COMMUNICABLE DISEASES
Q&A
1. 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
C-
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. Visitors should wash their
hands before and after touching the client.
2. 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
B-
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.
3. 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
C-
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.
4. 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
D-
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.
5. 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
B-
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).
6. A client is scheduled to receive an oral solution of radioactive iodine (131I). 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
A-
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.
7. 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 is 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
D-
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.
8. 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
D-
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), transmission also occurs by ingestion or by skin
invasion, particularly when bovine TB is poorly controlled
9. 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.
C-
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.
10. 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
A-
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. However, the primary
action is to wash the hands.
11. 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
a. Maintain the airway
b. Administer epinephrine 1:1000 as ordered
c. Monitor for hypotension with shock
d. Administer diphenhydramine as ordered
B-
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.
12. A client with a diagnosis of Methicillin resistant Staphylococcus aureus (MRSA) has died.
Which type of precautions is the appropriate type to use when performing postmortem care?
a. Airborne precautions
b. droplet precautions
Q&A
1. 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
C-
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. Visitors should wash their
hands before and after touching the client.
2. 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
B-
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.
3. 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
C-
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.
4. 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
D-
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.
5. 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
B-
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).
6. A client is scheduled to receive an oral solution of radioactive iodine (131I). 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
A-
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.
7. 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 is 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
D-
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.
8. 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
D-
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), transmission also occurs by ingestion or by skin
invasion, particularly when bovine TB is poorly controlled
9. 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.
C-
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.
10. 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
A-
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. However, the primary
action is to wash the hands.
11. 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
a. Maintain the airway
b. Administer epinephrine 1:1000 as ordered
c. Monitor for hypotension with shock
d. Administer diphenhydramine as ordered
B-
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.
12. A client with a diagnosis of Methicillin resistant Staphylococcus aureus (MRSA) has died.
Which type of precautions is the appropriate type to use when performing postmortem care?
a. Airborne precautions
b. droplet precautions
