Infection

Question 1

Cystitis is an infection of the:

a. Kidneys
b. Ureters
c. Bladder
d. Urethra

Answer 1

C. Bladder

Question 2

Which of the following about Respiratory Syncytial Virus is true?

a. RSV only occurs in immunocompromised children.
b. Nearly all children who develop RSV have to be hospitalized.
c. The only cure for RSV is the vaccine Synagis
d. RSV is a major cause of bronchiolitis

Answer 2

d

Question 3

Which of the following regarding COVID-19 is/are true? (SELECT ALL THAT APPLY) a. COVID-19 has been declared

a pandemic by the world health organization.

b. COVID-19 can only be prevented by using hand sanitizer
c. COVID-19 is primarily transmitted by person to person contact
d. The majority of people with symptoms of COVID-19 are being tested.

Answer 3

b,d

Question 4

A client with a suspected infection has a Complete blood count (CBC) with WBC differential count drawn. Results show that the client has elevated levels of eosinophils and basophils. The most likely source of the client’s infection is?

a. Parasite
b. Bacteria
c. Virus
d. Fungus

Answer 4

a

Question 5

The goals of community mitigation (flatten the curve) of the virus COVID-19 include all of the following except: (SELECT ALL THAT APPLY)

a. Eradicating the virus completely
b. Delaying the peak of the outbreak
c. Ensuring that healthcare providers have adequate PPE
d. Decreasing the burden on hospitals

Answer 5

a,c

Question 6

A man comes for a blood pressure screen at a wellness clinic. His blood pressure is 142/92. Which of the following should the nurse do first?

a. Inform the man that he has high blood pressure and needs to follow up immediately with his primary care provider.
b. Teach him about the use of antihypertensive medications to treat hypertension.
c. Recheck his blood pressure in about 5 minutes
d. Teach him the need for weight loss.

Answer 6

c

Question 7

When developing a teaching plan for a 61-year-old man with the following risk factors for coronary artery disease (CAD), the nurse should focus on the:

a. Family history of coronary artery disease.
b. Increased risk associated with the patient’s gender.
c. Increased risk of cardiovascular disease as people age.
d. Elevation of the patient’s low-density lipoprotein (LDL) level.

Answer 7

d

Question 8

The primary mechanism of action of nitrate medications for cardiac pain relief is by

a. Decreasing heart rate
b. Increasing blood pressure
c. Helping to improve blood flow
d. Increasing sympathetic stimulation to the heart

Answer 8

c

Question 9

The nurse is caring for a hospitalized client who is receiving captopril (Capoten) and spironolactone (Aldactone). Which laboratory value will be most important to monitor?

a. Blood urea nitrogen (BUN) level
b. Potassium level
c. Sodium level
d. C-reactive protein level

Answer 9

b

Question 10

Which one of the following classes of medications protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?

a. Beta-blockers
b. Calcium channel blockers
c. ACE inhibitors
d. Nitrates

Answer 10

a

Question 11

In teaching a patient about coronary artery disease, the nurse explains that the changes that occur in this disorder involve:

a. Diffuse involvement of plaque formation in coronary veins.
b. Accumulation of fats, cholesterol and fibrous tissue within the coronary arteries.
c. Formation of fibrous tissue around the coronary arteries
d. Chronic vasoconstriction of coronary arteries leading to permanent vasospasm

Answer 11

b

Question 12

A homeless man is brought to the emergency department in mild hypothermia with a temperature of 34.5°C. On initial assessment, the nurse would expect to find

a. Shivering and lethargy
b. Fixed and dilated pupils
c. Respirations of 6 to 8 per minute
d. BP obtainable only by Doppler

Answer 12

a

Question 13

The pediatric nurse receives a phone call from a father of a 5-year-old who was seen in the clinic earlier in the day. The child received an immunization during the visit and the father is concerned because the child’s temperature is now 100.1°F. Which responses is most appropriate for the nurse to give to the father?

a. “You need to take her to the emergency department.”
b. “A low grade fever can be a normal reaction after an immunization.”
c. “Give her Tylenol immediately.”
d. “She might be having an allergic reaction to the immunization”

Answer 13

b

Question 14

You’re caring for a baby in the NICU who is having body temperature continuously monitored. You know the baby is at risk for hypothermia because:

Infants blood vessels are closer to the skin and have a larger body surface-to-weight ratio

Infants have a thick layer of subcutaneous fat

Infants shiver more frequently

Infants have decreased brown fat metabolism with cold stress

Answer 14

Infant blood vessels are closer to the skin and have a larger body surface-to-weight ratio

Question 15

Which structure is also known as the body’s “thermostat?”

Hypothalamus
Pituitary gland Hippocampus Amygdala

Answer 15

Hypothalamus

Question 16

Which patient is at highest risk for venous thromboembolism?

60-year-old male who smokes

45-year-old female who takes estrogen-based contraception and smokes

30-year-old women who is pregnant

25-year-old man who smokes and has a sedentary lifestyle

Answer 16

45-year-old female who takes estrogen-based contraception and smokes

Question 17

To prevent a state of hyper coagulability for patients starting warfarin (Coumadin), the nurse teaches the patient about:

a. Administration of subcutaneous or IV heparin until INR is therapeutic
b. The use of aspirin until aPTT is therapeutic
c. Ibuprofen administration daily long-term
d. Administration of FFP daily to prevent bleeding

Answer 17

a. Administration of subcutaneous or IV heparin until INR is therapeutic

Question 18

Janet was admitted to the hospital with a deep vein thrombosis (DVT). She is started on IV heparin and oral warfarin (Coumadin). Janet asks the nurse why two medications are necessary. The nurse’s best response is:

a. “Heparin will dissolve the clot, and Coumadin will prevent more clots.”
b. “Heparin will work immediately, and Coumadin will take several days to effect coagulation.”
c. “Administering both medications will reduce the risk for recurrent DVT.”

d. “Because you are at risk for a pulmonary embolism, it is important for you to take both
medications. ”

Answer 18

b. “Heparin will work immediately, and Coumadin will take several days to effect coagulation.”

Question 19

The nurse is reviewing labs for a client with an open surgical wound. The white blood cell count is 15,000 and the count indicates a shift to the left. Assuming all are ordered, which of the following will the nurse do first?

a. Check the client’s oxygen level
b. Obtain wound cultures
c. Redress the wound with wet-to-dry dressings
d. Start empiric antibiotic therapy

Answer 19

b. Obtain wound cultures

Question 20

Which of the following is NOT an indication for surgical debridement of a wound?

a. The wound has a large amount of nonviable tissue present.
b. The wound is significantly infected.
c. The wound is extensive, and the client needs a skin graft.
d. The wound has a large amount of drainage.

Answer 20

d

Question 21

A client with a second degree burn on their arm is being treated with negative pressure wound therapy (wound vac). The nurse knows this therapy promotes wound healing by all of the following except:

a. Removing excess fluid and drainage.
b. Promoting oxygen diffusion into tissues.
c. Encouraging blood flow.
d. Reducing the bacterial count.

Answer 21

b. Promoting oxygen diffusion into tissues.

Question 22

The nurse is caring for a client who has limited mobility. During a skin assessment the nurse notes an area of non-blanchable redness over the client’s left heal. The nurse notes that the skin is otherwise intact. The nurse would document this as:

a. Stage I pressure ulcer
b. Erythema toxicum
c. A suspected deep tissue injury
d. Stage III pressure ulcer

Answer 22

a. Stage I pressure ulcer

Question 23

18. The nurse is providing education to a client with ulcerative colitis has been prescribed the medication sulfasalazine (Azulfidine). Which statement if made by the client indicates the teaching has been effective?

a. This medication will prevent all my GI symptoms.
b. I will need to avoid all contact with people who are sick.
c. This medication will prevent gastrointestinal infections.
d. This medication may cause my urine to turn orange.

Answer 23

d. This medication may cause my urine to turn orange.

Question 24

Which assessment data if reported by a client is consistent with a lower urinary tract infection?

a. Nausea and vomiting
b. Burning on urination
c. Costovertebral tenderness
d. Fever and chills

Answer 24

b. Burning on urination

Question 25

A 50-year-old client returns to the clinic with recurrent dysuria after being treated with trimethoprim/sulfamethoxazole for three days. Which action would be most appropriate for the nurse to do first?

a. Tell the patient the infection has probably spread to their kidneys.
b. Remind the client they need to drink 1000 mL of fluids every day.
c. Suggest the patient take Phenazopyridine (Pyridium) to relieve the symptoms.
d. Obtain a midstream urine specimen for culture and sensitivity testing.

Answer 25

d. Obtain a midstream urine specimen for culture and sensitivity testing.

Question 26

A patient with hypothermia is brought to the emergency department. The nurse should explain which most likely treatment to the family members?

Core rewarming with warm fluids

Ambulation to increase metabolism

Frequent oral temperature assessment

Gastric tube feedings to increase fluids

Answer 26

Core rewarming with warm fluids
Core rewarming with heated oxygen and administration of warmed oral or intravenous fluids is the preferred method of treatment. The patient would be too weak to ambulate. Oral temperatures are not the most accurate assessment of core temperature because of environmental influences. Warmed oral feedings are advised; gastric gavage is unnecessary.

Question 27

What clinical indicator will the nurse most likely identify when assessing a patient with pyrexia?

Dyspnea

Precordial pain

Increased pulse rate

Elevated blood pressure

Answer 27

Increased pulse rate

The pulse rate increases to meet increased tissue demands for oxygen in the febrile state. Fever may increase but does not cause difficulty in breathing. Pain is not related to fever. Blood pressure is not necessarily elevated in fever.

Question 28

The nurse admitting a patient to the emergency room on a cold winter night would suspect hypothermia when the patient demonstrates

increased respirations.

rapid pulse rate.

red, sweaty skin.

slow capillary refill.

Answer 28

slow capillary refill.
With hypothermia, there is slow capillary refill. There is an increased respiration rate with hyperthermia. The heart rate increases with hyperthermia. The skin is usually pale or cyanotic with hypothermia.

Question 29

A homeless person is brought to the emergency department after prolonged exposure to cold weather. The nurse would assess the patient for what manifestations of hypothermia?

Stupor

Erythema

Increased anxiety

Rapid respirations

Answer 29

Stupor

Stupor may occur with hypothermia because of slowed cerebral metabolic processes. Pallor, not erythema, would be present as a result of peripheral vasoconstriction. Drowsiness occurs; the patient would be unable to focus on anxiety-producing aspects of the situation. Respirations would be decreased.

Question 30

A 5-year-old boy with early flu symptoms is at school working with some math blocks. He sneezes into his hand and then continues working with his blocks. An unvaccinated teacher’s helper cleans up the blocks when the child leaves them on the table. After touching the blocks, she rubs her nose with her hand. Which represents the most likely mode of transmission?

The 5-year-old boy

The unvaccinated teacher’s helper

The hand-to-nose contact

The unwashed math blocks

Answer 30

The unwashed math blocks

The boy has the flu and sneezes into his hand while at school. When he works with the math blocks, he leaves the flu virus on the toys. The teacher’s helper picks up the virus with the blocks. When the parent touches her nose with her hand, the virus enters the susceptible host. The blocks act as the mode of transmission. The boy carries the pathogen, and his sneeze is the portal of exit. The teacher’s helper is the susceptible host. The hand-to-nose contact is the portal of entry.

Question 31

After patient teaching, the patient is able to verbalize that which occurrence can delay wound healing after surgery?

Adequate arterial blood flow to the wound

Supplemental oxygen therapy

A healthy diet

An increased hospital stay

Answer 31

An increased hospital stay

An increased hospital stay increases the risk for hospital-acquired infections, which can delay wound healing. Adequate arterial blood flow improves, rather than delays, wound healing. Supplemental oxygen can increase wound healing. A healthy diet is important to wound healing.

Question 32

Which of the following patients is at greatest risk for contracting a primary bacterial infection?

A patient with newly diagnosed diabetes mellitus

A patient whose lab results reveal leukopenia

A patient receiving broad-spectrum antibiotics

A patient following laparoscopic cholecystectomy

Answer 32

A patient whose lab results reveal leukopenia

The patient with a decrease in the number of white blood cells (leukopenia) is at greatest risk for contracting a primary infection because of a weakened primary defense system. A patient with a diagnosis of diabetes mellitus is at greater risk for infection than a patient who does not have the disease but does not have the greatest risk of the four patients described. The patient receiving broad-spectrum antibiotics already has an infection and is at risk for a secondary infection. The patient who has undergone a surgical procedure is at risk for a bacterial infection but does not have the greatest risk of the patients described. Laparoscopy minimizes invasion and tissue impairment.

Question 33

The nurse is teaching a class of junior high school students about infection control through effective hand washing. Which statement made by a student indicates the need for further teaching?

“Hand sanitizer works just as well as washing with soap and water.”

“If I sing the song “Happy Birthday” twice through while scrubbing my hands, that should be long enough.”

“I need to read the label on the hand sanitizer to be sure that it’s at least 60% alcohol.”

“We should all wash our hands before eating lunch every day.”

Answer 33

“Hand sanitizer works just as well as washing with soap and water.”

Hand sanitizer does not work as well as soap and water, because it is not effective against all pathogens or in all situations. For example, hand sanitizer should not be used when hands are visibly dirty. Repeating the song “Happy Birthday” twice takes about 20 seconds, which is how long hands should be rubbed together with soap. Hand sanitizer needs to be at least 60% alcohol to be effective. Hand washing before eating is recommended by the Centers for Disease Control.

Question 34

A patient is in contact isolation for a bacterial infection. The nurse is going to implement which of the following interventions for this patient?

Prevent all visitors from entering the room at any time during hospitalization.

Use personal protective equipment only when knowingly coming into contact with pathogens.

Help to ensure adequate social interaction and support.

Communicate with the patient over the call light whenever possible.

Answer 34

Help to ensure adequate social interaction and support.

Frequently, patients in contact isolation do experience a decrease in social interaction because of the isolation. The nurse must help provide adequate social stimulation for the patient. Frequently, this is done by educating the family and friends regarding isolation practices. Isolation does not mean that the patient cannot have visitors. Visitors must be educated on how to maintain the contact isolation while with the patient, especially hygiene guidelines. Personal protective equipment must be used when entering the room of a patient in contact isolation. Nurses and visitors do not always know when they will come into contact with a pathogen, especially if it is highly virulent. The patient in contact isolation should have regular face-to-face contact with the nurse. The nurse should not use the call light system to communicate with a patient in isolation any more than any other patient.

Question 35

A patient arrives in the emergency department reporting fever for 24 hours and lower right quadrant abdominal pain. After laboratory studies are performed, what does the nurse determine indicates the patient has a bacterial infection?

Increased platelet count

Increased blood urea nitrogen

Increased number of band neutrophils Correct

Increased number of segmented myelocytes

Answer 35

The finding of an increased number of band neutrophils in circulation is called a shift to the left, which is commonly found in patients with acute bacterial infections. Platelets increase with tissue damage through the inflammatory process and for healing but are not the best indicator of infection. Blood urea nitrogen is unrelated to infection unless it is in the kidney. Myelocytes increase with infection and mature to form band neutrophils, but they are not segmented. The mature neutrophils are segmented.

Question 36

A patient had abdominal surgery last week and returns to the clinic for follow-up. The nurse assesses thick, white, malodorous drainage. How should the nurse document this drainage?

Serous

Purulent Correct

Fibrinous

Catarrhal

Answer 36

Purulent drainage consists of white blood cells, microorganisms, and other debris that signal an infection. Serous drainage is a thin, watery, clear or yellowish drainage frequently seen with broken blisters. Fibrinous drainage occurs with fibrinogen leakage and is thick and sticky. Catarrhal drainage occurs when there are cells that produce mucus associated with the inflammatory response.

Question 37

A patient has been provided with a compression dressing in an attempt to facilitate rapid healing of an ankle sprain. What is a priority nursing assessment?

Frequent examination of the character and quantity of exudate

Monitoring for signs and symptoms of local or systemic infections Incorrect

Assessment of the patient’s circulation distal to the location of the dressing

Assessment of the range of motion of the ankle and the patient’s activity tolerance

Answer 37

Assessment of the patient’s circulation distal to the location of the dressing

Any compression dressing requires vigilant assessment of the circulation distal to the dressing site because tissue and nerve damage is a significant risk. This supersedes the importance of assessing the patient’s mobility. Exudate and infection would not normally accompany a soft tissue injury such as a sprain.

Question 38

A patient is postoperative after a breast reduction and arrives for a follow-up appointment at the clinic. The nurse assesses excess soft pink tissue from the surgical incision site. What complication of wound healing does the nurse recognize this to be?

Adhesion Incorrect
Contractions
Keloid formation
Excess granulation tissue Cor

Answer 38

Excess granulation tissue

Excess granulation tissue, the excess soft pink tissue on the wound, is what this complication of wound healing is called. Adhesions are bands of scar tissue that form between or around organs. Wound contraction, which is a normal part of healing, is a complication when it results in deformity by shortening the tissue and impairing function. Keloid formation is a great protrusion of scar tissue that extends beyond the wound edges and may be uncomfortable.

Question 39

A patient is seen in the emergency department for a sprained ankle. What initial interventions should the nurse teach the patient for treatment of this soft tissue injury?

Warm, moist heat and massage

Rest, ice, compression, and elevation Correct

Antipyretic and antibiotic drug therapy

Active movement and exercise to prevent stiffness

Answer 39

Rest, ice, compression, and elevation (RICE) is a key concept in treating soft tissue injuries and related inflammation. Heat may be applied 24 to 48 hours after the injury.

Question 40

A postoperative patient is now able to eat and is requesting a snack. What snack should the nurse recommend for the patient that will facilitate wound healing?

Apple Incorrect

Custard Correct

Popsicle

Potato chips

Answer 40

Custard would be the best snack because it is made from milk, egg, sugar, and vanilla. Wound healing is facilitated by protein, carbohydrates, and B vitamins. Custard also contains calcium and a small amount of vitamin A and zinc. The other snacks do not offer this abundance of healing nutrients. Orange juice with the custard would be good to provide the vitamin C and fluid that are also needed for healing.

Question 41

An older adult patient is transferred from the nursing home with a black wound on her heel. What immediate wound therapy does the nurse anticipate providing to this patient?

Dress it with an absorbent dressing for exudate.

Handle the wound gently and let it dry out to heal.

Debride the nonviable, eschar tissue to allow healing. Correct

Use negative-pressure wound (vacuum) therapy to facilitate healing.

Answer 41

With a black wound, the immediate therapy should be debridement (surgical, mechanical, autolytic, or enzymatic) to prepare the wound bed for healing. Black wounds may have purulent drainage, but debridement is done first. The red wound is handled gently because it is granulating and re-epithelializing, but it must be kept slightly moist to heal. The negative-pressure wound (vacuum) therapy is used to remove drainage and is more likely to be used after debridement.

Question 42

The nurse is caring for a patient who is immunocompromised while receiving chemotherapy for advanced breast cancer. What signs and symptoms will the nurse teach the patient to report that may indicate an infection?

Fever and chills

Increased blood pressure

Increased respiratory rate

General malaise and fatigue

Answer 42

General malaise and fatigue

An immunosuppressed individual may have the classic symptoms of inflammation or infection masked by the inability to launch a normal immune response. Therefore, in this person, early symptoms may be malaise, fatigue, or “just not feeling well.”

Question 43

The nurse is providing care to a patient with an open abdominal wound after surgery. What teaching should the nurse provide to the patient regarding the healing process?

The wound will be stapled together until it heals.

The healing will contract the area to close the wound.

The wound will be left open and heal from the edges inward.

The wound will be sutured after the current infection is controlled.

Answer 43

The wound will be left open and heal from the edges inward.

With secondary healing, the wound is left open and heals from the edges inward and from the bottom up. With primary intention, the wound edges are stapled or sutured, and healing occurs until the contraction of the healing area closes the defect and brings the skin edges closer together to form a mature scar. With tertiary healing, the contaminated wound is left open and closed after the infection is controlled.

Question 44

The nurse observes a patient experiencing chills related to an infection. What is the priority action by the nurse?

Provide a light blanket.

Encourage a hot shower.

Monitor temperature every hour.

Turn up the thermostat in the patient’s room.

Answer 44

Provide a light blanket.

Chills often occur in cycles and last for 10 to 30 minutes at a time. They usually signal the onset of a rise in temperature. For this reason, the nurse should provide a light blanket for comfort but avoid overheating the patient.

Question 45

The patient has inflammation and reports feeling tired, nausea, and anorexia. The nurse explains to the patient that these manifestations are related to inflammation in what way?

Local response

Systemic response

Infectious response

Acute inflammatory response

Answer 45

Systemic response

The systemic response to inflammation includes the manifestations of a shift to the left in the WBC count, malaise, nausea, anorexia, increased pulse and respiratory rate, and fever. The local response to inflammation includes redness, heat, pain, swelling, or loss of function at the site of inflammation. There is not an infectious response to inflammation, only an inflammatory response to infection. The acute inflammatory response is a type of inflammation that heals in 2 to 3 weeks and usually leaves no residual damage.

Question 46

The unlicensed assistive personnel (UAP) is assisting the patient with Crohn’s disease with perineal care. The UAP tells the nurse that the patient had feces coming from the vagina. What is the priority action by the nurse?

Notify the health care provider.

Document the fistula formation.

Assess the patient and vaginal drainage.

Have the UAP apply a dressing to the vagina.

Answer 46

Assess the patient and vaginal drainage.

With Crohn’s disease, a fistula may have formed between the bowel and the vagina. The nurse should first assess the patient and drainage from the vagina. Then the nurse should notify the health care provider, document the occurrence and care provided, describe interventions prescribed, and document the care and patient response.

Question 47

To which patient should the nurse plan to administer round-the-clock antipyretic drugs?

A 76-yr-old patient with bacterial meningitis and a temperature of 104.2°F

An 82-yr-old patient after hip replacement surgery and a temperature of 100.4°F

A 14-yr-old patient with infectious mononucleosis and a temperature of 101.6°F

A 59-yr-old patient with an acute myocardial infarction and a temperature of 99.8°F

Answer 47

A 76-yr-old patient with bacterial meningitis and a temperature of 104.2°F

Moderate fevers (up to 103°F) usually produce few problems in most patients and do not require antipyretic therapy. If the patient is very young or very old, is extremely uncomfortable, or has a significant medical problem (e.g., severe cardiopulmonary disease, brain injury), the use of antipyretics should be considered. High fevers (above 104°F) should be treated with antipyretics. High fevers can damage body cells and cause delirium and seizures.

Question 48

When assessing a patient who is receiving cefazolin for the treatment of a bacterial infection, which data suggest that treatment has been effective?

White blood cell (WBC) count of 8000/ìL; temperature of 101?5? F

White blood cell (WBC) count of 4000/ìL; temperature of 100?5?

White blood cell (WBC) count of 8500/ìL; temperature of 98.4?5?

White blood cell (WBC) count of 16,500/ìL; temperature of 98.8?5? F

Answer 48

White blood cell (WBC) count of 4000/ìL; temperature of 100?5?

This response is correct because both the WBC count and the temperature are within the normal range. A normal WBC is 4000 to 11,000/ìL. An elevated WBC count and elevated temperature are indicators of infection.

Question 49

What is Serosanguineous drainage?

Answer 49

Serosanguineous drainage is frequently seen postoperatively and is composed of RBCs and serous fluid so it is a semiclear pink drainage. Serous drainage is a thin, watery drainage. Hemorrhagic drainage is bloody drainage. Purulent drainage consists of WBCs, microorganisms, and other debris that signal an infection.

Question 50

Who is at risk for pressure ulcers?

Answer 50

Individuals at risk for the development of pressure ulcers include those who are older, incontinent, bed or wheelchair bound, or recovering from spinal cord injuries. Other examples of risk factors include diabetes mellitus, elevated body temperature, immobility, and anemia.