3rd_Ed Test Bank Foundations of Nursing in the Community by Stanhope_Lancaster
Chapter 26: Infectious Disease Prevention and Control
1. Worldwide, what is the number-one cause of death?
a. Chronic diseases (heart disease, cancer, stroke)
b. Infectious diseases
c. Injuries (accidental or purposeful)
In countries with higher standards of living, where people live longer, chronic diseases—heart disease, cancer, and stroke—are the leading causes of death. Infectious diseases, however, are still the number-one cause of death worldwide.
DIF: Cognitive Level: Knowledge REF: p. 485
2. VRSA and MRSA were formerly found primarily in hospitals, but where are outbreaks currently on the rise?
a. Areas where people share dressing or bathing facilities
b. Day care centers and schools
c. Long-term care facilities
d. Senior citizen centers
Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, and other close bathing areas.
DIF: Cognitive Level: Knowledge REF: p. 486
3. Which component of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics?
d. Agent and host
The antibiotic therapy eliminates a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman’s body, which causes a change in the vaginal environment and allows normally present fungi to proliferate, resulting in a yeast infection.
DIF: Cognitive Level: Synthesis REF: p. 487
4. During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. What sort of immunity will follow?
a. Active immunity
b. Long-lasting immunity
c. Natural immunity
d. Passive immunity
Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a nonimmunized individual, such as the transfer of antibody by administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination.
DIF: Cognitive Level: Application REF: p. 487
5. A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. “Why,” he asks, “should my tax dollars be used to pay for their children to be immunized?” What might be your response?
a. “Immunizations are required by law, and if their parents can’t afford it, you and I will have to pay for it.”
b. “It’s just the right thing to do.”
c. “Only by making sure most kids are immunized can we stop epidemics that might hurt all of us.”
d. “We’re a religious God-fearing community, and we take care of each other.”
Herd immunity is the resistance of a group of people to invasion and spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease.
DIF: Cognitive Level: Application REF: p. 487
6. Which represents an example of infectious disease spreading via a vector?
a. Being bitten by an infected mosquito
b. Disease spreading from infected mother to infant via the placenta
c. A group of partygoers hugging and shaking hands
d. Two persons, one of whom is infected, sharing a glass of soda
Vertical transmission is the passing of infection from parent to offspring via placenta. Horizontal transmission is the person-to-person spread of infection through (among other ways) contact. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, or other substance. Vectors include mosquitoes, which can transmit the infectious agent by biting the host.
DIF: Cognitive Level: Application REF: p. 488
7. What conclusion should the nurse draw when her Mantoux test is positive for exposure to tuberculosis?
a. The nurse has been exposed to tuberculosis.
b. The nurse has tuberculosis.
c. The positive test result probably is due a problem in the testing process.
d. The test is inaccurate and needs to be repeated.
An individual who tests positive has been exposed and may be infected, but if that person shows no clinical signs, the person is not diseased. Infection refers to the entry, development, and multiplication of the infectious agent in the susceptible host. Disease is one of the possible outcomes of infection. People with latent TB have no symptoms, are not infectious, and can continue on with life. They may develop active TB. A nurse who interacts with clients may receive INH for a year as a precaution.
DIF: Cognitive Level: Knowledge REF: p. 488
8. A student engages in unprotected sex under the influence of alcohol. Having an HIV test immediately afterward seems like the rational thing to do. Based on known statistics, what will the student’s HIV test probably show?
a. The results will probably be negative for HIV.
b. The results will probably be positive for HIV.
c. The probability of disease is so low, there is no reason to be tested.
d. The test results won’t be reliable so soon after exposure.
It may take up to 6 months after exposure to the HIV virus before an HIV antibody test can test positive, although most infected people will test positive within 3 months. A negative test, therefore, is not a reliable indicator of infection status if exposure is very recent. The incubation period or the time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease may be between 10 and 15 years for AIDS.
DIF: Cognitive Level: Synthesis REF: Entire chapter
9. Where should the nurse look to determine whether other communities are also having an epidemic of measles?
a. Centers for Disease Control and Prevention Weekly Report
b. Communicable Diseases Weekly Report
c. Morbidity and Mortality Weekly Report
d. Weekly National Report of Communicable Diseases
Requirements for disease reporting in the United States are mandated by state rather than federal law. The list of reportable diseases varies by state. State health departments, on a voluntary basis, report cases of selected diseases to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The National Notifiable Diseases Surveillance System (NNDSS) data are collated and published weekly in the Morbidity and Mortality Weekly Report (MMWR).
DIF: Cognitive Level: Knowledge REF: p. 489
10. There is great concern in the nurse’s community over three local cases of West Nile virus. How can the nurse best use this concern to help the community to become involved?
a. Ask the state department of health for assistance
b. Demand that everyone over age 65 become immunized immediately
c. Encourage immunization of all children under 12
d. Have an educational campaign to remove any containers of standing water
Periodic outbreaks of West Nile virus appear to result from a complex interaction of multiple factors, including weather—especially hot, dry summers followed by rain, which influences mosquito breeding sites and population growth. Removing standing water will remove mosquito breeding sites.
DIF: Cognitive Level: Application REF: p. 491
11. What is the most probable cause of the increase in new emerging infectious diseases?
a. Activities or behavior of humans, including changes in the environment
b. Increasing urbanization and growth in new housing materials
c. New infectious agents are evolving throughout the world
d. Overpopulation in many areas, creating a need to reduce global population
Most of the emergence factors are consequences of activities and behavior of the human hosts and of environmental changes such as deforestation, urbanization, and industrialization. For example, the rise in households with two working parents has increased the number of children in day care, and with this shift has come an increase in diarrheal diseases such as shigellosis. Urbanization is not a problem, but increasing development into formerly unaffected areas such as rainforests is.
DIF: Cognitive Level: Knowledge REF: p. 492
12. What is the current goal in relation to communicable diseases?
a. To control political borders so diseases cannot spread further
b. To exterminate specific infectious agents one by one
c. To expand health care facilities to improve infectious disease treatment
d. To achieve worldwide immunization to control new cases
The goal of prevention and control programs is to reduce the prevalence of a disease to a level at which it no longer poses a major public health problem. In some cases, diseases may even be eliminated or eradicated. The goal of elimination is to remove a disease from a large geographical area (e.g., a country or region of the world), such as has been done with polio in the Americas. Eradication is the irreversible termination of all transmission of infection by extermination of the infectious agents worldwide, as has been done with smallpox.
DIF: Cognitive Level: Knowledge REF: p. 492
13. Which biological warfare agent would pose the greatest bioterrorism threat to a community?
Because of factors such as the ability to become an aerosol, the resistance to environmental degradation, and a high fatality rate, inhalational anthrax is considered to have an extremely high potential for being the single greatest biological warfare threat.
DIF: Cognitive Level: Knowledge REF: p. 495
14. What public health action has been particularly instrumental in reducing childhood infectious diseases in the United States?
a. Answering parents’ questions about the safety and importance of vaccines today
b. Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen
c. “No shots, no school” legislation, which legally requires children be immunized before school
d. Offering all immunizations to all children free of any charge
Vaccines are one of the most effective methods of preventing and controlling communicable diseases. Hopefully, all nurses answer questions, remind colleagues to think about immunizations whenever a child is seen, and encourage continuing free or low-cost immunization clinics. One of the most effective programs has been the “no shots, no school” legislation, which has resulted in the immunization of most children by the time they enter school.
DIF: Cognitive Level: Knowledge REF: p. 496
15. A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student’s cheeks. What should the college health nurse do?
a. Inform all students, staff, and faculty of a possible rubella epidemic.
b. Inform all students, staff, and faculty of a possible measles epidemic.
c. Reassure the student that it is just a bad cold and will soon pass.
d. Tell the student to take two aspirin, acetaminophen, or ibuprofen and drink lots of fluids while resting.
Measles is an acute, highly contagious disease that, although considered a childhood illness, is often seen in the United States in adolescents and young adults. Symptoms include fever, sneezing, coughing, conjunctivitis, small white spots on the inside of the cheek (Koplik spots), and a red, blotchy rash beginning several days after the respiratory signs. Measles is serious. Around 10 % of measles cases require hospital admission. It can lead to pneumonia and encephalitis, and it can kill. Persons who may have been exposed should be informed that anyone under 18 who has not received both immunization doses should receive measles vaccine.
DIF: Cognitive Level: Application REF: p. 497
16. An instructor is reviewing Salmonella infections with her class. Which comment indicates that the student needs further review on how Salmonella is spread?
a. “Certain pets and farm animals may be Salmonella carriers.”
b. “It is possible to transmit Salmonella by person-to-person contact.”
c. “Salmonella may be spread by spores that form once contaminated blood is exposed to the air.”
d. “Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs.”
Meat, poultry, and eggs are the foods most often associated with salmonellosis outbreaks. Animals are the common reservoir for the various Salmonella serotypes, although infected humans may also fill this role. Animals are more likely to be chronic carriers. Reptiles such as iguanas have been implicated as Salmonella carriers, along with pet turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person transmission is an important consideration in day care and institutional settings. Anthrax (not Salmonella) forms spores when infected blood is exposed to air.
DIF: Cognitive Level: Application REF: p. 501
17. What is the most common vector-borne disease in the United States?
c. Lyme disease
d. Rocky Mountain spotted fever
All four are diseases borne by ticks as the vectors. Lyme disease became a nationally notifiable disease in 1991 and is now the most common vector-borne disease in the United States.
DIF: Cognitive Level: Knowledge REF: p. 502
18. What is the most common vector-borne disease worldwide?
c. Onchocerciasis (river blindness)
d. Yellow fever
Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion people at risk and more than 275 million cases reported each year. Over one million children die of malaria each year. Dengue is the second most common vector-borne disease.
DIF: Cognitive Level: Knowledge REF: p. 503
19. A student complains to the college health nurse that her academic work has been going downhill because of lack of sleep. “My 3-year-old probably misses her babysitter since she has started going to the big day care center. She hasn’t been sleeping well and keeps scratching her bottom. Hopefully, she’ll adapt to day care soon.” What advice should the nurse give?
a. “Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime.”
b. “Your daughter may have pinworms; let me teach you how to check for this.”
c. “Perhaps your child is not developmentally ready for group play.”
d. “Try to arrange more one-on-one time with your 3-year-old.”
Enterobiasis (pinworm infection) is the most common helminthic infection in the United States with about 42 million cases a year. This infection is seen most often among children in institutional settings. Pinworms cause itching, especially around the anus, which can result in a lack of sleep for both child and caregiver.
DIF: Cognitive Level: Application REF: p. 504
20. At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase “a virulent organism.” The nurse explains that this means the organism causing the disease is able to do what?
a. Bypass normal immunological response mechanisms
b. Invade major organ systems
c. Produce toxins and poisons that weaken the body
d. Produce very severe physical reactions
Virulence is the ability to produce a severe pathological reaction.
DIF: Cognitive Level: Application REF: p. 487 (Box 26-1)
21. Which infectious disease intervention represents primary prevention?
a. A client receives a tetanus booster every 10 years.
b. A client receives a tetanus booster after stepping on a nail.
c. A client receives tetanus immunoglobulin after stepping on a nail.
d. A client with tetanus is given antibiotics and is placed on seizure precautions.
Tetanus boosters given before exposure are a measure of primary prevention because exposure has not yet occurred. If given after exposure (i.e., the client may be infected but disease has not developed), they are considered secondary prevention (similar to the textbook examples of immunoglobulin and rabies immunizations given after exposure). Immunoglobulin would be given if the client had not been previously immunized; however, this again is after exposure, so it is secondary prevention. Because the client has the condition, treatment is aimed at prevention of further injury.
DIF: Cognitive Level: Knowledge REF: p. 494 (Levels of Prevention box)
22. Which infectious disease intervention represents secondary prevention?
a. Clients with HIV infection are encouraged to use condoms to protect sexual partners.
b. Clients with HIV infection are given medications to improve immunological response.
c. Health care workers are encouraged to receive annual vaccinations for influenza.
d. Health care workers are required to have a tuberculosis skin test or chest x-ray.
Tuberculosis screening for health care workers is an example of secondary prevention. TB skin tests and chest x-rays are methods of tuberculosis screening. Encouraging clients with HIV to use condoms is an example of primary prevention, because the goal is to prevent exposure to the partner. Encouraging annual influenza vaccinations is also an example of primary prevention. Giving clients with HIV medications is an example of tertiary prevention, because the goal is to reduce complications in those already having the infection.
DIF: Cognitive Level: Application REF: p. 494 (Levels of Prevention box)
23. Which approach to helping prevent foodborne disease would most likely be controversial?
a. Farmworkers receiving education on safe use of pesticides
b. Health exams of those employed in food processing facilities
c. Irradiation of meat and poultry
d. Unannounced inspections of food processing plants
Irradiation of meat and poultry is one option being used to prevent outbreaks of foodborne disease. However, there is debate about whether food is equally nutritious and safe after irradiation.
DIF: Cognitive Level: Synthesis REF: p. 501
1. Six students order meals at the local mom-and-pop restaurant. Which students are at high risk for illness? Select all that apply.
a. The first student asks for a salad with chicken strips and dressing on the side.
b. The second student asks for a hamburger, very rare.
c. The third student orders a tuna salad sandwich with extra mayonnaise.
d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast.
e. The fifth student asks for the recipe of the week, Carpaccio (raw beef tenderloin).
f. The sixth student orders two tomato-and-cheese pizza slices.
ANS: B, D, E
Escherichia coli O157:H7 can produce a strong cytotoxin that can cause a potentially fatal hemorrhagic colitis. Hamburger is often involved in outbreaks, since the grinding process exposes pathogens on the surface of the whole meat to the interior of the ground meat, effectively mixing the once-exterior bacteria thoroughly throughout the hamburger so that searing the surface no longer suffices to kill all bacteria. Also, hamburger is often made of meat ground from several sources. The best protection against foodborne pathogens is to thoroughly cook food before eating it. Salmonella is also transmitted by undercooked foods such as eggs, poultry, dairy products, and seafood. Consequently, students eating very rare hamburger, undercooked eggs, or raw beef are at high risk.
DIF: Cognitive Level: Application REF: p. 501
2. Experts are concerned that smallpox could be used in a bioterrorist attack. What symptom might suggest smallpox as opposed to the more common and much less dangerous chickenpox? Select all that apply.
a. Child appears only mildly ill until late stages in smallpox.
b. Lesions appear in various stages in the same area of the body rather than all at once.
c. Rash lesions are most abundant on the face and extremities, not on the trunk.
d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever.
e. Rash is macular and then vesicular but does not become pustular in smallpox.
f. Vesicles are deep seated instead of superficial.
ANS: C, D, F
Symptoms of smallpox include rash lesions on face and extremities, rash that occurs 2 to 4 days after onset of fever, and vesicles that are deep seated.
DIF: Cognitive Level: Knowledge REF: p. 495 (How To box)
3. The advanced practice nurse explains that the client has an upper respiratory infection (URI) and suggests several measures that might make the client more comfortable. Why won’t the nurse just prescribe some antibiotics as the client repeatedly requests? Select all that apply.
a. Antibiotics are expensive, whereas the support measures would be almost free of cost.
b. Clients cannot suggest treatments to care providers.
c. Clinics cannot afford to continually give antibiotics to anyone who asks for them.
d. In the midst of a flu epidemic, the supply of antibiotics is dangerously low.
e. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs.
f. Viral diseases are not affected by antibiotics.
ANS: E, F
Antibiotics are not effective against viral diseases, a fact found unacceptable to many clients looking for relief from the misery of a cold or flu. The inappropriate prescribing of antibiotics contributes to the growing problem of infectious agents that have developed resistance to once-powerful antibiotics.
DIF: Cognitive Level: Application REF: p. 485 (Briefly Noted box)
3rd_Ed Test Bank Foundations of Nursing in the Community by Stanhope_Lancaster