Infection for exam 2 NURN 153 including prepu questions
A client is receiving chloroquine as part of treatment for a rheumatic disorder. Which statement would lead the nurse to suspect that the client is experiencing toxicity? "I'm having trouble hearing." "My vision is getting really poor." "I feel like the room is spinning." "I get so dizzy sometimes."
"My vision is getting really poor." Chapter 8: Anti-Infective Agents - Page 94 Chloroquine can accumulate in the retina and optic nerve and cause blindness. Therefore, a client reporting changes in vision would be a cause for concern. Trouble hearing, feeling like the room is spinning, and dizziness are associated with problems involving the eighth cranial nerve.
A nurse is caring for a client who is hospitalized for pneumonia. The nurse reviews the electronic health record and evaluates that the microbiology data does not support the use of the broad spectrum antibiotic. Which statement is the nurse's best response to the provider about the results? "I think you need to review the microbiology report for the client." "I have reviewed the client's record and the client does not want the antibiotic." "The microbiology data is identifying another antibiotic appropriate for the client." "The charge nurse prefers that you call her about the antibiotic coverage for the client."
"The microbiology data is identifying another antibiotic appropriate for the client." ch 8 pg 93 Laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, so the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The nurse should communicate with the prescriber about the change so that a correction can be made as soon as possible. Telling the prescriber to review the microbiology report is incorrect. The basis of prescribing the antibiotic should be on the identifying bacteria's culture and sensitivity. Referring the prescriber to the charge nurse is inappropriate as it is the nurse's responsibility to discuss with the prescriber the client's care.
Several family members are visiting a client with an antibiotic-resistant infection who has been placed on contact precautions. When the nurse teaches the visitors about wearing gloves and gowns, a family member states, "I don't want to wear those. I can't catch anything just by holding my loved one's hand." What is the best response to educate the family about infection transmission? "I understand; wearing these items is not pleasant but it really isn't optional." "If you don't come into contact with anything with your body, you may wear gloves only, as long as you wash your hands after removing the gloves." "These barriers help prevent the transmission of infection to you or other people." "Wearing the gloves and gown prevents sharing additional microorganisms with the client."
"These barriers help prevent the transmission of infection to you or other people." chap 24 pg 615 Contact precautions block transmission of pathogens by direct or indirect contact Wearing a gown and gloves decreases the chance of the contaminating organism to be spread to the visitors via hands or clothing or even to others the visitors may come in contact with. While wearing gloves and gown may prevent sharing additional microorganisms with the client, that is not the reason for contact precautions. Agreeing that wearing the gown and gloves is not pleasant doesn't educate the family member.
Name the chain of infection process in order
1.Infectious Agent 2.Reservoir 3.Portal of Exit 4.Means of Transmission 5.Portals of Entry 6.Susceptible Host
The nurse is caring for four clients. Which client presents the most susceptibility for infection? 4-year old receiving antibiotics for strep throat 46-year old with a foley catheter following anesthesia 36-year old female experiencing her menstrual cycle 30-year old experiencing esophageal reflux
46-year old with a foley catheter following anesthesia Chapter 24: Asepsis and Infection Control - Page 536-537 Indwelling equipment, such as a urinary catheter, makes the client more susceptible to infection. Antibiotics, when used appropriately to treat a known illness such as strep, do not increase the risk of infection. A female experiencing menstruation is a normal body process, and is not at increased risk of infection. Esophageal reflux does not place the client at additional risk of infection.
n which situation is an alcohol-based rub not the appropriate option for hand hygiene? A. When the nurse's hands are visibly soiled B. When the nurse is caring for a client with an active infection C. When the nurse anticipates contact with the client's skin D. When the nurse leaves the room of an immunocompromised client
A
The nurse is caring for several medical clients who have infections. For which client would the administration of a broad spectrum antibiotic be most appropriate? A client with signs of infection who is awaiting the results of laboratory testing A client with pneumonia who has a confirmed allergy to penicillins A client who is being treated for a urinary tract infection for the third time this year A client with an infected surgical wound
A client with signs of infection who is awaiting the results of laboratory testing Chapter 8: Anti-Infective Agents - Page 93 Broad spectrum antibiotics are effective against a wide variety of microorganisms. None of the other listed clients have obvious indications for using a broad spectrum antibiotic.
A nurse is aware that the concept of selective toxicity is foundational to antimicrobial therapy. Which statement most accurately describes selective toxicity? A drug harms microbes without harming human cells. A drug's effect on microorganisms is proportionate to dose. Most microbes may be collected from a host and cultured on an alternative medium. A drug can be isolated and produced in a controlled manner in a laboratory setting.
A drug harms microbes without harming human cells. ch 8 pg 89 An important principle of antimicrobial therapy is selective toxicity, which is the ability to suppress or kill an infecting microbe without injury to the host. This concept does not denote dose-dependent effects, the ability to culture a microorganism, or the production of a drug.
For what client would the use of prophylactic anti-infective be most appropriate? A pre-surgical client who has an artificial heart valve A client who works in a clinic where many ill children are treated A client with type 2 diabetes who lives in a crowded home A client who uses street drugs intravenously
A pre-surgical client who has an artificial heart valve Chapter 8: Anti-Infective Agents - Page 93 A client with valve replacement is especially prone to the development of subacute bacterial endocarditis because of the vulnerability of their heart valves; prophylactic antibiotic therapy as a precaution. None of the other listed clients has particular indications for the use of prophylactic anti-infectives.
After meeting with the family to give an update on the surgical client, the nurse shakes their hands before leaving. Which method of hand hygiene is most appropriate following this encounter? Alcohol-based hand rub Soap and water hand washing technique Scrubbing hands with soap, water, and brush Mixture of soap and alcohol-based hand rub techniques
Alcohol-based hand rub Chapter 24: Asepsis and Infection Control - Page 606
What would be categorized as an anti-infective agent? Anthelmintics Anticoagulants Anticonvulsants Anticholinergics
Anthelmintics Chapter 8: Anti-Infective Agents - Page 89 Anthelmintics are a type of anti-infective agent used for infections caused by worms. Anticoagulants are agents that affect blood clotting. Anticonvulsants are agents that help to control seizures. Anticholinergics are agents that block the action of acetylcholine.
What would contribute to drug resistance? High dosage to eradicate the organism Antibiotic prescription for viral illness Around-the-clock scheduling Prescribed duration of therapy
Antibiotic prescription for viral illness Chapter 8: Anti-Infective Agents - Page 91-92 The use of antibiotic prescription for viral illnesses or infections is a contributing factor to the development of resistance. A high enough drug dosage and long enough duration of therapy helps to ensure complete eradication of even slightly resistant organisms. Around-the-clock dosage scheduling eliminates peaks and valleys in drug concentration and helps to maintain a constant therapeutic level to prevent the emergence of resistant microbes.
The nurse is caring for a client admitted with tuberculosis (TB). What would be the best action by the nurse? Wear a protective gown and gloves with any direct contact. Apply a nonparticulate (N-95) respirator when entering the room. Have the client wear a mask during care. Wear a mask with face shield during invasive procedures.
Apply a nonparticulate (N-95) respirator when entering the room. chap 24 pg 613 TB is an airborne infection, and the nurse should wear a nonparticulate mask (N-95) respirator. Gown and gloves would be indicated for infections that are transmitted via direct contact. A mask with a face shield would be for infections that are transmitted via droplet. The client does not need to wear a mask during care.
The nurse is caring for a client with pericarditis who has been prescribed vancomycin 1000 mg IV q12h. When assessing the client for adverse effects, the nurse should perform what assessments? (Select all that apply.) Assess the client for any auditory changes. Monitor the client's urine output, blood urea nitrogen and creatinine. Assess the client's orientation and level of consciousness. Test the client's stool for occult blood. Monitor the client's sodium and calcium levels.
Assess the client for any auditory changes. Monitor the client's urine output, blood urea nitrogen and creatinine. Chapter 8: Anti-Infective Agents - Page 91 Vancomycin is associated with ototoxicity and renal damage. Cognitive changes, GI bleeding and electrolyte imbalances are less common.
The nurse is preparing to administer an intravenous anti-infective agent to a client. When monitoring for common adverse effects, what assessments should the nurse perform? Select all that apply. Cardiac monitoring Assessment for signs of hypersensitivity Assessment of urine output Assessment of neurological status Assessment for muscle weakness
Assessment for signs of hypersensitivity Assessment of urine output Assessment of neurological status Chapter 8: Anti-Infective Agents - Page 94 Cardiac toxicity and weakness are not typically associated with anti-infective therapy. Adverse effects commonly associated with anti-infective therapy are direct toxic effects on the kidney, gastrointestinal tract, and nervous system along with hypersensitivity and superinfections.
While the nurse is conducting morning rounds, the nurse notices that the client's temperature has gradually increased for the past 3 days. Which assessment(s) should the nurse do next? Select all that apply. Auscultate lung sounds. Check site of wound. Check IV site for infiltration. Review how compliant the client has been with ambulation. Call the laboratory for blood culture test.
Auscultate lung sounds. check site of wound Check IV site for infiltration. Review how compliant the client has been with ambulation. ch 24 pg 557 Auscultation of breath sounds can help detect respiratory infections. Pneumonia can alter normal breath sounds, producing crackles (rales), rhonchi, and wheezes. Atelectasis, which can predispose a client to respiratory infection, is noted by crackles or diminished breath sounds. Determine whether the client is comfortable or in obvious pain. Detect any signs of fatigue in the client's posture and movement. Look for abnormal skin color, rashes or lesions, and any swelling and signs of inflammation.
A nurse has finished providing care for a client who is on contact precautions. When removing the protective gown, the nurse should take which action? Avoid touching the outer surfaces of the gown. Remove the gown before removing gloves. Remove the gown immediately after exiting the room. Perform hand hygiene before removing the gown.
Avoid touching the outer surfaces of the gown. ch24 pg 624-627 When removing a gown, it is important to touch only the inside of the gown. The gown should be removed inside the room and after removing gloves. Hand hygiene should be performed after removal.
A 78 year old male with urinary retention was recently admitted to the hospital with a new onset of confusion. The most likely explanation for his confusion is: A) Dementia B) Urinary Tract Infection C) Normal signs of Aging D) Diabetic Neuropathy
B
A client is admitted to the hospital with an asthma exacerbation. The nurse is preparing to enter the client's room. Which action would the nurse perform first? A) Assess the client's oxygen saturation B) Complete hand hygiene and don gloves C) Auscultate the client's breath sounds D) Explain the steps to use incentive spirometry
B
A nursing student complains to his classmate that he is feeling more tired than usual and can not get his headache to go away. Which stage of infection is the nursing student most likely experiencing? A. Incubation Period B. Prodromal Period C. Full Stage of Illness D. Convalescent Period
B
What is the most common infectious agent in healthcare?
Bacteria
A client is admitted to the hospital with elevated temperature, chills, cough, and fatigue. The health care provider orders a chest x-ray, which indicates pneumonia. The blood cultures also come back positive for a Gram-negative bacillus. The provider orders two antibiotics to be given to the client, one for Gram-negative organisms and one for Gram-positive organisms. Why does the provider not prescribe just one antibiotic for both types of bacteria? Broad-spectrum antibiotics can cause antibiotic resistance. It is better for the client to be on two medications. There are not any antibiotics available in the United States that treat both bacteria. There is a cost savings when prescribing narrow-spectrum antibiotics.
Broad-spectrum antibiotics can cause antibiotic resistance. ch 8 pg91 All antimicrobials have the ability to promote the emergence of drug-resistant microbes. However, resistance is more likely to occur in organisms exposed to broad-spectrum drugs. Although the use of antimicrobials promotes the potential for drug resistance to occur, they do not directly cause the resistance.
A new client is admitted to hospital and is diagnosed with Clostridium Difficile. What type of transmission precautions would the nurse expect to be initiated for this client? A. Droplet Precautions B. Airborne Precautions C. Contact Precautions D. Medical Asepsis
C
An adult client has been treated for strep throat with ampicillin by mouth. The client visits the occupational health nurse and reports vaginal itching. What organism is the cause of the vaginal itching? Klebsiella Enterobacter Candida Proteus
Candida The yeast Candida is a normal resident of the vagina and the intestinal tract. An antibacterial drug may destroy the normal bacterial flora without affecting the fungal organism. Klebsiella, Enterobacter, and Proteus will not contribute to the development of a yeast infection.
The health care provider orders an oral antibiotic for a male client three times a day for 7 days. The client asks the nurse if this is correct, because his sister took the same antibiotic for 5 days. On what factor is the amount and frequency of the antibiotic dosing based? Characteristics of the causative organism Age of the client Sex of the client Route of administration
Characteristics of the causative organism Chapter 8: Anti-Infective Agents - Page 92-93 The amount and frequency of anti-infective and antimicrobial agents should be individualized according to characteristics of the causative organism, the chosen drug, and the client's size and condition (e.g., type and severity of infection, ability to use and excrete the chosen drug).
what does a virus consist of?
Consists of single strand of DNA orRNA that is contained within aprotein coat called a capsid. Theymust bind to the host cellmembrane, enter the cell, and thenmove into the host cell nucleus toreproduce
A client who has had abdominal surgery develops an infection in the wound while still hospitalized. Which precautions are implemented by the nurse to prevent the spread of infection? Contact precautions Droplet precautions Airborne precautions Protective isolation precautions
Contact precautions cjap 24 page 610 Contact precautions are used for clients who have incisional wound infections with organisms that can be transmitted by hand or skin-to-skin contact, such as during client care activities or when touching the client's environmental surfaces or care items. Droplet precautions are used for microorganisms transmitted by larger particle droplets, which disperse into air currents and are not applicable for clients with incisional infections. Airborne precautions are used to protect against microorganisms transmitted by small particle droplets that can remain suspended and become widely dispersed by air currents and are not applicable to incisional infections. Protective isolation may still be used in high-risk situations to prevent infection for people whose body defenses are known to be compromised, which is not applicable to incisional infections.
what does a fungi contain and what is it surrounded by?
Contain a nucleus and are surrounded by a rigid cell wall
The nurse is donning a pair of sterile gloves. The nurse correctly dons the first glove, but inadvertently inserts the thumb and index finger into the thumb hole of the second glove. The glove remains intact. Which action is most appropriate? Continue to don the glove, then use the other gloved hand to carefully insert the finger into the proper hole. Leave both the thumb and finger in the thumb hole and perform the procedure to the best of the nurse's ability. Don a second pair of sterile gloves over the first pair. Use only the correctly gloved hand to perform the sterile procedure while making sure the other hand does not contaminate the sterile field.
Continue to don the glove, then use the other gloved hand to carefully insert the finger into the proper hole. chap 24 pg 633-637 It is appropriate to adjust the gloves as long as the nurse only touches sterile surface to sterile surface. Leaving the thumb and finger in the thumb hole or only using the correctly gloved hand to perform the sterile procedure would not be appropriate, nor would donning a second pair of gloves, in this case.
The nurse is inserting an indwelling catheter. What steps will the nurse distinguish as priority in preventing an infection? Create an area for sterile field and opening packages Place water-soluble lubricant on catheter tip prior to insertion Wash the perineal area with soap and water Ensure opening port of the catheter is closed
Create an area for sterile field and opening packages pg 628 chap 24 Pathogens require a portal of entry to cause infection. Insertion of an indwelling urinary catheter is a sterile technique; any contamination could cause a portal of entry. Using water-soluble lubricant on catheter tip prior to insertion is correct but will not prevent an infection nor will closing the opening port. Likewise, washing the perineal area with soap and water will reduce microorganisms but will not prevent infection alone.
An infant has been brought to the emergency department by the parents, and initial assessment is highly suggestive of bacterial meningitis. Consequently, the infant has been admitted, and empiric antibiotic therapy has been prescribed. The nurse should understand what characteristic of this infant's current treatment plan? Success or failure of treatment will not be apparent for several weeks. The infant will receive aggressive treatment with a narrow-spectrum antibiotic. Culture and sensitivity results of the infant's cerebrospinal fluid are still pending. The infant is suspected of having an antibiotic-resistant infection.
Culture and sensitivity results of the infant's cerebrospinal fluid are still pending. Chapter 8: Anti-Infective Agents - Page 93 Empiric therapy is based on an informed estimate of the most likely pathogen(s) given the client's signs and symptoms and the site of infection, as well as knowledge of communicable diseases currently infecting other people in the community. Because laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The other listed statements are not true of empiric therapy.
A client is to be started on an antibiotic. Which is most important to take into consideration before beginning the antibiotic regimen? Duration of symptoms Culture and susceptibility Client's hydration status Client's age and weight
Culture and susceptibility Chapter 8: Anti-Infective Agents - Page 92 Culture identifies the causative organism, and susceptibility tests determine which drugs are likely to be effective against the organism. The duration of symptoms and the client's hydration status, age, and weight are important, but not imperative, in determining the antibiotic of choice.
A client with an upper respiratory tract infection was prescribed roxithromycin, an antibiotic. The nurse tells the client that irregular administration of this medication could lead to what outcome? Decreased absorption of the drug Development of drug resistance Increased rate of elimination of the drug Increased chances of serious adverse events
Development of drug resistance Chapter 8: Anti-Infective Agents - Page 91-92 When there is irregular or indiscriminate use of antibiotics, certain pathogens may mutate or build a tolerance to the drug. The antibiotic then becomes ineffective against that organism. Irregular use does not affect the absorption or elimination of the drug or increase chances of serious adverse events of the antibiotic.
what are types of contact of the means of transmission?
Direct Indirect - vector or fomite Fecal-ora
When preparing a sterile field, the nurse notes that the bottle of sterile saline was opened 48 hours ago and is half full. What action does the nurse take to ensure that the saline used is sterile? Since the bottle has been open, previously used, and unexpired, "lip" it by pouring a small amount into a waste container or waste cup. Discard the bottle and get a new one because the saline has expired. Pour the saline into a sterile container on the sterile field by holding it 6 in (15 cm) above the container. Use the saline for the procedure and discard the remaining amount because it has been 48 hours since opening.
Discard the bottle and get a new one because the saline has expired. Chapter 24: Asepsis and Infection Control - Page 628 Once a bottle of sterile saline is open, the contents must be used within 24 hours of opening. Lipping the opening of the bottle and pouring the saline into a sterile container by holding it 6 in (15 cm) above the container would be appropriate, but contents in the bottle are expired. The nurse should discard the bottle and get a new one.
The nurse is setting up a sterile field to perform a catheterization when the client touches the end of the sterile field. What would be the nurse's next appropriate action? Change the sterile field, but reuse the sterile equipment. Proceed with the procedure since it was only touched by the client. Discard the sterile field and the supplies and start over. Call for help and ask for new supplies.
Discard the sterile field and the supplies and start over. Chapter 24: Asepsis and Infection Control - Page 640 The nurse's next appropriate action would be to discard the sterile field and the supplies and start over. The client touching the end of the sterile field contaminated the field and the items on the field. The nurse cannot reuse the sterile equipment because the items are no longer sterile. The nurse cannot proceed with the procedure since the items have been contaminated. Calling for help and asking for new supplies is not the best answer. The field has been contaminated also.
The nurse has finished caring for a client on contact precautions. Which nursing action regarding the stethoscope used to auscultate this client's lungs and bowel sounds is appropriate? Discard it in the waste can. Do nothing; it can be used again immediately. Disinfect it with alcohol swabs. Sterilize it by placing it in the autoclave.
Disinfect it with alcohol swabs. pg 610 chap 24 Equipment such as stethoscopes, sphygmomanometers, and other assessment tools that are used for clients on contact precautions should be cleaned and disinfected before use on other clients. The other answers are incorrect.
The nurse is educating a client who is recovering from pneumonia about ways to fight new infection. What education can the nurse provide to this client? Take prophylactic antibiotics. Eat a balanced diet and get adequate fluid intake, rest, and exercise. If a new infection is suspected, use any antibiotic remaining from pneumonia treatment. Call the heath care provider at the first sign of a cold or flu.
Eat a balanced diet and get adequate fluid intake, rest, and exercise. Chapter 8: Anti-Infective Agents - Page 89 Eating a balanced diet and getting adequate fluid intake, rest, and exercise helps the body fight infection, prevents further infection, and increases the effectiveness of antimicrobial drugs by optimizing body processes. Taking prophylactic antibiotics or using antibiotics that are left over from a previous infection increase the risk for developing antibiotic-resistant bacteria. Calling the health care provider at the first sign of infection does not assist with the prevention of infection.
Assessment of a newly admitted patient reveals the characteristic signs and symptoms of cellulitis on the back of the hand. A swab of the patient's wound was ordered upon admission, but the results of culture and sensitivity (C&S) testing are not yet available. What strategy will most likely be adopted to treat this patient's infection? A narrow-spectrum antibiotic will be administered for 3 to 5 days and then reevaluated. The patient will be given antipyretics and analgesics until the C&S is complete. Empiric antimicrobial therapy will be implemented until laboratory results are available. Treatment will be supportive, rather than antimicrobial, until testing has been completed.
Empiric antimicrobial therapy will be implemented until laboratory results are available. Chapter 8: Anti-Infective Agents - Page 93 Prescribing antibiotic treatment before the pathogen has been definitively identified is called empiric therapy. Empiric therapy typically utilizes broad-spectrum antibiotics.
When participating in the care of a client who is being treated with antimicrobials, the nurse can promote the appropriate use of these medications in which way? Encouraging the use of narrow-spectrum, rather than broad-spectrum, antibiotics Promoting the use of prophylactic antibiotics for clients possessing risk factors for infection Initiating empiric therapy for all older adult clients admitted to a health care facility Promoting the use of herbal treatment for infection rather than antimicrobial drugs
Encouraging the use of narrow-spectrum, rather than broad-spectrum, antibiotics Chapter 8: Anti-Infective Agents - Page 90 Guidelines to promote more appropriate use of antimicrobial drugs include using a narrow-spectrum antibacterial drug instead of a broad-spectrum drug, whenever possible, in order to decrease the risk of a superinfection. Herbal alternatives are frequently not available. Antibiotics should not normally be administered in the absence of a diagnosed infection.
The client is concerned about "catching the flu." What primary information can the nurse teach the client to best prevent the spread of infection? Hand hygiene Good nutrition and getting enough rest Avoid crowded areas and people who have the flu How to properly wear a mask during flu season
Hand hygiene pg 603 ch 24 Hand hygiene is the most effective way to control the spread of microorganisms. While it is true that the client may be less susceptible to illness when well rested, exposure to a pathogen can still result in influenza. Avoiding those with the flu is also appropriate; however, hand washing remains the best answer for prevention. Wearing a mask all season may or may not prevent the flu and is not the most reasonable choice.
An experienced nurse is teaching a student nurse about the proper use of hand hygiene. Which guideline should the nurse provide to the student? The use of gloves eliminates the need for hand hygiene. The use of hand hygiene eliminates the need for gloves. Hand hygiene is needed after contact with objects near the client. Hand lotions should not be used after hand hygiene.
Hand hygiene is needed after contact with objects near the client. chap 24 pg 622 Hand hygiene must be performed when moving from a contaminated body site to a clean body site during client care and after contact with inanimate objects near the client. Using gloves does not eliminate the need for hand hygiene and, in some cases, gloves must still be used after hand hygiene. Lotions may be used to prevent irritation.
What is HAI
Health care associated infections
What is active immunity? and what are the two types
Host produces antibodies in response to natural antigens or artificial antigens. natural active immunity artificial passive immunity
what the Two types of adaptive immune responses? and explain them
Humoral immunity - antigen-antibody reaction that is mediated by the B lymphocytes Cell-mediated immunity - mediated by the cytotoxic T lymphocytes (T cells)
Culture and susceptibility tests are performed prior to the prescription of antimicrobial drugs. What is the specific purpose of the culture test? Identifies the organism causing the infection determines the severity of the infection identifies the drugs that might be effective in treatment predicts the body's response to the infection
Identifies the organism causing the infection Chapter 8: Anti-Infective Agents - Page 93 Culture identifies the infection's causative organism. Susceptibility tests determine which drugs are likely to be effective against the organism.
what are the stages of infection and describe them
Incubation Stage The interval from the pathogens invasion and onset of symptoms Prodromal StageEarly signs and symptoms present but are vague and non-specific Full Stage of IllnessInfection specific signs and symptoms present. Height of infection Convalescent StageRecovery from the infection
what is a UTI? What is it caused by? What is the portal of entry?
Infection of the lower urinary tract of the bladder, upper urinary tract, or kidney Most uncomplicated lower UTIs caused by E. coli Most caused by bacteria that enters through the urethra. Can continue traveling from the bladder upwards through the ureters to the kidneys
A client is to receive penicillin. The nurse understands that this drug achieves its effect by which action? Interfering with the pathogen cell wall Not allowing the organism to use the substances it needs Disrupting the steps of protein synthesis Interfering with DNA synthesis
Interfering with the pathogen cell wall Chapter 8: Anti-Infective Agents - Page 91 Penicillins interfere with the biosynthesis of the pathogen cell wall. Sulfonamides, antimycobacterial drugs, and trimethoprim-sulfamethoxazole prevent the cells of the invading organism from using substances essential to their growth and development, leading to cell death. Aminoglycosides and macrolides interfere with the steps involved in protein synthesis. Fluoroquinolones interfere with DNA synthesis in the cell.
The nurse is preparing to administer a drug that is bactericidal. The nurse should explain what characteristic of this drug? It will directly cause the death of pathogenic cells. It is selective in its action on organisms. It is effective in interfering with cell reproduction. It is effective against many different organisms.
It will directly cause the death of pathogenic cells. Chapter 8: Anti-Infective Agents - Page 90-91 Bactericidal refers to a highly aggressive drug that causes cell death. An anti-infective with a narrow spectrum of activity is selective in its action so that it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Bacteriostatic refers to a drug's effectiveness in interfering with a cell's ability to reproduce or divide. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens.
After teaching a group of students about adverse reactions to anti-infective agents, the instructor determines that the students need additional teaching when they identify what as a common adverse effect? Cardiac toxicity Hypersensitivity Kidney damage Neurotoxicity
Kidney damage Chapter 8: Anti-Infective Agents - Page 94-95 Cardiac toxicity is not typically associated with anti-infective therapy. Adverse effects commonly associated with anti-infective therapy are direct toxic effects on the kidney, gastrointestinal tract, and nervous system along with hypersensitivity and superinfections.
A client is diagnosed with strep throat. Which of the factor has contributed to the development of the illness? Hypertension Anxiety Leukopenia Hypokalemia
Leukopenia ch 8 pg 93 Leukopenia is a decrease of white blood cells, which affects the body's defenses, contributing to the development of infection. Hypertension, anxiety, and hypokalemia do not contribute to the development of infection.
what is the body's first line of defense against an infection?
Mechanical Factors Skin and mucous membranes: barrier to invading microbes Chemical Factors Production of mucus, acidic pH, bile salts, normal flora: help to neutralize and break apart cells
What are the 5 moments of hand hygiene?
Moment 1 - Before touching a patient Moment 2 - Before a clean or aseptic procedure Moment 3 - After a body fluid exposure risk Moment 4 - After touching a patient Moment 5 - After touching patient surrounding
The nurse is caring for a client receiving continuous enteral feeding. Which nursing intervention is most important to prevent infection? Flush the feeding tube with sterile water every 4 hours. Monitor blood pressure every 4 hours. Monitor temperature elevation. Discard feeding formula every 8 hours.
Monitor temperature elevation. ch pg 557 Any invasive device that enters the body provides a portal of entry for microorganisms, thus increasing the chance for infection. Invasive devices are often used to treat illnesses. Urinary catheters or tubes placed in the GI tract for decompression or feeding also increase infection risk.
What are MDROs? and define them
Multidrug-resistant organism• Extensive use of antibiotic agents in agriculture and health care has led to a growing prevalence of organisms with fewer effective antibiotics
what is a reservoir and name the types of reservoirs
Natural habitat of the organism. Where infectious agent lives, grows and multiplies. People, Animals, Soil, Plants, Water, Food, insects, andInanimate objects
Are all pathogens harmful?
No
To ensure that the most appropriate drug is being used to treat a pathogen, which would need to be done first? Using combination therapy Obtaining sensitivity testing Checking client allergies Evaluating the bactericidal effects
Obtaining sensitivity testing ch 8 pg 93 Performing sensitivity testing on cultured microbes is important to evaluate the bacteria and determine which drugs are capable of controlling the particular organism. Once the sensitivity testing is completed, then the decision for the drug can be made. Combination therapy is used when appropriate after culture and when sensitivity testing has been completed. Checking client allergies also would be done after sensitivity testing but before administering the drug. The bactericidal effects of a drug may or may not play a role in the selection of the drug.
An adult client has been living with human immunodeficiency virus (HIV) for several years but has recently been admitted to the hospital after being diagnosed with herpes simplex. How would this client's herpes infection most likely be characterized? Community-acquired infection Opportunistic infection Secondary infection Nosocomial infection
Opportunistic infection Chapter 8: Anti-Infective Agents - Page 95 Microorganisms may become pathogens in hosts whose defense mechanisms are impaired. Opportunistic infections are likely to occur in people whose defenses are compromised due to human immunodeficiency virus (HIV) infection. This is not characterized as a nosocomial infection (hospital-acquired infection) or a secondary infection. The infection was likely to have been acquired in the community, but the client's HIV diagnosis means that it would be considered to be an opportunistic infection.
A group of nursing students are learning about the factors that underlie recent increases in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is known to contribute to antibiotic resistance? Increased survival rates from acute infections Increased population density Use of antibiotics that are ineffective against the infectious microorganism Overuse of antibiotics
Overuse of antibiotics Chapter 8: Anti-Infective Agents - Page 91-92 Antibiotic overuse can contribute to antibiotic resistance. Resistance is not typically attributable to increased age of clients, increased population density, or the use of ineffective antibiotics.
what is the means of transmission?
Passage of the pathogen from an infected host to a non-infected host
A nurse is instructing a colleague on how an antimicrobial produces a therapeutic effect. What should be included in the nurse's teaching? The first drugs used to treat infections date back to the 17th century. Fluoroquinolones interfere with the growth and development of the bacteria cell wall. Selective toxicity determines the appropriate drug dosage needed. Penicillin interferes with synthesis of the bacteria cell wall.
Penicillin interferes with synthesis of the bacteria cell wall. Chapter 8: Anti-Infective Agents - Page 91-92 The action of antimicrobials is to interfere with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells. Penicillin interferes with biosynthesis of the bacterial cell wall. Because bacteria cells have a slightly different composition than human cells, the bacteria are destroyed without interfering with the host. The first drugs used to treat systemic infections were developed in the early 20th century. Fluoroquinolones act by interfering with DNA synthesis. Sulfonamides interfere with growth and development of bacterial cells. The term selective toxicity refers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms but not by human cells
The nurse is caring for a client who has active tuberculosis and is under airborne precautions. The health care provider prescribes a computed tomography (CT) examination of the chest. Which action by the nurse is appropriate? Place a surgical mask on the client and transport to the CT department at the specified time. Notify the CT department in advance so other clients and staff can be removed from the area. Question the need for the examination, because the client must remain under airborne precautions. Request that the examination be done at the bedside.
Place a surgical mask on the client and transport to the CT department at the specified time. ch24 pg 615 Transport clients in airborne precautions out of the room only when necessary and place a surgical mask on the client if possible. Use airborne precautions for clients known or suspected to be infected with pathogens transmitted by the airborne route (e.g., tuberculosis, measles, chickenpox, disseminated herpes zoster). The nurse should not question the need for the examination or request that the examination be done at the bedside. It is not necessary to notify the CT department and allow for all clients and staff to be removed from the area.
what is a portal of exit?
Point of escape for the organism from the reservoir
The nurse uses a small amount of sterile solution from a large, multiuse bottle to moisten gauze in a sterile field. What technique does the nurse use?
Pour the liquid into a sterile container within the sterile field. pg 628-633 The solution container should be held outside the edge of the sterile field and poured steadily from a height of 4 to 6 inches into a sterile container previously added to the sterile field and positioned at the side of the sterile field. This assures minimal splashing, as moisture contaminates the sterile field, and maintains sterility of the bottle and solution.
For airborne precaution what type of room should the patient be in? type of PPE? Transport of patient?
Private negative pressure room Door must remain closed ◦ Respirator or N95 mask ◦ Transport patient out of room only when necessary ◦ Patient must wear surgical mask
Which intervention would the nurse implement to prevent infections in a client who is neutropenic as a result of chemotherapy and radiation therapy? Protective environment Airborne precautions Contact precautions Droplet precautions
Protective environment Chapter 24: Asepsis and Infection Control - Page 614-615 Environmental controls that foster a protective environment help to decrease the risk of infection in the most severely immunocompromised clients. Clients who are neutropenic as a result of chemotherapy, radiation therapy, or immunosuppressive medications are prime candidates. Airborne precautions are used to protect against microorganisms transmitted by small particle droplets that can remain suspended and become widely dispersed by air currents. Contact precautions are used with organisms that can be transmitted by hand or skin-to-skin contact, such as during client care activities or when touching the client's environmental surfaces or care items. Droplet precautions are used for microorganisms transmitted by larger particle droplets, which disperse into air currents.
A client with acne has been receiving an anti-infective agent for a prolonged period. Initially, the drug was effective, but over time its effectiveness as decreased. What is the nurse's best action? Refer the client to the health care provider because the client may be experiencing resistance. Assess the client for additional signs of superinfection. Assess the client for a new onset of drug hypersensitivity. Educate the client about the phenomenon of drug tolerance.
Refer the client to the health care provider because the client may be experiencing resistance. Chapter 8: Anti-Infective Agents - Page 91-92 Resistance refers to the organism's ability to adapt over time to an antibiotic and produce cells that are no longer affected by a particular drug. Destruction of the normal flora by anti-infectives commonly leads to superinfection, an infection that occurs when opportunistic pathogens that were kept in check by the normal bacteria have the opportunity to invade the tissues. Hypersensitivity or allergic reactions result from antibody formation. Tolerance exists when a client needs a higher dose to achieve the same therapeutic effect as in the past; with anti-infectives, however, resistance is more likely.
Clients receiving aminoglycosides should be monitored closely for which toxicity? Gastrointestinal Neurological Renal Pancreatic
Renal ch 24 pg 94 When clients are taking aminoglycosides, they should be monitored closely for any signs of renal dysfunction. To prevent any accumulation of the drug in the kidney, clients should be well hydrated throughout the course of the drug therapy.
What is an accurate guideline for the use of PPE? Put on PPE after entering the client's room. Substitute personal glasses for protective eyewear, if desired. Replace gloves if they are visibly soiled. When wearing gloves, work from "dirty" areas to "clean" ones.
Replace gloves if they are visibly soiled. chap 24 pg 624-628
Bacitracin (Baciguent) interferes with the cell wall synthesis of which type of bacteria? Proteus Streptococcal Staphylococcal Pseudomonas
Staphylococcal Chapter 8: Anti-Infective Agents - Page 90 Bacitracin is an antibiotic that interferes with the cell wall synthesis of susceptible staphylococcal bacteria.
Bacitracin (Baciguent) interferes with the cell wall synthesis of which type of bacteria? Proteus Streptococcal Staphylococcal Pseudomonas
Staphylococcal Chapter 8: Anti-Infective Agents - Page 90 Bacitracin is an antibiotic that interferes with the cell wall synthesis of susceptible staphylococcal bacteria.
Name 5 types of bacteria
Staphylococcal infections, streptococcal infections, syphilis, diphtheria, tetanus
The nurse planning to insert an indwelling urinary catheter into a client should utilize which technique? Surgical asepsis Medical asepsis Universal precautions Contact precautions
Surgical asepsis Chapter 24: Asepsis and Infection Control - Page 603 Surgical asepsis, also known as sterile technique, is utilized to keep objects and areas free from microorganisms when performing surgery and procedures such as insertion of an indwelling urinary catheter or IV catheter. Medical asepsis reduces the number and transfer of pathogens. Universal precautions and contact precautions help to decrease the risk of transmitting infection.
A client has tested positive for methicillin-resistant Staphylococcus aureus after being swabbed on admission to the hospital. Bacterial resistance to antibiotics is an example of: Means of transmission Spore production Aerobic activity Survival adaptation
Survival adaptation. Chapter 24: Asepsis and Infection Control - Page 609 An example of adaptation for survival is the development of antibiotic-resistant bacterial strains of Staphylococcus aureus, Enterococcus faecalis, E. faecium, and Streptococcus pneumoniae. Bacterial resistance is not demonstrated by aerobic activity. Spore production is another form of adaptation. Means of transmission is a component of the chain of infection, not an example of bacterial resistance.
The student nurse observes another nurse wash her hands in the client's bathroom before exiting the room. This client's stool came back positive (+) for Clostridium Difficile (C diff). Why is this behavior incorrect? Clostridium difficile bacteria is eradicated by the use of hand sanitizer only. The behavior is not a problem as long as the nurse uses gloves in the room. The nurse must make sure that the bathroom has been cleaned recently before washing her hands. The bathroom is highly contaminated with the Clostridium difficile bacteria.
The bathroom is highly contaminated with the Clostridium difficile bacteria. Chapter 24: Asepsis and Infection Control - Page 539-540 Hand hygiene and sterile technique are two significant measures to prevent the occurrence and transmission of infection in healthcare settings. Although healthcare professionals know the importance of handwashing in preventing the spread of infection, studies show that the rate of compliance continues to be less than 100%, sometimes as low as 50% to 60% (Ruef, 2009). The bathroom has a high concentration of pathogens since the client's stool is disposed in the toilet. Recontamination after handwashing in the client's bathroom will occur.
The nurse is providing care for an older adult who has a urinary tract infection. What aspect of this client's current health status should the nurse focus on when ensuring safe and effective antibiotic therapy? The client has a history of cirrhosis. The client has type 2 diabetes controlled with diet. The client uses bronchodilators for the treatment of asthma. The client had a hip fracture 8 months ago.
The client has a history of cirrhosis. ch8 pg 94 Cirrhosis causes decreased liver function, which would have a major bearing on medication therapy. Each of the other aspects of the client's history are significant, but none will have as direct an effect as liver disease.
A 30-year-old female client received an insect bite that has progressed to cellulitis over the past several days. What client characteristic should the nurse prioritize when administering anti-infectives? The client is in the second trimester of pregnancy. The client has known allergies to nonsteroidal anti-inflammatories. The client was treated for leukemia when she was a teenager. The client admits to using marijuana recreationally.
The client is in the second trimester of pregnancy. ch 8 pg 89 Pregnancy and breastfeeding have major effects on the decision to administer anti-infectives and the choice of medication. An allergy to NSAIDs would not have a significant effect on the administration of anti-infectives. Similarly, marijuana use and a distant history of cancer would not have such as large effect on the choice of medication.
A client has a nursing diagnosis of Deficient Knowledge related to prescribed antibiotic therapy. Which outcome would the nurse identify as most appropriate? The client will state how to safely take the prescribed antibiotic. The client will identify signs and symptoms of worsening infection. The client will verbalize measures appropriate to minimize infection transmission. The client demonstrates the proper technique for hand hygiene.
The client will state how to safely take the prescribed antibiotic. The client's knowledge deficit is related to antibiotic therapy. Therefore, the most appropriate outcome would be that the client states how to take the prescribed antibiotic. Identifying signs and symptoms of infection would relate to a nursing diagnosis of Deficient Knowledge related to infection. Verbalizing measures to minimize risk and demonstrating proper hand hygiene would be appropriate for a nursing diagnosis of Knowledge Deficit related to infection control or transmission, or possibly a nursing diagnosis of Risk for Infection.
A client's culture and sensitivity testing has confirmed the presence of an infection and the client has been prescribed a bacteriostatic antibiotic. What should the nurse teach the client about this medication? (Select all that apply.) The drug interferes with the bacteria's ability to reproduce. The drug has the potential to cure the infection. The drug's effects will be solely limited to bacterial cells. The drug will likely require a follow-up course of treatment in four to six weeks. The drug will need to be combined with a drug that is bactericidal.
The drug interferes with the bacteria's ability to reproduce. The drug has the potential to cure the infection. chp 8 pg 90 Bacteriostatic drugs block the normal reproduction of bacteria. They do not directly kill bacteria, but this does not mean they are unable to fully treat infections. All drugs have effects that go beyond the intended target cells. Follow-up treatment is not anticipated.
When describing an anti-infective agent with a narrow spectrum of activity, what would the nurse include? The drug is effective against many different organisms. The drug is highly aggressive in killing the pathogen. The drug is selective in its action on organisms. The drug is effective in interfering with the cell's reproduction.
The drug is selective in its action on organisms. Chapter 8: Anti-Infective Agents - Page 90 An anti-infective with a narrow spectrum of activity is selective in its action; thus, it is effective against only a few microorganisms with a very specific metabolic pathway or enzyme. Broad-spectrum activity refers to effectiveness against a wide variety of pathogens. Bactericidal refers to a highly aggressive drug that causes cell death. Bacteriostatic refers to a drug's effectiveness in interfering with a cell's ability to reproduce or divide.
A nurse is caring for a client who is diagnosed with tuberculosis. Which nursing intervention promotes infection control based on nursing practice standards for safety? The nurse places the client in a private room with the door open. The nurse uses droplet precautions when providing care for the client. The nurse keeps visitors 3 feet away from the infected person. The nurse places the client in a private room with monitored negative air pressure.
The nurse places the client in a private room with monitored negative air pressure. ch24 pg 615 When a client is diagnosed with tuberculosis it is important for the nurse to remember that the client should be placed in a private room with monitored negative air pressure. The client should not be placed in a room with the door open. The nurse must wear the appropriate respirator when caring for the client, but visitors must wear masks. Simply being 3 feet away will not keep the visitor from being exposed to the client. The nurse would use airborne precautions, not droplet precautions when caring for a client diagnosed with tuberculosis.
A nurse is applying the principles of Standard and Contact Precautions in the care of a hospital client. Which action violates these principles? The nurse performs hand hygiene after touching the client's surroundings. The nurse removes her gown and then removes her gloves. The nurse performs hand hygiene before putting on gloves. The nurse applies nonmedicated hand cream after performing hand hygiene.
The nurse removes her gown and then removes her gloves. ch24 pg 624-627 Gloves should be removed prior to a gown. Hand hygiene is necessary before applying gloves and after touching a client's surroundings. The use of moisturizers is acceptable.
what is the portal of entry
The point at which theorganism enters a newhost
A nurse has questioned why a client's health care provider has prescribed a narrow-spectrum antibiotic rather than a broad-spectrum drug in the treatment of an infection. Which facts provide the best rationale for the use of narrow-spectrum antibiotics whenever possible? Broad-spectrum antibiotics confound the results of subsequent culture and sensitivity testing. Narrow-spectrum antibiotics normally require a shorter duration of treatment. The efficacy of most narrow-spectrum antibiotics has not been proven. The use of broad-spectrum antibiotics can create a risk for a superinfection.
The use of broad-spectrum antibiotics can create a risk for a superinfection. Chapter 8: Anti-Infective Agents - Page 95 The benefit of a narrow-spectrum antimicrobial agent is that it limits the potential for adverse effects, such as superinfection. In a superinfection, an antibiotic suppresses all susceptible microbes, including the body's natural flora, which may keep other microbes in check. In the absence of these bacteria, nonsusceptible microbes can proliferate. Narrow-spectrum antibiotics do not lack demonstrated efficacy and they do not necessarily require a shorter duration of treatment. All antimicrobial drugs have the potential to impact subsequent C&S testing.
what is passive immunity?
Transferred from another source
The nurse is preparing to apply a prescription ointment to the client's wound After reviewing the image, what is the most important step for the nurse to take? Apply a 1-in (2.5-cm) layer of the ointment to the site using the index finger Use a sterile cotton-tipped applicator to apply the prescription to the site Place sterile 4 × 4 gauze on the wound and secure the dressing with dressing with paper tape Put soiled dressing change supplies in the client's bathroom garbage and double bag
Use a sterile cotton-tipped applicator to apply the prescription to the site Chapter 24: Asepsis and Infection Control - Page 604; 618 Applying the ointment with the gloved finger contaminates the prescription ointment. Sterile cotton-tipped applicators are used to apply ointments or solutions to the wound bed to avoid contaminating the wound. A 4 × 4 gauze pad should not be applied until the wound is cleansed properly with sterile supplies. Soiled dressing supplies should be placed in a biohazardous trash bag or container.
what are contact precautions and what type of room is needed and type of PPE
Used for serious organisms that are easily spread by skin-to-skin contact◦ Private patient room◦ Wear gown & gloves on room entry◦ Remove before exiting
Aminoglycoside antibiotics tend to collect in the eighth cranial nerve. The nurse would anticipate that which clinical manifestation may occur from the cranial nerve involvement? Inability to swallow Blindness Vertigo Slurred speech
Vertigo Chapter 8: Anti-Infective Agents - Page 94 The aminoglycosides antibiotics collect in the eighth cranial nerve and can cause dizziness, vertigo, and loss of hearing.
A hospital nurse is aware that nosocomial infections pose a significant threat to many clients' health status. In order to reduce the spread of nosocomial infections, the nurse should prioritize which action? Increased use of empiric antibiotic therapy Use of disinfectants when providing client hygiene Vigilant and thorough hand hygiene Client education on the causes of infection
Vigilant and thorough hand hygiene Good hand hygiene is probably the most effective method of preventing infections. This supersedes the importance of education regarding the causes of infection or the use of disinfectants. Antibiotic therapy should only be used on clients who clearly need this treatment.
Which client is receiving prophylactic anti-infectives? a client with metastatic lung cancer who will soon begin chemotherapy a client with human immunodeficiency syndrome who begins antiretroviral therapy a client who is prescribed a 3-day course of antibiotics prior to dental surgery a client who has been admitted for the treatment of an infected surgical incision
a client who is prescribed a 3-day course of antibiotics prior to dental surgery Chapter 8: Anti-Infective Agents - Page 93 In a situation where an infection is likely to occur, antibiotics can be used to prevent it. Giving antibiotics before surgery is an example of prophylaxis. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells; this is not prophylactic. Antiretroviral therapy and treatment of an active infection are not prophylactic.
Which client would be at risk of developing an infection? Select all that apply. a client with an impaired immune system a client who performs daily hygiene care a client experiencing diarrhea chronically an elderly client who has one chronic disease a client who takes nutritional supplements
a client with an impaired immune system a client experiencing diarrhea chronically an elderly client who has one chronic disease Many factors impair the host defense mechanisms and predispose a person to infection by disease-producing microorganisms. These include breaks in the skin and mucous membranes, impaired blood supply, neutropenia and other blood disorders, malnutrition, poor personal hygiene, suppression of normal bacterial flora by antimicrobial drugs, diabetes mellitus and other chronic diseases, and advanced age. A client who has chronic diarrhea can experience malnutrition. A client who performs daily care and a client who takes nutritional supplements are not at risk for infection.
Surgical asepsis is defined as:
absence of all microorganisms. pg 603 chap 24 Surgical asepsis refers to sterile technique and indicates procedures used to eliminate any microorganisms.
Successful treatment with bacteriostatic antibiotics depends upon what factor? adequate duration of drug therapy. stopping drug therapy when symptoms have subsided. using broad-spectrum antibacterial drugs to treat viral infections. the type of drug-resistant bacterial strains that can reproduce in the presence of antimicrobial drugs.
adequate duration of drug therapy. Chapter 8: Anti-Infective Agents - Page 91 Successful treatment with bacteriostatic antibiotics depends on the ability of the host's immune system to eliminate the inhibited bacteria and an adequate duration of drug therapy. Stopping an antibiotic prematurely can result in rapid resumption of bacterial growth. Antibiotics are not used to treat viral infections.
what is the size of an airborne means of transmission
airborne particles are less than 5 mcm
The nurse caring for clients at an outpatient clinic determines that which client is at greatest risk for infection? an 80-year-old woman a 2-year-old toddler a 12-year-old girl an 18-month-old infant
an 80-year-old woman chp 24 pg 601 Age, race, sex, and heredity all influence susceptibility to infection. Neonates and older adults tend to be most vulnerable to infection, so the 80-year-old woman is the client most at risk for infection. A neonate is defined as a child less than 4 weeks of age. An adolescent is a child aged 9 to 12 years. A toddler is a child who is 12 to 36 months or 1 to 3 years of age.
For which client would the use of standard precautions alone be appropriate? a client with diphtheria who needs p.m. care a client with TB who needs medications administered an incontinent client in a nursing home who has diarrhea a child with chickenpox who is treated in the emergency room
an incontinent client in a nursing home who has diarrhea ch24 pg 614-615 Standard precautions apply to blood and all body fluids, secretions, and excretions except sweat. Transmission-based precautions are used in addition to standard precautions for clients hospitalized with suspected infection by pathogens that can be transmitted by airborne, droplet, or contact routes, such as is the case in answers A, B, and D.
When an 86-year-old client reports an inability to concentrate, uneasiness, lightheadedness, weakness, muscle and joint discomfort, and demonstrates normal temperature, the clinic nurse recalls that: without an elevated temperature, infection is not present. the client's symptoms are typical of an older adult client. an older adult can have an infection without a fever. an infection was present and has dissipated.
an older adult can have an infection without a fever. Older adults may not show a fever or may produce only a low-grade fever when an infection is present.
What are classified as anti-infectives? (Select all that apply.) anthelmintics antifungals antiprotozoals anticonvulsants antimetabolites
anthelmintics antifungals antiprotozoals Chapter 8: Anti-Infective Agents - Page 89 Anti-infectives include antibiotics, antivirals, antifungals, antiprotozoals, and anthelmintic agents.
A client comes to the clinic reporting mouth sores that appear consistent with an oral yeast infection. The nurse should question the client about recent use of: antibiotics. oral contraceptive agents. antivirals. antiprotozoals.
antibiotics Chapter 8: Anti-Infective Agents - Page 95 The client is exhibiting signs of a superinfection, which can occur with the use of antibiotics. Superterm-152infections are not associated with oral contraceptives, multivitamins, or anticoagulants.
A group of students are reviewing information about anti-infective agents. The students demonstrate a need for additional review when they identify what as an anti-infective agent? antibiotic anthelmintic antiprotozoal anticoagulant
anticoagulant Chapter 8: Anti-Infective Agents - Page 89 An anticoagulant interferes with blood clotting and is not an anti-infective agent. Antibiotics, anthelmintics, antiprotozoals, antivirals, and antifungals are all anti-infective agents.
A client suffers from bloody diarrhea after eating contaminated food at a local restaurant. The client has been infected with a(an): bacteria. virus. fungi. protozoa.
bacteria chap 24 pg 610 Bacteria may be transmitted through air, food, water, soil, vectors, or sexual activity.
The laboratory calls the nurse to report the client has a shift of the differential count to the left. The nurse knows this indicates the client most likely suffers from: viral infection. bacterial infection. chickenpox. hepatitis.
bacterial infection. If the infection is severe or prolonged, the body cannot manufacture neutrophils quickly enough, resulting in the release of immature granulocytes into the blood. This increase in the number of immature cells is called a shift to the left or leftward shift in the granulocyte differential count.
When an anti-infective's function is to destroy the infective pathogen, it is classified as: resistant. bacteriostatic. bactericidal. sensitive.
bactericidal. Chapter 8: Anti-Infective Agents - Page 90 Anti-infectives can act to destroy an infective pathogen (bactericidal) or to prevent the pathogen from reproducing (bacteriostatic). Resistance is the ability over time to adapt to an anti-infective drug and produce cells that are no longer affected by a particular drug. Culture and sensitivity testing identify the causal pathogen and the most appropriate drug for treating the infection.
The nurse is initiating isolation precautions for a client who has chronic Clostridium difficile infection. What should the nurse be sure to include with these precautions? remind others to use a mask when caring for this client recognize that this type of infection requires droplet precautions be sure that there are gloves of various sizes and gowns for use include a N95 respirator mask for health care staff entering the room
be sure that there are gloves of various sizes and gowns for use cchap 24 pg 610 All health care workers and visitors should don a gown and gloves prior to entering the client's room. These bacteria are not transmitted by droplet. An N95 respirator mask is not required for this client.
what is an antibody?
body's response to antigen
What is natural passive immunity?
breast milk from mother to child
Administration of what type of antibiotic by the nurse would be most likely to cause a superinfection? broad spectrum narrow spectrum bactericidal bacteriostatic
broad spectrum Chapter 8: Anti-Infective Agents - Page 95 One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora, allowing opportunistic pathogens to invade tissue and cause a superinfection. Narrow-spectrum anti-infectives are less likely to kill normal flora, although it is not impossible. A drug may be bactericidal, meaning it kills the pathogen; or bacteriostatic, meaning it prevents reproduction of the pathogen, but this is not related to superinfections.fff
The nurse is caring for a client with a surgical wound. Which action by the nurse best reduces the reservoir of infection? changing the soiled dressing wearing clean unsterile gloves when changing the dressing isolating the client's belongings applying a face mask with shield
changing the soiled dressing Chapter 24: Asepsis and Infection Control - Page 617 A reservoir is a place where microbes grow and reproduce. A soiled dressing can be a reservoir for microbes to breed. Changing the soiled dressing reduces the microbes at the wound. Wearing gloves, isolating client's belongings, and applying a face mask decrease the transmission of infection.
Which clients are at a heightened risk for infection? Select all that apply. client with hypothermia client with gastric tube feeding client with an indwelling catheter client with an IV catheter client with hypertension
client with gastric tube feeding client with an indwelling catheter client with an IV catheter Chapter 24: Asepsis and Infection Control - Page 537 Clients with gastric tube feedings, indwelling catheters, and IV catheters are at a greater risk for infection than clients with hypothermia or hypertension. Pathogens can enter susceptible hosts through body orifices. Breaks in the skin or mucous membranes (from wounds or from abrasions) increase opportunities for organisms to enter hosts. Long-term IV or gastric feedings and drainage of body cavities further increase the number of potential routes of entry into the body, thus increasing the risk of infection.
The nurse is caring for a client with acute viral conjunctivitis. Which precautions will the nurse begin? airborne droplet contact none
contact Chapter 24: Asepsis and Infection Control - Page 551 Acute vital conjunctivitis is transmitted through contact; therefore, contact precautions are appropriate.
The nurse is caring for a client with acute viral conjunctivitis. Which precautions will the nurse begin? airborne droplet contact none
contact ch24 pg551 Acute vital conjunctivitis is transmitted through contact; therefore, contact precautions are appropriate.
The nurse is caring for a client with a draining abscess. Which precautions will the nurse begin?
contact pg 615 chap 24
what is the size of droplet means of transmission?
droplet particles are greater than 5 mcm
The nurse and a colleague have admitted a client who is on contact precautions. The nurse and colleague are removing their personal protective equipment and the nurse sees the colleague perform inappropriate removal of gloves. What is the nurse's most appropriate response? encourage the colleague to remove the glove by grasping the cuff teach the colleague why the gloves should be removed outside the room maintain a distance of at least 5 ft (1.5 m) from the colleague take no action at this time
encourage the colleague to remove the glove by grasping the cuff chapter 24 pg 626 The colleague should grasp the outside of one glove with the opposite gloved hand and peel the glove off, turning it inside out while peeling it off. The glove should not be pulled by the fingers, because this is unlikely to remove the glove and it may snap back. Personal protective equipment should normally be removed while inside the room, and there is no need to maintain a wide distance from the colleague.
what is natural active immunity
environmental exposure
When discontinuing use of a gown in the care of a client in droplet precautions, which method does the nurse use to dispose of this personal protective equipment (PPE)? fold soiled side to the inside and roll with inner surface exposed fold soiled side to the outside and roll with outer surface exposed fold soiled side to the inside and roll with outer surface exposed fold soiled side to the outside and roll with inner surface exposed
fold soiled side to the inside and roll with inner surface exposed chap 24 627 To dispose of the gown, the nurse will fold the soiled side to the inside and roll with the inner surface exposed. The other answers are incorrect.
What is an antigen?
foreign invader
The nurse is preparing discharge instructions for a family member who will be caring for a client with an abdominal incision. Which concept should be the priority in the teaching plan? hand washing sterile technique putting on gloves signs of healing
hand washing Chapter 24: Asepsis and Infection Control - Page 602 Hand washing technique is the single most important procedure in reducing the spread of microorganisms from either the client to the surroundings or the surroundings to the client. A client does not need to learn a sterile technique for the abdominal incision. Most client procedures are related to clean handing and do not need gloves to be added to a dressing change. The nurse should review signs of infection and healing of the abdominal incision.
A physician performs lumbar puncture and advises the nurse to send the obtained cerebrospinal fluid for Gram stains. The nurse understands that this type of testing is beneficial for which reason? permits selection of antibiotic concentration helps in reducing proliferation of multidrug-resistant organisms narrows the therapeutic range to avoid prolonged use helps to determine prescribed antibiotic therapy
helps to determine prescribed antibiotic therapy Gram staining helps to order antibiotic therapy while waiting for specific culture results, whereas minimum inhibitory concentration permits selection of antibiotic concentration, helps in reducing proliferation of multidrug-resistant organisms, narrows the therapeutic range, and avoids prolonged use.
To eliminate needlesticks as potential hazards to nurses, the nurse should:
immediately deposit uncapped needles into a puncture-proof plastic container. Chapter 24: Asepsis and Infection Control - Page 605
what are fungi present?
in the air, wind, and water
What is the second line of defense in microbial invasion? Inflammation Infection Disease Disability
inflammation
The nurse is caring for a client receiving penicillin for the treatment of syphilis. When teaching the client about the therapeutic effect of this medication, the nurse should describe what mechanism? physical destruction of DNA inhibition of protein synthesis inhibition of cell wall biosynthesis bacterial mutation
inhibition of cell wall biosynthesis Chapter 8: Anti-Infective Agents - Page 89 Some antiinfectives interfere with biosynthesis of the bacterial cell wall. Because bacterial cells have a slightly different composition than human cells, this is an effective way to destroy the bacteria without interfering with the host. The penicillins work in this way. They do not inhibit protein synthesis, cause mutations, or destroy DNA.
what is artificial passive immunity?
injection of antibodies
The nurse is receiving a confused client with a draining wound onto the medical-surgical unit. Which room assignment will the nurse make? into a private room with a client with pneumonia with a client with a myocardial infarction with another client with a draining wound
into a private room chap 24 pg 615 The client with confusion and a draining wound would, as would other clients on the unit, benefit most from a private room. The client cannot be expected to assist in maintaining appropriate hygiene or environmental control, so placement with another client who has a susceptible condition is not appropriate.
A nurse is preparing an education plan for a client being discharged home after successful treatment for a wound infection. What would the nurse be least likely to include in the education plan? signs and symptoms of infection intravenous antibiotic administration hand hygiene measures vital sign monitoring
intravenous antibiotic administration
A client is receiving aminoglycoside therapy. The nurse would be alert for: kidney dysfunction. hallucinations. lethargy. loss of vision.
kidney dysfunction. Chapter 8: Anti-Infective Agents - Page 94 Kidney dysfunction (i.e., nephrotoxicity) is associated with aminoglycosides. Hallucinations are not associated with the use of aminoglycosides. Lethargy is not associated with aminoglycoside therapy. Loss of vision is more commonly associated with neurotoxic agents such as chloroquine. Hearing loss is a possibility with aminoglycosides.
If clients receive drugs that are known to induce superinfections, they should be monitored for signs of:
new infection. Chapter 8: Anti-Infective Agents - Page 95 If clients receive drugs that are known to induce superinfections, they should be monitored closely for any signs of new infection, such as sore patches in the mouth, vaginal itching, diarrhea, and the appropriate treatment for any superinfection should be started as soon as possible.
What intervention is most important for the nurse to perform before antibiotic therapy is initiated? increasing the client's fluid intake educating the client about adverse effects obtaining a specimen for culture and sensitivity administer an antidiarrheal to prevent gastrointestinal (GI) upset
obtaining a specimen for culture and sensitivity Chapter 8: Anti-Infective Agents - Page 93 It is good practice to collect specimens (e.g., sputum, urine) for culture and Gram's stain before giving the first dose of an antibiotic. Fluid intake and medication education may take place after the therapy is initiated, while antidiarrheal medication is administered if the client demonstrates signs/symptoms of GI distress.
what are standard precautions?
precautions used in the care of ALL hospitalized patients regardless of their diagnosis or possible infection status
what type of room, PPE, and distance for droplet precautions? how and when is the patient transported out of the room
private patient room◦ Surgical mask or N(%◦ Keep 3-6ft distance between patient and visitors◦ Transport patient out of room only when necessary◦ Patient must wear surgical mask
A parent of a 9-year-old child states to the nurse, "I have not noticed any fever yet but my child describes feeling achy and not well." Which phase of the fever does the nurse identify the child may be experiencing? prodromal invasion stationary resolution
prodromal pg 600 ch 24 Often, the child will experience symptoms prior to the fever surfacing, which is called the prodromal phase and includes the nonspecific symptoms that occur before the body temperature rises. The onset or invasion phase indicates an elevation in body temperature, as well as symptoms related to the fever such as shivering. The stationary phase is when the fever is sustained. The final phase is the resolution or defervescence phase when the temperature abates and returns to the child's baseline temperature.
what is the most infectious period during the stages of infection?
prodromal stage
The most common infection in children is: respiratory. gastrointestinal. neurologic. urinary.
respiratory
What would a nurse least expect as an adverse reaction to anti-infective agents? kidney damage hypersensitivity respiratory toxicity neurotoxicity
respiratory toxicity Chapter 8: Anti-Infective Agents - Page 94 The least commonly encountered adverse effect associated with the use of anti-infective agents is respiratory toxicity. The most commonly encountered adverse effects are direct toxic effects on the kidney, gastrointestinal tract, and nervous system along with hypersensitivity and superinfections.
The nurse administering an anti-infective agent recognizes that the drug will destroy some human cells as well as pathogens because of the absence of: selective toxicity. virulence. resistance. antigens.
selective toxicity. Chapter 8: Anti-Infective Agents - Page 89 Although anti-infective agents target foreign organisms infecting the body of a human host, they do not possess selective toxicity, which is the ability to affect certain proteins or enzyme systems used only by the infecting organism but not by human cells. Virulence would apply to the destructive power of the infection, not the drug. Resistance is the pathogen's ability to no longer respond to specific anti-infectives. Antigens are proteins bound to the cell that help the body identify a cell as belonging (or not) in the body, and are not the cause of human cell destruction.
what are the different types of isolation precautions?
standard airborne contact droplet
The nurse is observing a sterile field that was prepared by another staff member. Which, if present, would indicate that the sterile field is contaminated? sterile drape positioned with the moisture-proof side facing up sterile drape hanging off the work surface sterile 4 × 4 gauze dressings, removed from the packaging and placed in the middle of the sterile field sterile gloves, removed from the outer wrapping, 4 in (10 cm) away from the edge of the sterile field
sterile drape positioned with the moisture-proof side facing up chap 24 629 If the sterile drape is placed with the moisture-proof side up, it will become contaminated if it gets wet. It is acceptable to place gloves away from the field and to place gauze on the field. The edges commonly overhang the end of the table slightly, and this is acceptable.
what is the difference between sterilization and disinfection?
sterilization kills all microorganisms and disinfection destroy all pathogenic organisms expect spores
Some anti-infective medications are more powerful when given in combination. This means that they are: compatible. synergistic. incompatible. antagonistic.
synergistic. Chapter 8: Anti-Infective Agents - Page 93 Synergistic drugs are drugs which are more powerful when given in combination.
A client is in the fever phase. His temperature remains significantly elevated. The nurse is preparing to implement sponge bathing. Which type of water would the nurse most likely use? Cool water Tepid water Ice water Warm water
tepid water Tepid baths or sponging are used for febrile clients when temperature reaches elevated levels. Tepid water is used to prevent chilling, which would trigger the shivering mechanism.
what is the body's second line of defense against an agent?
the adaptive immune response
describe a susceptible host for the infectious agent
the agent needs to overcome any resistance by the host's defenses. Needs to receive nourishment
A client has been diagnosed with osteomyelitis and has been prescribed clindamycin, a narrow spectrum antibiotic. When planning this client's care, the nurse should understand that: the microorganism causing the infection is likely known. the client likely has compromised immune function. broad spectrum antibiotics were likely administered without success. the care team wished to reduce the client's risk of adverse effects.
the microorganism causing the infection is likely known. Chapter 8: Anti-Infective Agents - Page 90 Narrow spectrum antibiotics are appropriate when the identity of the microorganism is known or strongly suspected. This is unrelated to the client's immune function. Broad spectrum drugs are not necessarily trialed before using narrow spectrum drugs. The risk of adverse effects is not the determining factor.
A client has been diagnosed with osteomyelitis and has been prescribed clindamycin, a narrow spectrum antibiotic. When planning this client's care, the nurse should understand that: the microorganism causing the infection is likely known. the client likely has compromised immune function. broad spectrum antibiotics were likely administered without success. the care team wished to reduce the client's risk of adverse effects.
the microorganism causing the infection is likely known. Chapter 8: Anti-Infective Agents - Page 90 Narrow spectrum antibiotics are appropriate when the identity of the microorganism is known or strongly suspected. This is unrelated to the client's immune function. Broad spectrum drugs are not necessarily trialed before using narrow spectrum drugs. The risk of adverse effects is not the determining factor.
A nurse is caring for a 55-year-old postoperative client. The client returns to the ICU after surgery intubated and mechanically ventilated with a Salem sump nasogastric tube, a Foley catheter, and a PICC line in place. Based on the nurse's knowledge of the most common hospital-acquired infections, which apparatus is most important to remove first? urinary catheter PICC line Salem sump nasogastric tube endotracheal tube
urinary catheter Chapter 24: Asepsis and Infection Control - Page 608 Urinary catheters account for the highest percentage (26%) of hospital-associated infections. The four most common types of HAIs are related to invasive devices or surgical procedures: catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), surgical site infection (SSI), and ventilator-associated events (VAEs). A peripherally inserted catheter is an invasive line. Nasogastric tubes and endotracheal tubes are not associated with HAIs.
What is Artificial active immunity
vaccination and boosters
An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with ciprofloxacin. clindamycin. vancomycin. an antistaphylococcal penicillin.
vancomycin. Chapter 8: Anti-Infective Agents - Page 91 Vancomycin is the drug of choice to manage infections caused by MRSA. MRSA is resistant to all of the antistaphylococcal penicillins, as well as to ciprofloxacin and clindamycin.
Which care intervention should the nurse anticipate when providing care to a client admitted with a possible diagnosis of tuberculosis (TB)? wearing a particulate respirator for all care and interaction with this client wearing a face mask when entering and staying at a distance from the client wearing protective eye wear for contact with this client placing the client in a regular, private room
wearing a particulate respirator for all care and interaction with this client chapter 24 page 615 To prevent the transmission of TB, the National Institute for Occupational Safety and Health recommends the use of a particulate air filter respirator that fits snugly to the face for all client care and interaction. A face mask does not block small TB particles effectively. Protective eyewear is only needed if contact with bodily fluids is expected. The client would be placed in a negative pressure room to prevent the potential spread of TB.
what is a fungi?
yeast and mold
Does a virus need a host to reproduce?
yes
can the entry route may be the same as the exit route from the prior reservoir?
yes
