NSG 550/ NSG550 Exam 2 V2 – Diagnostic Reasoning for Nurse Practitioners Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 550/ NSG550 Exam 2 V2 – Diagnostic Reasoning for Nurse Practitioners Guide| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A How does aging affect the immune system's response to infection? Decreased antibody production, lymphocytes, and fever response What changes occur in the integumentary system of older patients that may increase infection risk? Thinning skin, decreased subcutaneous tissue, decreased vascularity, slower wound healing What respiratory system changes in older patients can contribute to infection risk? Decreased cough and gag reflexes How does aging affect the GI system and infection risk? Decreased gastric acid and intestinal motility What chronic illnesses in older patients may increase their susceptibility to infections? Diabetes mellitus, chronic obstructive pulmonary disease, neurologic impairments What functional and cognitive impairments in older patients can elevate infection risk? Immobility, incontinence, dementia What role do invasive devices play in increasing infection risk for older patients? Urinary catheters, feeding tubes, IV devices, tracheostomy tubes How does institutionalization impact infection risk in older patients? Increased person-to-person contact and transmission Recommended Immunizations for Older Adults • Pneumococcal 13-valent conjugate vaccine to prevent pneumonia • Pneumococcal vaccine polyvalent vaccine to prevent pneumonia • Yearly influenza vaccine (trivalent or quadrivalent) to prevent influenza (flu) • Zoster vaccine recombinant to prevent shingles (herpes zoster) • Adult Tdap vaccine to prevent tetanus, diphtheria, and pertussis (whooping cough) (and Tdap booster every 10 years) When should you wash your hands with soap and water? When hands are visibly soiled or contaminated with proteinaceous material or visibly soiled with blood or other body fluids. When is it appropriate to use an alcohol-based hand rub? If hands are not visibly soiled, use an alcohol-based hand rub (ABHR) for decontaminating hands or wash with soap and water. Why is it important to decontaminate hands before direct patient contact? To prevent the spread of infections, decontaminate hands before having direct contact with patients. When should you decontaminate hands before donning sterile gloves? Decontaminate hands before donning sterile gloves to perform procedures like inserting an invasive device. When should you decontaminate hands after contact with a patient? Decontaminate hands after contact with a patient's intact skin, body fluids, excretions, or secretions. Why is it important to decontaminate hands after removing gloves? To prevent cross-contamination, decontaminate hands after removing gloves. When should you decontaminate hands after contact with inanimate objects near the patient? Decontaminate hands after contact with inanimate objects, including medical equipment, in the immediate vicinity of the patient. Do not use an ABHR before when inserting eyedrops, ointments, or contact lenses because alcohol can irritate the patient's eyes, causing burning and redness. Standard Precautions: - Handwashing or Alcohol Based Hand Rubs - Donning Gloves - Posted Signs - Covering nose and mouth with tissue and prompt tisssue disposal or using Surgical Masks - Seperation from the person with respiratory infection more than 3-6 feet Airborne Precautions Equipment: Gown, Gloves, Mask w/ PAPR or N95 HEP A filter 1. Private room required with monitored negative airflow (with appropriate number of air exchanges and air discharge to outside or through HEPA filter); keep door(s) closed 2. Special respiratory protection: • Wear PAPR for known or suspected TB • Susceptible people not to enter room of patient with known or suspected measles or varicella unless immune caregivers are not available • Susceptible people who must enter room must wear PAPR or N95 HEPA filter 3. Transport: patient to leave room only for essential clinical reasons, wearing surgical mask Disease examples for airborne precautions • Measles (rubeola) • Mycobacterium tuberculosis, including multidrug-resistant TB (MDRTB) • Varicella (chickenpox); disseminated zoster (shingles) • COVID-19 (likely spread as airborne) Droplet Precautions Equipment: Gown, Gloves, Mask 1. Private room preferred: if not available, may cohort with patient with same active infection with same microorganisms if no other infection present; maintain distance of at least 3 feet from other patients if private room not available 2. Mask: required when working within 3 to 6 feet of patient 3. Transport: patient to leave room only for essential clinical reasons, wearing surgical mask Droplet Precautions disease examples • Diphtheria (pharyngeal) • Streptococcal pharyngitis • Pneumonia • Influenza • Rubella • Invasive disease (meningitis, pneumonia, sepsis) caused by Haemophilus influenzae type B or Neisseria meningitidis • Mumps • Pertussis • COVID-19 (coronavirus) Contact Precautions 1. Private room preferred: if not available, may cohort with patient with same active infection with same microorganisms if no other infection present 2. Wear gloves when entering room 3. Wash hands with antimicrobial soap before leaving patient's room 4. Wear gown to prevent contact with patient or contaminated items or if patient has uncontrolled body fluids; remove gown before leaving room 5. Transport: patient to leave room only for essential clinical reasons; during transport, use needed precautions to prevent disease transmission 6. Dedicated equipment for this patient only (or disinfect after use before taking from room) Contact Precaution Disease examples • Clostridium difficile • Colonization or infection caused by multidrug-resistant organisms (e.g., MRSA, VRE) • Pediculosis • Respiratory syncytial virus • Scabies Disinfection Definition A cleaning process that does not kill spores and only ensures a reduction in the level of disease causing organisms. High-level disinfection is adequate when an item is going inside the body where the patient has resident bacteria or normal flora (e.g., GI and respiratory tracts). Sterilization Definition A cleaning process that destroys all living microorganisms and bacterial spores. All items or devices that invade human tissue where bacteria are not commonly found should be sterilized. Methods of Infection Control and Prevention According to CDC • Hand hygiene • Disinfection and sterilization • Standard Precautions • Transmission-Based Precautions • Staff and patient placement and cohorting Methicillin-Resistant Staphylococcus aureus (MRSA) Precautions - Contact Precautions. - Treatment (IV ceftaroline fosamil is the first cephalosporin antibiotic approved to treat MRSA) - bathing patients with chlorhexidine wipes and administering nasal mupirocin ointment to decrease microbes • Performing frequent hand hygiene, including using hand sanitizers • Avoiding close contact with people who have infectious wounds • Avoiding large crowds • Avoiding contaminated surfaces • Using good overall hygiene Vancomycin-Resistant Enterococcus (VRE) Precautions - Contact Precautions - VRE can live on almost any surface for days or weeks and still be able to cause an infection. - discontinue Contact Precautions after at least one negative stool or rectal swab culture after antimicrobial therapy is discontinued. Clostridium difficile (C. diff) Precautions - Contact Precautions - Patient's room should be disinfected with a sporicidal cleaning product - Wash hands w/ Soap and Water to kill spores Gastroesophageal reflux disease (GERD) Risk Factors - Overweight or Obesity - Older Age - Sleep Apnea - NG Tube - Helicobacter pylori - Factors Contributing to Decreased Lower Esophageal Sphincter Pressure: • Caffeinated beverages • Coffee, tea, and cola • Chocolate • Nitrates • Citrus Fruits • Tomatoes and Tomato products • Alcohol • Peppermint, spearmint • Smoking and use of other tobacco products • Calcium channel blockers • Anticholinergic drugs • High levels of estrogen and progesterone • Nasogastric tube placement Gastroesophageal reflux disease (GERD) Key Features/Signs and Symptoms/Physical Assessment: • Dyspepsia (indigestion) After Each Meal for 20min to 2hrs - Worse Symptoms while Dying Down • Regurgitation (may lead to aspiration or bronchitis) • Water brash (hypersalivation) • Dental caries (severe cases) • Dysphagia • Odynophagia (painful swallowing) • Globus (feeling of something in back of throat • Pharyngitis • Coughing, hoarseness, or wheezing at night • Chest pain • Pyrosis (heartburn) • Epigastric pain • Generalized abdominal pain • Belching • Flatulence • Nausea Gastroesophageal reflux disease (GERD) History Cues - history of heartburn or atypical chest pain associated with the reflux of GI contents. - newly diagnosed with asthma, - experienced morning hoarseness, or has coughing or wheezing, especially at night. - dysphagia and odynophagia (painful swallowing), which can accompany chronic GERD. Gastroesophageal reflux disease (GERD) Psychosocial Assessment - fearing that they are having a myocardial infarction Gastroesophageal reflux disease (GERD) Diagnostic Assessment - classic GERD symptoms are diagnosed on the basis of clinical symptoms and history alone - Atypical symptoms may benefit from an upper endoscopy (also called esophagogastroduodenoscopy [EGD]). - Ambulatory esophageal pH monitoring is the most accurate method of diagnosing GERD Gastroesophageal reflux disease (GERD) Intervention Teaching Points - Teach the patient that GERD is a chronic disorder that requires ongoing management. - Avoid Irritating Foods (peppermint, chocolate, fatty foods (especially fried), caffeine, and carbonated beverages) - Restrict spicy and acidic foods (e.g., orange juice, tomatoes) until esophageal healing occurs. - Recommend applications ("apps") that can help the patient follow a healthier diet - Recommend eating four to six small meals each day rather than three large ones. - Avoid eating at least 3 hours before going to bed - sleep propped up to promote gas exchange - sleep on Right Side - alcohol and tobacco should be avoided, - Discourage heavy lifting, straining, and working in a position in which the patient bends at the abdomen. - Encourage comfortable, nonrestrictive clothing. Gastroesophageal reflux disease (GERD) Drug Therapy - Some drugs lower LES pressure and cause reflux; these include: Oral contraceptives, Anticholinergic agents, Sedatives, NSAIDs (e.g., ibuprofen), Nitrates, Calcium Channel Blockers. Peptic ulcer disease (PUD) definition A condition that results when GI mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin. Peptic ulcer disease (PUD) types of ulcers duodenal ulcers, gastric ulcers, and stress ulcers (less common) Peptic ulcer disease (PUD) Risk Factors - H. pylori infection - NSAID's - Corticosteroids - Severe Stress - Family History - Excess Alcohol Consumption Peptic ulcer disease (PUD) History Cues - patient is taking corticosteroids, chemotherapy, or NSAIDs - any GI surgeries, especially a partial gastrectomy, which can cause chronic gastritis. - alcohol intake and tobacco use - A history of GI upset, pain and its relationship to eating and sleep patterns - pain that was once intermittent and relieved by food and antacids becomes constant and radiates to the back or upper quadrant, the patient may have ulcer perforation Peptic ulcer disease (PUD) Physical Assessment/Signs and Symptoms - Epigastric tenderness and pain - Rigid, boardlike abdomen accompanied by rebound tenderness and intense pain (peritonitis). - Hyperactive bowel sounds, but these may diminish with progression of the infection. - Dyspepsia (indegestion) is the most commonly reported symptom associated with PUD. It is typically described as sharp, burning, or gnawing pain. - fluid volume deficit that may occur from a bleeding ulcer, take orthostatic blood pressures and monitor for signs and symptoms of dehydration Peptic ulcer disease (PUD) Laboratory Assessment - Detecting H. pylori in the patient’s blood, breath, or stool - urea breath test involves swallowing a capsule, liquid, or pudding that contains urea with a special carbon atom. After a few minutes the patient exhales; and, if the special carbon atom is found, the bacterium is present. - Stool antigen test is performed on a stool sample provided by the patient, which is tested for H. pylori antigens. - decreased hemoglobin and hematocrit values. The stool may also be positive for occult (not seen) blood if bleeding is present Peptic ulcer disease (PUD) Diagnostic Assessment The major diagnostic test for PUD is esophagogastroduodenoscopy (EGD), which is the most accurate means of establishing a diagnosis.