Chapter 21 Perspectives in Infectious Disorders

Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive
Outcomes, 7th Edition
Chapter 21: Perpectives on Infectious Disorders
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. nosocomial infection.
c. viral infection.
d. nidus formation.
ANS: b
Nosocomial (hospital-acquired) infections are those acquired through some aspect of treatment
in the facility.
DIF: Cognitive Level: Knowledge REF: Text Reference: 417

TOP: Nursing Process Step: Intervention MSC:
NCLEX: Physiological Integrity
2. The nurse explaining an infection to a client with the flu would describe an infection as
a. an inflammatory response to an irritant.
b. a defect in the immune system.
c. a parasitic relationship between an organism and host.
d. a hypersensitivity reaction between a human antigen and a biologic agent.
ANS: c
Infection is a process by which an organism establishes a parasitic relationship with its host.
DIF: Cognitive Level: Comprehension REF: Text Reference: 417

TOP: Nursing Process Step: Intervention
MSC: NCLEX: Physiological Integrity
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. latent period.
d. infection curve.
ANS: c
The period when a pathogen is replicating but before it can be shed from the host is called the
latent period.

Chapter 21: Perpectives on Infectious Disorders 2

MSC: NCLEX: Health Promotion and Maintenance
4. The nurse caring for a client infected with methicillin-resistant Staphylococcus aureus
(MRSA) should
a. place the client in protective isolation.
b. encourage transfer to a long-term care facility.
c. prepare the client environment for body substance isolation (BSI) precautions.
d. encourage the client to increase fluid consumption.
ANS: c
BSI precautions are used to treat all moist and potentially infectious body substances as if they
were contaminated. The nurse uses gloves and disposes of moist material as appropriate.
DIF: Cognitive Level: Application REF: Text Reference: 425

5. A notation on a client’s 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. reports of fatigue and lassitude after the infection.
d. no systemic manifestations of disease.
ANS: d
An asymptomatic pathologic response is called a subclinical infection.

TOP: Nursing Process Step: Assessment
6. For a client thought to be in the period of communicability for influenza, the nurse will focus
the interventions on
a. protecting the client from influenza.
b. ensuring that the client does not infect others.
c. supporting the client’s immune system.
d. evaluating the client’s response to the organism.
ANS: b
The time period when an organism can be shed is called the period of communicability.

Elsevier items and derived items  2005 by Elsevier Inc.

7. The client who has giardiasis has just flown back from a 3-week diving vacation in
Honduras, where he stayed at a local hotel known for its native food. The nurse explains to
the client that he probably contracted the infection from having
a. flown on an airplane in close contact with other persons.
b. taken the necessary inoculations required to travel in Honduras.
c. eaten food and drunk beverages prepared in Honduras.
d. swam in the coastal waters of Honduras.
ANS: c
Giardiasis results form a Giardia organism that attacks the gastrointestinal system. It is
contracted from ingesting contaminated food and water in areas where sanitation is suspect.
DIF: Cognitive Level: Application REF: Text Reference: 420, Table 21-1;
8. The nurse explains to a client with vancomycin-resistant Enterococcus (VRE) that resistant
organisms evolve by
a. mutation of the pathogen.
b. the host’s weakened immune system.
c. repeated nosocomial infections.
d. untreated infections in the past.
ANS: a
Resistant organisms evolve through changes in their DNA from long-term and frequent exposure
to antibiotics.

MSC: NCLEX: Safe, Effective Care Environment;
9. The nurse managing the care of a client with hepatitis A develops a plan to eliminate
common vehicle transmission by
a. instructing the client to blow the nose vigorously.
b. having the client’s paper dishes treated as “hazardous.”
c. placing the client in a room for special respiratory isolation.
d. washing the client with a germicidal soap.
ANS: b
Common vehicle transmission involves contracting an infectious organism from a contaminated
source, such as food, water, medications, or devices.


10. The client who has mononucleosis tells the nurse he is “pretty sure I got the kissing disease
from my girlfriend.” The nurse explains that this mode of transmission, although pleasant, is
called
a. direct.
b. indirect.
c. passive.
d. sexual.
ANS: a
Direct transmission means the organism moves from an infected person (or carrier) to a
noninfected person through direct contact between their body surfaces.

11. The nurse assesses a client’s systemic manifestations of fever and malaise as the line of
defense known as
a. primary.
b. secondary.
c. partial.
d. complete.
ANS: b
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.
DIF: Cognitive Level: Analysis REF: Text Reference: 421

TOP: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
12. The home health nurse is teaching universal precautions to the wife of a client with influenza
and pressure ulcers as a way to avoid exposure to infectious disease. The wife shows that she
understands the instructions when she
a. applies an antibiotic cream to the client’s infected pressure ulcer.
b. sprays the rim of the client’s bedpan with a disinfectant before the client uses it.
c. minimizes the amount of time spent administering direct care to the client.
d. wears gloves when she discards the tissues in which the client has spit.
ANS: d
Universal, or standard, precautions apply to non-intact skin, mucous membranes, blood, and all
body fluids, secretions, and excretions except sweat.

TOP: Nursing Process Step: Evaluation

13. The nurse knows the measure that will be least effective in prevention of infection in an 88-
year-old woman hospitalized for a hip fracture is
a. deep breathing.
b. frequent turning.
c. encouraging fluids.
d. inserting a Foley catheter.
ANS: d
Urinary tract infections (UTIs) are the most common of all nosocomial infections, and about
80% stem from urethral catheterization.

TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
14. The nurse caring for a client with a minor burn infection will observe the type of precautions
known as
a. enteric precautions.
b. strict isolation.
c. universal precautions.
d. contact isolation.
ANS: d
BSI precautions are followed for all dressing and moist material from an infected client; these
items are treated as “hazardous.”

15. Reviewing an assignment, the nurse identifies the client who should be placed under airborne
precautions as the
a. 22-year-old man with amebic dysentery.
b. 34-year-old man with Lyme disease.
c. 60-year-old woman with tuberculosis.
d. 32-year-old woman with hepatitis B.
ANS: c
Airborne precautions are designed to reduce the risk of transmission of pathogens on airborne
droplet nuclei. In addition to universal and transmission precautions, the Centers for Disease
Control and Prevention (CDC) has issued special guidelines to prevent nosocomial transmission
of tuberculosis.

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

a. hysterectomy.
b. repair of a perforated bowel.
c. craniotomy for tumor removal.
d. tonsillectomy.
ANS: b
The perforated bowel would expose the entire abdomen to Escherichia coli, a bacterial organism
in the colon.

TOP: Nursing Process Step: Assessment
17. The nurse can best instruct a client to avoid the acquisition of hookworm by
a. teaching the client good hand-washing technique.
b. encouraging the client to wear shoes outdoors.
c. advising the client to drink only bottled water when traveling.
d. advising the client not to eat raw pork products.
ANS: b
Hookworm eggs are shed in feces, but hookworm larvae enter through the skin of a person
walking barefoot in soil containing hatched eggs.

18. 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 body’s 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: Cognitive Level: Analysis REF: Text Reference: 421

TOP: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity
19. 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. “Bugs are common vectors of diseases.”
b. “Indirect transmission of a disease requires a vehicle to transmit the organism.”
c. “The vehicle of transmission for an organism that causes diseases is always a
living vector.”

d. “The host environment can either allow an organism to survive or not.”

ANS: c
Organisms can have more than one route of transmission from the reservoir to the new host. In
fact, transmission can occur as contact, droplet, airborne, common vehicle, or vector
transmission.

TOP: Nursing Process Step: Evaluation
20. 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. yellow fever immunization.
c. a three-dose series of hepatitis B vaccine.
d. immunization against cholera.
ANS: c
The 1991 CDC recommendations for hepatitis B immunization of high-risk individuals,
including health care professionals, includes a complete series of three doses within 6 months.
DIF: Cognitive Level: Knowledge REF: Text Reference: 427, Table 21-3;
TOP: Nursing Process Step: N/A MSC: NCLEX: N/A
21. 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. 3 days.
ANS: c
Bacteria introduced into the urinary collection system can migrate to the bladder in 24 to 48
hours.


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Black & Hawks: Medical-Surgical Nursing: Clinical Management for Positive

Outcomes, 7th Edition

Chapter 21: Perpectives on Infectious Disorders

DIF: Cognitive Level: Knowledge REF: Text Reference: 417

DIF: Cognitive Level: Comprehension REF: Text Reference: 417

DIF: Cognitive Level: Comprehension REF: Text Reference: 421

TOP: Nursing Process Step: Intervention

DIF: Cognitive Level: Application REF: Text Reference: 425

DIF: Cognitive Level: Application REF: Text Reference: 421

DIF: Cognitive Level: Application REF: Text Reference: 421

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 424

DIF: Cognitive Level: Application REF: Text Reference: 426

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 419

DIF: Cognitive Level: Analysis REF: Text Reference: 421

DIF: Cognitive Level: Application REF: Text Reference: 429

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Comprehension REF: Text Reference: 421

DIF: Cognitive Level: Application REF: Text Reference: 429

DIF: Cognitive Level: Application REF: Text Reference: 429

Elsevier items and derived items  2005 by Elsevier Inc.

DIF: Cognitive Level: Application REF: Text Reference: 421

DIF: Cognitive Level: Comprehension REF: Text Reference: 419

DIF: Cognitive Level: Analysis REF: Text Reference: 421

Elsevier items and derived items  2005 by Elsevier Inc.

d. “The host environment can either allow an organism to survive or not.”

DIF: Cognitive Level: Application REF: Text Reference: 419

DIF: Cognitive Level: Application REF: Text Reference: 422

Elsevier items and derived items  2005 by Elsevier Inc.

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