NU271 Week 8 EAQ Evolve Elsevier: Infection

The new nurse is approached by a surveyor from the department of health. The surveyor asks the nurse about the best way to prevent the spread of infection. Which answer by the nurse is correct? 1). "Let me get my preceptor." 2). "Wash your hands before and after any client care." 3). "Clean all instruments and work surfaces with an approved disinfectant." 4). "Ensure proper disposal of all items contaminated with blood or body fluids."

2). "Wash your hands before and after any client care." The best means to prevent the spread of infection is to break the chain of infection. This is most easily accomplished by the simple act of hand washing before and after all client contact. "Let me get my preceptor" and "Clean all instruments and work surfaces with an approved disinfectant" may be correct, but they are not the best responses for this situation. It is not necessary that all items contaminated with blood or body fluids be disposed.

Which medication would the nurse administer to prevent maternal transmission of infection to the newborn of a client with gonorrhea? Select all that apply. One, some, or all responses may be correct. 1). Penicillin 2). Acyclovir 3). Ceftriaxone 4). Doxycycline 5). Levofloxacin

3). Ceftriaxone Ceftriaxone is used to prevent transmission of maternal gonorrheal infection to the newborn during the birthing process. Penicillin is used to treat syphilis. Acyclovir is administered for neonatal herpes infection. Doxycycline is used to treat chlamydia. Levofloxacin is used for sexually acquired epididymitis.

Which medication is considered first-line therapy for an infant with congenital syphilis? 1). Vidarabine 2). Pyrimethamine 3). Intravenous (IV) penicillin 4). Trimethoprim-sulfamethoxazole

3). Intravenous (IV) penicillin IV penicillin destroys the cell wall of Treponema pallidum, the causative organism of syphilis. Vidarabine is an antiviral medication; it does not treat congenital syphilis in an infant. Pyrimethamine and trimethoprim-sulfamethoxazole are ineffective in the treatment of syphilis.

Which client would the nurse suspect as being in the last stage of syphilis? 1). Client A 2). Client B 3). Client C 4). Client D

4). Client D Syphilis is a sexually transmitted disease caused by Treponema pallidum. The symptoms of the tertiary, or last, stage of syphilis are the presence of gummas on the skin. Client D meets the criteria for the last stage of syphilis. Client A, with a chancre in the mouth, is in the primary stage of syphilis. Client B, exhibiting malaise, low-grade fever, headache, muscular aches, and sore throat, meets the criteria for the secondary stage of syphilis. Client C, presenting with gray-white wartlike lesions on the skin, meets the criteria for the secondary stage of syphilis. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and assistant/client interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking.

Which priority nursing action would the nurse implement for an infant recently admitted with a diagnosis of diarrhea caused by a Salmonella infection? 1). Monitoring oral fluid intake 2). Establishing a play schedule 3). Obtaining a recent food history 4). Establishing a skin care routine

4). Establishing a skin care routine Enzymes in the stool may irritate the skin; maintaining skin integrity is the priority. Fluid intake is important to monitor for dehydration, though some infants may receive IV fluids. Establishing a play schedule is not the priority of care. Physiologic problems, such as altered skin integrity, should be addressed first. Although obtaining a food history is important, it is not the priority.

Which type of immunity would a 4-year-old child develop during the course of an infection with varicella? 1). Active natural immunity 2). Active artificial immunity 3). Passive natural immunity 4). Passive artificial immunity

1). Active natural immunity In active natural immunity, the infected child's immune system responds to the invading organism (varicella) by producing antibodies specific to the antigen. Passive natural immunity is acquired by the fetus from the mother. Active artificial immunity is acquired by the injection of antigens; after this, the child develops antibodies. Passive artificial immunity is acquired through the injection of antibodies.

The school nurse presented a program for teachers about infection-control and hand-washing techniques. Which evaluation method is the most effective way for the nurse to evaluate the teachers' knowledge of hand-washing techniques? 1). Observe the teachers lecture the children about hand hygiene. 2). Administer an objectively written final examination to the teachers. 3). Have the teachers share their knowledge of hand washing. 4). Watch the teachers demonstrate infection-control techniques.

4). Watch the teachers demonstrate infection-control techniques. The best way to evaluate learning is by feedback demonstration of precautions related to infection control, such as hand-washing techniques. This method is observable and must meet objective criteria. Although observing a lecture, giving a written examination, or sharing what has been learned in a seminar are all evaluation techniques that may be used, none of these methods are as objective and definitive as observing an actual psychomotor demonstration of techniques.

The nurse is teaching unlicensed assistant personnel about ways to prevent the spread of infection. The nurse decides to emphasize the need to break the cycle of infection. Which teaching would be priority? 1). Hand washing before and after providing client care 2). Cleaning all equipment with an approved disinfectant after use 3). Wearing personal protective equipment (PPE) when providing client care 4). Using medical and surgical aseptic techniques at all times

1). Hand washing before and after providing client care Hand washing before and after providing care is the single most effective means of preventing the spread of infection by breaking the cycle of infection. Although all the other interventions are acceptable procedures and may assist in preventing the spread of infection, none are as effective as hand washing.

An older adult client with postherpetic neuralgia reports deep tissue pain. Which skin infection does the nurse expect to observe in the client's electronic medical record? 1). Cellulitis 2). Candidiasis 3). Herpes zoster 4). Herpes simplex

3). Herpes zoster Postherpetic neuralgia in older clients is associated with an infection caused by herpes zoster virus, which can leave the client with deep pain after the lesions have resolved. Cellulitis is associated with lymphadenopathy and fever. Candidiasis is associated with oral whitish lesions. Herpes simplex is associated with vesicles that evolve to pustules that rupture, weep, and crust.

When assessing a client with Hepatitis A, the nurse is particularly careful with which substance to prevent transmission of the disease? 1). Urine 2). Saliva 3). Blood 4). Fecal matter

4). Fecal matter The reservoir for Hepatitis A is fecal matter, so the nurse is particularly careful with any contact with fecal matter to prevent transmission of infection. Gonorrhea is contained in the genitourinary tract. Herpes is contained in saliva. Hepatitis B is contained in the blood.

Which factor that influences the spread of sexually transmitted infections (STIs) would the nurse include in a teaching session? Select all that apply. One, some, or all responses may be correct. 1). Age 2). Drug abuse 3). Lack of education 4). Multiple sex partners 5). Absent or subtle symptoms 6). Limited access to health care

1). Age 2). Drug abuse 3). Lack of education 4). Multiple sex partners 5). Absent or subtle symptoms 6). Limited access to health care Despite medical advances and public health efforts, STIs continue to be a serious public health problem in the United States. Factors that influence the spread of STIs include age (those younger than 30 years of age are at higher risk), drug abuse, lack of education, having multiple sex partners, the fact that these infections often have absent or subtle symptoms that are easily ignored, and limited access to health care. Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Which type of hepatitis virus spreads through contaminated food and water? 1). Hepatitis A virus 2). Hepatitis B virus 3). Hepatitis C virus 4). Hepatitis D virus

1). Hepatitis A virus Hepatitis A virus spreads through contaminated food and water. Hepatitis B, C, and D viruses spread through contaminated needles, syringes, and blood products.

Which statement made by the nurse will be most significant when teaching strategies to reduce the risk for developing antibiotic-resistant infections? 1). "Wash your hands frequently with warm soapy water." 2). "Do not skip any prescribed doses of your antibiotics." 3). "Do not save unfinished antibiotics for later use." 4). "Do not stop taking the antibiotics when you feel better."

2). "Do not skip any prescribed doses of your antibiotics." "Do not skip any doses of your antibiotics" is an umbrella answer to the question. The other statements are true, but they are not the most significant or inclusive of all the statements. If clients do not skip any doses of the antibiotic, they are unable to save any doses for later use, and are not able to stop taking the antibiotics when they feel better. Antibiotic-resistant infection develops when the hardiest bacteria survive and multiply. This may happen when a client stops taking an entire course of antibiotics, which leads to infections resistant to many antibiotics. A client should not skip any dose of an antibiotic. Hand washing is required to prevent infections, but there is not a relationship between hand washing and antibiotic-resistant infections. Antibiotics should not be stopped, even if the client has started feeling better. The clients should take the full course of treatment. Noncompliance in taking the full course of prescribed antibiotics can lead to an antibiotic-resistant infection. Taking the unfinished antibiotics at a later time for another infection is dangerous and may prove fatal if the antibiotics are outdated.

The nurse would include which instruction to the parents of a child being treated with oral ampicillin for otitis media? 1). Complete the entire course of antibiotic therapy. 2). Herbal fever remedies are highly discouraged. 3). Administer the medication with meals. 4). Stop the antibiotic therapy when the child no longer has a fever.

1). Complete the entire course of antibiotic therapy. Once antibiotic therapy is initiated, the antibiotics start to destroy specific bacterial infections that the health care provider is trying to treat. Antibiotic therapy takes a specific dose and number of days to completely eliminate the bacteria. If the caregivers start a dose and stop it before the course is complete, the remaining bacteria have a chance to grow again, become resistant to antibiotic treatment, and multiply. The nurse would not discourage use of herbal fever remedies; however, the herbal treatment would be reviewed to see if it is contraindicated. Ampicillin would be taken 1 to 2 hours after meals. Antibiotic therapy would be completed as prescribed.

Which infection requires airborne precautions? Select all that apply. One, some, or all responses may be correct. 1). Measles 2). Influenza 3). Clostridium difficile 4). Bacterial meningitis 5). Methicillin-resistant Staphylococcus aureus (MRSA)

1). Measles Varicella, measles, and tuberculosis require airborne precautions because these infections spread through small particles in the air. Droplet precautions are implemented to prevent the spread of influenza and bacterial meningitis. C. difficile and MRSA require the use of contact precautions.

A client is diagnosed as having the hepatitis B virus (HBV). The nurse reviews the client's health history for situations in which exposure may have occurred. Which event does the nurse determine is most likely the source of this infection? 1). The client received a small tattoo on the arm 3 months ago. 2). The client assisted in the emergency birth of a baby 2 weeks ago. 3). The client worked for a month in an undeveloped area in a foreign country 4 months ago. 4). The client attended an ecological conference in a large urban center 2 months ago

1). The client received a small tattoo on the arm 3 months ago. Any situation in which a needle is inserted under the skin is a potential source of hepatitis; according to the Centers for Disease Control and Prevention, the range of the incubation period is 45 to 180 days; however, the average incubation period is 60 to 90 days. Hepatitis B is not transmitted via inadequate sanitation or a contaminated water supply. Hepatitis B is not transmitted by casual proximity to others.

Which would the nurse teach the parent of an infant who is at risk for infections? 1). "You must avoid placing the infant in bright sunlight." 2). "Breast-feeding will provide protection against bacteria." 3). "Use soy-based infant formulas to help prevent infection." 4). "The infant will be less susceptible to infections later in life."

2). "Breast-feeding will provide protection against bacteria." Breast milk contains immunoglobulin G (IgG) that protects the infant against many bacteria, such as Escherichia coli. The nurse instructs the parent to avoid placing the infant in bright sunlight for a long period of time to prevent burns, but not to prevent infections. Soy-based infant formulas are used only if the infant is allergic to lactose in the breast milk and are not used to prevent the risk for infections. Later, susceptibility would be dependent on multiple factors, including nutrition and exposure to infections.

The nurse in the clinic is assessing a teenager with a tentative diagnosis of primary syphilis. Which is an early sign of this infection? 1). Rash 2). Genital lesion 3). Genital discharge 4). Multiple gummatous lesions

2). Genital lesion A chancre is the earliest sign of syphilis; a dark-field examination of a scraping will reveal the Treponema organism. A rash occurs in the secondary stage of syphilis. A genital discharge is associated with gonorrhea. Multiple lesions are late manifestations of syphilis.

A primary health care provider diagnoses the client's condition as otitis media. Which assessment finding supports that diagnosis? 1). Nodules on the pinna 2). Redness of the eardrum 3). Lesions in the external canal 4). Excessive cerumen in the external canal

2). 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 affects the hearing acuity, but not the manifestation of otitis media.

A client with a urinary catheter in place was admitted to the hospital and has a diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) in the urine. No private rooms are available. Which room assignment would be appropriate for this client? 1). A roommate who has a urinary catheter without any infectious illness 2). A roommate who is bedridden and uses a bedpan for urination 3). A roommate who has MRSA in the urine, is ambulatory, and is confused 4). A roommate who is alert and oriented, has pneumonia, and practices good hygiene

3). A roommate who has MRSA in the urine, is ambulatory, and is confused If a private room is not available, the client may be placed in a room with another client who (a) has the same active infection, (b) the same microorganism, and (c) does not have additional infections present. The roommate with a urinary catheter, who is bedridden, or who has pneumonia does not indicate MRSA in the urine.

Which sexually transmitted infection receives antiviral medications as the treatment of choice? 1). Syphilis 2). Gonorrhea 3). Genital herpes 4). Chlamydial infection

3). Genital herpes Genital herpes is a sexually transmitted infection caused by the herpes simplex virus and treated with antiviral medications. Bacteria cause syphilis, gonorrhea, and chlamydial infections.

Which statement helps the nurse determine that a woman with genital herpes (HSV-2) infection understands her self-care? 1). "When I have a baby, I don't want a cesarean." 2). "I can have sex as soon as the herpes sores have healed." 3). "When I finish the acyclovir prescription I will be cured."). 4). "I must be careful when I have sex because herpes is a lifelong problem."

4). "I must be careful when I have sex because herpes is a lifelong problem." HSV-2 infection is characterized by remissions and exacerbations; it cannot be cured and is a lifelong infection. Some pregnant women with HSV-2 need cesarean deliveries, which are indicated if there is an outbreak of HSV-2 near the time of birth to prevent their newborns from contracting the disease while passing through the vagina. Herpes is most contagious when active lesions are present; however, the virus can still be shed after the lesions have healed. Use of a condom can reduce the risk of transmission. Herpes can be controlled but not cured.

Which statement by the client indicates that the nurse's teaching was effective regarding intravenous gentamicin therapy? 1). "I should drink lots of water if I am retaining urine." 2). "I should use eyeglasses if I develop vision problems." 3). "I should stop the medication when the symptoms have subsided." 4). "I should report any hearing loss to the primary health care provider."

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

Which nursing action is most effective in controlling the spread of infection for an infant with diarrhea? 1). Wearing a gown and gloves during care 2). Allowing only registered nurses to give direct care 3). Restricting visitors to the infant's immediate family 4). Washing hands before and after contact with the infant

4). Washing hands before and after contact with the infant The most effective method of preventing the spread of infection is hand washing not only before and after care but also before and after using gloves. A gown and gloves are not required for contact precautions. The level of education of the caregiver does not guarantee the correct technique for preventing the spread of infection. The risk for spread of infection is not in the number of visitors but in the aseptic technique practiced by these visitors.

Which action would the nurse take when administering azithromycin to treat sexually transmitted infections (STIs). Select all that apply. One, some, or all responses may be correct. 1). Observing clients for hypertension and diaphoresis 2). For allergic clients, administering the antibiotic with diphenhydramine 3). Instructing clients to take the medication until they feel better 4). Treating sexual partners after the course of antibiotics has been completed 5). Obtaining specimens for culture before administering the first dose of the antibiotic

5). Obtaining specimens for culture before administering the first dose of the antibiotic When treating a client with an STI, the nurse would obtain specimens for culture before administering the first dose of the antibiotic so that the antibiotic action does not skew the culture results. The nurse would observe the client for signs of a possible allergic reaction, including rash, difficulty breathing, and hypotension. If the client reports an allergy to the antibiotic, the nurse would hold the medication and notify the health care provider to prescribe a different medication. The client would be instructed to always finish the full course of antibiotic therapy. Sexual partners would be treated at the same time so that no one is reinfected.