occur while receiving gentamicin. This could become permanent with continued use. C. Increased urinary output is not an adverse effect. D. Nausea is not a common adverse effect.

36.17 The purpose of general pharmacotherapy for human immune virus (HIV)/AIDS is to: a. Cure the disease. b. Relieve symptoms for a longer period of time. c. Kill the virus. d. Decrease viral load.

Answer: B Relieve symptoms for a longer period of time. Rationale: A. Anti-retroviral drugs cannot cure the disease B. The purpose is to remain symptom-free for longer. C. Anti-retroviral drugs will not kill the virus. D. Viral load is not decreased.

34.17 What is the action of bactericidal drugs? a. They will slow the slow growth of the bacteria. b. They will kill the bacteria. c. They have a high potency. d. They disrupt normal cell function.

Answer: B They will kill the bacteria. Rationale: A. Bacteriostatic drugs slow the growth of bacteria. B. Bactericidal drugs kill the bacteria. C. Potency is related to the properties of resistance. D. They do not disrupt normal cell function.

35.17 Which client is at the greatest risk of acquiring a serious fungal infection? a. A teenager with no health problems b. A client with diabetes mellitus c. A client who is immunosuppressed d. A client with a history of heart problems

Answer: C A client who is immunosuppressed Rationale: A. A teenager with no health problems is most likely resistant to a serious fungal infection. B. A client with diabetes mellitus can acquire an infection, but most likely not a serious one. C. Clients who are immunosuppressed, such as HIV or organ transplant clients, are very non-resistant to serious infections. D. A client with heart problems most likely is resistant to a serious fungal infection.

36.16 The nurse is aware that the major structural components of viruses are: a. Intracellular bacteria. b. Extracellular bacteria. c. Intracellular parasites. d. Extracellular parasites.

Answer: C Intracellular parasites. Rationale: A. Viruses are not bacteria. B. Viruses are not bacteria. C. Viruses are intracellular parasites. They must be inside a host cell to cause infection. D. Viruses are not extracellular parasites.

35.18 Treatment for malaria involves: a. Single-drug therapy. b. Dietary restrictions. c. Multi-drug therapy. d. Topical drug therapy.

Answer: C Multi-drug therapy. Rationale: A. The treatment of choice is multi-drug therapy. B. Dietary restrictions are not treatment. C. Multi-drug therapy is the treatment of choice due to the life cycle of the protozoan parasite. D. Topical therapy would be ineffective due to the infestation of the parasite in the red blood cells.

36.21 The primary purpose of agents for herpesviruses is to: a. Inhibit HIV protease. b. Bind directly to reverse transcriptase DNA. c. Prevent viral DNA synthesis. d. Create a defective DNA strand.

Answer: C Prevent viral DNA synthesis. Rationale: A. Protease inhibitors for HIV inhibit HIV protease. B. Non-nucleoside reverse transcriptase inhibitors for HIV bind directly to reverse transcriptase DNA. C. Herpesvirals prevent viral DNA synthesis. D. Nucleoside and nucleotide reverse transcriptase inhibitors create a defective DNA strand.

36.18. The drug most likely to be ordered for the client with herpes simplex virus is which of the following? a. Methonidazole (Flagyl) b. Nystatin (Fungizone) c. Zidovudine (Retrovir) d. Acyclovir (Zovirax)

Answer: D Acyclovir (Zovirax) Rationale: A. Methonidazole is an antifungal medication. B. Nystatin is an antifungal medication. C. Zidovudine is an antiviral mainly used in the treatment of HIV. D. The drug acyclovir (Zovirax) is an antiviral drug used for herpes simplex virus and influenza.

35.19 The nurse is preparing to administer an antifungal medication\to an adult client. The nurse will administer the medication: a. With water. b. With milk. c. With other medications. d. Alone, and will allow the client to swish and swallow the medication.

Answer: D Alone, and will allow the client to swish and swallow the medication. Rationale: A. The client should wait at least 10 minutes after antifungal treatment to put anything else in the mouth. B. The client should wait at least 10 minutes after antifungal treatment to put anything else in the mouth. C. Other medications should be given before or after the nystatin. D. Medication should be swished and swallowed and swished and spit without anything else in the mouth.

34.21 The drug that would most likely be used in the treatment of tuberculosis is: a. Erythromycin (E-mycin). b. Gentamicin (Garamycin). c. Vancomycin (Vancocin). d. Isoniazid (INH).

Answer: D Isoniazid (INH). Rationale: A. Erythromycin is most effective against gram-positive bacteria. B. Gentamicin is used for bactericidal reasons. C. Vancomycin used for bactericidal reasons. D. Isoniazid (INH) Is the drug of choice for anti-tuberculosis therapy.

34.22 Treatment of tuberculosis usually involves: a. The use of a single drug. b. Keeping the client hospitalized. c. Surgical removal of tubercular lesions. d. The use of two or more drugs at the same time.

Answer: D The use of two or more drugs at the same time. Rationale: A. Multi-drug therapy is usually the treatment, so use of a single drug is not usual. B. It is not necessary to keep the client in the hospital. C. Surgery is not the treatment. D. Multi-drug therapy for 6-12 months is the usual