Immune System

Question 1

Diptheria

Answer 1

Diphtheria can manifest in cutaneous or pharyngeal forms. Large droplets can spread pharyngeal diphtheria, so one must use droplet precautions. Transmission of cutaneous diphtheria is via direct contact with the skin sores of an infected person, carriers, or contaminated articles. The communicable period refers to the duration for which the person can remain infectious. The communicable period for diphtheria varies but is usually 2 to 4 weeks.Diphtheria is a serious bacterial infection that primarily affects the respiratory system and is spread through respiratory droplets or by contact with contaminated objects. It is not caused by a virus. Diphtheria is a serious bacterial infection that is caused by the bacterium Corynebacterium diphtheriae. It is spread through respiratory droplets or contact with skin lesions of infected individuals. The bacterium produces a toxin that can cause a thick, gray coating in the throat and nose, making it difficult to breathe and swallow. The toxin can also damage the heart, nervous system, and other organs. ✓Vaccination against diphtheria is recommended for all children, and booster shots are recommended every 10 years for adults. Treatment for diphtheria typically involves antibiotics to kill the bacteria and antitoxin to neutralize the toxin. Supportive care, such as respiratory support and hydration, may also be necessary.

Question 2

rheumatic fever

Answer 2

✓ Rheumatic fever is a result of an abnormal immune response to a group A streptococci (GAS) infection, usually pharyngitis

✓ Rheumatic fever is self-limiting and is typically triggered after an untreated pharyngitis

✓ Manifestations include fever, polyarthritis, chest pain, muffled heart sounds, emotional lability, chorea, and muscle weakness

✓ Untreated rheumatic fever may cause significant damage to the mitral valve

✓ Treatment for rheumatic fever involves treating the streptococci with antibiotics

✓ Other treatments include NSAIDs or steroids for the inflammation & polyarthritis
Polyarthritis is characterized by swollen, painful, hot joints that are commonly seen in rheumatic fever. Other manifestations associated with rheumatic fever include chest pain, fever, muffled heart sounds, pericardial friction rub, chorea, muscle weakness, and emotional lability. Treatment for painful polyarthritis is an NSAID or a steroid. Naproxen is commonly used because of its easy dosing schedule.

Question 3

Patients with impetigo require which precautions

Answer 3

Patients with impetigo need to be placed on contact precautions to prevent spreading this highly contagious disease. According to the CDC, these precautions are “for patients who may be infected or colonized with specific infectious agents for which additional precautions are needed to prevent infection transmission. Contact precautions will be used for any disease in which direct contact with the infectious organism can cause illness. This includes impetigo and other conditions such as viral gastroenteritis, MRSA, and scabies. Contact precautions will require a gown and gloves before entering the room.

Question 4

Neutropenia

Answer 4

eutropenia is classified when the neutrophil count is less than 1,500. Neutropenia can be caused by various factors, including medications, disease, or congenital causes. The biggest threat to a client with neutropenia is the risk of bacterial, fungal, or viral infection. This infection can be localized or, at worse, become systemic. Sickle cell anemia is not a consequence of neutropenia, nor is chronic renal failure.

The cornerstone of neutropenic precautions involves having the nurse perform meticulous hand hygiene. The nurse should require visitors and other staff members to adhere to this practice. Healthcare workers who are sick should not care for a client with neutropenia. Wearing sterile gloves for routine client care is not necessary. Wearing a respirator is not necessary for a client with neutropenia. This would be an intervention for a client with airborne precautions.

Blood cultures should be obtained for a client with neutropenia and showing signs of infection to determine if bacteremia is present. Blood cultures should be obtained before the initiation of antibiotics. Two blood culture sets are recommended and should contain blood collection in an aerobic and anaerobic bottle. If cystitis is suspected, a urine culture may be obtained, but not a 24-hour urine collection or arterial blood gasses.

Question 5

Neutropenia Interventions

Answer 5

For a client with neutropenia, the nurse should implement the following interventions –

Place the client in a private room
Perform meticulous hand hygiene
Avoid (or limit) the use of invasive devices such as indwelling catheters
Visitors and staff with signs and symptoms of illness should be restricted
Ensure the environment is clean with approved cleaning agents
Report a temperature increase of one degree to the primary healthcare provider
Administer prophylactic antibiotics, antifungals, and antivirals, as prescribed

Question 6

Nephroblastoma Considerations

Answer 6

The nurse should not perform abdominal palpation in a patient with a nephroblastoma (Wilm’s tumor). Vigorously palpating the mass can cause the tumor to rupture and bleed into the peritoneal cavity. In patients with early-stage disease, rupture of the tumor may also cause it to spread to other parts of the body. If necessary, the physician may palpate the tumor cautiously. Nephroblastoma develops from immature kidney cells and grows into the peritoneal cavity. It is the 4th most common cancer in children. Nephroblastoma most commonly presents with an asymptomatic, palpable abdominal mass. Other features include hypertension, abdominal pain, microscopic hematuria, and fever. Occasionally, gross hematuria may be present. Long-standing hypertension in nephroblastoma may lead to cardiomyopathy/congestive heart failure.

Question 7

Precautions for Haemophilus influenzae, type b meningitis

Answer 7

Haemophilus influenzae, type b Meningi requires droplet precautions. Droplet precautions require the nurse to don a surgical mask upon entry to the client’s room. Cohorting with droplet precautions is permitted as long as the other individual has the same pathogen. Clients who require transport or want to ambulate outside their room should don a surgical mask.

Question 8

Meniere’s Disease

Answer 8

Meniere’s disease is characterized by excessive endolymphatic fluid. This causes three main features of vertigo, tinnitus, and sensorineural hearing loss. Nursing care aims to provide education that should focus on diet medication (low salt, limiting caffeine and alcohol) and adherence to pharmacotherapy, including antiemetics, diuretics, antihistamines, and glucocorticoids.
educing dietary sodium intake is key to reducing attacks associated with Meniere’s disease. By reducing sodium, the client will reduce endolymphatic fluid, reducing the incidence of attacks.

Question 9

Lyme Disease

Answer 9

Classic features of Lyme disease include erythema migrans which is a bullseye type appearing rash. Additional features of Lyme disease include myalgias, arthralgias, fatigue, lymphadenopathy, and conjunctivitis.
✓ Lyme disease is a tick-borne illness causing the client to have B. burgdorferi

✓ Symptoms may begin one month after a client was exposed to the bacteria via the tick

✓ The symptoms start with the classic bullseye rash progressing to lymph node enlargement, arthralgias, malaise, fatigue, and encephalopathy

✓ The mainstay treatment is antibiotics such as doxycycline

✓ The client can reduce their exposure risk by wearing long sleeve clothing, tick repellent, and avoiding high grass and wooded areas without the recommended attire

Question 10

Systemic Lupus Erythematosus (SLE)

Answer 10

Systemic lupus erythematosus (SLE) is associated with an elevated risk of lupus nephritis, a severe complication in which the immune system attacks the kidneys. In addition to signs and symptoms associated with SLE, clients with lupus nephritis will often exhibit or report foamy urine (due to the amount of protein in the urine) and possibly hematuria. Once these findings are reported to the nurse, the nurse should perform an additional assessment, assessing the client for possible renal involvement or dysfunction. The nurse should then alert the health care provider (HCP) of these findings and initiate further diagnostic testing as ordered.
Systemic lupus erythematosus (SLE) presents in females about ten times more frequently than in males.
Evaluate all SLE clients for renal involvement.
When using corticosteroids or other drugs that control inflammation to maintain remission in SLE clients, use these medications at the lowest possible dose(s).

Question 11

follow up labs for Systemic Lupus Erythematosis

Answer 11

A patient with SLE needs monthly urine specimens to check for proteinuria and any kidney functioning damage.

Question 12

pre-exposure prophylaxis for human immunodeficiency virus (HIV)

Answer 12

Tenofovir-emtricitabine

Question 13

Brachytherapy

Answer 13

Brachytherapy is an internal radiation therapy where a radiation source ( small radioactive implant) is placed close to cancer. This way, cancer receives a very high dose of radiation, but only low levels reach adjacent tissues thus, limiting side effects. Brachytherapy is commonly used to treat prostate, uterus, cervix, and vaginal cancers. It is essential to have safety measures in place during brachytherapy to protect the visitors and healthcare staff. Patients may be admitted to the hospital for a few days in a single room during brachytherapy. Once the level of radioactivity goes down to a safe level, the patients can go home. Following discharge, the clients should avoid contact with children and pregnant women for quite some time. The following are nursing specific instructions in caring for the clients receiving radioactive source implants:

The patient should be in a single room with access to the bathroom.
Post specific “stay times” on the room door and do not spend any more time in the room than needed to care for the patient.
No pregnant visitors
No visitors under the age of 18 years
Visitors should remain at least 6 feet from the patient. The time can vary from 30 minutes to 2 hours per visitor per day.
Housekeeping should not enter the room unless escorted by the nurse, and only essential cleaning must be performed.

Question 14

Brachytherapy considerations

Answer 14

With brachytherapy, the radiation source in your body will give off radiation for a while. If the radiation you receive is a very high dose, you may need to follow some safety measures.

Staying in a private hospital room to protect others from radiation coming from your body.
Being treated quickly by nurses and other hospital staff. They will provide all the care you need but may stand at a distance, talk with you from the doorway of your room, and wear protective clothing.
Your visitors will also need to follow safety measures, which may include

not being allowed to visit when the radiation is first put in
needing to check with the hospital staff before they go to your room
standing by the doorway rather than going into your hospital room
keeping visits short, about 30 minutes or less each day (the length of visits depends on the type of radiation being used and the part of your body being treated)
not having visits from pregnant women and children younger than a year old
You may also need to follow safety measures once you leave the hospital, such as not spending much time with other people. Your doctor or nurse will talk with you about any safety measures you should follow when you go home.

Question 15

Heparin-Induced Thrombocytopenia

Answer 15

Heparin-induced thrombocytopenia (HIT) is a hypercoagulable condition and promotes clotting. Continuing heparin in a client with HIT and acute pulmonary embolism may cause an extension of thrombus and even death. The physician must be notified; however, the heparin infusion must be held while awaiting the physician’s orders. HIT is an adverse response to heparinoids. This autoantibody reaction causes venous ( deeper vein thrombosis, pulmonary embolism) and arterial thrombosis ( thrombotic strokes, myocardial infarction, arterial thromboembolism)

The priority of HIT is to recognize it and stop the heparin product.
The classic presentation of HIT is a reduction in the platelets by up to 50%, which is likely to occur between days four and five of heparin therapy.
The nurse must report this type of platelet reduction immediately to the primary healthcare physician (PHCP).
HIT treatment includes using an alternative anticoagulation agent such as fondaparinux, warfarin, rivaroxaban, dabigatran, and argatroban, inhibiting thrombin. Note that anticoagulation must be pursued in HIT despite thrombocytopenia.

Question 16

Who is most at risk for HIT?

Answer 16

• Persons with cardiovascular disease and interventions
• Patients undergoing orthopedic surgery
• Very sick hospitalized patients

Question 17

Treatment of HIT

Answer 17

The diagnosis of heparin-induced thrombocytopenia requires stopping of all forms of heparin, including removal of heparin-coated catheters or use of low molecular weight heparins. Once heparin is stopped, the platelet count should begin to increase in two to five days.
Even after the heparin is stopped, the patient continues to be at high risk of heparin-induced thrombocytopenia-related clotting for the next 30 days. Because of this clotting risk, the patient often needs alternative anticoagulation, depending on his or her clinical circumstances. Use of oral anticoagulation with warfarin alone should not be used in patients with this condition because of the high risk of developing warfarin-induced skin necrosis and gangrene in the veins of the limbs.

Question 18

Hepatitis C Transmission

Answer 18

The primary way HCV is transmitted is through blood exposure which a needle stick may trigger. The nurse should discuss safety regarding the disposal of needles, such as the importance of not recapping needles.
HCV does not currently have a vaccine. A vaccine is available for hepatitis A and B, but it is not available for HCV. However, a robust cure for HCV does exist. HCV is not spread through urine or feces. The primary mode of transmission is through the exposure of the infected individual’s blood. Individuals with HCV are not isolated and receive standard precautions.
✓ Hepatitis C symptoms have an insidious onset. During the illness, the client may be asymptomatic.

✓ Hepatitis C has an incubation period between 2 weeks and six months.

✓ The virus is spread through infected blood. Thus, hepatitis C may be transmitted via needlesticks, unregulated tattooing, perinatal, and contact with infected blood.

✓ While sexual transmission is possible, the risk is relatively low with sexual contact.

✓ No vaccination exists for hepatitis C; however, robust cures are available for specific genotypes.

Question 19

Dexromethorphan

Answer 19

Dextromethorphan is a cough suppressant. It is the ingredient in many over the counter cough medicines such as Delsym, Robitussin, and NyQuil. Dextromethorphan works by signaling the brain to stop triggering the cough reflex.

Question 20

Bells Palsy Treatment

Answer 20

Prednisone or another corticosteroid is likely to be prescribed. The anti-inflammatory action of these medications may help to reduce the swelling of the facial nerve and lessen the impingement that is causing the facial drooping. Antivirals are controversial, but some studies show that the combination of antivirals with corticosteroids may be helpful in clients with severe facial drooping. Both of these medications should be given as soon as possible after the symptoms start. Physical therapy to massage facial muscles can help to minimize permanent damage.

Question 21

Teaching following radio iodine testing

Answer 21

Unless the dosage is extremely high, there is no need to separate the client from her family.

Question 22

Hepatitis C Education

Answer 22

Hepatitis C is often asymptomatic and frequently goes unrecognized until the manifestation of chronic liver disease occurs, making detection and testing difficult. Many clients are asymptomatic and do not have jaundice, although some have malaise, anorexia, fatigue, and nonspecific upper abdominal discomfort. Often, the first findings are signs of cirrhosis (e.g., splenomegaly, spider nevi, palmar erythema) or complications of cirrhosis (e.g., ascites, encephalopathy, etc.).
Hepatitis C diagnosis is confirmed by finding positive anti-HCV and positive HCV RNA.
Treatment varies depending on genotype, but includes using one or more direct-acting oral antiviral drugs with or without ribavirin.
Decompensated cirrhosis due to hepatitis C is the most common indication for liver transplantation in the United States.
Sexual transmission is possible, although the risk is relatively low.

Question 23

Wilms Tumour origin

Answer 23

Wilms tumor, also known as nephroblastoma, is a cancer of the kidneys. Its tumor cells originate from renal cells.
The lungs, however, are the most common location for cancer to metastasize to.

Question 24

People with banana allergies are susceptible to an allergy to what allergen>

Answer 24

Individuals with allergies to bananas are at an increased risk of developing an allergy to latex. Tropical fruit allergies may also indicate an increased risk. Working in a profession with increased exposure to latex, such as a hairdresser or house cleaner, also places a person at an increased risk for developing this allergy.

Question 25

Tumor Lysis Syndrome

Answer 25

TLS is characterized by intracellular contents, and subsequent cellular by-products of damaged cancer cells are released into the bloodstream faster than the body can eliminate them. TLS can cause life-threatening electrolyte imbalances such as hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. TLS may be a positive sign that the tumor responds to antineoplastic treatment. Common cancers likely to cause TLS include acute leukemia, small cell lung cancer, melanoma, and multiple myeloma. A key intervention for the nurse is educating the client about drinking at least three to five liters of water daily. Medications used for TLS include allopurinol which may decrease the uric acid secreted by the lysed cancer cell. This syndrome, if left untreated, may lead to dangerously high potassium levels and an acute kidney injury.

Question 26

Ebola Virus

Answer 26

Ebola Virus Disease
✓ Spread by direct contact with blood or bodily fluids, as well as splashes
✓ Contact + Droplet precautions are required, along with eye protection
✓ Manifestations include fever, fatigue, diarrhea, and vomiting that may progress to hypovolemic shock
✓ Bleach is an effective cleaning agent for surfaces
✓ A vaccine for EVD is available, and treatment is aggressive fluid resuscitation and monoclonal antibodies

Question 27

The plague

Answer 27

The Plague
✓ Spread by rodents such as fleas and rodents (bubonic plague)
✓ Can be spread by infected droplets from human to human (pneumonic plague)
✓ Yersinia pestis is the pathogen behind the plague
✓ Bubonic plague manifestations include lesion where bitten, fever, chills, and lymphadenopathy
✓ Pneumonic plague manifestations include chest pain, dyspnea, fever, and lymphadenopathy
✓ Bubonic plague is standard precautions
✓ Pneumonic plague is droplet precautions

Question 28

Smallpox

Answer 28

✓ Smallpox is spread by aersolized droplets
✓ Vaccination is available to those at high risk

Question 29

Nephroblastoma

Answer 29

✓ Nephroblastoma is a tumor affecting the kidney(s).
✓ The average age at diagnosis is three years in children with single kidney disease.
✓ It is slightly younger for those with bilateral involvement.
Nephroblastoma nursing care involves
✓ Frequent blood pressure monitoring because this tumor may induce renin-related hypertension
✓ Avoid any activities that may cause palpation of the abdomen
✓ Gastrointestinal assessment as obstruction may consequently occur (absent bowel sounds, abdominal distention should be reported)
✓ Assessment of hemorrhage (tachycardia and hypotension)

Question 30

which medication for hypertension should be used for patients with nephroblastoma

Answer 30

Enalapril is an ACE inhibitor used to lower blood pressure. Since clients with nephroblastoma are hypertensive due to increased renin levels, this medication is commonly prescribed to decrease their blood pressure. Any ACE inhibitor reduces blood pressure by inhibiting the formation of angiotensin II in the renin-angiotensin-aldosterone system (RAAS), so they are an excellent choice for treating hypertension caused by nephroblastoma. While ACE-I’s may be nephrotoxic, this is still the recommended treatment and is therapeutic as long as the creatinine levels are monitored closely.

Question 31

which infectious diseases are reportable to the local health department

Answer 31

Infectious conditions are reportable to the local health department including Human immunodeficiency virus (Choice C), Hepatitis-A (Choice D) and Syphilis (Choice E). Other reportable conditions include chlamydia, pulmonary tuberculosis, rabies, chickenpox, influenza, and gonorrhea. Healthcare providers have the responsibility to report these to the state/local health departments.

Question 32

Mononucleosis

Answer 32

Mononucleosis (Mono) is an acute infectious disease common for individuals younger than 25. Mono may produce symptoms such as –

Fever
Significant fatigue
Pharyngitis that has exudate and petechiae
Enlarged tonsils
Lymphadenopathy
Splenomegaly
This condition is usually self-limiting and treated with supportive measures such as cool fluids and acetaminophen. This condition is caused Epstein-Barr virus spread by oral secretions. Antibiotics are not effective for this condition. The splenomegaly is concerning because if the individual plays contact sports, they are at high risk of splenic injury, which could lead to life-threatening hemorrhage. Thus, contact sports should be restricted until the spleen returns to its normal size, which may take several weeks.

Question 33

Risk factors for breast cancer

Answer 33

Female
Age: For a woman living in the United States, the lifetime risk of 1 in 8
Race: White women are more likely to develop breast cancer, but Black women are more likely to die because they tend to develop breast cancer at an age younger than 40 and are more aggressive. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.
Early menarche (<12 years), late menopause (>55 years)
Nulliparity or first pregnancy after 30 years
Personal history of breast cancer
Genetic risk factors
Family history in first-degree relatives (mother, sister, daughter)
Family history of other cancer
Mutations in the BRCA1 and BRCA2 genes
Mutations in other genes: CHEK-2 gene, ATM (ataxia-telangiectasia mutated) gene, PTEN gene
Previous irradiation of the chest area as a child or a young woman as a treatment for another cancer (such as Hodgkin’s disease or non-Hodgkin’s lymphoma)
Previous abnormal breast biopsy results
Atypical hyperplasia increases the risk four to five times.
Fibrocystic changes without proliferative changes do not change breast cancer risk.
Long-term hormone replacement therapy with estrogen and progesterone
Excessive alcohol consumption
Overweight or obesity
Physical inactivity

Question 34

Breast Cancer Prevention

Answer 34

Strong primary prevention measures the nurse can advocate for to prevent breast cancer include motivating the client to maintain a normal body mass index, exercise regularly, smoking cessation, and moderation of alcohol intake. Secondary prevention includes mammography. Most women have an average risk for breast cancer and should begin yearly mammograms at age 45.

Question 35

The nurse cares for a child diagnosed with laryngotracheobronchitis who is assessed to have worsening inspiratory stridor with an oxygen saturation of 92% on room air. The nurse should obtain a prescription for which medication?

Answer 35

Nebulized racemic epinephrine is an effective medication in moderate to severe laryngotracheobronchitis (croup) because it has a rapid onset of action and acts by reducing airway edema. It decreases the stridor and helps to lessen airway obstruction. Racemic epinephrine is given via nebulizer for over fifteen minutes and can be repeated until symptom reduction.

Question 36

The nurse is caring for a child who is immunocompromised and diagnosed with varicella. The nurse should expect a prescription for which medication?
A. Amoxicillin-Clavulanate
B. Acyclovir
C. Doxycycline
D. Azithromycin

Answer 36

Antiviral medications such as acyclovir or valacyclovir are commonly used to treat varicella infections. While these medications are not routinely prescribed for all infections, immunocompromised individuals are at risk for varicella complications, including meningitis. Thus, antiviral medications would be appropriate in this circumstance.

Question 37

Varicella

Answer 37

Varicella is a highly contagious viral infection spread by aerosolized droplets, contaminated surfaces, and direct contact with the lesions. Treatment is symptomatic with prescribed acetaminophen and therapeutic baths with cool water and uncooked oatmeal or baking soda. If a client is admitted with varicella, they should be isolated using airborne and contact precautions until the lesions have crusted.

Question 38

Cystic Fibrosis

Answer 38

Cystic fibrosis is a multisystem disorder that has no cure. A well-balanced diet rich in calories, protein, and fat is recommended to help prevent (or treat) the malabsorption associated with CF. Foods rich in sodium are also recommended because of the salt loss through the skin. A multivitamin is commonly prescribed to help mitigate the vitamin deficiencies that may develop. Finally, pancrelipase is prescribed before snacks and meals to enable the digestion of the dietary items.Pancrelipase is a digestive enzyme that is given to the client with meals. This allows the client to digest the food and absorb the vitamins and minerals. This is the exact reason that a multivitamin is necessary for the treatment of cystic fibrosis.

Question 39

Doxycycline

Answer 39

Doxycycline is a commonly used tetracycline antibiotic that effectively treats various bacterial infections, including acne, pelvic inflammatory disease, and Lyme disease.

Because dairy products contain calcium, doxycycline should not be concomitantly administered with milk. This also includes avoiding antacids containing calcium, aluminum, and magnesium. Doxycycline intake and ingestion of these products must be separated by 2–3 hours.
Doxycycline is recommended to be taken on an empty stomach.
Oral contraception and doxycycline: Current literature suggests no evidence of increased contraceptive failure when doxycycline is used concurrently with estrogen-containing oral contraceptives. Older literature recommended additional birth control methods (e.g., barrier methods) during concomitant use of estrogen-based oral contraceptives and doxycycline due to the theoretical risk of decreased contraceptive effect. However, this theory remains unproven.
Pregnancy and breast-feeding: Doxycycline crosses the placenta and is excreted in breast milk—doxycycline chelates with calcium in the bones and the teeth. If given to pregnant women, it may lead to skeletal growth retardation and permanent teeth discoloration in the fetus. Doxycycline in breastfed infants and children under eight causes permanent teeth discoloration, tooth enamel damage, skeletal growth retardation, and photosensitivity. Therefore, it should be avoided in these populations.

Question 40

Risk factors for ovarian cancer

Answer 40

Risk factors for ovarian cancer include -

➢ Early menarche and late menopause; this is because of the increased number of ovulations which may cause endothelial trauma

➢ BRCA variants

➢ Family history

➢ Nulliparity, this is because of the increased number of ovulations which may cause endothelial trauma

➢ Older age, with the highest risk being between ages 55-64

Question 41

Teaching for a client with neutropenia

Answer 41

✓For a client who is neutropenia, some teaching points include

✓ Avoid all forms of intercourse until the neutropenia has resolved

✓ Clean commonly touched surfaces with a disinfectant

✓ Avoid crowded places

✓ Avoid cleaning up after pets

✓ Practice good oral hygiene with a soft toothbrush

✓ Clean the toothbrush weekly with a dilutional bleach solution

Question 42

The pediatric nurse is treating an 18-month-old who has tested positive for Respiratory Syncytial Virus (RSV). Which signs and symptoms would the nurse expect to find?

Answer 42

Thin nasal secretions are an expected symptom of RSV. This is an acute viral infection that affects the bronchioles. Children experience significant upper respiratory congestion when dealing with RSV and may need frequent suctioning to keep the airway clear and lessen the work of breathing.
Nasal flaring is an expected sign of RSV. This is a typical signal of respiratory distress in an infant or young child. The nares flare outward with inspiration due to use of accessory muscles and increased effort to breathe.
Crackles in the lungs are an expected finding with RSV. This sound occurs due to inflammation or fluid accumulation in the alveoli which results in decreased gas exchange. Wheezing may also occur due to the thick mucus in the bronchioles that restricts air flow

Question 43

The nurse is caring for a client with a sacral wound infected with Methicillin-resistant staphylococcus aureus. Which personal protective equipment (PPE) is necessary to care for this client?

Answer 43

A gown and gloves should be used when coming into contact with an MRSA wound. This prevents secretions from the wound from infecting the nurse.
✓ MRSA is a gram-positive bacteria that is found frequently in healthcare facilities

✓ MRSA is spread by direct contact and affects most older adults through indwelling urinary catheters, vascular access devices, open wounds, and endotracheal tubes

✓ It is susceptible to only a few antibiotics, such as IV vancomycin and oral linezolid

For a client on contact precautions, the door may remain open

✓ During client transport, the wound should be covered with a dry dressing

Question 44

Doxycycline

Answer 44

Doxycycline is a tetracycline antibiotic that fights bacteria in the body. It treats many different bacterial infections, such as acne, sexually transmitted infections, and pneumonia

This antibiotic should not be administered concurrently with products rich in calcium because it will weaken the effects of the antibiotic
The client should avoid exposure to tanning beds and direct sunlight, use sunscreen, and/or wear protective clothing because of drug-related photosensitivity
Photosensitive effects may be noticed within a few minutes to hours after taking the drug and may last up to several days after the drug has been discontinued

Question 45

The nurse is caring for a client immediately following transsphenoidal hypophysectomy. It would be essential for the nurse to obtain a prescription for which medication?

A. Ondansetron
B. Methimazole
C. Omeprazole
D. Methylphenidate

Answer 45

Prophylactic nausea and vomiting prevention is essential following this surgery. If the client were to vomit, this would put pressure on the operative site and cause wound disruption. Following this surgery, the client is instructed not to cough, blow their nose, or sneeze. Vomiting should be avoided because it exerts pressure on the operative site, which is detrimental.
After hypophysectomy, the client should be monitored closely for increased intracranial pressure, headaches, urine output, and vital signs. The client should be instructed to avoid blowing their nose, coughing, or straining. The most serious adverse effect of this surgery is CSF leakage, increased intracranial pressure, infection, and diabetes insipidus.

Perioperative and postoperative steroids are routinely prescribed to prevent diabetes insipidus.

Question 46

Sepsis Considerations

Answer 46

Sepsis claims more than 200,000 lives annually in the United States. Clients often present with fever, shaking chills, and rapid heartbeat. Severely ill clients may also have drowsiness, rapid breathing, sweating, decreased urine output, and low blood pressure. Packed red blood cell (pRBC) transfusion has been incorporated into the recommended treatment bundle of sepsis since 2004. Packed red blood cells are used to treat illness and anemia as well as to improve oxygen delivery to tissues. Packed red blood cell transfusion may be indicated in the following circumstances: In clients with evidence of hemorrhagic shock or proof of acute illness and hemodynamic instability or inadequate oxygen delivery. Since the client in this question also has a clotting disorder, interventions to prevent bleeding are observed. These measures include avoiding constipation by offering stool softeners and preventing the use of sharp or hard objects to provide care. For example, a mouth sponge may be used for oral care, rather than a regular toothbrush. The bristles of the toothbrush may cause too much damage to the clients gingival tissue and cause further bleeding issues. Clients with septic shock are at high risk for falls and injury due to weakness and confusion (Choice E. The nursing care plan should include measures to prevent falls such as bed rails, non-slip footwear, and close monitoring by the nursing staff.
✓ With shock, there is lots of cellular death and tissue damage from too little oxygen reaching the tissues. Vital organs have been damaged and cannot respond effectively to interventions, so that the shock cascade will continue.

✓ The release of toxic metabolites and enzymes causes cell damage. This is called multiple organ dysfunction syndrome (MODS).

✓ Once the damage cycle has started, the cycle continues as more cells die and release metabolites. This triggers small clots (microemboli) to form, which blocks tissue perfusion, and more cells start to die.

✓ At this stage, liver, brain, kidney, and heart damage occurs.

✓ This client, who has a baseline history of clotting disorders coupled with their diagnosis of sepsis, raises concern for DIC.

✓ Clients in DIC need to be placed on bleeding precautions, and interventions should be aimed at preventing further bleeding and promoting perfusion.

Question 47

Kawasaki’s Disease

Answer 47

Kawasaki disease is an autoimmune disorder that occurs primarily in individuals younger than five. This disease process may consequently cause inflammation of the coronary arteries leading to aneurysms. Thus, an electrocardiogram should be performed along with an echocardiogram. Soft foods and liquids should be offered because of the chapping of the lips. Fluids would be encouraged because of the fever commonly associated with Kawasaki disease. Finally, treatment for this disease includes either medium to high dose aspirin or intravenous immunoglobin.
Kawasaki disease is an inflammatory syndrome commonly found in individuals younger than five, affecting males more than females. Classic symptoms include fever, chapped lips, bilateral conjunctivitis, and polymorphous rash. Prompt treatment with aspirin or intravenous immunoglobin is needed to prevent injury to the coronary arteries. It is important to note that Kawasaki disease is the one time that aspirin is administered in the pediatric population. Usually, it is avoided due to the risk of Reye’s syndrome. However, Kawasaki disease is the exception to this rule, and aspirin is routinely used in this case.

Question 48

An ovarian oncology client receiving the chemotherapy agent cisplatin for cancer begins experiencing nausea and vomiting. The nurse’s most important role when caring for this client is

Answer 48

The nurse needs to assess the client’s symptoms in terms of onset, frequency, and severity. Through this assessment, the nurse will be able to identify patterns and collaborate with the health care provider (HCP) in scheduling round-the-clock and as needed (PRN) emetic therapy, as antiemetics as often administered before chemotherapy and repeated based on the response and duration of chemotherapy-induced nausea and vomiting. The nursing assessment will assist in identifying the response (and duration of the response) to these medications. Therefore, the nursing priority is coordinating with the client and health care provider (HCP) to ensure adequate control of chemotherapy-induced nausea and vomiting.
Regardless of which drugs are prescribed to prevent or reduce chemotherapy-induced nausea and vomiting, these medications are most effective when used with an evidence-based approach on a scheduled basis for prevention and management and when given before nausea and vomiting begin.
When clients receive dose-dense chemotherapy, the intensity of chemotherapy-induced nausea and vomiting also increases, and more aggressive antiemetic therapy is needed.
Teach clients to continue the therapy even when chemotherapy-induced nausea and vomiting appear to be controlled.
Clients should take an antiemetic at the first sign of nausea to prevent it from becoming uncontrollable.

Question 49

HIV

Answer 49

✓ Human immunodeficiency virus (HIV) is a retrovirus that may lead to Acquire Immunodeficiency Syndrome (AIDS) if untreated

✓ Modes of transmitting HIV include -

• Sexual: genital, anal, or oral (low risk) sexual contact with exposure of mucous membranes to infected semen or vaginal secretions
• Parenteral: sharing of needles (“sharps”) or equipment contaminated with infected blood or receiving contaminated blood products
• Perinatal: from the placenta, from contact with maternal blood and body fluids during birth, or from breast milk from an infected mother to child. Pregnancy is a risk factor for HIV as the pregnant individual has engaged in unprotected copulation. HIV testing is routinely done in the third trimester

✓ HIV is not transmitted by

Casual contact in the home, school, or workplace
Sharing household utensils, towels, linens, and toilet facilities
Mosquitos or other insects do not spread HIV
✓ HIV and AIDS treatment goals include increasing the CD4 count and reducing the viral load (VL) to undetectable

✓ PrEP (pre-exposure prophylaxis) is prescribed to clients with risk factors of contracting HIV

Question 50

Herpes Zoster PPE precautions

Answer 50

Since herpes zoster is spread through airborne means and by direct contact with the lesions, contact and airborne precautions should be followed in case of “disseminated” herpes zoster. This means the nurse should wear an N95 respirator or high-efficiency particulate air filter respirator, a gown, and gloves. Herpes zoster, also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV), the same virus that causes varicella (chickenpox). Primary infection with VZV causes varicella. Once the illness resolves, the virus remains latent in the dorsal root ganglia. VZV can be reactive later in a person’s life and create a painful, maculopapular rash called herpes zoster. Active herpes zoster lesions are infectious, through direct contact with vesicular fluid, until they dry and crust over. People with active herpes zoster lesions should cover their injuries and avoid contact with susceptible people in their household and occupational settings until their wounds are dry and crusted.

Question 51

Most effective cleaning agent against C-Diff

Answer 51

Bleach is the most effective agent against Clostridium difficle. C. diff is a spore-producing bacterium that can be transmitted between clients, environmental surfaces, and contaminated hands. The nurse should instruct the client to launder their clothes (especially underwear) with bleach and use hot water and a hot dryer temperature.
According to the Centers for Disease Control, a client, while at home, should prevent C.difficle disease transmission through:

Meticulous hand hygiene with soap and water.
Avoid using alcohol-based hand sanitizers.
Use a separate bathroom from others.
Disinfect surfaces with a bleach solution, not isopropyl alcohol.
Launder clothing, especially undergarments, with bleach and hot water.

Question 52

The nurse is counseling a female client newly diagnosed with herpes simplex virus in the genitals. Which symptoms should the nurse educate the client to expect before an outbreak?

Answer 52

The initial outbreak of herpes simplex is often the worst (as it pertains to symptoms). Clients typically experience prodromal symptoms such as headaches, a low-grade fever, malaise, paresthesia, and itching at the site of the outbreak. Then the client will experience the eruption of the painful vesicles.
Herpes simplex virus (HSV) is both sexually and non-sexually transmitted. The client often experiences the worst symptoms during the initial outbreak, which include headache, malaise, fever, and localized lymphadenopathy. Following these prodromal symptoms, painful skin eruptions occur, putting the client at higher risk of transmitting the infection. The client should be educated that even when an outbreak is not present, they risk infecting others with the virus. Medications to manage outbreaks are best taken early and include valacyclovir.

Question 53

Addisons Disease

Answer 53

Addison’s disease is when the client has insufficient cortisol and aldosterone.

The mainstay treatment is lifelong corticosteroid replacement with hydrocortisone. If the client experiences stressful events or illnesses, the dosage may need to increase.

During an adrenal crisis, the priority treatment is administering hydrocortisone intravenously. The client is volume depleted, hypoglycemic, and hyponatremic and will need

rapid fluid resuscitation. Dangerously high potassium levels are also evident in an adrenal crisis and require cardiac monitoring and medications such as sodium polystyrene.

Question 54

Normal Skin Changes in the Older Adult

Answer 54

Skin Changes in the Older Adult

✓ Decreased nail growth increasing the risk for fungal infection

✓ Increased nail thickness causing a potential overhang over the toes

✓ Decreased epidermal thickness causing skin transparency

✓ Decreased melanocytes which increase the risk of a sunburn

✓ Decreased dermal blood flow causing skin dryness

✓ Thinning subcutaneous layer leading to hypothermia

✓ Decreased eccrine and apocrine glands cause the skin to become dry

Question 55

DTap Vaccine

Answer 55

The DTaP vaccine is given as five primary and one booster (all intramuscular injections) during childhood as follows: at age two months, four months, six months, 15 to 18 months, and 4 to 6 years (before school entry).
The fifth dose is not necessary if the fourth dose was given at age ≥ 4 years and at least six months after the third dose.
If the pertussis vaccine is contraindicated, a combined diphtheria and tetanus vaccination is available without the pertussis component.

Question 56

The nurse is discussing infection control with a group of nursing students. Which conditions require contact precautions?

Answer 56

Conditions requiring contact precautions include RSV, pediculosis, Clostridium difficle, and scabies. Pediculosis refers to infestation with head lice. Clostridium difficle is a spore-forming bacteria that causes diarrhea. Rubeola (measles) is primarily spread by aerosolized droplets. Rubeola is extremely contagious and may be spread four days before the rash appears.
Herpes simplex virus (HSV)
Varicella-Zoster Virus (VZV) requires contact and airborne precautions until all the lesions crust over.
Respiratory Syncytial Virus (RSV) - although transmitted by large droplets, the spread is through contact with droplets. Hence, droplet isolation is not necessary for RSV.
Enterovirus
Scabies
Impetigo
Abscesses
Pediculosis
Enteric infections ( Norovirus, Clostridium difficle)
Multidrug-resistant bacteria [Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci ( VRE), multidrug-resistant gram-negative bacteria]

Question 57

Enterobiasis

Answer 57

Enterobiasis (pinworm) infections are a parasite that classically causes intense perianal itching that most commonly occurs at night. This constant itching causes the child to have sleep disturbances that may cause daytime irritability because of poor sleep.
✓ Pinworm infestation is the most common helminthic infection in the United States.

✓ Enterobiasis infestation is seldom harmful, and reinfestation is common, as ova deposited in the environment can survive three weeks.

✓ Pinworm eggs may be ingested when people touch their mouth after they scratch their perianal area or after they handle contaminated clothes or other objects (e.g., bed linens).

✓ Treatment is available over the counter and may need to be repeated if the hygiene habits are not implemented.

✓ The oral treatment will need to be repeated in two weeks to ensure total eradication of the parasite.

✓ The nurse should recommend that the child adheres to strict hand hygiene, cut the nails short to prevent ova under the nails, and do daily showering.

✓ It is also recommended that linens are washed with warm water.

Question 58

Pediculosis capitis

Answer 58

Pediculosis capitis is a parasite spread primarily by hygiene products and clothing articles

✓ White eggs (nits) firmly attached to the hair shafts. Lice are small and grayish-tan, have no wings, and are visible to the naked eye

✓ A classic manifestation of this infestation is pruritus, primarily behind the client’s ears, occipital area, and nape of neck

✓ Lice do not fly or jump

✓ Treatment is 1% permethrin cream and retreating five to seven days after the initial treatment for a cure

✓ Home management is laundering linens, towels, hats, and scarves and preventing others from wearing these items

✓ Soak combs, brushes, and hair accessories in lice-killing products for 1 hour or in boiling water for 10 minutes

✓ Remove the nits from the child’s hair with a metal nit comb daily