communicable diseases

Communicable Disease Nursing Question and Rationale Part 1

This communicable disease nursing is related to airborne precautions, meningococcal meningitis, radioactive iodine, tuberculosis, and head lice.

communicable diseases
Communicable Disease Nursing

A 20 year-old client has an infected leg wound from a motorcycle accident, and the client has returned home from the hospital. The client is to keep the affected leg elevated and is on contact precautions. The client wants to know if visitors can come. The appropriate response from the home health nurse is that

a. Visitors must wear a mask and a gown
b. There are no special requirements for visitors of clients on contact
c. Visitors should wash their hands before and after touching the client
d. Visitors should wear gloves if they touch the client

Rationale:

C is the correct answer.The visitors should wash their hands before and after touching the client Gown and gloves are worn by persons coming in contact with the wounds or infected equipment.

Several clients are admitted to an adult medical unit. The nurse would ensure airborne precautions for a client with which medical condition?

a. Autoimmune deficiency syndrome (AIDS) with cytomegalovirus (CMV)
b. A positive purified protein derivative with an abnormal chest x-ray
c. A tentative diagnosis of viral pneumonia with productive brown sputum.
d. Advanced carcinoma of the lung with hemoptysis

Rationale:

B is the correct answer.A positive purified protein derivative with an abnormal chest x-ray. The client who must be placed in airborne precautions is the client with a positive PPD (purified protein derivative) who has a positive x-ray for a suspicious tuberculin lesion. A sputum smear for acid fast bacillus would be done next. CMV usually causes no signs or symptoms in children and adults with healthy immune systems. When signs and symptoms do occur, they”re often similar to those of mononucleosis, including: sore throat, fever, muscle aches, fatigue. Good handwashing is recommended for CMV.

A child is admitted to the pediatric unit with a diagnosis of suspected meningococcal meningitis. Which admission orders should the nurse do first?

a. Institute seizure precautions
b. Monitor neurologic status every hour
c. Place in respiratory/secretion precautions
d. Cefataxime IV 50 mg/kg/day divided q6h

Rationale:

C is the correct answer. Meningococcal meningitis has the risk of being a bacterial infection. The initial therapeutic management of acute bacterial meningitis includes respiratory/secretions precautions, initiation of antimicrobial therapy, monitor neurological status along with vital signs, institute seizure precautions and lastly maintenance of optimum hydration. The first action is for nurses to take any necessary precautions to protect themselves and others from possible infection. Viral meningitis usually does not require protective measures of isolation.

A client is diagnosed with methicillin resistant staphylococcus aureus pneumonia. What type of isolation is most appropriate for this client?

a. Reverse
b. Airbourne
c. Standard precautions
d. Contact

Rationale:

D is the correct answer. Contact precautions or Body Substance Isolation (BSI) involves the use of barrier protection (e.g. gloves, mask, gown, or protective eyewear as appropriate) whenever direct contact with any body fluid is expected. When determining the type of isolation to use, one must consider the mode of transmission. The hands of personnel continue to be the principal mode of transmission for methicillin resistant staphylococcus aureus (MRSA). Because the organism is limited to the sputum in this example, precautions are taken if contact with the patient”s sputum is expected. A private room and contact precautions , along with good hand washing techniques, are the best defenses against the spread of MRSA pneumonia.

Which of these clients with associated lab reports is a priority for the nurse to report to the public health department within the next 24 hours?

a. An infant with a positive culture of stool of Shigella
b. An elderly factory worker with a lab report that is positive for acid-fast bacillus smear
c. A young adult commercial pilot with a positive histopathological examination from an induced sputum for Pneumocystis carinii
d. A middle-aged nurse with a history of varicella-zoster virus and with crops of vesicles on an erythematous base that appear on the skin

Rationale:

B is the correct answer. Tuberculosis is a reportable disease because persons who had contact with the client must be traced and often must be treated with chemoprophylaxis for a designated time. Options a and d may need contact isolation precautions. Option c findings may indicate the initial stage of the autoimmune deficency syndrome (AIDS).

Pratice Question Test

Results

#1. A nurse administers the influenza vaccine to a client in a clinic. Within 15 minutes after the immunization was given, the client complains of itchy and watery eyes, increased anxiety, and difficulty breathing. The nurse expects that the first action in the sequence of care for this client will be to

B is the correct answer. All the answers are correct given the circumstances. The correct sequence of care is to administer the epinephrine, then maintain airway. In the early stages of anaphylaxis, when the patient has not lost consciousness and is normatensive, administering the epinephrine and then applying the oxygen, watching for hypotension and shock are later responses. The prevention of a severe crisis is maintained by using diphenhydramine.
finish

A client is scheduled to receive an oral solution of radioactive iodine. In order to reduce hazards, the priority information for the nurse to include during the instructions to the client is which of these statements?

a. In the initial 48 hours avoid contact with children and pregnant women, and after urination or defecation flush the commode twice
b. Use disposable utensils for 2 days and if vomiting occurs within 10 hours of the dose, do so in the toilet and flush it twice
c. Your family can use the same bathroom that you use without any special preacautions
d. Drink plenty of water and empty your bladder often during the initial 3 days of therapy

Rationale:

A is the correct answer. The client”s urine and saliva are radioactive for 24 hours after ingestion, and vomitus is radioactive for 6 to 8 hours. The client should drink 3 to 4 liters a day for the initial 48 hours to help remove the agent from the body. Staff should limit contact with hospitalized clients to 30 minutes per day per person.

A newly admitted adult client has a diagnosis of hepatitis A. The charge nurse should reinforce to the staff members that the most significant routine infection control strategy, in addition to handwashing, to be implemented in which of these?

a. Apply appropriate signs outside and inside the room
b. Apply a mask with a shield if there is a risk of fluid splash
c. Wear a gown to change soiled linens form incontinence
d. Have gloves on while handling bedpans with feces

Rationale:

D is the correct answer. The specific measure to prevent the spread of hepatitis A is careful handling and protection while handling fecal material. All of the other actions are correct but not the most significant.

The nurse is assigned to a client newly diagnosed with active tuberculosis. Which of these protocols would be a priority for the nurse to implement?

a. Have the client cough into a tissue and dispose in a separate bag
b. Instruct the client to cover the mouth with a tissue when coughing
c. Reinforce for all to wash their hands before and after entering the room
d. Place client in a negative pressure private room and have all whoenter the room use masks with shields

Rationale:

D is correct. A client with active tuberculosis should be hospitalized in a negative pressure room to prevent respiratory droplets from leaving the room when the door is opened. Tuberculosis (TB) is caused by spore-forming mycobacteria, more often Mycobacterium tuberculosis. In developed countries the infection is airborne and is spread by inhalation of infected droplets. In underdeveloped countries (Africa, Asia, South America), the transmission also occurs by ingestion or by skin invasion, particularly when bovine TB is poorly controlled.

The school nurse is teaching the faculty the most effective methods to prevent the spread of lice in the school. The information that would be most important to include would be which of these statements?

a. The treatment requires reapplication in 8 to 10 days
b. Bedding and clothing can be boiled or steamed
c. Children are not to share hats, scarves, and combs
d. Nit combs are necessary to comb out nits.

Rationale:

C is the correct answer. Head lice live only on human beings and can be spread easily by sharing hats, combs, scarves, coats, and other items of clothing that touch the hair. All of the options are correct statements. However they do not best answer the question of how to prevent the spread of lice in a school setting.

During the care of a client with a salmonella infection, the primary nursing intervention to limit transmission is which of these approaches?

a. Wash hands thoroughly before and after client contact
b. Wear gloves when in contact with body secretions
c. Double glove when in contact with feces or vomitus
d. Wear gloves when disposing of contaminated linens

Rationale:

A is correct. Gram-negative bacilli cause Salmonella infection. Two million new cases appear each year. Lack of sanitation is the primary means of contamination. Thorough handwashing can prevent the spread of salmonella. Note that all of the options are correct actions. The primary action is to wash the hands.

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