1.1 Infection #3 EAQ

Which is the first medication approved to reduce the risk of human immunodeficiency virus (HIV) infection in unaffected individuals? Truvada Abacavir Cromolyn Methdilazine

Truvada Rationale Truvada is the first medication approved to reduce the risk of HIV infection in unaffected individuals who are at a high risk of HIV infection. Abacavir is administered to treat HIV infection and is a reverse transcriptase inhibitor. Cromolyn is administered in the management of allergic rhinitis and asthma. Methdilazine, an antihistamine, is administered to treat the skin and provide relief from itching.

A 4-year-old child develops thrombocytopenia after vaccination. Which vaccination may be responsible? Rotavirus vaccine Varicella virus vaccine Human papillomavirus vaccine Measles, mumps, and rubella virus vaccine (MMR)

(MMR) Rationale Measles, mumps, and rubella virus vaccine ( MMR) may cause transient thrombocytopenia. It is generally benign and occurs only rarely. Rotavirus vaccine carries a small risk for intussusception. Varicella virus vaccine and human papillomavirus vaccine may cause mild effects such as fever and fainting.

Which drug can be administered via the intramuscular route to treat anaphylaxis? Epinephrine Methdilazine Phenylephrine Mycophenolate mofetil

Epinephrine Rationale Epinephrine is administered through the intramuscular route to treat anaphylaxis. Methdilazine is administered to treat allergic reactions and pruritus. Phenylephrine is administered orally, not intramuscularly, to treat anaphylaxis. Mycophenolate mofetil is administered intravenously as an immunosuppressant agent.

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? "Report any changes in vision." "Take the medicine with my meals." "Call my doctor if my urine or tears turn red-orange." "Continue taking the medicine even after I feel better."

"Continue taking the medicine even after I feel better." Rationale 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.

Which child is at the highest risk for blunt trauma associated with the indirect entry (hematogenous stage) of microorganisms? 8-year-old boy 10-year-old girl 13-year-old girl 14-year-old boy

8-year-old boy Rationale The indirect entry of microorganisms, which is the hematogenous stage of osteomyelitis, most frequently affects the growing bones of boys younger than 12 years of age. Therefore an 8-year-old boy would be at the highest risk for blunt trauma.

A client who is scheduled for a surgical resection of the colon and creation of a colostomy for a bowel malignancy asks why preoperative antibiotics have been prescribed. The nurse explains that the primary purpose is to do what? Decrease peristalsis Minimize electrolyte imbalance Decrease bacteria in the intestines Treat inflammation caused by the malignancy

Decrease bacteria in the intestines Rationale To decrease the possibility of contamination, the bacteria count in the colon is lowered with antibiotics before surgery. Preoperative antibiotics do not have an effect on peristalsis, electrolyte balance, or treating inflammation.

What is the nurse's priority concern when caring for an infant born with exstrophy of the bladder? Urine retention Excoriation of the skin Impending dehydration Development of an infection

Development of an infection Rationale The constant seepage of urine from the exposed ureteral orifices makes the area susceptible to infection; infection must be prevented or controlled because it may ultimately lead to renal failure. Urine retention will not occur because of the constant seepage of urine. Although skin excoriation is a major concern, it is secondary to the development of a life-threatening infection. Although dehydration is a major concern, risk for infection is the priority for the infant at this time.

A client reports facial lesions that are surrounded by redness and cause itching. On assessment, the lesions are found to be thick with a honey-colored crust and surrounded by erythema. Which infection is suspected by the primary healthcare provider? Shingles Impetigo Folliculitis Verruca vulgaris

Impetigo Rationale Impetigo is a primary bacterial infection most common on the face. This is clinically manifested as vesiculopustular lesions that develop as thick, honey-colored crust surrounded by erythema. Shingles or herpes zoster is a viral infection that usually occurs unilaterally on the trunk, face, and lumbosacral areas. Folliculitis is a bacterial infection seen most commonly on the scalp, beard, and extremities in men. Verruca vulgaris is a viral infection that is clinically manifested as circumscribed, hypertrophic, flesh-colored papule limited to the epidermis.

A school nurse is teaching a group of parents about pediculosis capitis (head lice). What common secondary infection does the nurse teach the parents to identify? Eczema Impetigo Cellulitis Folliculitis

Impetigo Rationale Impetigo may develop as a secondary bacterial infection because of breaks in the skin caused by scratching. Eczema is an allergic response, not an infection. Cellulitis is an extended inflammation that is not commonly found in children with pediculosis. Folliculitis is a pimple or an infection of the hair follicle; it does not occur as a result of pediculosis.

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? Start a 24-hour urine collection. Prepare for urinary catheterization. Teach the client how to perform perineal care. Obtain a urine specimen for culture and sensitivity.

Obtain a urine specimen for culture and sensitivity Rationale 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 caring for a school-aged child with AIDS. Which action is the nurse's priority of care? Maintaining optimal hydration Protecting the child from infection Promoting growth and development Ensuring adequate and balanced nutrition

Protecting the child from infection Rationale Children with AIDS have a dysfunction of the immune system (depressed or ineffective T cells, B cells, and immunoglobulins) and are susceptible to opportunistic infections; infection can result in death. Although optimal hydration is important, insufficient hydration is not as potentially life threatening as an infection. Although children with AIDS are most likely small for their age, and promoting growth and development is important, inability to do so is not as potentially life threatening as an infection. Although adequate and balanced nutritional intake is important, it is not the priority because it is not as potentially life threatening as an infection.

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? Altered urinary pH Hormonal secretions Juxtaposition of the bladder Proximity of the urethra to the anus

Proximity of the urethra to the anus Rationale 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.

What sexually transmitted diseases are caused by bacteria? Select all that apply. Syphilis Hepatitis Gonorrhea Herpes simplex Trichomoniasis

Syphilis, Gonorrhea Rationale Syphilis is caused by Treponema pallidum, a motile spirochete bacterium. Gonorrhea is caused by a bacteria called Neisseria gonorrhoeae. Hepatitis A and herpes simplex are caused by viruses. Trichomoniasis is caused by a protozoan.

A client with a skin infection reports an itching sensation associated with pain at the site of infection. The assessment finding shows erythematous blisters and interdigital scaling and maceration. What could be the possible condition in the client? Tinea pedis Tinea cruris Tinea corporis Tinea unguium

Tinea pedis Rationale Tinea pedis is a fungal infection with an itching sensation associated with pain. It is clinically manifested as interdigital scaling and maceration and a scaly plantar surface, sometimes with erythema and blistering. Tinea cruris is a fungal infection that is clinically manifested with well-defined scaly plaque in the groin area. Tinea corporis is clinically manifested as an erythematous, annular, ring-like scaly appearance with well-defined margins. Tinea unguium or onychomycosis is manifested with scaliness under the distal nail plate.

What is the most effective strategy for preventing the transmission of infection? Wearing gloves and a gown Applying face mask and a gown Applying a face mask and gloves Wearing gloves and hand hygiene

Wearing gloves and hand hygiene Rationale The combination of hand hygiene and wearing gloves is the most effective strategy for preventing infection transmission. A gown and face mask are considered personal protective equipment; however, they are not considered the most effective strategy to prevent the transmission of infection.

The nurse is preparing to initiate intravenous antibiotic therapy for a client who developed an infection along the incision after having a total knee replacement. Before starting the first dose of intravenous antibiotics, which task should the nurse ensure has been completed? Red blood cell count Wound culture Knee x-ray Urinalysis

A wound culture always should be completed before the first dose of antibiotic. A wound culture is obtained to determine the organism that is growing. A broad spectrum antibiotic often is given first; after the organism has been identified an organism-specific antibiotic can be given. There is no indication that a red blood cell count is needed; however, a white blood cell count would be beneficial. A urinalysis is not needed, because data gathered during the assessment indicate an incisional infection. At the early stage of the infection, there is no need to obtain a knee x-ray.

Which type of immunity will clients acquire through immunizations with live or killed vaccines? Natural active immunity Artificial active immunity Natural passive immunity Artificial passive immunity

Artificial active immunity Rationale Artificial active immunity is acquired through immunization with live or killed vaccines. Natural active immunity is acquired when there is natural contact with antigens through a clinical infection. Natural passive immunity is acquired through the transfer of colostrums from mother to child. Artificial passive immunity is acquired by injecting serum from an immune human.

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

Ceftriaxone Rationale 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.

Which complication will the nurse suspect in a client with genital herpes disease? Infertility Cold sores Reactive arthritis Bartholin's abscess

Cold sores Rationale Cold sores are the autoinoculation of the virus to extragenital sites, such as the fingers and lips. It is a complication of genital herpes disease. Infertility and reactive arthritis are the complications of chlamydial infection. Bartholin's abscess is a complication of gonorrhea.

The client reports crumbly, discolored, and thickened toenails. What could be the possible reason for this condition? Allergy Insect bite Fungal infection Bacterial infection

Fungal infection Rationale Exposure to the pathological fungal varieties may cause infections to the nails along with hair and skin. Dermatological problems associated with allergies and hypersensitivity reactions may include only skin and may not include nails and hair. Insect bites may cause life-threatening allergic reactions due to the venom of the insect. Bacteria may cause scalp infections to hair and skin but do not usually cause nail infections.

A female client who has been sexually active for 5 years is diagnosed with gonorrhea. The client is upset and asks the nurse, "What can I do to keep from getting another infection in the future?" Which statement by the client indicates that the teaching by the nurse was effective? "I'll douche after each time I have sex." "Having sex is a thing of the past for me." "My partner has to use a condom all the time." "I'll be using a spermicidal cream from now on."

"My partner has to use a condom all the time." Rationale Although not 100% effective, a condom is the best protection against gonorrhea in a sexually active person. Douching has no proven protective effect against sexually transmitted infections; excessive douching can alter the natural environment of the vagina and may even promote an ascending infection. Although abstaining from sex is the best way to prevent a sexually transmitted infection, it is not the most realistic response for a sexually active person. Once people become sexually active, they usually remain sexually active. Spermicidal creams do not have a protective effect against sexually transmitted infections; spermicides kill sperm and limit the risk for pregnancy.

A client, experiencing an exacerbation of Crohn disease, is admitted to the hospital for intravenous steroid therapy. The nurse should not assign this client to a room with a roommate who has which illness? Pancreatitis Thrombophlebitis Bacterial meningitis Acute cholecystitis

Rationale Bacterial meningitis The bacteria that cause meningitis are transmitted via air currents; the client should be in a private room with airborne precautions to protect other people. Pancreatitis is not a communicable disease; it is most often caused by autodigestion of pancreatic tissue by its own enzymes. Thrombophlebitis is not a communicable disease; it is inflammation of a vein (phlebitis) associated with thrombus formation. Cholecystitis is not a communicable disease; it is inflammation of the gallbladder.

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? Cystoscopy and bilirubin level Specific gravity and pH of the urine Urinalysis and urine culture and sensitivity Creatinine clearance and albumin/globulin (A/G) ratio

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? Cystoscopy and bilirubin level Specific gravity and pH of the urine Urinalysis and urine culture and sensitivity Creatinine clearance and albumin/globulin (A/G) ratio! Urinalysis and urine culture and sensitivity Rationale 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 client has the highest risk for human immunodeficiency virus (HIV) infection? A client who is involved in mutual masturbation A client who undergoes voluntary prenatal HIV testing A client who shares equipment to snort or smoke drugs A client who engages in insertive sex with a non-infective partner

A client who shares equipment to snort or smoke drugs. Rationale Clients who use equipment to snort (straws) and smoke (pipes) drugs are at the highest risk for becoming infected with HIV as their judgment may be impaired regarding the high-risk behaviors. Safe activities that prevent the risk of contracting HIV include mutual masturbation, masturbation, and other activities that meet the "no contact" requirements. A client who undergoes perinatal HIV voluntary testing may reduce the chances of getting infected. Insertive sex between partners who are not infected with HIV are not at risk of becoming infected with HIV.

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

Provides cells for wound healing Rationale 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.

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? Use a consistent approach to care and encourage participation. Prepare equipment while doing the procedure and explain the treatment to the client. Rinse the burn area with 105° F (40.6° C) water to prevent loss of body temperature. Arrange for a change of staff every 4 to 5 days and have the client select the time for the procedure to be done.

Rationale 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.

What finding in the client is a sign of allergic rhinitis? <p>What finding in the client is a sign of allergic rhinitis?</p> Presence of high-grade fever Reduced breathing through the mouth Presence of pinkish nasal discharge Reduced transillumination on the skin over the sinuses

Reduced transillumination on the skin over the sinuses Rationale Reduced transillumination on the skin overlying the sinuses indicates allergic rhinitis. This effect is caused by the sinuses becoming inflamed and blocked with thick mucoid secretions. Generally, fever does not accompany allergic rhinitis unless the client develops a secondary infection. In allergic rhinitis, the client is unable to breathe through the nose because it gets stuffy and blocked. Instead the client will resort to mouth breathing. Clients with allergic rhinitis will have clear or white nasal discharge.

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? <p>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?</p> Tolerance of the child Sensitivity of the bacteria Selectivity of the bacteria Preference of the healthcare provider

Sensitivity of the bacteria Rationale 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.