Chapter 19: Perspectives on Infectious Disease and Bioterrorism Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 19: Perspectives on Infectious Disease and Bioterrorism

MULTIPLE CHOICE

1. The nurse caring for a client who develops a urinary tract infection during hospitalization explains that the infection is likely a

a.

consequence of bacteremia.

b.

nidus formation.

c.

nosocomial infection.

d.

viral infection.

ANS: C

Nosocomial (hospital-acquired) infections are those acquired through some aspect of treatment in the facility. The UTI could cause a bacteremia since it is most likely bacterial, not viral. A nidus is a place or location where something (like infection) originates. Certainly the urinary catheter insertion site could be the nidus of the infection.

DIF: Comprehension/Understanding REF: p. 328 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

2. The nurse explaining an infection to a client with the flu would describe an infection as a/an

a.

defect in the immune system.

b.

hypersensitivity reaction between a human antigen and a biologic agent.

c.

inflammatory response to an irritant.

d.

parasitic relationship between an organism and host.

ANS: D

Infection is a process by which an organism establishes a parasitic relationship with its host.

DIF: Comprehension/Understanding REF: pp. 323-325 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

3. A client has been exposed to an infectious organism but has no clinical manifestations of disease. The nurse cautions the client that this period of time is the

a.

cell gap.

b.

immune response.

c.

infection curve.

d.

latent period.

ANS: D

The period when a pathogen is replicating but before it can be shed from the host is called the latent period.

DIF: Comprehension/Understanding REF: pp. 326-327 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. The nurse caring for a client infected with methicillin-resistant Staphylococcus aureus (MRSA) should

a.

discourage transfer to a long-term care facility.

b.

encourage the client to increase fluid consumption.

c.

place the client in protective isolation.

d.

use standard precautions plus transmission-based precautions.

ANS: C

Standard precautions is the more important of the two tiers of isolation strategies proposed by the Hospital Infection Control Practices Advisory Committee of the CDC. They are designed for the care of all clients and synthesize the major components of the older universal precautions and body substance isolation. They are used for contact with non-intact skin, mucous membranes, blood, and all body fluids, secretions, and excretions except sweat. Transmission-based precautions form the second tier of infection control and are used for clients who have diagnosed or suspected infections, or who are colonized with transmissible pathogens. The three types of transmission-based precautions are contact, droplet, and airborne.

DIF: Application/Applying REF: p. 335 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Standard/Transmission Based/Other Precautions

5. A notation on a clients health record notes that she has a subclinical infection. The nurse assessing this client would expect

a.

clinical manifestations of the disease that are not as dramatic as usual.

b.

fever with no elevation in the white blood cell count.

c.

no systemic manifestations of disease.

d.

reports of fatigue and lassitude after the infection.

ANS: C

An asymptomatic pathologic response is called a subclinical infection.

DIF: Comprehension/Understanding REF: pp. 326-327 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

6. For clients thought to be in the period of communicability for influenza, the community health nurse will focus the interventions on

a.

ensuring that clients do not infect others.

b.

evaluating clients response to the organism.

c.

protecting clients from complications.

d.

supporting clients immune systems.

ANS: A

The time period when an organism can be shed and infect others is called the period of communicability. Interventions would need to focus on preventing the spread of the disease, particularly in the case of a pandemic.

DIF: Application/Applying REF: pp. 327-328 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

7. A client is taking a 3-week diving vacation in a foreign country and will be staying at a local hotel known for its native food. The nurse cautions the client that a common travelers infection is giardiasis, and that the client should be cautious about

a.

eating food and drinking beverages prepared in the foreign country.

b.

flying on an airplane in close contact with other persons.

c.

swimming in the coastal waters of the foreign country.

d.

taking the necessary inoculations required to travel.

ANS: A

Giardiasis results from a Giardia organism that attacks the gastrointestinal system. It is contracted from ingesting contaminated food and water in areas where sanitation is suspect.

DIF: Comprehension/Understanding REF: p. 327 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

8. The infection control nurse explains to the staff that resistant organisms, like vancomycin-resistant Enterococcus (VRE), evolve by

a.

colonizing a client who has had repeated nosocomial infections.

b.

contact with the hosts weakened immune system.

c.

infecting a client with a history of untreated infections.

d.

mutation of the pathogen because of frequent exposure to antibiotics.

ANS: D

Resistant organisms evolve through changes in their DNA from long-term and frequent exposure to antibiotics. Studies have shown that up to 37.8% of hospitalized clients receive antibiotics and half of those are prescribed inappropriately. In the ICU over 80% of clients receive antibiotics. Health care professionals and researchers are growing increasingly concerned over this increasing and widespread use of antibiotics as the most important contributing factor in the development of antimicrobial resistance is antimicrobial use. This leads to spontaneous genetic mutations or genetic transfer of plasmids or chromosomal DNA in organisms, which results in resistance.

DIF: Comprehension/Understanding REF: pp. 330-331 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Infection Control

9. A nurse is concerned about caring for three postoperative clients and one client with an infectious disease. The nursing manager educates the nurse about the most effective way to prevent the spread of infectious diseases, which is to

a.

care for the postoperative clients first, and then see the infected client.

b.

place the infected client in the appropriate isolation.

c.

practice appropriate hand-washing and sanitation.

d.

transfer the infected client to a private room at the end of the hallway.

ANS: C

The simplest and most effective way to prevent transmission of infections is meticulous hand-washing and the use of alcohol-based hand rubs. Hand hygiene is an absolute necessity, even when gloves are worn and even when the client is in isolation. It might be a good idea to see the postoperative clients before the infectious one (clean before dirty) and isolation procedures must be followed, but no measure takes the place of hand-washing.

DIF: Application/Applying REF: p. 332 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Infection Control

10. The nurse assesses a clients systemic manifestations of fever and malaise as the line of defense known as

a.

complete.

b.

partial.

c.

primary.

d.

secondary.

ANS: D

Secondary (inflammatory process) and tertiary (immune response) lines of defense share several physiologic components, including the immune system, leukocytes, and a multitude of proteins and enzymes. The primary (first line) defenses act to bar infection and include physical and chemical barriers and the bodys own natural flora.

DIF: Application/Applying REF: p. 326 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

11. An elderly client is admitted and placed into contact and respiratory isolation. The clients spouse becomes upset seeing health care providers in gowns and masks and demands they refrain from wearing them because it is confusing to the client and the spouse thinks the health care providers are scaring the client. The best response by the nurse to help the client and spouse would be to say

a.

Has anyone explained the reason for the isolation to you?

b.

I understand you are upset, but we have to protect other clients from infection.

c.

Its hospital policy and we all have to abide by the isolation precautions.

d.

Let me show you the items we need when we come in the room.

ANS: A

The best response by the nurse starts with the first step of the nursing process, which is assessment. The nurse first needs to ascertain what the client/spouse knows and understands about the isolation precautions and the need for them. Only then can the nurse provide the specific education the client/spouse needs in order to better cope with the environment, which seems unusual to them.

DIF: Application/Applying REF: p. 335 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

12. The infection control nurse in a long-term care facility (LTCF) understands that infection control procedures have to be adopted for use in the LTCF because

a.

elderly clients are much less likely to acquire an infectious disease in a LTCF.

b.

residents are usually not allowed to enter LTCFs with infectious diseases.

c.

they must balance the need for infection control and socialization in the LTCF.

d.

with fewer staff, it is difficult for a staff member to transmit an infectious disease.

ANS: C

As opposed to hospitals, residents of LTCFs are long-term residents, not visitors, and the LTCF is their home. Strict barrier approaches used in hospitals may have a negative effect on the residents and on the facilitys social and rehabilitative goals. For many reasons, the elderly are more susceptible to infection, and nosocomial infections are common among residents of LTCF, being major sources of morbidity and mortality.

DIF: Comprehension/Understanding REF: p. 336 OBJ: Intervention

MSC: Psychosocial Integrity Psychosocial Adaptation-Quality of Life

13. The nurse working on a community initiative to respond to pandemic flu would design priority interventions that would

a.

bolster the communication network with the federal government.

b.

educate the public on what to do in a pandemic.

c.

limit person-to-person transmission.

d.

provide antiviral medications to every person in the community.

ANS: C

All options are valid activities of the nurse working on a community project for pandemic flu preparedness. However, the primary response strategy must be to implement public health measures to reduce person-to-person transmission. These measures might include a ban on large gatherings, isolation of infected individuals, prophylaxis of the entire community, and possibly a large-scale quarantine. However, the federal government plan calls for purchasing enough influenza vaccine for only 20 million people and enough antiviral drugs for only another 20 million people, so medicating an entire community may not be feasible.

DIF: Application/Applying REF: p. 324 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Disaster Planning

14. An elderly client was admitted yesterday for dehydration. The client has an IV infusion and a Foley catheter. Today the client appears restless and will not eat. The clients vital signs are T 99.2 F, P 88 beats/min, R 20 breaths/min, BP mm Hg. The nurse should first assess the client further for

a.

an infection.

b.

medication usage.

c.

orientation status.

d.

stroke/TIA.

ANS: A

All options would be part of a comprehensive assessment to determine the cause of a change in status. However, the elderly are very susceptible to infection and often do not exhibit usual signs and symptoms. This client has two obvious portals of entry for infection: the IV line and the catheter. Suspect infection in an elderly client with a temperature over 99 F, changes in mental status, worsening cognition, lethargy, agitation, loss of appetite, incontinence, or an increased tendency to fall.

DIF: Analysis/Analyzing REF: p. 330 OBJ: Intervention

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Age Related Differences

15. The nurse assesses for surgical wound infection particularly closely in the client who has undergone

a.

craniotomy for tumor removal.

b.

hysterectomy.

c.

repair of a perforated bowel.

d.

tonsillectomy.

ANS: C

The most common source of surgical site infection is the clients own flora. The perforated bowel would expose the entire abdomen to Escherichia coli, a bacterial organism in the colon.

DIF: Application/Applying REF: p. 329 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

16. The nurse can best instruct a client to avoid the acquisition of hookworm by

a.

advising the client not to eat raw pork products.

b.

advising the client to drink only bottled water when traveling.

c.

encouraging the client to wear shoes outdoors.

d.

teaching the client good hand-washing technique.

ANS: C

Hookworm eggs are shed in feces, but hookworm larvae enter through the skin of a person walking barefoot in soil containing hatched eggs. Knowledge of the portal of entry for this organism is a health promotion measure.

DIF: Comprehension/Understanding REF: p. 326 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

17. The nurse is explaining defense mechanisms to a client and uses the representative barrier example in the first line of defense known as

a.

antigen-antibody reaction.

b.

cell-mediated immunity.

c.

inflammatory response.

d.

pH of vaginal secretions.

ANS: D

First-line defenses include physical and chemical barriers and the bodys own natural flora. The chemical composition of body secretions such as tears and sweat, together with the pH of saliva, vaginal secretions, urine, and digestive juices, further prevents or inhibits growth of organisms.

DIF: Comprehension/Understanding REF: p. 326 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

18. The nurse is teaching a group of clients about ways that infections are transmitted. The comment made by one of the clients that shows the need for further instruction is

a.

A vector transmits infection by biting someone who doesnt have the infection.

b.

Sneezing can put infected droplets in the air for someone else to breathe.

c.

The portal of entry and the portal of exit are always the same.

d.

You can get infections from touching something contaminated by a sick person.

ANS: C

The portals of entry and exit are often similar, but variations exist. One example is hookworm. The portal of exit is feces, but the portal of entry is through the skin of a person walking barefoot in soil containing hatched eggs.

DIF: Application/Applying REF: p. 326 OBJ: Evaluation

MSC: Physiological Adaptation Physiological Adaptation-Pathophysiology

19. The nurse, in compliance with the 1991 Recommendations for Immunization of Healthcare Workers by the CDC, will have received

a.

a tetanus booster every year.

b.

HIV vaccination upon employment.

c.

immunization against cholera.

d.

the three-dose series of hepatitis B vaccine.

ANS: D

The 1991 CDC recommendations for hepatitis B immunization of high-risk individuals, including health care professionals, include a complete series of three doses within 6 months.

DIF: Knowledge/Remembering REF: p. 336 OBJ: N/A

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Immunizations

20. The nurse gives diligent catheter care to the clients in a nursing home because the nurse is aware that bacteria can migrate into the bladder in

a.

5 hours.

b.

10 hours.

c.

24 hours.

d.

72 hours.

ANS: C

Bacteria introduced into the urinary collection system can migrate to the bladder in 24 to 48 hours.

DIF: Application/Applying REF: p. 328 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

MULTIPLE RESPONSE

1. General health promotion measures a nurse can teach a group of clients in order to prevent infections include (Select all that apply)

a.

controlling portals of exit of infectious organisms.

b.

eliminating personal behaviors that might lead to infection.

c.

examining cultural behaviors that might promote infection.

d.

maintaining good nutritional status.

e.

preventing displacement of normal flora.

ANS: B, C, D, E

Some people are more susceptible to infections than others. Factors that influence host susceptibility include personal behaviors (drug use, sexual practices), cultural behaviors (eating raw fish for example), nutrition, and the preservation of indigenous normal flora specific for certain tissues. Knowledge of portals of exit is important for preventing transmission of disease, but since they involve excretions and secretions, they cannot be totally controlled.

DIF: Comprehension/Understanding REF: p. 326 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

2. The nurse is aware that anthrax is at the top of the threat list for bioterror weapons because (Select all that apply)

a.

early manifestations are vague and look like a cold.

b.

it would have a high mortality rate.

c.

the attack would be invisible and odorless.

d.

there is no vaccination available.

ANS: A, B, C

The first three options are true. All of these things would make an anthrax attack potentially very lethal. An anthrax vaccination does exist but right now is recommended only for high-risk persons. In 2001 letters contaminated with anthrax were sent through the postal system and sickened and killed nearly 24 people.

DIF: Comprehension/Understanding REF: p. 338 OBJ: N/A

MSC: Safe, Effective Care Environment Safety and Infection Control-Disaster Planning

3. The nurse collaborating on a community committee designing responses for a bioterrorism attack would understand that an attack by smallpox (Select all that apply)

a.

can be perpetuated through contact with infected items.

b.

could be made with only a small amount of the virus.

c.

is predicted to be deadly because there is no vaccine available.

d.

will create terror because there is no effective treatment for smallpox.

e.

would be hard to control because of the long time between infection and illness.

ANS: A, B, D, E

Smallpox now represents one of the greatest bioterror threats, decades after smallpox as a disease was eradicated. Many features of smallpox make it a desirable weapon, but there is a vaccine. In fact, there has been enough vaccine produced to vaccinate every person in the United States.

DIF: Comprehension REF: pp. 327, 338 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Disaster Planning

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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