Chapter 71: Management of Patients With Infectious Diseases NCLEX

B (Chlamydia Explanation: Co-infection with chlamydia often occurs in clients infected with gonorrhea. Therefore, the nurse would expect the client to receive treatment for both of these diseases. Human immunodeficiency virus, syphilis, and herpes simplex are not commonly associated with gonorrhea. pg.2108)

The nurse is providing care to a client who has been diagnosed with gonorrhea. The nurse also prepares the client for treatment of which of the following? a) Human immunodeficiency virus b) Chlamydia c) Syphilis d) Herpes simplex

A, C, E (Explanation: The six components involved in the transmission of microorganisms are described as the chain of infection. All components in the chain of infection must be present to transmit an infectious disease from one human or animal to a susceptible host: an infectious agent, an appropriate reservoir, exit route, means of transmission, portal of entry, and susceptible host. pg.2085)

During flu season, you are teaching clients at your clinic about the chain of infection. Which of the following are considered "links" in this chain? Select all that apply. a) Infectious agent b) Fomites c) Portal of entry d) Virulence e) Susceptible host

B (Ectopic pregnancy Explanation: All patients who have had PID need to be informed of the signs and symptoms of ectopic pregnancy because they are prone to this complication. Other complications include bacteriemia with septic shock and thrombophlebitis with possible embolization. Patients who have PID are not prone to inguinal lymphadenopathy)

Patients who have had pelvic inflammatory disease (PID) are prone to which of the following complications? a) Thrombophlebitis b) Ectopic pregnancy c) Inguinal lymphadenopathy d) Bacteremia

B (Sexual transmission Explanation: Pelvic infection is most commonly caused by sexual transmission but can also occur with invasive procedures such as endometrial biopsy, surgical abortion, hysteroscopy, or insertion of an intrauterine device.)

Pelvic infection is most commonly caused by which of the following? a) Insertion of intrauterine device b) Sexual transmission c) Hysteroscopy d) Surgical abortion

B (Coronavirus Explanation: SARS is caused by the coronavirus. pg.2087)

SARS is caused by which of following? a) Salmonella b) Coronavirus c) Shigella d) E. coli

D (Bacterial vaginosis Explanation: Bacterial vaginosis is the most common cause of vulvovaginal infections, followed by vulvovaginal candidiasis and trichomoniasis. Desquatmative vaginitis is another type but is much less common.)

Students are reviewing information related to the various types of vulvovaginal infections. They demonstrate understanding of the information when they identify which of the following as the most common cause of vulvovaginal infections? a) Desquamative vaginitis b) Candidiasis c) Trichomoniasis d) Bacterial vaginosis

C (Dyspareunia Explanation: Symptoms of pelvic infection usually begin with vaginal discharge, dyspareunia (painful sexual intercourse), lower abdominal pelvic pain, and tenderness that occur after menses. Other symptoms include fever, general malaise, anorexia, nausea, headache, and possibly vomiting.)

Symptoms of pelvic infection usually begin with which of the following? a) Fever b) Anorexia c) Dyspareunia d) Headache

C (The patient should be placed in a private room when possible. Explanation: When possible, the patient requiring contact isolation is placed in a private room to facilitate hand hygiene and decreased environmental contamination. Masks are not needed, doors do not need to be closed, and a room with negative air pressure is not required. pg.2090)

When a hospitalized patient is in contact precautions, which of the following responses is necessary? a) The patient should be in a room with negative air pressure. b) Masks are worn when caring for the patient. c) The patient should be placed in a private room when possible. d) The patient's door should be closed.

D (Rapid, thready pulse Explanation: Severe dehydration is manifested by signs of shock such as rapid, thready pulse, cyanosis, cold extremities, rapid breathing, lethargy, and coma. Dry oral mucous membranes and increased thirst suggest mild dehydration. These findings along with sunken eyes suggest moderate dehydration. pg.2105)

When assessing a client with infectious diarrhea, which of the following would lead the nurse to suspect that the client is experiencing severe dehydration? a) Increased thirst b) Sunken eyes c) Dry oral mucous membranes d) Rapid, thready pulse

C (Metronidazole (Flagyl) Explanation: The most effective treatment for trichomoniasis is metronidazole and tinidazole. Penicillin G benzathine is used for syphilis. Doxycycline and azithromycin are used in the treatment of Chlamydia.)

Which of the following is the most effective treatment for trichomoniasis? a) Doxycycline (Adoxa) b) Azithromycin (Zithromax) c) Metronidazole (Flagyl) d) Penicillin G benzathine

B (Campylobacter infection Explanation: Campylobacter species are the most frequent cause of diarrheal disease worldwide. pg.2098)

Which of the following is the most frequent cause of diarrheal disease worldwide? a) Shigella infection b) Campylobacter infection c) Salmonella infection d) Escherichia coli

C (10 years Explanation: HIV is transmitted through sexual, percutaneous, or perinatal contact. The incubation period for HIV infection is greater than 3 to 6 months. The incubation period for HIV infection is greater than 1 year. The incubation period for HIV infection is greater than 5 years. The median incubation period for AIDS infection is 10 years. pg.2086)

Which of the following is the usual incubation period (infection to first symptom) for AIDS? a) 3 to 6 months b) 1 year c) 10 years d) 5 years

D (Acyclovir (Zovirax) Explanation: The antiviral agents acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir) are recommended to suppress the viral load and decreases recurrence and shedding. Flagyl and Cleocin are not used for this action.)

Which of the following medications are used to suppress viral load of the HSV-2 infection? a) Clindamycin (Cleocin) b) Penicillin c) Metronidazole (Flagyl) d) Acyclovir (Zovirax)

A (You must inform all sexual partners. Explanation: The spread of the infection could quickly multiple if the client's sexual partners are infected and continue to spread the virus to others; thus, it is most important to emphasize that all sexual partners must be informed. All of the other options are correct but not most important. pg.1653)

Which of the following nursing instructions is most important for the nurse to emphasize to the client with a new HSV-2 diagnosis? a) You must inform all sexual partners. b) Wear loose underwear to promote air circulation. c) Keep lesions dry with alcohol or peroxide. d) Use a condom during sexual activity.

D (Herpes simplex Explanation: Herpes simplex and syphilis can be transmitted perinatally and sexually. Chlamydia, gonorrhea, and trichomoniasis are transmitted sexually.)

Which of the following sexually transmitted infections (STIs) could be transmitted perinatally? a) Gonorrhea b) Chlamydia c) Trichomoniasis d) Herpes simplex

C ("The flu shot is recommended for people over 6 months of age." Explanation: The influenza vaccine is recommended for all people over 6 months of age. The patient is in the recommended age range. Ascertaining if the patient has any chronic illnesses is important, but it does not change the recommendation by the Centers for Disease Control and Prevention. There is no recommendation that the immunization be given only if the patient works around children or the elderly. pg.2093)

A 36-year-old patient is in the clinic for an annual physical. The patient asks the nurse "should I get a flu shot." Which of the following is the best response by the nurse? a) "Do you have any chronic illnesses?" b) "No, you are not in the age range for the flu shot." c) "The flu shot is recommended for people over 6 months of age." d) "Only if you work around children or the elderly."

A (Put on gloves, a mask, and eye protection during suctioning, and then apply a mask to the client's face for transport. Explanation: Bacterial meningitis is spread through contact with infected droplets. The nurse should wear gloves, a mask, and eye protection when suctioning the client. Additionally, the client should wear a mask when out of the isolation room for diagnostic testing. Standard precautions don't adequately protect staff and other clients from bacterial meningitis. pg.2090)

A client admitted with bacterial meningitis must be transported to the radiology department for a repeat computed tomography scan of the head. His level of consciousness is decreased, and he requires nasopharyngeal suctioning before transport. Which infection control measures are best when caring for this client? a) Put on gloves, a mask, and eye protection during suctioning, and then apply a mask to the client's face for transport. b) Take no special precautions for this client. c) Use standard precautions, which require gloves for suctioning. d) Put on gloves, a mask, and eye protection.

B (An abscess Explanation: To prevent the spread of pathogens to adjacent tissues, a fibrin barrier forms around the injured area. Inside the barrier, a thick, white exudate (pus) accumulates. This collection of pus is called an abscess, which may break through the skin and drain or continue to enlarge internally. A lesion would not be filled with pus, nor would a cancerous tumor. A fluid-filled vesicle is associated with a viral type illness. pg.1285)

A client comes to the clinic and informs the nurse that he has a "painful area under his armpit."The nurse observes a 2-cm raised area that is erythremic and has a white substance inside of it. What does the nurse suspect the patient may be experiencing? a) A cancerous tumor b) An abscess c) A lesion d) A fluid-filled vesicle

B (Institute enteric precautions. Explanation: The stool specimen indicates that the client has E. coli in his stool. The nurse should institute enteric precautions, and all who come in contact with this client should observe good hand washing and gown technique to prevent the spread of infection. Restoring fluid balance is a goal of therapy, but because the dehydration is mild, oral rehydration will be the first choice for replacing fluids. The nurse should also clean and protect the anal area from irritation from diarrhea, but on an ongoing basis, not as the priority for care. It is not necessary for the family to wash all of their bed linens because only those in contact with the client are contaminated. pg.2105)

A client has been admitted with diarrhea. He has mild dehydration (less than 5%). The nurse is reviewing the laboratory report of the stool specimen, as indicated in the following: WBC: Mildly elevated RBC: Few Bacteria: Positive for Escherichia coli Ova and parasites: Negative Based on the laboratory report, what should the nurse do first? a) Instruct the family to wash all family bed linens in hot water. b) Institute enteric precautions. c) Clean and protect the anal area. d) Start an I.V. infusion.

A (A painless genital ulcer that appeared about 3 weeks after unprotected sex Explanation: A painless genital ulcer is a symptom of primary syphilis. Macules on the palms and soles after fever are indicative of secondary syphilis, as is patchy hair loss. Wartlike papules are indicative of genital warts.)

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis? a) A painless genital ulcer that appeared about 3 weeks after unprotected sex b) Copper-colored macules on the palms and soles that appeared after a brief fever c) Patchy hair loss and red, broken skin involving the scalp, eyebrows, and beard areas d) One or more flat, wartlike papules in the genital area that are sensitive to touch

A (An isolation room three doors from the nurses' station Explanation: A client with bacterial meningitis should be kept in isolation for at least 24 hours after admission and, during the initial acute phase, should be as close to the nurses' station as possible to allow maximal observation. Placing the client in a room with a client who has viral meningitis may cause harm to both clients because the organisms causing viral and bacterial meningitis differ; either client may contract the other's disease. Immunity to bacterial meningitis can't be acquired; therefore, a client who previously had bacterial meningitis shouldn't be put at risk by rooming with a client who has just been diagnosed with this disease. pg.2091)

A client is admitted with bacterial meningitis. Which hospital room is the best choice for this client? a) An isolation room three doors from the nurses' station b) A private room down the hall from the nurses' station c) A two-bed room with a client who previously had bacterial meningitis d) A semiprivate room with a client who has viral meningitis

B (Azithromycin Explanation: Azithromycin or a flouroquinolone such as moxifloxacin, is the drug of choice for treating Legionnaire's disease. Trimethoprim sulfate may be used to treat pertussis. Ceftriaxone may be used to treat gonorrhea. Penicillin G benzathine is the drug of choice for treating syphilis. pg.2111)

A client is diagnosed with Legionnaire's disease. The nurse anticipates which medication to be prescribed? a) Penicillin G benzathine b) Azithromycin c) Ceftriaxone d) Trimethoprim sulfate

A (Administration of prescribed vancomycin Explanation: A client with MRSA typically will be treated wtih either vancomycin or linezolid. Contact precautions are used. Removal of a vascular access device would be indicated if the client was experiencing bacteremia or fungemia. Strict aseptic technique would be appropriate for any invasive measure or care activity but not for all care activities. pg.2092)

A client is diagnosed with a methicillin-resistant staphylococcus aureus (MRSA) infection. When developing the client's plan of care, the nurse would include which of the following? a) Administration of prescribed vancomycin b) Implementation of droplet precautions c) Preparation for removal of vascular access device d) Institution of strict aseptic technique for care

D ("Prescribing antibiotics for a viral infection may result in drug-resistant bacteria." Explanation: Causes of antibiotic resistance, a consequence of bacterial mutations that interfere with the mechanism of antibiotic action, are related to inappropriate prescription of antibiotics for viral (rather than bacterial) infection. Because viral infections are often self-limiting, with symptoms control, the client will get better. Indicating that the client is not thinking positively is a nontherapeutic comment. Option D is not an informative response. pg.2092)

A client is diagnosed with a viral illness and requests an antibiotic to "cure" his illness. When the request is refused by the physician, the client states to the nurse, "I will never get better."What is the best response by the nurse? a) "You need to think positively, and you will get better soon." b) "Taking antibiotics when you don't need them will make you sick." c) "I will speak with the physician again. You will only get better while taking an antibiotic." d) "Prescribing antibiotics for a viral infection may result in drug-resistant bacteria."

C ("Wash your hands thoroughly to avoid transferring the infection to your eyes." Explanation: Adults and children with gonorrhea may develop gonococcal conjunctivitis by touching the eyes with contaminated hands. The client should avoid sexual intercourse until treatment is completed, and a follow-up culture confirms that the infection has been eradicated (which usually takes 4 to 7 days). A client who doesn't refrain from intercourse before treatment is completed should use a condom in addition to informing sex partners of the client's health status and instructing them to wash well after intercourse. Meningitis and widespread CNS damage are potential complications of untreated syphilis, not gonorrhea. pg.2108)

A client is diagnosed with gonorrhea. When teaching the client about this disease, the nurse should include which instruction? a) "If you have intercourse before treatment ends, tell sexual partners of your status and have them wash well after intercourse." b) "If you don't get treatment, you may develop meningitis and suffer widespread central nervous system (CNS) damage." c) "Wash your hands thoroughly to avoid transferring the infection to your eyes." d) "Avoid sexual intercourse until you've completed treatment, which takes 14 to 21 days."

C (Debridement Explanation: Debridement is the removal of dead and damaged tissue surgically. Application of a dry dressing will not debride the wound, nor will the administration of Neupogen or injecting antibiotics into the wound. pg.1767)

A client is hospitalized for an infected decubitus ulcer of the sacral area. The physician is planning to remove the dead and damaged tissue. What type of procedure will the nurse prepare the client for? a) Administration of filgrastim (Neupogen) b) Application of a dry dressing c) Debridement d) Inject antibiotics into the wound

A (Gloves and gowns for all client contact Explanation: Care of a client with C. difficile infection requires contact precautions with the use of gowns and gloves for all client contact. These spores are resistant to alcohol; therefore, the nurse needs to use soap and water to wash the hands. Bleach-based solutions and cleaning products are preferred for clean-ups. pg.2090)

A client is hospitalized with a Clostridium difficile infection. Which of the following would the nurse include when providing care to this client? a) Gloves and gowns for all client contact b) Alcohol-based products for hand hygiene c) Ammonia-based solutions for spill clean-up d) Droplet precautions

D (Chlorhexidine Explanation: Although povidone-iodine or alcohol may be used, the preferred agent to clean the skin prior to insertion of an intravenous device is chlorhexidine. Normal saline would not be appropriate. pg.2089)

A nurse is preparing to insert a peripheral intravenous access device into the arm of a client. When preparing the skin for insertion, which of the following should the nurse use to prevent possible health-care associated bloodstream infections? a) Alcohol b) Normal saline c) Povidone-iodine d) Chlorhexidine

C (Pseudomembranous colitis Explanation: When a client is taking an antibiotic, a superinfection can result from overgrowth of microorganisms not affected by the drug. This can lead to a serious inflammation of the colon called pseudomembranous colitis accompanied by potentially life-threatening diarrhea. Report fever, abdominal cramps, and severe diarrhea immediately. The other distractors are incorrect and not related to the use of the antibiotics. pg.2090)

A client is in the acute care facility for the administration of intravenous (IV) antibiotics to treat bacterial pneumonia. The client begins to have severe diarrhea 3 days after the IV antibiotics with abdominal cramping and pain. What does the nurse suspect the client has developed due to the antibiotic use? a) A helminth infection b) An allergic reaction to the antibiotic c) Pseudomembranous colitis d) Food poisoning

A, B, D (Explanation: Two or more of the following characterize sepsis: temperature greater than 100.4°F (38°C), heart rate greater than 90 beats/minute, respiratory rate greater than 20 breaths/minute or PaCO2 less than 32 mm Hg, WBC count greater than 12,000 cells/mm3, or 10% immature (band) forms. Blood pressure is not an indicator of sepsis, and a PaCO2 of 42 mm Hg is not an indicator. pg.302)

A client is suspected of sepsis from a postsurgical incision infection. What characteristic of sepsis would the nurse recognize? Select all that apply. a) Temperature of 102°F b) Heart rate of 120 beats/minute c) Blood pressure of 120/80 mm Hg d) Respiratory rate of 24 breaths/minute e) PaCO2 of 42 mm Hg

B (The client has a multidrug-resistant strain of bacteria. Explanation: Some bacteria, such as Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli, are developing multidrug resistance, the ability to remain unaffected by antimicrobial drugs such as antibiotics. There are no facts to indicate the client has been misdiagnosed. Staphylococcus aureus is treated with antibiotics and is a bacterium, not a fungus. pg.2092)

A client with a Staphylococcus aureus infection present in a sacral pressure ulcer has received treatment with three courses of antibiotics without eliminating the infection. What does the nurse understand has occurred with the client? a) Staphylococcus aureus is a fungus and must be treated with an antifungal agent, not an antibiotic. b) The client has a multidrug-resistant strain of bacteria. c) The client has been misdiagnosed and has another type of microorganism present. d) Staphylococcus aureus cannot be treated by antibiotics.

C (Direct identification in a specimen from the chancre lesion Explanation: The conclusive diagnosis of syphilis can be made by direct identification of the spirochete obtained from the chancre lesions of primary syphilis. Serologic tests such as VDRl, RPR-CT, and FTA-ABS are used in the diagnosis of secondary and tertiary syphilis. pg.2107)

A client with suspected primary syphilis is to undergo diagnostic testing. Which of the following would the nurse expect to be done to confirm this diagnosis? a) Venereal Disease Research Laboratory (VDRL) test b) Rapid plasma reagin circle card test (RPR-CT) c) Direct identification in a specimen from the chancre lesion d) Fluorescent treponemal antibody absorption tests (FTA-ABS)

A ("People in hospitals are often more susceptible to infections because they are already ill and they are exposed to germs while they are in the hospital." Explanation: Hospitalized clients are more susceptible to infections than well people because they are exposed to pathogens in the healthcare environment, may have incisions or invasive equipment (e.g., intravenous lines) that compromise skin integrity, or may be immunosuppressed from poor nutrition, their disease process, or its treatment. Although all answers are correct, the most complete answer is A. pg.2088)

A client you are caring for has developed a bladder infection while in the hospital. The client has had a Foley catheter for two weeks. The client's family asks you how the client got this infection. What would be your best response? a) "People in hospitals are often more susceptible to infections because they are already ill and they are exposed to germs while they are in the hospital." b) "People in hospitals sometimes exhibit signs of infections they had before being admitted." c) "Sometimes people in hospitals get exposed to microorganisms that their visitors bring in." d) "People in hospitals are surrounded by infectious agents, so they can get infections they didn't have before being admitted."

A (The invasive nature of the catheter provides a portal for infection. Explanation: Catheters provide a portal for infection because they are invasive. Although catheters are not used as frequently in older adults for the control of urinary incontinence, there are some bed-confined clients who use them. Family requests for catheters may be considered, but physicians make the decision if it will benefit the patient. Catheters are not flushed daily with anything. pg.2085)

A family member of a client in a long-term care facility asks the nurse why he cannot insert a catheter so the client will not develop skin breakdown from being wet. What should the explanation include when the nurse responds to the family member? a) The invasive nature of the catheter provides a portal for infection. b) Catheters are no longer used for treatment of incontinence. c) Older adult residents are able to have catheters inserted if the family requests them. d) If a catheter is inserted, it must be flushed with normal saline daily.

A (Human papilloma virus Explanation: Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid. pg.1647)

A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata? a) Human papilloma virus b) Haemophilus ducreyi bacillus c) Treponema pallidum d) Herpes virus

A (Explanation: The use of aseptic technique interrupts the chain of infection at the portal of entry. Employee health, environmental sanitation, and disinfection and sterilization interfere with the reservoir element. Hand hygiene, control of secretions, and excretions and proper trash and waste disposal interfere with the portal of exit. Isolation, proper food handling, airflow control, standard precautions, sterilization, and hand hygiene interfere with the means of transmission. pg.2085)

A nurse implements aseptic technique as a means to break the chain of infection at which element? a) Portal of entry b) Portal of exit c) Means of transmission d) Reservoir

C (Thirst or irritability. Explanation: Early signs and symptoms of dehydration include thirst, irritability, dry mucous membranes, and dizziness. Coma, seizures, sunken eyeballs, poor skin turgor, and increased heart rate with hypotension are all later signs. pg.2102)

A nurse is assessing a client who may be in the early stages of dehydration. Early manifestations of dehydration include: a) coma or seizures. b) sunken eyeballs and poor skin turgor. c) thirst or irritability. d) increased heart rate with hypotension.

C, D (c) Giardia d) Cryptosporidium Explanation: Parasitic infections associated with diarrhea include Giardia, cryptosporidium, and entamoeba hystolytica. E. coli, salmonella, and shigella are bacterial causes of diarrhea. pg.2098)

A nurse is assessing a client with diarrheal disease and determines that the condition has most likely resulted from a parasitic infection. Which of the following would be a potential cause? Select all that apply. a) Shigella b) E. coli c) Giardia d) Cryptosporidium e) Salmonella

A (Foul-smelling discharge from the penis Explanation: Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes. pg.2108)

A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? a) Foul-smelling discharge from the penis b) Rashes on the palms of the hands and soles of the feet c) Cauliflower-like warts on the penis d) Painful red papules on the shaft of the penis

D ("I noticed a strange fishy odor during my period." Explanation: Bacterial vaginosis is characterized by a fishlike odor that is particularly noticeable after sexual intercourse or during menstruation. Most clients do not experience local discomfort or pain; more than one half of clients do not notice any symptoms. Intense itching is often associated with candidiasis or trichomoniasis. A cottage-cheese like discharge is associated with candidiasis. A thin, yellow discharge is most commonly noted with trichomoniasis. pg.2108)

A nurse is assessing a woman with vaginal discharge. The nurse suspects bacterial vaginosis when the client states which of the following? a) "The discharge is yellowish but thin." b) "The discharge looks almost like cottage cheese." c) "I've been experiencing some really intense itching." d) "I noticed a strange fishy odor during my period."

D (Educate the client about why it's important to inform sexual contacts so they can receive treatment. Explanation: The nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits. pg.2108)

A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed? a) Inform the health department that this client contracted an STD. b) Inform the client's sexual contacts of their possible exposure to chlamydia. c) Do nothing because the client's sexual habits place him at risk for contracting other STDs. d) Educate the client about why it's important to inform sexual contacts so they can receive treatment.

D (Burning on urination Explanation: Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.)

A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea? a) Diffuse skin rash b) Painless chancre c) Dry, hacking cough d) Burning on urination

A ("Many people infected with gonorrhea are infected with chlamydia as well." Explanation: Treatment for gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin (Zithromax) is also ordered. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure. pg.2109)

A nurse is caring for a male client with gonorrhea who's receiving ceftriaxone (Rocephin) and doxycycline (Vibramycin). The client asks the nurse why he's receiving two antibiotics. How should the nurse respond? a) "Many people infected with gonorrhea are infected with chlamydia as well." b) "The combination of these two antibiotics reduces the risk of reinfection." c) "Because there are many resistant strains of gonorrhea, more than one antibiotic may be required for successful treatment." d) "This combination of medications will eradicate the infection faster than a single antibiotic."

A (Wear a condom every time he has intercourse. Explanation: Wearing a condom during intercourse considerably reduces the risk of contracting STDs. Asking all potential sexual partners if they have an STD; considering intercourse safe if his partner has no visible discharge, lesions, or rashes; and expecting to limit the number of sexual partners won't reduce the risk of contracting an STD to the extent wearing a condom will. A monogamous relationship also reduces the risk of contracting STDs. pg.2106)

A nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to: a) wear a condom every time he has intercourse. b) consider intercourse safe if his partner has no visible discharge, lesions, or rashes. c) ask all potential sexual partners if they have an STD. d) expect to limit the number of sexual partners to less than five over his lifetime.

C (A client who complains of genital pruritus and paresthesia Explanation: Pruritus and paresthesia as well as redness of the genital area are prodromal symptoms of recurrent herpes infection. These symptoms occur 30 minutes to 48 hours before the lesions appear. Headache and fever are symptoms of viremia associated with the primary infection. Vaginal and urethral discharge is also a local sign of primary infection. Dysuria and lymphadenopathy are local symptoms of primary infection that may also occur with recurrent infection.)

A nurse is caring for the following clients who have a history of genital herpes infection. Which client is most at risk for an outbreak of genital herpes? a) A client who complains of dysuria and lymphadenopathy b) A client who complains of a headache and fever c) A client who complains of genital pruritus and paresthesia d) A client who complains of vaginal and urethral discharge

C (Acute pain related to the development of the genital lesions Explanation: Although deficient knowledge, ineffective coping, and hyperthermia are possible nursing diagnoses, the priority would be acute pain because the initial infection is usually very painful and lasts about 1 week. pg.2109)

A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority? a) Hyperthermia related to body's response to an infectious process b) Deficient knowledge related to the disease and its transmission c) Acute pain related to the development of the genital lesions d) Ineffective coping related to the increased stress associated with the infection

A (Explanation: The size of the induration, not including the surrounding area of erythema, is measured in millimeters. The measurement determines whether the reaction is significant. For example, a tuberculin skin test is test is considered positive if the induration is 10 mm or greater in persons with no known risk factors for TB; smaller measurements are significant in certain risk groups, such as immunocompromised clients. The other answers are not indicative of positive results. pg.588)

A nurse is having a yearly employee tuberculin skin test. Which skin test results would indicate a positive result? a) An induration of 12mm b) An induration of 4 mm c) An induration of less than 1 mm d) An uneven erythemic area

B (Eliminating rodent food sources in areas near humans Explanation: Prevention of hantavirus pulmonary syndrome focuses on reducing human contact with rodents and their droppings. One prevention strategy is to eliminate rodent food sources in areas close to humans and using traps in areas where humans work and rodents may enter. Vaccination would be appropriate to prevent pertussis. Avoidance of whirlpool spas eliminates a risk factor for Legionnaire's disease. Wearing insect repellent could help to prevent West Nile Virus, which is transmitted from infected mosquitoes. pg.2112)

A nurse is preparing a presentation for a local community group in a small rural area about hantavirus pulmonary syndrome. Which of the following would the nurse suggest as a major prevention strategy? a) Vaccinating infants and children b) Eliminating rodent food sources in areas near humans c) Avoiding whirlpool spas d) Wearing insect repellent

B (the importance of informing his partners of the disease. Explanation: Clients with genital herpes should inform their partners of the disease to help prevent transmission. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices. pg.2109)

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of: a) why the disease is transmittable only when visible lesions are present. b) the importance of informing his partners of the disease. c) the need for the use of petroleum products. d) the option of disregarding safer-sex practices now that he's already infected.

A, D, E (Explanation: Disorders requiring droplet precautions include pertussis, mumps, and parvovirus B 19. Scabies and viral hemorrhagic infections such as Ebola would require contact precautions. pg.2091)

A nurse would implement droplet precautions for a client with which condition? Select all that apply. a) Mumps b) Ebola virus c) Scabies d) Parvovirus B 19 e) Pertussis

A (Request an order from the physician for IV rehydration therapy. Explanation: The patient is demonstrating hemodynamic instability that could lead to shock, therefore IV rehydration therapy is indicated for this patient. Once the patient becomes hemodynamically stable, then oral rehydration therapy may begin. Although it is appropriate for the nurse to take vital signs frequently, the patient needs fluid replacement and that need should be addressed first. Stool specimens can be obtain once the patient is hemodynamically stable. pg.2105)

A patient complains of nausea, vomiting, and diarrhea for 5 days. The nurse assesses the mucous membranes to be pale and dry. The patient has sunken eyes with the following vital signs: pulse 122 and thready, respirations 23, blood pressure 78/55, temperature 101.8°F oral. Which of the following is the priority nursing intervention? a) Request an order from the physician for IV rehydration therapy. b) Initiate oral rehydration therapy at 100 mL/kg of oral rehydration solution (ORS) over 4 hours. c) Obtain stool specimen for analysis. d) Assess vital signs every 15 minutes.

B (Explanation: Influenza is transmitted via droplets; therefore, the nurse should initiate droplet precautions. Tuberculosis and varicella would qualify for airborne precautions. Contact precautions are used for organisms that are transmitted by skin-to-skin contact. Neutropenic (or reverse) precautions are used for immunosuppressed patients. pg.2090)

A patient diagnosed with influenza is admitted to the hospital. Which of the following transmission-based precautions should the nurse initiate? a) Airborne b) Droplet c) Contact d) Neutropenic

D (Use proper storage and cooking of meat. Explanation: Campylobacter infection is caused by the consumption of undercooked or raw meat. Proper storage and cooking of meat will prevent further episodes of Campylobacter. The patient should also be told to prepare meat separately from other foods, including the use of utensils. Giardia lamblia diarrhea is caused by drinking contaminated water. Shigella infection is transmitted via the fecal-oral route, so handwashing after going to the bathroom would help prevent the illness. Salmonella infections are usually caused by consuming raw eggs; it also can be transmitted via produce. pg.2098)

A patient in the clinic is diagnosed with diarrhea caused by Campylobacter. Which of the following instructions should the nurse provide to prevent further episodes? a) Drink water only from purified or filtered sources. b) Wash hands after going to the bathroom. c) Do not ingest raw eggs. d) Use proper storage and cooking of meat.

A (Wear an N-95 respirator. Explanation: Tuberculosis is acquired via airborne transmission. With airborne precautions, the room door must remain shut to ensure the effectiveness of the negative pressure room. All personnel entering the room should wear an N-95 respirator or similarly approved respirator. A simple face mask with an eye shield is not an effective barrier to stop transmission. There is no need to minimize verbal interactions with a patient with tuberculosis. pg.2090)

A patient is placed in isolation for suspected tuberculosis. Which of the following actions should the nurse take when entering the patient's room? a) Wear an N-95 respirator. b) Apply a face mask with an eye shield. c) Minimize verbal interactions. d) Leave the door open when in the room.

B (Instruct the patient not to drink alcohol with this treatment. Explanation: While counseling to abstain from sex for 1 week is appropriate, the most important intervention is counseling to avoid alcohol during Flagyl treatment. Alcohol consumption while taking Flagyl creates a severe gastrointestinal reaction of nausea, vomiting, and flushing. Flagyl does not have to be taken with milk, and further STI testing is indeed recommended with the diagnosis of an STI.)

A patient presents with vulvar itching and diffuse green vaginal discharge. Upon evaluation, she is prescribed metronidazole (Flagyl). What is the paramount nursing intervention in discharge planning? a) Counsel the patient to refrain from sex for 1 week. b) Instruct the patient not to drink alcohol with this treatment. c) Advise the patient to take medication with a glass of milk. d) Reassure the patient further sexually transmitted infection (STI) testing is not indicated.

A (Gonorrhea Explanation: Gonococcal infections can be completely eliminated by drug therapy. This cure is documented by a negative culture 4 to 7 days after therapy is finished. Genital warts aren't curable and are identified by appearance, not culture. Genital herpes isn't curable and is identified by the appearance of the lesions or cytologic studies. The diagnosis of syphilis is done using dark-field microscopy or serologic tests.)

A physician tells a client to return 1 week after treatment to have a repeat culture done to verify the cure. This order would be appropriate for a woman with which condition? a) Gonorrhea b) Syphilis c) Genital herpes d) Genital warts

B (Vigorously scrubbing between the fingers Explanation: Effective handwashing requires at least 15 seconds of vigorous scrubbing with special attention to the area around nail beds and between fingers, where there is high bacterial load. Hands should be thoroughly rinsed after washing and then dried. Artificial fingernails should not be worn. pg.2089)

After demonstrating to a group of nursing students the proper technique for handwashing using soap and water, the nursing instructor determines that the teaching has been successful when the students demonstrate which of the following? a) Removing the soap with a paper towel before rinsing b) Vigorously scrubbing between the fingers c) Washing underneath artificial fingernails d) Washing the hands for 5 to 10 seconds

B (September Explanation: The vaccine for human papillomavirus is given in three intramuscular doses, with the initial dose followed by a second dose in 2 months, and a third dose in 6 months after the first dose. For this girl, the second dose would be given 2 months after July, which would be September. pg.2095)

After discussing the vaccine available for human papillomavirus with the mother of a 12-year-old female client, the mother agrees to have her daughter immunized. It is July when the nurse administers the first dose. The nurse would instruct the mother to bring the girl in for her second dose at which time? a) November b) September c) October d) August

D (Syphilis Explanation: The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDs. Genital herpes, hepatitis B, veneral warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law. pg.2107)

An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported? a) Condylomata acuminata b) Hepatitis B c) Genital herpes d) Syphilis

B (Means of transmission Explanation: As a person sneezes or coughs, if he or she doesn't cover his or her mouth and nose, the airborne microbes can be spread to others, finding a susceptible host. Covering up when coughing or sneezing is vital protection against infection. The reservoir refers to the environment in which the infectious agent can survive and reproduce. This refers to the route by which the infectious agent escapes from the environment in which it lives and reproduces. This refers to the agent that has the power to produce disease. pg.2085)

Flu and cold season offers excellent examples of physiologic reflexes to ward off illness. One problem is that an effective mechanical defense for one person can complete a link in the chain of infection for someone else. To which link is the above referring? a) Infectious agent b) Means of transmission c) Reservoir d) Portal of entry

A (Yearly Explanation: Women with HPV should have annual Pap smears because of the potential of HPV to cause dysplasia.)

How often should women diagnosed with human papillomavirus (HPV) have Pap smears? a) Yearly b) Every 3 years c) Every 6 months d) Every 2 years

A (Impetigo Explanation: Contact precautions should be instituted for patient with impetigo. Airborne precautions are used for patients with measles varicella, and TB. pg.2091)

In addition to standard precaution, contact precautions should be implemented for which of the following? a) Impetigo b) Varicella c) Measles d) TB

A (Clients infected with the human papillomavirus (HPV) Explanation: HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of hormonal contraceptives don't increase the risk of cervical cancer.)

In which group is it most important for the client to understand the importance of an annual Papanicolaou test? a) Clients infected with the human papillomavirus (HPV) b) Clients with a pregnancy before age 20 c) Clients with a history of recurrent candidiasis d) Clients with a long history of hormonal contraceptive use

D (Being asymptomatic Explanation: Many women who have gonorrhea are asymptomatic, a factor that contributes to the spread of the disease. Knowing the signs and symptoms of STIs will not help with an asymptomatic disease. Being sexually inactive currently will not prevent having been infected with a disease in the past. All options are not correct. pg.1655)

Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually transmitted infection, gonorrhea. What would contribute to her ignorance of her condition? a) Knowing the signs and symptoms of STIs b) Being sexually inactive c) All options are correct. d) Being asymptomatic

A (IV penicillin G—single dose Explanation: A single dose of parenterally administered penicillin G (Pfizerpen, Wycillin) is used to treat primary and secondary syphilis. pg.2107)

Max Thornton, a 24-year-old chef, is being seen by a physician at the urology group where you practice nursing. He has developed a painless ulcer on his penis and is rather concerned about his health. The urologist will be communicating his diagnosis of syphilis and prescribing treatment. What would you expect the physician prescribe as treatment? a) IV penicillin G—single dose b) Oral penicillin G—single dose c) IV tetracycline d) IV penicillin G—multiple dosing

C (Acyclovir Explanation: Acyclovir is an antiviral and is prescribed for herpes. Penicillin G may be used to treat syphilis and gonorrhea. Erythromycin may be used to treat syphilis, gonorrhea, chlamydia, chancroid, lymphogranuloma venereum, and prophylactically to prevent eye infections in newborns. Ceftriaxone is used to treat gonorrhea. pg.1653)

Mr. Jones, a client in your clinic, has been diagnosed with gonorrhea. The physician is selecting a drug to prescribe for him. Which of the following would not be prescribed? a) Erythromycin b) Ceftriaxone c) Acyclovir d) Penicillin G

A (Time between exposure and onset of symptoms Explanation: The incubation period is time between contact or exposure and the development of the first signs and symptoms. The presence of microorganisms without the host interacting with them is called colonization. The state in which the host displays a decrease in wellness characterizes an infectious disease. The process of the host shedding the microorganisms to another reflects the mode of exit. pg.2085)

Nursing students are reviewing information about infectious diseases and events associated with infection. Students demonstrate understanding of the information when they identify the incubation period as which of the following? a) Time between exposure and onset of symptoms b) Presence of microorganisms without the host interacting with them c) Process of the host shedding the microorganisms to another d) State in which the host displays a decrease in wellness

B (Syphilis Explanation: Syphilis is manifested by a painless chancre lesion. Psoriasis is exhibited by plaques with scales. Kaposi's sarcomas are cutaneous lesions blue-red or dark brown in color. Urticaria is wheals or hives due to infection or allergic reactions. pg.2107)

Painless chancre lesions are associated with which systemic disease? a) Urticaria b) Syphilis c) Kaposi's sarcoma d) Psoriasis

B (Syphilis Explanation: Syphilis is manifested by a painless chancre or ulcerated lesion. Psoriasis is exhibited by plaques with scales. Kaposi's sarcoma are cutaneous lesions blue-red or dark brown in color. Urticaria is wheals or hives due to infection or allergic reactions. pg.2107)

Painless chancre or ulcerated lesions are associated with which systemic disease? a) Urticaria b) Syphilis c) Kaposi's sarcoma d) Psoriasis

C (Consistently uses condoms with sexual activity Explanation: Consistent use of condoms for sexual activity indicates that the client has knowledge of the disorder and its transmission, thereby taking steps to reduce the risk of transmission. This action supports achievement of the outcome. Sexual activity even when lesions are not present can still lead to transmission of the infection. Lesions should be cleaned with mild soap and water and patted dry; occlusive ointments, powders, or dressings should be avoided because they do not allow the lesions to dry. pg.2106)

The following outcome appears on the plan of care for a client with genital herpes: "Client demonstrates knowledge about measures to reduce the risk of transmission and recurrences." Which of the following, if reported by the client, would support achievement of this outcome? a) Cleans lesions with strong anti-bacaterial soap b) Applies occlusive dressings to lesions c) Consistently uses condoms with sexual activity d) Avoids sexual activity when lesions are present

B (Hand hygiene Explanation: Infections with multidrug-resistant microorganisms are very difficult to destroy with current pharmacologic agents, increasing the need to be vigilant about performing hand hygiene measures. It is unnecessary to use contact precautions, administer antibiotics prophylactically, or empty trash cans immediately for the preventions of multidrug-resistant infections. pg.2089)

The infection control nurse collects data that indicates an increase in the number of clients in the hospital with multidrug-resistant infections. What priority education should healthcare providers receive? a) Emptying trash cans immediately in client's rooms b) Hand hygiene c) Administering antibiotics to all clients prophylactically d) Using contact precautions on all clients in the hospital

D ("I'll wear occlusive underwear to prevent transmission of the virus." Explanation: The client should wear loose, cotton underwear to promote cleanliness and dryness in the genital area. Sitz baths can promote cleanliness and decrease inflammation in the area. A hair dryer, set on a cool setting, can be used to carefully dry the lesions in the perineal area. Drinking plenty of fluids is advised to decrease dysuria, which accompanies genital herpes.)

The nurse has been teaching a client with genital herpes how to care for the lesions. Which of the following statements by the client indicates that she needs additional instruction? a) "It's important that I drink plenty of fluids." b) "I'll use a sitz bath to decrease the inflammation of the sores." c) "I can use a hair dryer to dry the lesions as long as I use a cool setting." d) "I'll wear occlusive underwear to prevent transmission of the virus."

B (Explanation: An opportunistic or superinfection occurs among immunocompromised hosts. Examples would be yeast infections in the mouth, bladder infections, gastroenteritis, and Pneumocystis carinii. An acute infection has a sudden onset with serious and sometimes life-threatening manifestations. A chronic infection is an extended infection that resists treatment. A secondary infection is a complication of some other disease process that occurred first. pg.2109)

The nurse is caring for a client who has acquired immunodeficiency disease (AIDS) and has developed oral thrush. What type of infection is the nurse aware that has developed due to the immunocompromised state of the client? a) Secondary b) Opportunistic c) Acute d) Chronic

C (Impaired Skin Integrity Explanation: The priority nursing diagnosis focuses on the Impaired Skin Integrity. Interventions would include nursing instruction on the care of the skin to prevent further infection to self and others. The nurse would also focus on the management of the disease. Because this is a reoccurrence, Knowledge Deficit is not a priority. Psychosocial nursing diagnoses are not a priority at this time unless other data suggests. pg.1653)

The nurse is caring for a client with genital herpes experiencing a reoccurrence. Which nursing diagnosis would be the priority? a) Anxiety b) Powerlessness c) Impaired Skin Integrity d) Knowledge Deficit

D ("Coronavirus" Explanation: SARS is caused by the coronavirus. All other answers are incorrect. pg.2085)

The nurse is caring for a patient diagnose with severe acute respiratory syndrome (SARS). A family member asks what causes SARS. Which of the following responses by the nurse is accurate? a) "Shigella" b) "Salmonella" c) "E. coli" d) "Coronavirus"

A (Many people are asymptomatic and show no symptoms contributing to the spread of the disease. Explanation: The nurse is most correct to place information regarding prevention of sexually transmitted diseases in bold letters. The information that many people are asymptomatic and show no symptoms is an important point to stress. Common age-groups are an interesting fact. Repercussions of the disease are also important to highlight; however, prevention is most important. pg.1652)

The nurse is completing a community education via a pamphlet on sexually transmitted diseases. Which key point would the nurse place in bold letters? a) Many people are asymptomatic and show no symptoms contributing to the spread of the disease. b) Common age-groups for clients with sexually transmitted diseases are in their late teens and 20s. c) Some sexually transmitted diseases can cause infertility caused by scarring of reproductive organs. d) Some sexually transmitted diseases can be transmitted to newborns through the birth canal.

A (Initiate contact isolation protocol. Explanation: Impetigo is a bacterial infection transmitted via contact. Therefore, the nurse should initiate contact isolation protocol. The patient would not be taking an antiviral medication for impetigo, would not need a negative pressure room, and would not wear a mask when outside the room. pg.2090)

The nurse is completing the admission assessment on a patient with renal failure. The patient states, "I was diagnosed with impetigo yesterday." Which of the following is the appropriate nursing intervention? a) Initiate contact isolation protocol. b) Educate the patient about wearing a mask outside of the assigned room. c) Transfer the patient to a negative pressure room. d) Obtain the name of the antiviral medication used to treat the impetigo.

C ("45 to 160 days" Explanation: Hepatitis B is responsible for more than 200 deaths of health care workers annually. The incubation period for hepatitis B is 45 to 160 days. The incubation periods for hepatitis D, E, and G are unclear. pg.2086)

The nurse is educating a group of people on hepatitis B. One participant asks what is the usual incubation period for hepatitis B. Which of the following responses by the nurse is appropriate? a) "15 to 50 days" b) "Varies from days to years" c) "45 to 160 days" d) "6 to 9 months"

D ("Make sure your family has all their childhood immunizations." Explanation: To help prevent and control community-acquired infections, nurses should encourage childhood immunizations. Vaccines stimulate the body to produce antibodies against a specific disease organism. The immunization protects children as well as adults who may not have developed sufficient immunity. Following a proper diet and exercise regimen and going for regular checkups are important, but these measures do not help prevent or control community-acquired infections. Smoking cessation does not reduce the risk of such infections either. pg.2093)

The nurse is giving an educational talk to a local parent-teacher association. A parent asks how he can help his family avoid community-acquired infections. What would be the nurse's best response to help prevent and control community-acquired infections? a) "Encourage your family to stop smoking." b) "Encourage your family to adopt a healthy diet and exercise regimen." c) "Make sure your family has regular checkups." d) "Make sure your family has all their childhood immunizations."

C (Human papilloma viral (HPV) Explanation: Human papilloma viral (HPV) infection is the most commonly transmitted sexual disease in the United States. A strain of this infection can cause cervical cancer. An HPV vaccine is available to both females and males. For females, the vaccine decreases the risk of cervical cancer and genital warts. For males, the vaccine decreases the risk of genital warts and anal cancers. Hepatitis B vaccine protects against a liver disease. Herpes zoster is the vaccine for shingles. The meningococcal vaccine protects against several diseases including meningitis. pg.1652)

The nurse is instructing an adolescent female on potential vaccinations available. Which vaccination would the nurse state that decreases the risk of cervical cancer? a) Meningococcal b) Herpes zoster c) Human papilloma viral (HPV) d) Hepatitis B

A ("Have they had chickenpox or the varicella vaccine?" Explanation: To answer the question correctly, the nurse needs to know if the children had chickenpox or the varicella vaccine. If the children had the vaccine or the disease, then they are considered immune and no precautions are needed. If the children have not been vaccinated for chickenpox nor had the disease, it would be best to maintain distance. Shingles is contagious. Even though the patient may be in pain, this should not guide the nurse's response. pg.2096)

The nurse is instructing the family on home care of a patient with shingles. The family member asks if their teenage children should stay in a different room. What is the best response by the nurse? a) "Have they had chickenpox or the varicella vaccine?" b) "Yes, shingles is highly contagious." c) "Because the patient is in quite a bit of pain, it would probably be best." d) "No, shingles is not contagious."

C (Have the nursing assistant wash hands with soap and water. Explanation: Although all actions listed are appropriate, the priority nursing action is to ensure that nursing assistants wash their hands with soap and water. Allowing nursing assistants to continue with their job without washing their hands will lead to the nursing assistant infecting other patients with whom they come in contact. The potential for health care-associated acquisition is increased because the spore is relatively resistant to disinfectants and can be spread on the hands of health care providers. pg.2090)

The nurse is observing a nursing assistant leave the room of patient diagnosed with Clostridium difficile (C. difficile) without washing hands. Which of the following is the highest priority action the nurse should follow? a) Provide written documentation about the incident. b) Report the nursing assistant to the nurse manager. c) Have the nursing assistant wash hands with soap and water. d) Teach the nursing assistant about the chain of infection.

C (Genital herpes Explanation: Chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes is not. pg.1653)

The nurse is presenting a community lecture about STIs. She emphasizes that some STIs are easily cured with early and adequate treatment. Which of the following is not among these easily treated diseases? a) Gonorrhea b) Chlamydia c) Genital herpes d) Syphilis

A (Complete all prescribed medication. Explanation: The prescribed discharge medication is an antibiotic; thus, the therapeutic outcome would be to have no further infection. The nurse is most correct to instruct to complete all doses or the infection could return. Vibramycin does not have a cardiac side effect; thus, the client does not need to obtain a pulse prior to administration. It is correct to instruct the client to use an alternate form of birth control and take on an empty stomach (if tolerated); however, that instruction does not determine the therapeutic outcome. pg.1655)

The nurse is providing discharge instructions to a female client following inpatient therapy for a gonorrhea infection. The client is being discharged on doxycycline (Vibramycin) for 7 days. Which nursing instruction is essential for a therapeutic outcome? a) Complete all prescribed medication. b) Take medication on an empty stomach. c) Use an alternate form of birth control. d) Obtain a pulse prior to administering medication.

C (Monitor the patient's vital signs Explanation: When caring for a patient susceptible to developing sepsis, the nurse should monitor vital signs every 4 hours or as ordered medically, because changes may be the earliest indication of sepsis. The nurse should also encourage fluid and food intake in the patient, as sufficient intake helps restore biologic defense mechanisms. The patient may be weak and, therefore, need not be encouraged to perform mild activity. pg.2102)

The nurse is required to manage and minimize sepsis in a patient with severe infection. Which of the following would be an appropriate nursing intervention? a) Limit the patient's food intake b) Limit the patient's fluid intake c) Monitor the patient's vital signs d) Encourage the patient to perform mild activity

A (Withhold the immunization. Explanation: The nurse should withhold the immunization until a further investigation of the type of reaction and immunization received is completed. Patients who have had serious reactions or encephalopathy after receiving the pertussis vaccine should not receive the vaccine again. The patient may suffer a severe reaction if the Tdap is administered without investigation. Documentation of the reaction cannot happen until the nurse receives further information. pg.2094)

The nurse is scheduled to administer tetanus, diphtheria, and pertussis (Tdap) vaccine to a patient at the clinic. The patient states, "I had a reaction the last time I got an immunization." What action should the nurse take first? a) Withhold the immunization. b) Document the reaction to the previous immunization. c) Administer the Tdap as ordered. d) Obtain further history regarding the reaction and immunization.

C ("There is no treatment for West Nile virus infection." Explanation: Patients with West Nile virus are supported by fluid replacement, airway management, and standard nursing care while the patient has meningitis symptoms. The incubation period (from mosquito bite until onset of symptoms) is between 5 and 15 days. Most human infections are asymptomatic. When symptoms are present, headache and fever are most frequently reported. Less than 1% of those infected develop more severe illness, including meningitis. Birds are the natural reservoir for the virus. Mosquitoes become infected when feeding on birds and can transmit the virus to animals and humans. pg.2110)

The nurse is teaching about West Nile virus. Which statement by the nurse is accurate? a) "Patients with West Nile virus present with gastrointestinal complaints, such as nausea, vomiting, diarrhea, and abdominal pain." b) "The incubation period for the virus is 3 to 5 days." c) "There is no treatment for West Nile virus infection." d) "The most common transmission mode of West Nile virus is from human to human."

A (Prepare for a cesarean section. Explanation: The nurse is most accurate to prepare for a cesarean section because the mother has an active lesion and does not want to transmit the virus to the newborn. Antibiotic therapy, at this time, does not prevent the transmission of the infection. A full assessment is always completed on the newborn and is not an adjustment in the plan of care. Antibacterial ointment is not placed on the mother's lesions. pg.1653)

The nurse is working in the labor and delivery suite when a client with active herpes simplex virus type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care will the nurse prepare for? a) Prepare for a cesarean section. b) Administer an intravenous antibiotic to the mom while in labor. c) Complete a full assessment of the newborn on delivery. d) Place an antibacterial ointment on the mother's lesions.

C (Ask the physician to wash her hands with soap and water. Explanation: C. difficile is resistant to alcohol-based and other hand sanitizers; therefore physicians should be instructed to wash their hands with soap and water. The nurse could report the observation to the infection control department, but that does not address the immediate concern of the physician contaminating other patients. There is no need for the room door to be closed. The nurse must take action to ensure the safety of other patients. pg.2089)

The nurse observes a physician leave the room of a patient in isolation for Clostridium difficile (C. difficile). The physician uses the alcohol-based hand sanitizer hanging on the wall to wash her hands and leaves the door open. Which of the following actions should the nurse take? a) Close the door to the room. b) No action is needed. The physician was following isolation protocol. c) Ask the physician to wash her hands with soap and water. d) Report the observation to the infection control department.

A ("When the vesicles and pustules have crusted." Explanation: When the lesions have crusted, the patient is no longer contagious to others. The child remains contagious when the rash is present, and if the fever occurs as the rash is progressing. The child is still contagious when the rash is changing into vesicles and pustules. pg.2094)

The parent of a child diagnosed with chickenpox asks when the child can go to play group again. What is the best response by the nurse? a) "When the vesicles and pustules have crusted." b) "When the fever disappears." c) "Two days after the rash appears." d) "When the rash is changing into vesicles, and pustules appear."

B (Mode of entry to host Explanation: The six elements necessary for infection are a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and a mode of entry to host. A mode of entry to the host, not a mode of exit from the host, is necessary for infection. pg.2085)

The six elements necessary for infection include a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, in addition to which of the following? a) Mode of exit from the host b) Mode of entry to host c) Latent time period d) Virulent host

D (With proper treatment, the disease can eventually be cured. Explanation: For a client with syphillis, proper treatment will improve the symptoms of skin lesions and other sequelae of infection, with serology eventually reflecting a cure. Typically, early syphilis or early latent syphilis is treated with a one-time intramuscular dose of penicillin G benzathine; three injections at one week intervals are used for clients with late latent or laten syphilis of unknown duration. Condoms significantly reduce the risk of transmission of syphilis and other sexually transmitted infections. Sexual contact is avoided until previous or current partners have been treated. pg.2107)

When developing a teaching plan for a client with syphillis, which of the following would be most important to include? a) Sexual contact can be resumed after treatment. b) Oral therapy needs to continue after the initial injection. c) Condoms have little effect in preventing the transmission of the disease. d) With proper treatment, the disease can eventually be cured.

C (Chlamydia trachomatis infection Explanation: Chlamydia is a common sexually transmitted disease (STD) requiring the treatment of all current sexual partners to prevent reinfection. Bartholinitis results from obstruction of a duct. Candidiasis is a yeast infection that commonly occurs as a result of antibiotic use. Sexual partners may become infected, although men can usually be treated with over-the-counter products. Endometriosis occurs when endometrial cells are seeded throughout the pelvis and isn't an STD.)

Which condition of generally requires the identification and treatment of sexual partners? a) Bartholinitis b) Candidiasis c) Chlamydia trachomatis infection d) Endometriosis

B (Human papillomavirus (HPV) Explanation: HPV infection is the most common STI among young, sexually active people. Millions of Americans are infected with HPV, many unaware that they carry the virus.)

Which of the following is the most common sexually transmitted infection (STI) among young, sexually active people? a) Chlamydia b) Human papillomavirus (HPV) c) Trichomoniasis d) Gonorrhea

A (Limit stress and emotional upset as much as possible. Explanation: Stress, anxiety, and emotional upset seem to predispose a client to recurrent outbreaks of genital herpes. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it isn't known whether the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing. Because a relationship has been found between genital herpes and cervical cancer, a Pap test is recommended every year.)

Which instruction should be given to a woman newly diagnosed with genital herpes? a) Limit stress and emotional upset as much as possible. b) Have your partner use a condom when lesions are present. c) Use a water-soluble lubricant for relief of pruritus. d) Obtain a Papanicolaou (Pap) test every 3 years.

B (Make the patient wait at least 30 minutes before leaving the health care facility. Explanation: After administering injections of penicillin, the nurse should make the patient wait at least 30 minutes before allowing him or her to leave the health care facility. This is because reactions are frequent and can be severe enough to be fatal. The muscle in which the injection is given does not need to be massaged. There is no indication for the patient to deep breathe or to lie flat for 6 hours following the injection. pg.2107)

Which intervention should a nurse perform after administering an injection of penicillin to a patient with an infection? a) Encourage the patient to deep breathe. b) Make the patient wait at least 30 minutes before leaving the health care facility. c) Advise the patient to massage the muscle used for the injection for 10 minutes. d) Instruct the patient to lie flat for 6 hours once home.

D (Oral rehydration solution (ORS) Explanation: ORS may be used for rehydration therapy for diarrheal disorders. Foods that are high in simple sugars, such as undiluted apple juice or gelatin, should be avoided. Sports drinks do not replace fluid losses correctly and should not be used. pg.2105)

Which of the following can be used for rehydration therapy for diarrheal disorders? a) Undiluted apple juice b) Sports drinks c) Gelatin d) Oral rehydration solution (ORS)

C (Infection Explanation: Infection indicates a host interaction with an organism. The term colonization is used to describe microorganisms present without host interference or interaction. Infectious disease is the state in which the infected host displays a decline in wellness due to the infection. Reservoir is the term used for any person, plant, animal, substance, or location that provides nourishment for microorganisms and enables further dispersal of the organisms.)

Which of the following describes host interaction with an organism? a) Colonization b) Infectious disease c) Infection d) Reservoir

C (The gold standard for HSV diagnosis is a culture of the lesion. Serology may help determine new versus chronic infection when obtained concurrently with positive culture of the lesion. The other diagnostics may be used for diagnosis of skin disorders, but would not be used for HSV.)

Which of the following is the gold standard for herpes simplex virus (HSV) diagnosis? a) Shave biopsy b) Punch biopsy c) Culture d) Excisional biopsy

D (Penicillin G benzathine Explanation: A single dose of penicillin G benzathine intramuscular injection is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration. Patients who are allergic to penicillin are usually treated with doxycycline or tetracycline. Rocephin is not the medication of choice for syphilis.)

Which of the following is the medication of choice for early syphilis? a) Doxycycline b) Rocephin c) Tetracycline d) Penicillin G benzathine

C (Untreated genital warts may resolve on their own, remain unchanged, or increase in size or number. Explanation: Untreated genital warts do not lead to AIDS. Untreated genital warts may resolve on their own, remain unchanged, or increase in size or number. They may lead to cervical or other pelvic reproductive types of cancer. pg.1652)

Which of the following statements holds true for a client with untreated genital warts? Choose the correct option. a) Untreated genital warts may lead to AIDS. b) Untreated genital warts do not lead to any other illness and resolve on their own without treatment. c) Untreated genital warts may resolve on their own, remain unchanged, or increase in size or number. d) Untreated genital warts do not resolve on their own and increase in size with abscess formations.

D (There is no treatment for West Nile virus infection. Explanation: Patients with West Nile virus are supported by fluid replacement, airway management, and standard nursing care support while the patient has meningitis symptoms. The incubation period (from mosquito bite until onset of symptoms) is between 5 to 15 days. Most human infections are asymptomatic. When symptoms are present, headache and fever are most frequently reported. Less than one percent of those infected develop more severe illness, including meningitis. Birds are the natural reservoir for the virus. Mosquitoes become infected when feeding on birds and can transmit the virus to animals and humans. There is no human-to-human transmission of the virus. pg.2110)

Which of the following statements reflects the nursing management of the patient with West Nile virus infection? a) Transmission of West Nile virus is from human-to-human. b) The incubation period for the virus is three to five days. c) Patients with West Nile virus present with gastrointestinal complaints, such as nausea,vomiting, diarrhea, and abdominal pain. d) There is no treatment for West Nile virus infection.

A (Latency Explanation: Latency is the time interval after primary infection when a microorganism lives within the host without producing clinical evidence. Virulence is the degree of pathogenicity of an organism. The incubation period is the time between contact and onset of sign and symptoms. Susceptibility is not possessing immunity to a particular pathogen. pg.2084)

Which of the following terms describes the time interval after primary infection when a microorganism lives within the host without producing clinical evidence? a) Latency b) Incubation period c) Virulence d) Susceptibility

C (Colonization Explanation: Understanding the principle of colonization facilitates interpretation of microbiologic reports. A susceptible host is a host that does not possess immunity to a particular pathogen. An immune host is a host that is not susceptible to a particular pathogen. Infection refers to host interaction with an organism. pg.2088)

Which of the following terms refers to a state of microorganisms being present within a host without causing host interference or interaction? a) Infection b) Susceptible c) Colonization d) Immune

C (Staphylococcus aureus Explanation: Staphylococcus aureus is the responsible organisms for impetigo. Histoplasma capsulatum is responsible for histoplasmosis. Bacillus anthracis is responsible for anthrax. Clostridium difficile is responsible for some diarrheal diseases. pg.2086)

Which organism is responsible for impetigo? a) Clostridium difficile b) Bacillus anthracis c) Staphylococcus aureus d) Histoplasma capsulatum

B (Latency Explanation: Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. A period of latency occurs when the infected person has no signs or symptoms of syphilis. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.)

Which stage or period of syphilis occurs when the infected person has no signs or symptoms of syphilis? a) Tertiary b) Latency c) Secondary d) Primary

D ("I need to treat this infection so it doesn't spread into my pelvis because I want to have children some day." Explanation: Chlamydia is a common cause of pelvic inflammatory disease and infertility. It doesn't affect the kidneys or cause birth defects. It can cause conjunctivitis and respiratory infection in neonates exposed to infected cervicovaginal secretions during delivery. Use of a diaphragm isn't a risk factor.)

Which statement made by a client with a chlamydial infection indicates understanding of the potential complications? a) "I'm glad I'm not pregnant; I'd hate to have a malformed baby from this disease." b) "I hope this medicine works before this disease gets into my urine and destroys my kidneys." c) "If I had known a diaphragm would put me at risk for this, I would have taken birth control pills." d) "I need to treat this infection so it doesn't spread into my pelvis because I want to have children some day."

A (The diagnosis should be considered in a patient who has a febrile, hemorrhagic illness after traveling to Asia or Africa. Explanation: The diagnosis should be considered in a patient who has a febrile, hemorrhagic illness after traveling to Asia or Africa, or who has handled animals or animal carcasses from those parts of the world. Antibiotic therapy, such as penicillin, would not be effective for the treatment of viruses. Treatment must be largely supportive maintenance of the circulatory and respiratory systems. The infected patient likely would need ventilator and dialysis support through the acute phases of illness. The viruses are usually spread by exposure to blood or other body fluid, insect bite, and mucous membrane exposure. Symptoms include fever, rash, and encephalitis which progress rapidly to profound hemorrhage, organ destruction, and shock. pg.2112)

Which statement reflects what is known about the Ebola and Marburg viruses? a) The diagnosis should be considered in a patient who has a febrile, hemorrhagic illness after traveling to Asia or Africa. b) Treatment during the acute phase includes administration of penicillin and ventilator and dialysis support. c) The viruses are usually transmitted by airborne exposure. d) Symptoms include severe lower abdominal pain, nausea, vomiting, and dehydration.

A (Herpes infection Explanation: The nurse is most accurate to highlight the herpes infection as the virus can remain dormant in the ganglia of the nerves. Symptoms are usually more severe with the initial outbreak. Subsequent episodes are usually shorter and less intense. The other infections are important to note in the history. pg.1653)

Which type of sexually transmitted disease is the nurse most accurate to highlight in the client's history as it remains dormant in the body and can reoccur at any time? a) Herpes infection b) Syphilis c) Gonorrhea d) Chlamydia

D ("All parts of the chain of infection have to be present for the disease to be passed to another human." Explanation: All components in the chain of infection must be present for an infectious disease to be transmitted from one human or animal to a susceptible host. This makes options A, B, and C incorrect. pg.2085)

You are a school nurse teaching a health class about the chain of infection in the transmission of sexually transmitted diseases (STDs). A student asks you which part of the chain of infection can be missing when transmission occurs. What would be your best answer? a) "Not everyone is susceptible to STDs, but they still get them." b) "STDs can be gotten from bed linens and toilet seats, so you don't really need a reservoir." c) "You can be missing any part of the chain of infection except the infectious agent." d) "All parts of the chain of infection have to be present for the disease to be passed to another human."

B (Apply principles of medical and surgical asepsis. Explanation: Nosocomial infections are acquired when receiving care in a healthcare facility. To help prevent and control nosocomial infections, nurses should apply principles of medical and surgical asepsis whenever they care for clients. Childhood immunizations control community-acquired infections. Maintaining a proper diet and exercise regimen and use of antibiotics do not help control nosocomial infections. pg.2089)

You are caring for a client with an impaired immune system. You are concerned about the client acquiring a nosocomial infection. What intervention would help nurses control nosocomial infections? a) Use proper antibiotics. b) Apply principles of medical and surgical asepsis. c) Ensure childhood immunizations. d) Maintain a proper diet and exercise regimen.

A, D (d) Boost the immune system a) Increase white blood cell production Explanation: Bone marrow transplantation or administration of drugs that boost white blood cell production, such as filgrastim (Neupogen), may help immunosuppressed clients. Neupogen does not increase the platelet count or boost red blood cell production. pg.1703)

You are caring for a client with breast cancer who has been receiving chemotherapy. The client was admitted with an infected lesion on her left leg. The physician has ordered Neupogen. What will Neupogen do for this client? a) Increase white blood cell production b) Increase platelet count c) Boost red blood cell production d) Boost the immune system

B, C, D (Explanation: Certain people are at increased risk for infection because their defenses are compromised in one or more ways. For example, older adults, premature infants, malnourished and debilitated clients, clients receiving immunosuppressive agents, and clients with impaired skin, bone marrow suppression, or disorders of the immune system are especially susceptible to virulent and nonvirulent strains of microorganisms. Clients with pancreatic disease and adolescents are not at higher risk for infections. pg.2088)

You are teaching a pathophysiology class to pre-nursing students. Today you are teaching about infection. What groups of people would you tell the students are at increased risk for infection? (Mark all that apply.) a) Adolescents b) Clients with impaired skin c) Debilitated clients d) Older adults e) Clients with pancreatic disease

B (The infection is being transmitted by healthcare personnel. Explanation: Healthcare personnel are in frequent and direct contact with many clients who harbor various microorganisms; the risk for transmitting pathogenic microorganisms between clients is high. pg.2090)

You work on a long-term care unit. In the last two weeks more than half the clients on your unit have been diagnosed with gastroenteritis. What is the most likely reason? a) The clients are in too small an area, so they pass around diseases. b) The infection is being transmitted by healthcare personnel. c) The visitors brought the disease into the unit. d) The clients don't wash their hands after going to the bathroom.

B (Monitor your client's vital signs. Explanation: Clients who are septic will exhibit two or more of the following: temperature greater than 100.4°F (38°C) or less than 96.8°F (36°C), heart rate greater than 90 beats/minute, respiratory rate greater than 20 breaths/minute or PaCO2 less than 32 mm Hg, and WBC count greater than 12,000 cells/mm3 or 10% immature (band) forms. pg.2102)

Your client was admitted to your unit for observation regarding possible sepsis. As her nurse, you monitor her carefully and are to report any suspicious findings, which could indicate the development of systemic infection. What would be your primary nursing tasks in this effort? a) Encourage the client to perform mild activity. b) Monitor your client's vital signs. c) Observe the client's mental status. d) Limit the client's fluid intake.