FA 2019- Infection EAQ 2

The nurse obtains a laboratory report that shows acid-fast rods in a client's sputum. Which disorder should the nurse consider may be related to these results? A. Influenza virus B. Diphtheria bacillus C. Bordetella pertussis D. Mycobacterium tuberculosis

D. Mycobacterium tuberculosis Mycobacterium tuberculosis[1][2] is the acid-fast causative organism of tuberculosis. Acid-fast rods are not related to influenza viruses. The diphtheria bacillus is not an acid-fast rod. The microorganism that causes pertussis is not an acid-fast rod.

Shortly after birth the nurse instills erythromycin ophthalmic ointment in the newborn's eyes. The father asks why an antibiotic is needed. The nurse explains that it is routinely administered to prevent what type of infection? A. Gonorrhea B. Toxoplasmosis C. Rubella D. Cytomegalovirus

A. Gonorrhea The antibiotic ointment is administered prophylactically to prevent the development of ophthalmia neonatorum, which may be contracted during a vaginal birth to a mother with gonorrhea, chlamydia, or both infections. Cytomegalovirus, toxoplasmosis, and rubella are contracted by the fetus in utero during various stages of pregnancy, not during birth. Erythromycin ophthalmic ointment would be ineffective treatment for these conditions.

Which are examples of actively acquired specific immunity? Select all that apply. A. Recovery from measles B. Recovery from chickenpox C. Maternal immunoglobulin in the neonate D. Immunization with live or killed vaccines E. Injection of human gamma immunoglobulin

A. Recovery from measles B. Recovery from chickenpox D. Immunization with live or killed vaccines. Naturally acquired active-type immunity is seen in a client who has recovered from measles or chickenpox or who has been immunized with a live- or killed-virus vaccine. Maternal immunoglobulin in a neonate and an injection of human gamma immunoglobulin into a client are examples of passively acquired specific immunity.

What disease is more commonly seen in preschoolers? A. Sinusitis B. Lung cancer C. Hypertension D. Angina pectoris

A. Sinusitis Toddlers and preschoolers are very prone to developing upper respiratory tract infections such as sinusitis. Lung cancer is seen commonly in young or middle-aged adults due to a smoking habit. Hypertension is commonly seen in middle-aged adults due to an unhealthy diet, lack of exercise, and stress. Angina also tends to affect young and middle-aged adults.

A nurse is teaching a breastfeeding mother about cleansing her nipples. What technique should the nurse emphasize? A. Wash the breasts and nipples with water when bathing B. Wipe the nipples with sterile water before each feeding C. Swab the nipples with an alcohol sponge after each feeding C. Rub the breasts and nipples with soapy water when showering

A. Wash the breasts and nipples with water when bathing Daily washing of the breasts and nipples with water is sufficient for cleanliness. It is unnecessary to use sterile water; the infant's gastrointestinal tract is not sterile. Alcohol is drying and may cause the nipples to crack. Scrubbing, as well as the use of soap, may irritate and dry the nipples.

A client who is recovering from deep partial-thickness burns develops chills, fever, flank pain, and malaise. The primary healthcare provider makes a tentative diagnosis of urinary tract infection. Which diagnostic tests should the nurse expect the primary healthcare provider to prescribe to confirm this diagnosis? A. Cystoscopy and bilirubin level B. Specific gravity and pH of the urine C. Urinalysis and urine culture and sensitivity D. Creatinine clearance and albumin/globulin (A/G) ratio

C. Urinalysis and urine culture and sensitivity The client's manifestations may indicate a urinary tract infection; a culture of the urine will identify the microorganism, and sensitivity will identify the most appropriate antibiotic. A cystoscopy is too invasive as a screening procedure; altered bilirubin results indicate liver or biliary problems, not urinary signs and symptoms. Creatinine clearance reflects renal function; A/G ratio reflects liver function. Although an increased urine specific gravity may indicate red blood cells (RBCs), white blood cells (WBCs), or casts in the urine, which are associated with urinary tract infection, it will not identify the causative organism.

Which immunodeficiency disorders affect polymorphonuclear leukocytes and monocytes? Select all that apply. A. Job syndrome B. DiGeorge syndrome C. Ataxia-telangiectasia D. Graft-versus-host disease E. Chronic granulomatous disease

A. Job syndrome E. Chronic granulomatous disease Job syndrome and chronic granulomatous disease are immunodeficiency disorders that affect polymorphonuclear leukocytes and monocytes. DiGeorge syndrome affects T-cells. Ataxia-telangiectasia affects B- and T-cells. Graft-versus-host disease affects B- and T-lymphocytes.

The nurse has administered lymphocyte immunoglobulin to a client. Which side effects are most likely to occur? Select all that apply. A. Leukopenia B. Peptic ulcer C. Tachycardia D. Serum sickness E. Urinary infection

A. Leukopenia C. Tachycardia D. Serum sickness Lymphocyte immunoglobulin is an immunosuppressant directed against T-lymphocytes. Tachycardia, leukopenia, and serum sickness are side effects associated with lymphocyte immunoglobulin therapy. Peptic ulcers may occur when corticosteroids are injected. A urinary infection may occur when an immunosuppressant such as belatacept is administered.

Which test result should a nurse review to determine if the antibiotic prescribed for the client will be effective? A. Serologic test B. Sensitivity test C. Serum osmolality D. Sedimentation rate

B. Sensitivity test Infected body fluids are tested to determine the antibiotics to which the organism is particularly sensitive or resistant (sensitivity). The serologic test checks for antibody content. The serum osmolality test provides data about fluid and electrolyte balance. The erythrocyte sedimentation rate (ESR) is a nonspecific test for the presence of inflammation.

An older client who is living in a nursing home is admitted to the hospital to be treated with intravenous antibiotics for sepsis. After the client becomes agitated and attempts to pull out the IV, the healthcare provider prescribes a stat dose of haloperidol 0.5 mg intramuscularly (IM). The haloperidol is available in a vial that contains 2 mg/mL. How much solution will the nurse administer? Record your answer using two decimal places. Include a leading zero if applicable.

0.25 mL

After performing an otoscopic examination on a client who reports a decrease in hearing acuity, the primary healthcare provider diagnoses the condition as otitis media. Which assessment finding supports the diagnosis? A. Nodules on the pinna B. Redness of the eardrum C. Lesions in the external canal D. Excessive soft cerumen in the external canal

B. Redness of the eardrum Many conditions are associated with a decrease in hearing acuity. One such condition is otitis media. This condition is diagnosed by redness of the eardrum observed during the otoscopic examination. Nodules on the pinna may be an indication of rheumatoid arthritis, chronic gout, or basal or squamous cell carcinoma. Lesions in the external canal may cause a decrease in hearing acuity but not the manifestation of otitis media. Excessive soft cerumen in the external canal impacts the hearing acuity but not the manifestation of otitis media.

The nurse is teaching a client regarding the usage of antibiotics. Which statement made by the client indicates effective teaching? A. "I should not take antibiotics to treat the flu." B. "I should take an antibiotic to prevent illness." C. "I should stop an antibiotic regimen when I am feeling better." D. "I should borrow an antibiotic from a family member or friend in an emergency."

A. "I should not take antibiotics to treat the flu." Antibiotics are effective against bacterial infections; therefore the nurse instructs the client to avoid antibiotic use for viral infections such as flu and cold. Antibiotics should not be taken for preventing the disease as they may lead to resistance. The nurse should advise the client to not stop taking an antibiotic when feeling better as doing so may lead to the survival and multiplication of the hardiest bacteria, resulting in resistance. The client should not borrow an antibiotic as the antibiotic may not be appropriate in terms of dose, activity, and illness.

At 6 weeks' gestation a client is found to have gonorrhea. What medication does a nurse expect the primary healthcare provider to prescribe? A. Ceftriaxone B. Levofloxacin C. Sulfasalazine D. Trimethoprim/ sulfamethoxazole

A. Ceftriaxone Ceftriaxone, a broad-spectrum antibiotic, is preferred during pregnancy. Levofloxacin, although listed as for unlabeled use against gonococcal infection, should not be prescribed during pregnancy. Sulfonamides may cause hemolysis in the fetus. Trimethoprim/sulfamethoxazole contains a sulfonamide and is contraindicated during pregnancy.

A woman and her children, who have not received immunizations for childhood diseases, immigrate to the United States (Canada). Before being immunized, one of the school-aged children contracts varicella (chickenpox). What does the nurse teach the mother about varicella? A. Communicable until all vesicles are dry B. Still communicable even when dry scabs remain C. No longer communicable after the fever has subsided D. Not communicable while vesicles are surrounded by red areolas

A. Communicable until all vesicles are dry When all the vesicles have dried, varicella (chickenpox) is no longer transmissible; dried vesicles and scabs do not harbor the varicella virus. Varicella is not associated with a fever unless a bacterial complication such as pneumonia is present. Vesicles that are surrounded by areolas occur in successive crops; they contain the varicella virus.

A client will be taking nitrofurantoin 50 mg orally every evening at home to manage recurrent urinary tract infections. What instructions should the nurse give to the client? A. Increase the intake of fluids. B. Strain the urine for crystals and stones. C. Stop the drug if urinary output increases. D. Maintain the exact time schedule for taking the drug.

A. Increase the intake of fluids. To prevent crystal formation, the client should have sufficient intake to produce 1000 to 1500 mL of urine daily while taking this drug. Straining urine is not indicated when the client is taking a urinary antiinfective. Urinary decrease is of concern because it may indicate renal failure. If fluids are encouraged, the client's output should increase. The drug need not be taken at a strict time daily.

Which is the preferred drug of choice for the treatment of syphilis in a pregnant adolescent? A. Penicillin G B. Doxycycline C. Tetracycline D. Erythromycin

A. Penicillin G According to the Center for Disease Control and Prevention, penicillin G is the preferred drug of choice for any stage of syphilis in pregnant women. Both doxycycline and tetracycline are contraindicated during pregnancy. Erythromycin may not be able to cure a fetal infection.

The nurse is caring for a client who underwent surgery for a brain tumor. On assessment, the nurse suspects meningitis in the client. Which finding would help confirm the nurse's suspicion? A. Positive Kernig sign B. Glasgow coma score: 10 C. Absence of nuchal rigidity D. Negative Brudzinski sign

A. Positive Kernig sign Meningitis may occur secondary to surgical procedures on the brain. It is highly probable when Kernig sign is positive. The Glasgow coma scale is used as a reliable way of recording the conscious state of the client, but it is not used to diagnose meningitis. A meningitis diagnosis is highly probable with a positive Brudzinski sign and the presence of nuchal rigidity (e.g., stiff neck).

What is the function of the dermis? A. Provides cells for wound healing B. Assists in retention of body heat C. Acts as mechanical shock absorber D. Inhibits proliferation of microorganisms

A. Provides cells for wound healing The dermis is present between the epidermis and subcutaneous layers and has such functions as giving the skin its flexibility and strength and providing cells for wound healing. Subcutaneous tissue is the innermost layer of the skin that helps in retention of body heat and acts as a mechanical shock absorber. Epidermis is the outermost layer of skin that inhibits the proliferation of microorganisms.

While assessing a client, the nurse finds inflammation of the skin at the bases of the client's nails. What might be the reason behind this condition? A. Trauma B. Trichinosis C. Pulmonary disease D. Iron-deficiency anemia

A. Trauma Paronychia is an abnormality of the nail bed. The condition is marked by inflammation of the skin at the base of the nail; this condition may be caused by trauma or a local infection. Trichinosis is associated with red or brown linear streaks in the nail bed. Pulmonary diseases can cause changes in the angle between nail and nail base, which is a phenomenon known as clubbing. Koilonychia, a concave curvature of the nails, may occur as a result of iron-deficiency anemia.

A client who sustained a burn injury involving 36% of the body surface area is receiving hydrotherapy. Which is the best nursing intervention when providing wound care? A. Use a consistent approach to care and encourage participation. B. Prepare equipment while doing the procedure and explain the treatment to the client. C. Rinse the burn area with 105° F (40.6° C) water to prevent loss of body temperature. D. Arrange for a change of staff every 4 to 5 days and have the client select the time for the procedure to be done.

A. Use a consistent approach to care and encourage participation. Client participation provides for a sense of control, and a consistent approach provides a routine with no surprises; these approaches may limit pain and promote adherence to the regimen. Preparation of the equipment and explanation of the procedure should be performed before the procedure; when performed during the procedure, it wastes time, which can prolong pain and increase anxiety. Water temperature of 105° F (40.6° C) is too hot; the rinse water should be room temperature. Changing staff disrupts the client's routine and sense of trust.

A nurse is caring for a client with an infection caused by group A beta-hemolytic streptococci. The nurse should assess this client for responses associated with which illness? A. Hepatitis A B. Rheumatic fever C. Spinal meningitis D. Rheumatoid arthritis

B. Rheumatic fever Antibodies produced against group A beta-hemolytic streptococci sometimes interact with antigens in the heart's valves, causing damage and symptoms of rheumatic heart disease; early recognition and treatment of streptococcal infections have limited the occurrence of rheumatic heart disease. Hepatitis A, an inflammation of the liver, is caused by the hepatitis A virus (HAV), not by bacteria. The most common causes of meningitis, an infection of the membranes surrounding the brain and spinal cord, include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Rheumatoid arthritis is believed to be an autoimmune disorder; it is not caused by microorganisms.

A toddler with cystic fibrosis has been hospitalized with bacterial pneumonia. The nurse determines that the child has no known allergies. What does the nurse conclude is the reason that the healthcare provider selected a specific antibiotic? A. Tolerance of the child B. Sensitivity of the bacteria C. Selectivity of the bacteria D. Preference of the healthcare provider

B. Sensitivity of the bacteria When the causative organism is isolated, it is tested for antimicrobial susceptibility (sensitivity) to various antimicrobial agents. When a microorganism is sensitive to a medication, the medication is capable of destroying the microorganism. The tolerance of the child of the particular antibiotic is unknown because up to this time the child has not exhibited any allergies. Bacteria are not selective. Although the healthcare provider may have a preference for a particular antibiotic, it first must be determined whether the bacteria are sensitive to it.

A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting human immunodeficiency virus (HIV). Which guidance is most appropriate for the nurse to provide? A. Ask her partner to withdraw before ejaculating. B. Make certain their relationship is monogamous. C. Insist that her partner use a condom when having sex. D. Seek counseling about various contraceptive methods.

C. Insist that her partner use a condom when having sex. A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals. Preejaculatory fluid carries HIV in an infected individual, so withdrawing before ejaculation is not effective. Although a monogamous relationship is less risky than having multiple sexual partners, if one partner is HIV positive, the other person is at risk for acquiring HIV. The client is not asking about various contraceptive methods. Most contraceptives do not provide protection from HIV.

A client is diagnosed with pulmonary tuberculosis, and the healthcare provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the drug is effective when the client reports which action as most important? A. "Report any changes in vision." B. "Take the medicine with my meals." C. "Call my doctor if my urine or tears turn red-orange." D. "Continue taking the medicine even after I feel better."

D. "Continue taking the medicine even after I feel better." The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.

A nurse is teaching a client with pruritus about personal care interventions. Which statement made by the client indicates the nurse needs to intervene? A. "I will trim my fingernails regularly." B. "I will wear mittens or splints at night." C. "I will apply moisturizing lotion after bath." D. "I will not file the edges of fingernails."

D. "I will not file the edges of fingernails." The nurse should intervene if the client states that fingernail edges will not be filed to correct this misconception. Rough edges of fingernails should regularly be filed to prevent skin damage and secondary infection. All the other statements are correct and require no follow up. Regular trimming of the nails, wearing of splints at night, and application of moisturizing lotion after bath are some interventions to be taken by the client to protect skin in pruritus.

The nurse is teaching a client undergoing intravenous gentamicin therapy for the treatment of acute osteomyelitis. Which statement by the client indicates effective learning? A. "I should drink lots of water if I retain urine." B. "I should use eyeglasses if I have vision problems." C. "I should stop the medication when the symptoms have subsided." D. I should report any hearing loss to the primary healthcare provider."

D. I should report any hearing loss to the primary healthcare provider." Acute oseteomyelitis is treated with antibiotics such as gentamicin. Gentamicin use can cause ear toxicity; therefore, the client should report any hearing loss to the primary healthcare provider. Gentamicin also causes urine retention, but increasing water intake can aggravate this condition; therefore, the client should report this issue to the primary healthcare provider instead of increasing water consumption. Gentamicin may cause visual disturbances and should be reported to the primary healthcare provider; use of inappropriate eyeglasses, or use of glasses without first consulting the primary healthcare provider, increases the risk. The client should not stop taking the medication without consulting the primary healthcare provider, even if the symptoms have subsided.

A client undergoing corticosteroid therapy is admitted with a peptic ulcer, osteoporosis, and hypertension. Which medication may have caused this condition? A. Everolimus B. Azathioprine C. Mycophenolate acid D. Methylprednisolone

D. Methylprednisolone Methylprednisolone is a corticosteroid that suppresses inflammatory responses and inhibits both cytokine production and T-cell activation. This drug may cause a peptic ulcer, osteoporosis, and hypertension. Everolimus may cause urinary tract infections, hyperlipidemia, and peripheral edema. Azathioprine may cause bone marrow suppression, neutropenia, and thrombocytopenia. Mycophenolate acid may cause diarrhea, neutropenia, and increased incidence of malignancies.

A client in a nursing home is diagnosed with urethritis. What should the nurse plan to do before initiating antibiotic therapy prescribed by the primary healthcare provider? A. Start a 24-hour urine collection. B. Prepare for urinary catheterization. C. Teach the client how to perform perineal care. D. Obtain a urine specimen for culture and sensitivity.

D. Obtain a urine specimen for culture and sensitivity. The causative organism should be isolated before starting antibiotic therapy; a culture and sensitivity[1][2] should be obtained before starting the antibiotic. A 24-hour urine test will not determine the infective organism causing the problem. Catheterization is not a routine intervention for urethritis. Although client teaching is important, it is not the priority at this time.

A nurse is counseling a woman who had recurrent urinary tract infections. Which factor should the nurse explain is the reason why women are at a greater risk than men for contracting a urinary tract infection? A. Altered urinary pH B. Hormonal secretions C. Juxtaposition of the bladder D. Proximity of the urethra to the anus

D. Proximity of the urethra to the anus Because a woman's urethra is closer to the anus than a man's, it is at greater risk for becoming contaminated. Urinary pH is within the same range in both men and women. Hormonal secretions have no effect on the development of bladder infections. The position of the bladder is the same in men and women.

An infant with cardiopulmonary disease who displays signs and symptoms of bronchiolitis and pneumonia was admitted to the hospital. What condition is the infant likely to have? A. Poliomyelitis B. Pneumococcal infection C. Meningococcal infection D. Respiratory syncytial virus infection

D. Respiratory syncytial virus infection Respiratory syncytial virus infections are the most common cause for hospitalization of infants younger than 1 year of age; this disease especially affects premature infants and infants with cardiopulmonary disease. Poliomyelitis is caused by the poliovirus. Streptococcus pneumonia infections cause meningitis, sepsis, pneumonia, and otitis media. Neisseria meningitidis causes meningitis.