A kid is receiving a series of Hep B vaccines and

COMMUNICABLE DISEASES arrives for a second dose. Before giving the nurse
should ask the kid and parent about a history of a
The nurse provides home care instructions to the severe allergic reaction to what?
parents of a child hospitalized with pertussis who is
in the convalescent stage and is being prepared for 1. Eggs
d/c. What statement made by parent indicates a 2. PCN
NEED for further instruction? 3. Sulfonamides
4. A previous dose of HEP B vaccine or component
1. We need to encourage our child to drink fluids
2. Coughing spells may be triggered by dust or 4
smoke * A contraindication is a previous reaction to a
3. Vomiting may occur when our child has previous dose of HEP B or a component
coughing episodes ( aluminum hydroxide or yeast protein)
4. We need to maintain droplet precautions and a
quiet environment for at least 2 weeks A nurse visits a child with Mono and provides care
instructions to the parents. Which instruction should
4 the nurse give the parents?
* pertussis is transmitted by direct contact or resp.
droplets from coughing 1. maintain bed rest for 2 weeks
2. maintain Resp. precautions for 1 week
An infant receives a a DTaP immunization at a well 3. Notify HCP if kid develops a fever
baby clinic. The parent returns home and calls the 4. Notify HCP if child develops ABD pain Left
clinic and reports swelling & redness at the shoulder pain
injection site. Which is an appropriate action?
4
1. Monitor the infant for a fever * Mono is caused by Epstein- Barr virus. Parents
2. Bring the infant back to clinic need to report pain in ABD, especially in LUQ or
3. Apply hot pack left shoulder pain ; this may indicate that the spleen
4. Apply cold pack has ruptured.

4 A 4 month old comes to clinic for shots. The child

* On occasion tenderness, swelling and redness is up to date. What vaccines should the kid get at
appear at the site of a DTaP injection. Cold packs this time?
for the first 24 hrs, followed by cold or warm
compresses if inflammation persist. 1. varicella, HEP B
2. DTaP, MMR, IPV
A child is scheduled to receive inactivitated Polio 3. MMR, Hib, DTaP
vaccine (IPV) and the nurse preparing the vaccine 4. DTaP, hib, PCV, RV
reviews the kids chart. The nurse should question
this if what is in the kids chart? 4
DTap, hib, PVC and RV are given at 4 months
1. Recent recovery from cold
2. A history of frequent respiratory infections A nurse prepares to give a MMR to a 5 yr old. What
3. A history of an anaphyalactic reaction to route should this be given?
neomycin
4. A local reaction at the site if injection of a 1. Sub Q in the gluteal muscle
previous IPV 2. IM in the deltoid
3. subq in the outer aspect of the upper arm
3 4. IM in the anterolateral aspect of the thigh
*This contains neomycin
3 B - If an infectious disease is transmitted directly from
MMR is given subq in the outer aspect of the upper one person to another, it is a communicable disease.
arm Portals of entry and exit are the mechanisms of disease
transmission. A susceptible host is a person who can
A kid with rubeola (measles) is being admitted to
acquire an infection.
hosp. The nurse should plan for which precaution
In infectious diseases such as hepatitis B and C, a
1. enteric reservoir for pathogens is:
2. airborne
3. protective
4. neutropenic A) The blood
B) The urinary tract
2
C) The respiratory tract
* rubeola is transmitted via airborne particles and D) The reproductive tract
dirsct contact with the infectious drops. People
involved with the kid should wear a mask, private A - The blood is a reservoir for pathogens in hepatitis B
room, door remains closed, and C. Neither organism can survive in the urinary,
reproductive, or respiratory tract
A nurse is assessing a kid who is scheduled to
receive a live vaccine. What are the general The most effective way to break the chain of infection is
contraindications associated with receiving a live by:
virus vaccine? SELECT ALL

1. The kid has symptoms of a cold A) Practicing good hand hygiene

2. The child has a previous anaphylactic reaction to B) Wearing gloves
the vaccine C) Placing clients in isolation
3. mother reports the kid is having intermittent D) Providing private rooms for clients
episodes of diarrhea
4. mother reports that the kid has had no appetite A - Good hand hygiene is the most effective way to
and has been fussy break the chain of infection. Wearing gloves can help in
5. The kid has a severely deficient immune system decreasing disease transmission, but clean hands are
6. Mother reports that the kid has recently been required for it to be truly effective. Placing clients in
exposed to infectious disease
isolation is costly and often unnecessary, and clients can
2, 5 be psychologically harmed by isolation. Even providing
private rooms for clients will not be effective if health
The contraindications for this are a previous care workers do not follow good hand hygiene
anaphylactic episode, weakened immune systems, practices.
those with a severe sensitivity to gelatin, or
pregnant women A nurse is assigned to care for a client with a deep
wound infection. Which of the following actions would
If an infectious disease can be transmitted directly from result in the contamination of sterile gloves?
one person to another, it is:

A) The nurse grasps a sterile cotton-tipped swab to

A) A susceptible host clean wound edges.
B) A communicable disease B) The nurse takes a gauze pad in hand and places it in
C) A portal of entry to a host the wound.
D) A portal of exit from the reservoir C) The nurse picks up a gauze pad soaked in sterile
saline to cleanse the wound.
D) The nurse pulls up the sheet over the client's When a nurse is performing surgical hand hygiene, the
perineum for better draping. nurse must keep the hands:

D - If the nurse touches a sheet (nonsterile) with sterile

gloves, the gloves are contaminated. The other actions A) Above the elbows
do not contaminate sterile gloves. B) Below the elbows
C) At a 45-degree angle
A client is isolated because the client has pulmonary D) In a comfortable position
tuberculosis. The nurse notes that the client seems
angry but knows this is a normal response to isolation. A - When surgical hand hygiene is performed, the hands
The best intervention is to: should always be kept above the elbows so that the
water runs from the hands to the elbows.

A) Provide a dark, quiet room to calm the client. To remove a glove that is contaminated, what should
B) Explain the isolation procedures and provide the nurse do first?
meaningful stimulation.
C) Reduce the level of precautions to keep the client
from becoming angry. A) Rinse the glove before removing it to minimize
contamination.
D) Limit family and other caregiver visits to reduce the
risk of spreading the infection B) Pull the glove off the back of the hand until it slides
off the entire hand and discard it.
B - When a client is in isolation, the nurse should take C) Grasp the outside of the cuff or palm of the glove and
measures to improve the client's stimulation and make pull it away from the hand without touching the wrist or
sure to explain the isolation procedures. Darkening the fingers.
room can increase the sense of isolation. The nurse D) Put the thumb inside the wrist to slide the glove over
should not change the isolation level but should provide the hand with minimal touching of the hand by the
plenty of emotional support and make time for the other gloved hand.
client to prevent a sense of isolation. As long as family
and caregivers follow infection precautions, there is no C - When the outside of the cuff is grasped with the
contaminated gloved hand, then dirty to dirty
reason to limit contact with these individuals.
remains intact. Pulling the glove away from the
A gown should be worn when: hand entirely without touching the wrist or fingers
further minimizes the contamination by the gloved
hand. If the nurse puts the gloved thumb inside the
A) The client's hygiene is poor. glove, the nurse has contaminated the bare hand
B) The client has acquired immunodeficiency syndrome
with a contaminated thumb. Pulling the glove off by
holding it at the back sounds good and could
(AIDS) or hepatitis.
minimize contamination, but it is very difficulty to
C) The nurse is assisting with medication administration. remove a glove this way without the risk of tearing
D) Blood or body fluids may get on the nurse's clothing the glove and creating contamination through the
from a task the nurse plans to perform. tear. If excessive secretions are present on gloves,
then a towel or the drape could be used to wipe off
D - Gowns should be worn when there is a possibility excessive secretions before an attempt is made to
that blood or body fluids could get on the nurse's remove the gloves.
clothes or when the client is on contact isolation status.
The other options are not appropriate uses of gowns.
What is the single most effective method by which the body, and cross contamination will occur. As in surgical
nurse can break the chain of infection? areas, anything below the waist should be considered at
potential risk for infection. Needles are not to be
recapped or cut because of the increased risk of
A) Give all clients antibiotics. experiencing puncture wounds while doing so. Not all
B) Wear gloves when caring for all clients. dressings need to be placed in red bags; only dressings
C) Wash hands between procedures and clients. with moisture require placement in a red bag. Bottles of
D) Make sure housekeeping staff are using the right solution that are sitting in the client's room should be
chemicals. closed to prevent airborne contaminants from entering
C - Adequate hand washing will remove bacteria and and creating an unsterile situation.
wastes or contaminates to minimize cross The nurse has just admitted a client to rule out active
contamination between clients. Use of alcohol-based hepatitis B. The client is confused, spitting and
waterless antiseptics between clients is also effective if scratching everyone who enters the room. The nurse
the guidelines for using these cleansers are followed. should:
Giving all clients antibiotics is impractical and is a source
of new superinfections when persons who do not need
antibiotics are given them and then the bacteria mutate A) Wait an hour until the client calms down and then
to become resistant to older drugs. It would be both use gloves when touching the client.
unethical and costly to try to control infections by B) Use gloves, mask, face shield, and gown when
treating everyone in the facility. Although wearing entering the room to perform the initial assessment.
gloves to perform procedures that carry the risk of C) Administer a sedative and then perform the
direct contact with contaminated material is a correct assessment after the client is asleep; no precautions
method of bacterial control, wearing gloves at all times would be needed.
is impractical, expensive, and unrealistic. Housekeeping D) Realize that isolation equipment might further
staff are trained to use the correct agents for confuse the client and avoid using a face mask and
decontamination and disinfection of all surfaces that shield but use gown and gloves.
place clients at risk.
B - Hepatitis virus is a blood-borne virus, but the client is
Which of the following statements reflects the current increasing the risk of cross contamination by spitting
trend in the directives from the Centers for Disease (saliva can be a source of bacterial contamination) and
Control and Prevention (CDC) for minimizing risks of scratching others, which can break the skin and become
infection? a source of risk. All of the barriers listed would minimize
cross contamination from the client to the nurse. Even
though gloves may be all that is needed because of
A) Discard all dressings into red bags. limited contact with the client, after an hour the client
B) Do not recap bottles of solutions to minimize risk of will remain confused and may not understand. The
contamination. client may become aggressive again and spit or scratch,
C) Recap syringes or break needles off before discarding and other barriers are needed to stop that source of
into sharps containers. possible risks. A sedative may be given if needed, but
D) Keep all drainage tubing below the level of the waist trying to perform an assessment when the client is
and/or site of insertion. asleep is not appropriate and will prevent the nurse
D - Keeping the solution in drainage tubes draining away from successfully establishing rapport with the client.
from the drainage site on the body reduces the risk for Although masks and shields might be frightening to
bacteria growth. Running any solution backward in the some confused clients, if the client is spitting and body
tubing puts the client at risk by bringing any bacteria fluids could be exchanged, a barrier should still be used.
that may be present lower in the system back to the
For which airborne disease(s) would the nurse be mask. Head covers are usually not worn in isolation
required to use gloves, respiratory devices, and gown rooms as a barrier.
when in close contact with the client?
The nurse is setting up a sterile field for the physician.
Which of the following statements concerning a sterile
A) Herpes simplex, scabies field is correct?
B) Viral pneumonia, atelectasis
C) Chickenpox, pulmonary tuberculosis
A) The sides of the drape over the table are still sterile
D) Multidrug-resistant respiratory syncytial virus
until they are touched.
C - Airborne precautions are required for chickenpox B) Reaching over the field is not a source of
and tuberculosis, because in these diseases small contamination if the nurse has on a clean gown and
particles float in the air and a barrier is required to gloves.
prevent contamination of the nurse. A respiratory C) One inch around the border should be considered to
protection device is form-fitted to the face to prevent be the barrier between the sterile field and under the
the escape of air around the seal. Gloves and gown are table.
also worn to prevent contamination and transport of D) A liquid spill onto the sterile field is a source of
infective particles to other clients. For viral pneumonia contamination from the table below the drape, even if
a regular mask is used as a barrier because the particles the barrier is waterproof.
do not float in the air and are more likely to be found on
surfaces unless coughing or spitting is occurring. C - A 1-inch margin is considered unsterile and is the
barrier spacing between the sterile field in the center of
Atelectasis is the collapse of alveoli, and airborne
precautions are not needed. Herpes and scabies are the drape and the edge of the drape. Liquids spilled on
a waterproof drape will not absorb from or be
spread by contact, and gloves and gown would be
necessary; masks would not be needed. For multidrug- contaminated from the surface beneath. Although such
a situation could be messy, bacteria would not cross
resistant respiratory syncytial virus the protection of the
client would be as important as preventing the spread from the unsterile to the sterile side. The edge of the
table and the 1-inch border create the edge of the
of these disorders. Therefore, gown, gloves, and mask
would be used as in reverse isolation to prevent cross sterile field. Anything below the edge, including the side
of the drape, becomes unsterile. Reaching over a sterile
contamination of the client.
field is always a source of contamination and should not
Before the nurse washes the hands when leaving an be done.
isolation room, what is the last thing that is removed?
When transferring a sterile item to a sterile field, the
nurse should:
A) Mask
B) Gown
A) Open the outer package and let the sterile assistant
C) Goggles
D) Head cover take the item from the nurse to put on the edge of the
drape.
A - Remove goggles by touching only the ear pieces. B) Use a sterile lifting tool (forceps) to pick up the inner
Next remove the gown and the nurse should untie the package and transfer it to the middle of the field.
neck ties and allow the gown to fall from shoulders and C) Open the outer package and use a sterile glove to
only touch the inside of the gown. The mask is removed pick up the item and drop it on the sterile field in the
last by removing the elastic from the ears or untying the middle of the drape.
bottom mask string followed by the top mask string. In D) Open the package by peeling back the cover without
both cases the nurse's hands only touch the ties of the touching the inner package and drop the item within
the sterile field without touching the 1-inch border.
D - The rule is "sterile to sterile" to prevent What part of a sterile glove is considered contaminated
contamination. The outer cover is considered unsterile. once the glove is applied by the open gloving method?
As long as the inner packet is not touched, the packet is
considered sterile. The 1-inch border or barrier between
the edge of the drape and the field is the dividing line A) The inner cuff of each glove
B) The back of the gloved hands
for sterile versus nonsterile. Using a sterile glove to
remove the inner packet is all right, but dropping it into C) Any surface that the powder from the gloves touches
D) The outer part of the glove that touched the inner
the middle of the field will contaminate other items. A
sterile assistant can take the item from the nurse, but wrapper
placing it on the edge of the drape will contaminate the A - The cuff is folded and touched to apply the glove;
item because it is not inside the 1-inch border/barrier. thus, it becomes contaminated during application of the
Using sterile forceps to remove the inner packet is glove. Usually the cuff will fall down over the wrist, but
acceptable, but putting the item into the middle of the if it does not, then it is considered unsterile and should
field will again risk potential contamination from not be touched during the procedure. All of the outer
reaching over the sterile field. part of the glove is sterile unless it has been
contaminated. The inner wrapper that held the sterile
Which statement comparing a surgical scrub with a
regular hand-washing session is correct? glove is not contaminated unless one touches it.
Therefore, the outer part of the glove can touch it
without contamination. The powder is sterile and will
A) Water and soap are turned on with the leg or foot not contaminate anything it touches.
pedal in both cases.
B) A surgical scrub lasts the same length of time as a The interval when a client manifests signs and
symptoms specific to a type of infection is the:
hand washing between clients.
C) The hands are held in the same position after the
1. Illness Stage
scrub as after regular hand washing to prevent
contamination from other sources of contact. 2. Convalescence
3. Prodromal Stage
D) The fingers are held down to rinse in routine hand-
washing but are held upright when performing a 4. Incubation Period
surgical scrub. 1. Illness Stage
D - In hand washing, rinsing is from clean to dirty; the After coming in contact with infected clients, and after
arms are considered cleaner than the fingers and handling contaminated equipment or organic material,
therefore rinsing is away from the cleaner part of the visitors are encouraged to:
arm. In the surgical scrub the arm is considered more
contaminated because the hands and nails are more 1. Wear gloves before eating or handling food
thoroughly scrubbed; therefore, in a surgical scrub the 2. Use a private room to talk with family members
hands are held above the elbows. In hand washing the 3. Leave the facility to prevent contamination of others
fingers are held downward to rinse and are dried in the 4. Perform hand hygiene before eating or handling food
same manner. Keeping hands in sight is important in
both cases, but no special position is needed after hand 4. Perform hand hygiene before eating or handling food
washing. Although a foot or knee pedal is a preferred
method of soap and water delivery, using a faucet can
be just as safe if a paper towel is used to turn off the
water after the hands have been washed.
The nurse has redressed a client's wound and now plans A. A diagnosis of AIDS and cytomegalovirus
to administer a medication to the client. It is important B. A positive PPD with an abnormal chest x-
to: ray
C. A tentative diagnosis of viral pneumonia
D. Advanced carcinoma of the lung
1. Leave the gloves on to administer the medication
2. Remove gloves and perform hand hygiene before
4. Which of the following is the FIRST priority in
leaving the room preventing infections when providing care for a
3. Remove gloves and perform hand hygiene before client?
administering the medication
4. Leave the medication on the bedside table to avoid A. Handwashing
having to remove gloves before leaving the client's B. Wearing gloves
room C. Using a barrier between client’s furniture
and nurse’s bag
Remove gloves and perform hand hygiene before D. Wearing gowns and goggles
administering the medication
5. An adult woman is admitted to an isolation unit
To sterilize surgical instruments, parenteral solutions, in the hospital after tuberculosis was detected
and surgical dressings: during a pre-employment physical. Although
frightened about her diagnosis, she is anxious to
1. An autoclave is used
cooperate with the therapeutic regimen. The
teaching plan includes information regarding the
2. Soap and water is used
most common means of transmitting the tubercle
3. Ethylene oxide gas is used bacillus from one individual to another. Which
4. Chemicals are used for disinfection contamination is usually responsible?
An autoclave is used
A. Hands.
B. Droplet nuclei.
1. A child is admitted to the pediatric unit with a C. Milk products.
diagnosis of suspected meningococcal meningitis. D. Eating utensils.
Which of the following nursing measures should the
nurse do FIRST? 6. A 2 year old is to be admitted in the pediatric
unit. He is diagnosed with febrile seizures. In
A. Institute seizure precautions preparing for his admission, which of the following
B. Assess neurologic status is the most important nursing action?
C. Place in respiratory isolation
D. Assess vital signs A. Order a stat admission CBC.
B. Place a urine collection bag and specimen
2. A client is diagnosed with methicillin resistant cup at the bedside.
staphylococcus aureus pneumonia. What type of C. Place a cooling mattress on his bed.
isolation is MOST appropriate for this client? D. Pad the side rails of his bed.

A. Reverse isolation 7. A young adult is being treated for second and

B. Respiratory isolation third degree burns over 25% of his body and is now
C. Standard precautions ready for discharge. The nurse evaluates his
D. Contact isolation understanding of discharge instructions relating to
wound care and is satisfied that he is prepared for
3. Several clients are admitted to an adult medical home care when he makes which statement?
unit. The nurse would ensure airborne precautions
for a client with which of the following medical A. “I will need to take sponge baths at home to
conditions? avoid exposing the wounds to unsterile bath
water.”
 B. “If any healed areas break open I should first C. A nurse with open, weeping lesions of the
cover them with a sterile dressing and then hands puts on gloves before giving direct
report it.” client care.
C. “I must wear my Jobst elastic garment all D. The nurse puts on a mask, a gown, and
day and can only remove it when I’m going gloves before entering the room of a client
to bed.” on strict isolation.
D. “I can expect occasional periods of low-
grade fever and can take Tylenol every 4 11. The charge nurse observes a new staff nurse
hours.” who is changing a dressing on a surgical wound.
After carefully washing her hands the nurse dons
8. An eighty five year old man was admitted for sterile gloves to remove the old dressing. After
surgery for benign prostatic hypertrophy. removing the dirty dressing, the nurse removes the
Preoperatively he was alert, oriented, cooperative, gloves and dons a new pair of sterile gloves in
and knowledgeable about his surgery. Several hours preparation for cleaning and redressing the wound.
after surgery, the evening nurse found him acutely The most appropriate action for the charge nurse is
confused, agitated, and trying to climb over the to:
protective side rails on his bed. The most
appropriate nursing intervention that will calm an A. interrupt the procedure to inform the staff
agitated client is nurse that sterile gloves are not needed to
remove the old dressing.
A. limit visits by staff. B. congratulate the nurse on the use of good
B. encourage family phone calls. technique.
C. position in a bright, busy area. C. discuss dressing change technique with the
D. speak soothingly and provide quiet music. nurse at a later date.
D. interrupt the procedure to inform the nurse
9. Ms. Smith is admitted for internal radiation for of the need to wash her hands after removal
cancer of the cervix. The nurse knows the client of the dirty dressing and gloves.
understands the procedure when she makes which
of the following remarks the night before the 12. Nurse Jane is visiting a client at home and is
procedure? assessing him for risk of a fall. The most important
factor to consider in this assessment is:
A. She says to her husband, “Please bring me a
hamburger and french fries tomorrow when A. Correct illumination of the environment.
you come. I hate hospital food.” B. amount of regular exercise.
B. “I told my daughter who is pregnant to C. the resting pulse rate.
either come to see me tonight or wait until I D. status of salt intake.
go home from the hospital.”
C. “I understand it will be several weeks before 13. Mrs. Jones will have to change the dressing on
all the radiation leaves my body.” her injured right leg twice a day. The dressing will
D. “I brought several craft projects to do while be a sterile dressing, using 4 X 4s, normal saline
the radium is inserted.” irrigant, and abdominal pads. Which statement best
indicates that Mrs. Jones understands the
10. The nurse in charge is evaluating the infection importance of maintaining asepsis?
control procedures on the unit. Which finding
indicates a break in technique and the need for A. “If I drop the 4 X 4s on the floor, I can use
education of staff? them as long as they are not soiled.”
B. “If I drop the 4 X 4s on the floor, I can use
A. The nurse aide is not wearing gloves when them if I rinse them with sterile normal
feeding an elderly client. saline.”
B. A client with active tuberculosis is asked to C. “If I question the sterility of any dressing
wear a mask when he leaves his room to go material, I should not use it.”
to another department for testing.
 D. “I should put on my sterile gloves, then open 17. Jayson, 1 year old child has a staph skin
the bottle of saline to soak the 4 X 4s.” infection. Her brother has also developed the same
infection. Which behavior by the children is most
14. A client has been placed in blood and body fluid likely to have caused the transmission of the
isolation. The nurse is instructing auxiliary organism?
personnel in the correct procedures. Which
statement by the nursing assistant indicates the best A. Bathing together.
understanding of the correct protocol for blood and B. Coughing on each other.
body fluid isolation? C. Sharing pacifiers.
D. Eating off the same plate.
A. Masks should be worn with all client
contact. 18. Jessie, a young man with newly diagnosed
B. Gloves should be worn for contact with acquired immune deficiency syndrome (AIDS) is
nonintact skin, mucous membranes, or being discharged from the hospital. The nurse
soiled items. knows that teaching regarding prevention of AIDS
C. Isolation gowns are not needed. transmission has been effective when the client:
D. A private room is always indicated.
A. verbalizes the role of sexual activity in
15. A client has been placed in blood and body fluid spread of the disorder.
isolation. The nurse is instructing auxiliary B. states he will make arrangements to drop his
personnel in the correct procedures. Which college classes.
statement by the nursing assistant indicates the best C. acknowledges the need to avoid all contact
understanding of the correct protocol for blood and sports.
body fluid isolation? D. says he will avoid close contact with his
three-year-old niece.
A. Masks should be worn with all client
contact. 19. Which question is least useful in the assessment
B. Gloves should be worn for contact with of a client with AIDS?
nonintact skin, mucous membranes, or
soiled items. A. Are you a drug user?
C. Isolation gowns are not needed. B. Do you have many sex partners?
D. A private room is always indicated. C. What is your method of birth control?
D. How old were you when you became
16. The nurse is evaluating whether nonprofessional sexually active?
staff understand how to prevent transmission of
HIV. Which of the following behaviors indicates 20. Mrs. Parker, a 70-year-old woman with severe
correct application of universal precautions? macular degeneration, is admitted to the hospital the
day before scheduled surgery. The nurse’s
A. A lab technician rests his hand on the desk preoperative goals for Mrs. M. would include:
to steady it while recapping the needle after
drawing blood. A. independently ambulating around the unit.
B. An aide wears gloves to feed a helpless B. reading the routine preoperative education
client. materials.
C. An assistant puts on a mask and protective C. maneuvering safely after orientation to the
eye wear before assisting the nurse to room.
suction a tracheostomy. D. using a bedpan for elimination needs.
D. A pregnant worker refuses to care for a
client known to have AIDS.
37. A 4-month-old with meningococcal meningitis a. "The patient meets the criteria for a diagnosis of
has just been admitted to the pediatric unit. Which an acute HIV infection."
nursing intervention has the highest priority? b. "The patient will be diagnosed with
asymptomatic chronic HIV infection."
A. Instituting droplet precautions c. "The patient has developed acquired
B. Administering acetaminophen (Tylenol) immunodeficiency syndrome (AIDS)."
C. Obtaining history information from the d. "The patient will develop symptomatic chronic
parents HIV infection in less than a year."
D. Orienting the parents to the pediatric unit
c
42. A tuberculosis intradermal skin test to detect
tuberculosis infection is given to a high-risk A patient with a positive rapid antibody test result
adolescent. How long after the test is administered for human immunodeficiency virus (HIV) is
should the result be evaluated? anxious and does not appear to hear what the nurse
is saying. What action by the nurse is most
A. Immediately important at this time?
B. Within 24 hours
C. In 48 to 72 hours a. Teach the patient about the medications available
D. After 5 days for treatment.
b. Inform the patient how to protect sexual and
needle-sharing partners.
HIV/AIDS c. Remind the patient about the need to return for
retesting to verify the results.
A patient who has vague symptoms of fatigue, d. Ask the patient to notify individuals who have
headaches, and a positive test for human had risky contact with the patient.
immunodeficiency virus (HIV) antibodies using an
enzyme immunoassay (EIA) test. What instructions c
should the nurse give to this patient?
A patient who is diagnosed with acquired
a. "The EIA test will need to be repeated to verify immunodeficiency syndrome (AIDS) tells the nurse,
the results." "I feel obsessed with thoughts about dying. Do you
b. "A viral culture will be done to determine the think I am just being morbid?" Which response by
progression of the disease." the nurse is best?
c. "It will probably be 10 or more years before you
develop acquired immunodeficiency syndrome a. "Thinking about dying will not improve the
(AIDS)." course of AIDS."
d. "The Western blot test will be done to determine b. "It is important to focus on the good things about
whether acquired immunodeficiency syndrome your life now."
(AIDS) has developed." c. "Do you think that taking an antidepressant might
be helpful to you?"
a d. "Can you tell me more about the kind of thoughts
that you are having?"
A patient who has a positive test for human
immunodeficiency virus (HIV) antibodies is d
admitted to the hospital with Pneumocystis jiroveci
pneumonia (PCP) and a CD4+ T-cell count of less
than 200 cells/uL. Based on diagnostic criteria
established by the Centers for Disease Control and
Prevention (CDC), which statement by the nurse is
correct?
A pregnant woman with a history of asymptomatic A patient who is human immunodeficiency virus
chronic human immunodeficiency virus (HIV) (HIV)-infected has a CD4+ cell count of 400/µL.
infection is seen at the clinic. The patient states, "I Which factor is most important for the nurse to
am very nervous about making my baby sick." determine before the initiation of antiretroviral
Which information will the nurse include when therapy (ART) for this patient?
teaching the patient?
a. HIV genotype and phenotype
a. The antiretroviral medications used to treat HIV b. Patient's social support system
infection are teratogenic. c. Potential medication side effects
b. Most infants born to HIV-positive mothers are d. Patient's ability to comply with ART schedule
not infected with the virus.
c. Because she is at an early stage of HIV infection, d
the infant will not contract HIV.
d. It is likely that her newborn will become infected The nurse will most likely prepare a medication
with HIV unless she uses antiretroviral therapy teaching plan about antiretroviral therapy (ART) for
(ART). which patient?

b a. Patient who is currently HIV negative but has

unprotected sex with multiple partners
Which patient exposure by the nurse is most likely b. Patient who was infected with HIV 15 years ago
to require postexposure prophylaxis when the and now has a CD4+ count of 840/µL
patient's human immunodeficiency virus (HIV) c. HIV-positive patient with a CD4+ count of
status is unknown? 160/µL who drinks a fifth of whiskey daily
d. Patient who tested positive for HIV 2 years ago
a. Needle stick with a needle and syringe used to and now has cytomegalovirus (CMV) retinitis
draw blood
b. Splash into the eyes when emptying a bedpan d
containing stool
c. Contamination of open skin lesions with patient The nurse palpates enlarged cervical lymph nodes
vaginal secretions on a patient diagnosed with acute human
d. Needle stick injury with a suture needle during a immunodeficiency virus (HIV) infection. Which
surgical procedure action would be most appropriate for the nurse to
take?
a
a. Instruct the patient to apply ice to the neck.
A young adult female patient who is human b. Advise the patient that this is probably the flu.
immunodeficiency virus (HIV)-positive has a new c. Explain to the patient that this is an expected
prescription for efavirenz (Sustiva). Which finding.
information is most important to include in the d. Request that an antibiotic be prescribed for the
medication teaching plan? patient.

a. Driving is allowed when starting this medication. c

b. Report any bizarre dreams to the health care
provider. Which information would be most important to help
c. Continue to use contraception while on this the nurse determine if the patient needs human
medication. immunodeficiency virus (HIV) testing?
d. Take this medication in the morning on an empty
stomach. a. Patient age
b. Patient lifestyle
c c. Patient symptoms
d. Patient sexual orientation
a
A patient who uses injectable illegal drugs asks the c. Discuss a change in antiretroviral therapy.
nurse about preventing acquired immunodeficiency d. Talk about treatment with antifungal agents.
syndrome (AIDS). Which response by the nurse is
best? c

a. "Avoid sexual intercourse when using injectable The nurse prepares to administer the following
drugs." medications to a hospitalized patient with human
b. "It is important to participate in a needle- immunodeficiency (HIV). Which medication is
exchange program." most important to administer at the right time?
c. "You should ask those who share equipment to be
tested for HIV." a. Oral acyclovir (Zovirax)
d. "I recommend cleaning drug injection equipment b. Oral saquinavir (Invirase)
before each use." c. Nystatin (Mycostatin) tablet
b d. Aerosolized pentamidine (NebuPent)

Which nursing action will be most useful in b

assisting a college student to adhere to a newly
prescribed antiretroviral therapy (ART) regimen? To evaluate the effectiveness of antiretroviral
therapy (ART), which laboratory test result will the
a. Give the patient detailed information about nurse review?
possible medication side effects.
b. Remind the patient of the importance of taking a. Viral load testing
the medications as scheduled. b. Enzyme immunoassay
c. Encourage the patient to join a support group for c. Rapid HIV antibody testing
students who are HIV positive. d. Immunofluorescence assay
d. Check the patient's class schedule to help decide
when the drugs should be taken. a

d The nurse cares for a patient who is human

immunodeficiency virus (HIV) positive and taking
A patient with human immunodeficiency virus antiretroviral therapy (ART). Which information is
(HIV) infection has developed Mycobacterium most important for the nurse to address when
avium complex infection. Which outcome would be planning care?
appropriate for the nurse to include in the plan of
care? a. The patient's blood glucose level is 142 mg/dL.
b. The patient complains of feeling "constantly
a. The patient will be free from injury. tired."
b. The patient will receive immunizations. c. The patient is unable to state the side effects of
c. The patient will have adequate oxygenation. the medications.
d. The patient will maintain intact perineal skin. d. The patient states, "Sometimes I miss a dose of
zidovudine (AZT)."
d
d
A patient treated for human immunodeficiency
virus (HIV) infection for 6 years has developed fat Eight years after seroconversion, a human
redistribution to the trunk, with wasting of the arms, immunodeficiency virus (HIV)-infected patient has
legs, and face. What instructions will the nurse give a CD4+ cell count of 800/µL and an undetectable
to the patient? viral load. What is the priority nursing intervention
at this time?
a. Review foods that are higher in protein.
b. Teach about the benefits of daily exercise. a. Teach about the effects of antiretroviral agents.
b. Encourage adequate nutrition, exercise, and
sleep. The nurse designs a program to decrease the
c. Discuss likelihood of increased opportunistic incidence of human immunodeficiency virus (HIV)
infections. infection in the adolescent and young adult
d. Monitor for symptoms of acquired populations. Which information should the nurse
immunodeficiency syndrome (AIDS). assign as the highest priority?

b a. Methods to prevent perinatal HIV transmission

b. Ways to sterilize needles used by injectable drug
Which of these patients being seen at the human users
immunodeficiency virus (HIV) clinic should the c. Prevention of HIV transmission between sexual
nurse assess first? partners
d. Means to prevent transmission through blood
a. Patient whose latest CD4+ count is 250/µL transfusions
b. Patient whose rapid HIV-antibody test is positive
c. Patient who has had 10 liquid stools in the last 24 c
hours
d. Patient who has nausea from prescribed The nurse cares for a patient infected with human
antiretroviral drugs immunodeficiency virus (HIV) who has just been
diagnosed with asymptomatic chronic HIV
c infection. Which prophylactic measures will the
nurse include in the plan of care (select all that
An older adult who takes medications for coronary apply)?
artery disease has just been diagnosed with
asymptomatic chronic human immunodeficiency a. Hepatitis B vaccine
virus (HIV) infection. Which information will the b. Pneumococcal vaccine
nurse include in patient teaching? c. Influenza virus vaccine
d. Trimethoprim-sulfamethoxazole
a. Many medications have interactions with e. Varicella zoster immune globulin
antiretroviral drugs.
b. Less frequent CD4+ level monitoring is needed a,b,c
in older adults.
c. Hospice care is available for patients with According to the Center for Disease Control (CDC)
terminal HIV infection. guidelines, which personal protective equipment
d. Progression of HIV infection occurs more rapidly will the nurse put on when assessing a patient who
in older patients. is on contact precautions for diarrhea caused by
Clostridium difficile (select all that apply)?
a
a. Mask
The registered nurse (RN) caring for an HIV- b. Gown
positive patient admitted with tuberculosis can c. Gloves
delegate which action to unlicensed assistive d. Shoe covers
personnel (UAP)? e. Eye protection

a. Teach the patient about how to use tissues to b,c

dispose of respiratory secretions.
b. Stock the patient's room with all the necessary The nurse plans a presentation for community
personal protective equipment. members about how to decrease the risk for
c. Interview the patient to obtain the names of antibiotic-resistant infections. Which information
family members and close contacts. will the nurse include in the teaching plan (select all
d. Tell the patient's family members the reason for that apply)?
the use of airborne precautions.
b
a. Continue taking antibiotics until all the
medication is gone. The nurse is instructing an unlicensed health care
b. Antibiotics may sometimes be prescribed to worker on the care of the client with HIV who also
prevent infection. has active genital herpes. Which statement by the
c. Unused antibiotics that are more than a year old health care worker indicates effective teaching of
should be discarded. standard precautions?
d. Antibiotics are effective in treating influenza
associated with high fevers. A) ''I need to know my HIV status, so I must get
e. Hand washing is effective in preventing many tested before caring for any clients."
viral and bacterial infections. B) ''Putting on a gown and gloves will cover up the
itchy sores on my elbows.''
a,b,e C) ''Washing my hands and putting on a gown and
gloves is what I must do before starting care.''
A patient who has tested positive for the human D) ''I will wash my hands before going into the
immunodeficiency virus (HIV) arrives at the clinic room, and then put on gown and gloves only for
with a report of fever, nonproductive cough, and direct contact with the client's genitals."
fatigue. The patient's CD4 count is 184 cells/mcL.
How should the healthcare provider interpret these (C)
findings? C) ''Washing my hands and putting on a gown and
Please choose from one of the following options. gloves is what I must do before starting care.''
Rationale: Standard precautions include whatever
A. The patient is diagnosed with acquired personal protective equipment (PPE) is necessary
immunodeficiency syndrome (AIDS). for the prevention of transmission of HIV and
B.The patient is now in the latent stages of HIV genital herpes.
infection
C.These findings provide evidence that the patient Which statement made to the nurse by a health care
has seroconverted. worker assigned to care for the client with HIV
D. This is an expected finding because the patient indicates a breach of confidentiality and requires
has tested positive for HIV. further education by the nurse?

The patient is diagnosed with acquired A) ''I told the family members they needed to wash
immunodeficiency syndrome (AIDS). their hands when they enter and leave the room.''
B) ''The other health care worker and I were out in
Which member of the health care team the hallway discussing how we were concerned
demonstrates reducing the risk for infection for the about getting HIV from our client, so no one could
client with acquired immunodeficiency syndrome hear us in the client's room.''
(AIDS)? C) ''Yes, I understand the reasons why I have to
wear gloves when I bathe my client.''
A) The dietary worker hands the disposable meal D) ''The client's spouse told me she got HIV from a
trays to the LPN assigned to the client. blood transfusion.
B) The social worker encourages the client to
verbalize about stressors at home. (B)
C) Housekeeping thoroughly cleans and disinfects B) ''The other health care worker and I were out in
the hallways near the client's room. the hallway discussing how we were concerned
D) Health care provider orders vital signs including about getting HIV from our client, so no one could
temperature every 8 hours. hear us in the client's room.''
Rationale: Discussing this client's illness outside the
(A) client's room is a breach of confidentiality.
A) The dietary worker hands the disposable meal
trays to the LPN assigned to the client.
Rationale: This limits the number of health care
personnel entering the room.
When preparing the newly diagnosed client with time.''
HIV and significant other for discharge, which Rationale: People who are planning to get married
explanation by the nurse accurately describes proper should be tested for HIV.
condom use?
Which interventions does the home health nurse
A) ''Condoms should be used when lesions on the teach to family members to reduce confusion in the
penis are present.'' client diagnosed with AIDS dementia? (Select all
B) ''Always position the condom with a space at the that apply.)
tip of an erect penis.''
C) ''Make sure it fits loosely to allow for penile A) Report any behavior changes.
erection.'' B) Use the Glasgow Coma Scale on a daily basis.
D) ''Use adequate lubrication such as petroleum C) Change the decorations in the home according to
jelly.'' the season.
D) Put the bed close to the window.
B) E) Write out all instructions and have the client read
B) ''Always position the condom with a space at the them over before performing a task.
tip of an erect penis.'' F) Ask the client when he or she wants to shower or
Rationale: This allows for the collection of semen at bathe.
the tip of the condom. G) Mark off the days of the calendar, leaving open
the current date.
The nurse presents a seminar on HIV testing to a H) For continuity, the primary caregiver should be
group of seniors and their caregivers in an assisted the only person reorienting the client.
living facility. Which responses fit the Centers for
Disease Control and Prevention's (CDC's) -(C, D, F, G)
recommendations for HIV testing? (Select all that
apply.) C) Change the decorations in the home according to
the season.
A) ''I am 78 years old and I was treated and cured of Rationale: Seasonal decorations in the home helps
syphilis many years ago.'' with maintaining orientation.
B) ''In 1986, I received a transfusion of platelets.'' D) Put the bed close to the window.
C) ''Seven years ago, I was released from a Rationale: This allows the client to visualize
penitentiary.'' seasonal and weather changes and assists in
D) ''I used to smoke marijuana 30 years ago, but I orientation.
have not done any drugs since.'' F) Ask the client when he or she wants to shower or
E) ''I had sex with a man with a disreputable past bathe.
from New York back in the late 1960s, but I have Rationale: Involving the client in planning the daily
been happily married since 1971.'' schedule helps with orientation.
F) ''At 68, I am going to get married for the fourth G) Mark off the days of the calendar, leaving open
time.'' the current date.
G) ''Downtown was where I picked up the best Rationale: Using calendars and crossing off past
hookers back in the 1950s.' dates helps with orientation.

-(A, C, F) The home health nurse is making an initial home

A) ''I am 78 years old and I was treated and cured of visit to the client currently living with family
syphilis many years ago.'' members after being hospitalized with pneumonia
Rationale: People who have had sexually and newly diagnosed with AIDS. Which statement
transmitted diseases should be tested for HIV. by the nurse best acknowledges the client's fear of
C) ''Seven years ago, I was released from a discovery by his family?
penitentiary.''
Rationale: HIV testing is recommended for people A) ''Do you think that I could post a sign on your
who are or have been in jails or prisons. bedroom door for everyone about the need to wash
F) ''At 68, I am going to get married for the fourth their hands?''
B) ''Is there somewhere private in the home we can other functions such as breathing. Options B, C, and
go and talk?'' D are important interventions for the client with
C) ''I hope that all of your family members know AIDS but do not address the subject of activities of
about your disease and how you need to be daily living.
protected, since you have been so sick.''
D) ''It is your duty to protect your family members A client who was tested for human immunodeficiency
from getting AIDS.'' virus (HIV) after a recent exposure had a negative result.
During the post-test counseling session, the nurse tells
(B) the client which of the following?
B) ''Is there somewhere private in the home we can
go and talk?'' a) the test should be repeated in 6 months
Rationale: A nonthreatening approach initially to b) this ensures that the client is not infected with the
find out whether the client has informed family HIV virus
members or desires privacy is very important. c) the client no longer needs to protect himself from
sexual partners
A client with acquired immunodeficiency syndrome d) the client probably has immunity to the acquired
(AIDS) has a nursing diagnosis of Imbalanced immunodeficiency virus
nutrition: less than body requirements. The nurse
plans which of the following goals with this client? A
- A negative test result indicates that no HIV
a) consume foods and beverages that are high in antibodies were detected in the blood sample. A
glucose repeated test in 6 months is recommended because
b) plan large menus and cook meals in advance false-negative test results have occurred early in the
c) eat low-calorie snacks between meals infection.
d) eat small, frequent meals throughout the day
A client is diagnosed with late stage human
D immunodeficiency virus (HIV), and the client and family
- The client should eat small, frequent meals are extremely upset about the diagnosis. The priority
throughout the day. The client also should take in psychosocial nursing intervention for the client and
nutrient-dense and high-calorie meals and snacks family is to:
rather than those that are high in glucose only. The
client is encouraged to eat favorite foods to keep a) tell the client and family to stop smoking because
intake up and plan meals that are easy to prepare. it will predispose the client to respiratory infections
The client can also avoid taking fluids with meals to b) tell the client and family that raw or improperly
increase food intake before satiety sets in. washed foods can produce microbes
c) encourage the client and family to discuss their
A client with acquired immunodeficiency syndrome feelings about the disease
(AIDS) is experiencing shortness of breath related d) advise the client to avoid becoming pregnant
to Pneumocystis jiroveci pneumonia. Which because of the risk of transmission of the infection
measure should the nurse include in the plan of care
to assist the client in performing activities of daily C
living? - The priority psychosocial nursing intervention for
the client and family is to encourage the client and
a) provide supportive care with hygiene needs family to discuss their feelings about the disease.
b) provide meals and snacks with high-protein, high Options A, B, and D identify physiological not
calorie, and high-nutritional value psychosocial concerns.
c) provide small, frequent meals

A
- Providing supportive care with hygiene needs as
needed reduces the client's physical and emotional
energy demands and conserves energy resources for
A client is diagnosed with human Nurse Vince sustained a dirty needle stick injury.
immunodeficiency virus (HIV) infection. The nurse Which diagnostic test would be ordered on a client?
prepares a care plan for the client, knowing that
HIV is primarily a condition in which: A. Enzyme-linked immunosorbent assay (ELISA)
B. SUDS screening test
a) immunosuppression occurs and is indicated by a C. Antibody titers
T4 lymphocyte count of less than 200/mm3 D. Skin biopsy for Kaposi's sarcoma
b) bacterial infection occurs, causing weakness
c) fungal infection occurs, causing a rash and B
pruritus SUDS screening test results are available in 30 to
d) protozoan infection occurs, causing a fever and 60 minutes. The test is performed on a client to
nonproductive cough determine if the health care worker with a dirty
needle stick injury should begin antiretroviral
A treatment. ELISA test results indicate exposure to or
- HIV infection causes immunosuppression and is infection with human immunodeficiency virus
indicated by a T4 lymphocyte count of less than (HIV), but the test does not diagnose acquired
200/mm3. Although bacterial, fungal, and protozoal immunodeficiency syndrome (AIDS). Antibody
infection can occur, these occur as opportunistic titers would not be appropriate to determine
infections as a result of the immunosuppression. whether the health care worker has been exposed to
HIV or hepatitis. Kaposi's sarcoma is usually
Which intervention should the nurse implement associated with AIDS but not immediately after a
when caring for a client diagnosed with needle stick.
Pneumocystis carinii pneumonia related to acquired
immunodeficiency syndrome who is crying over the After the first injection of an immunotherapy
loss of friends and family members because they program, the nurse notices a large, red wheal on the
will not talk to him anymore? client's arm, coughing, and expiratory wheezing.
Which intervention should the nurse implement
A. Advising the client not to worry, and telling him first?
everything will be alright
B. Asking the health care provider for a psychiatric A. Notifying the health care provider immediately
consult to assess the client's mental functioning B. Administering I.M. epinephrine per protocol
C. Sitting down and listening to the client's C. Beginning oxygen by way of nasal cannula
concerns and frustrations D. Starting an I.V. line for medication
D. Telling the client that the friends probably were administration
not true friends anyway
B
C Immediately on noticing the client's sign and
rying is evidence that the client is beginning to symptoms, the nurse would determine that the client
express concerns to the nurse. In response, active, is experiencing anaphylaxis to the injection. The
nonjudgmental listening would most appropriate first action is to give 0.2 to 0.5 ml of 1:1,000
because is aids in the development of a trusting epinephrine I.M. Notifying the health care provider,
relationship. Advising the client not to worry or beginning oxygen administration, and starting an
saying that everything will be alright provides false I.V. line follow after the initial injection of
reassurance, which does not help the client cope. epinephrine is administered.
Further assessment is needed to determine whether
a psychiatric consult should be considered. Telling During the past 6 months, a client diagnosed with
the client that the friends were not true friends acquired immunodeficiency syndrome has had
discounts the client's feeling and hinders the chronic diarrhea and has lost 18 pounds. Additional
development of a therapeutic relationship. assessment findings include tented skin turgor, dry
mucous membranes, and listleness. Which nursing
diagnosis focuses attention on the client's most
immediate problem?
 B
A. Deficient fluid volume related to diarrhea and The status of the client with a diagnosis of Impaired
abnormal fluid loss gas exchange would be evaluated against the
B. Imbalanced nutrition: less than body standard outcome criteria for this nursing diagnosis.
requirements related to nausea and vomiting These would include the client stating that breathing
C. Disturbed thought processes related to central is easier and is coughing up secretions effectively,
nervous system effects of disease and has clear breath sounds. The client should not
D. Diarrhea related to the disease process and acute limit fluid intake because fluids are needed to
infection decrease the viscosity of secretions for
expectoration.
A
Based on the client's assessment findings, the most Human Papilloma Virus in AIDS patients is
immediate problem is dehydration because of manifested as:
chronic diarrhea. The nursing diagnosis of deficient
fluid volume is the priority, and interventions are A. Cough, evening fever, night sweats, weight loss
geared to improving the client's fluid status. and anemia
Although imbalanced nutrition, disturbed thought B. Persistent fever, tachypnoea, hypoxia, cyanosis
processes, and diarrhea are involved, they assume a and tachycardia.
lower priority at this time. C. Genital warts, flat warts, skin warts, neoplasm of
cervix, vagina and penis
For a male client who has acquired D. Watery diarrhea, abdominal pain, nausea and
immunodeficiency syndrome with chronic diarrhea, vomiting
anorexia, a history of oral candidiasis, and weight
loss, which dietary instruction would be included in C
the teaching plan? Dermatologic human papillomavirus (HPV)
infection in HIV patients manifests as both
A. "Follow a low-protein, high-carbohydrate diet." anogenital and nongenital skin disease. Cutaneous
B. "Eat three large meals per day." HPV-related disease in nongenital skin is also
C. "Include unpasteurized dairy products in the increased in HIV-positive patients, in the form of
diet." benign common warts, epidermodysplasia
D. "Follow a high-protein, high-calorie diet. verruciformis-like skin lesions, and nonmelanoma
skin cancers.
D
Dietary instructions should include the need for a A client is diagnosed with oral candidiasis. Nurse
high-protein, high-calorie diet. The patient should Tina knows that this condition in AIDS is treated
be taught to eat small, frequent meals and include with:
low-microbial foods, such as pasteurized dairy
products, washed and peeled fruits and vegetables, A. Trimethoprim + sulfamethoxazole
and well-cooked meats. B. Fluconazole
C. Acyclovir
A client with acquired immunodeficiency syndrome D. Zidovudine
has a respiratory infection from Pneumocystis
jiroveci and a nursing diagnosis of Impaired Gas B
Exchange written in the plan of care. Which of the Oral candidiasis usually responds to topical
following indicates that the expected outcome of treatments such as clotrimazole troches and nystatin
care has not yet been achieved? suspension (nystatin "swish and swallow").
Systemic antifungal medication such as fluconazole
A. Client has clear breath sounds or itraconazole may be necessary for oropharyngeal
B. Client now limits his fluid intake infections that do not respond to these treatments.
C. Client expectorates secretions easily
D. Client is free of complaints of shortness of breath
The decision to begin antiretroviral therapy is based limits of detection of commercially available
on: assays.

A. The CD4 cell count Which is the most common HIV-related

B. The plasma viral load neurological complication?
C. The intensity of the patient's clinical symptoms
D. All of the above A. Tuberculosis
B. Kaposi's sarcoma
D C. Toxoplasmosis
A person's CD4 count is an important factor in the D. Lymphoma
decision to start ART. A low or falling CD4 count
indicates that HIV is advancing and damaging the C
immune system. A rapidly decreasing CD4 count Toxoplasmosis is the most common central nervous
increases the urgency to start ART. Regardless of system infection in patients with the acquired
CD4 count, there is greater urgency to start ART immunodeficiency syndrome (AIDS) who are not
when a person has a high viral load or any of the receiving appropriate prophylaxis. This infection
following conditions: pregnancy, AIDS, and certain has a worldwide distribution and is caused by the
HIV-related illnesses and co infections. intracellular protozoan parasite, Toxoplasma gondii.

Which client problem relating to altered nutrition is Ms. X is diagnosed with acquired
a consequence of AIDS? immunodeficiency syndrome (AIDS). The nurse
caring for this patient is aware that for a patient to
A. Increased appetite be diagnosed with HIV she should have which
B. Decreased protein absorption condition?
C. Increased secretions of digestive juices
D. Decreased gastrointestinal absorption a. Infection of HIV, have a CD4+ T-cell count of
500 cells/microliter, history of acute HIV infection
B b. Infection with Tuberculosis, HIV and
cytomegalovirus
Often the complications of the acquired c. Infection of HIV, have a CD4+ T-cell count of
immunodeficiency syndrome (AIDS) have a >200 cells/microliter, history of acute HIV infection
negative impact on nutritional status. Weight loss d. Infection with HIV, history of HIV infection and
and protein depletion are commonly seen among the T-cell count below 200 cells/microliter
AIDS population.
Answer C. The three criteria for a client to be
As a knowledgeable nurse, you know that the diagnosed with AIDS are the following:
primary goals of antiretroviral therapy (ART) • HIV positive
include all, EXCEPT: • CD4+ T-cell count below 200 cells/microliter
• Have one or more specific conditions that include
A. Reduce HIV-associated morbidity and prolong acute infection of HIV
the duration and quality of survival
B. Restore and preserve immunologic function The nurse observes precaution in caring for Mr. X
C. Maximally and durably suppress plasma HIV as HIV is most easily transmitted in:
viral load
D. Elimination of HIV entirely from the body a. Vaginal secretions and urine
b. Breast milk and tears
D c. Feces and saliva
Eradication of HIV infection cannot be achieved d. Blood and semen
with available antiretroviral (ARV) regimens even
when new, potent drugs are added to a regimen that Answer D. Keyword: MOST EASILY. Rationale:
is already suppressing plasma viral load below the HIV is MOST EASILY transmitted in blood, semen
and vaginal secretions. However, it has been noted
to be found in fecal materials, urine, saliva, tears Human Immunodeficiency virus belongs to which
and breast milk. classifications?

Nurse Jaja is giving an injection to Ms. X. After a. Rhabdovirus

giving an injection, the nurse accidentally stuck her b. Rhinovirus
finger with the needle when the client became very c. Retrovirus
agitated. To determine if the nurse became infected d. Rotavirus
with HIV when is the best time to test her for HIV
antibodies? Answer C. Rationale: HIV is a retrovirus that has a
ribonucleic acid dependent reverse transcriptase.
a. Immediately and repeat the test after 12 weeks
b. Immediately and repeat the test after 4 weeks When teaching a patient infected with HIV
c. After a week and repeat the test in 4 months regarding transmission of the virus to others, which
d. After a weeks and repeat the test in 6 months statement made by the patient would indicate a need
for further teaching?
Answer A. Keyword: BEST TIME. Rationale: To
determine if a preexisting infection is present a test A. "I will need to isolate any tissues I use so as not
should be done immediately and is repeated again in to infect my family."
3 months time (12 weeks) to detect seroconversion B. "I will notify all of my sexual partners so they
as a result of the needle stick. can get tested for HIV."
C. "Unprotected sexual contact is the most common
The blood test first used to identify a response to mode of transmission."
HIV infection is: D. "I do not need to worry about spreading this
virus to others by sweating at the gym."
a. Western blot
b. ELISA test A. "I will need to isolate any tissues I use so as not
c. CD4+ T-cell count to infect my family."
d. CBC
HIV is not spread casually. The virus cannot be
Answer B. Keyword: FIRST. Rationale: The ELISA transmitted through hugging, dry kissing, shaking
test is the first screening test for HIV. A Western hands, sharing eating utensils, using toilet seats, or
blot test confirms a positive ELISA test. Other attending school with an HIV-infected person. It is
blood tests that support the diagnosis of HIV not transmitted through tears, saliva, urine, emesis,
include CD4+ and CD8 + counts, CBC, sputum, feces, or sweat.
immunoglobulin levels, p24 antigen assay, and
quantitative ribonucleic acid assays. The nurse is providing care for a patient who has
been living with HIV for several years. Which
What is the main reason why it is difficult to assessment finding most clearly indicates an acute
develop a vaccine against HIV? exacerbation of the disease?

a. HIV is still unknown to human A. A new onset of polycythemia

b. HIV mutates easily B. Presence of mononucleosis-like symptoms
c. HIV spreads rapidly throughout the body C. A sharp decrease in the patient's CD4+ count
d. HIV matures easily D. A sudden increase in the patient's WBC count

Answer B. Keyword: MAIN REASON. Rationale: C. A sharp decrease in the patient's CD4+ count
HIV was identified in 1983, thus, A is incorrect. By
1988 two strains of HIV existed, HIV-1 and HIV-2. A decrease in CD4+ count signals an exacerbation
Viruses spread rapidly and mature easily but these of the severity of HIV. Polycythemia is not
factors don't affect the potential for development characteristic of the course of HIV. A patient's
against HIV. Mutating too easily makes it hard to WBC count is very unlikely to suddenly increase,
create a vaccine against it. with decreases being typical. Mononucleosis-like
symptoms such as malaise, headache, and fatigue and opportunistic diseases. HIV cannot be cured.
are typical of early HIV infection and CD4+ T cell counts increase with therapy. There are
seroconversion. dangerous interactions with many antiretroviral
drugs and other commonly used drugs.
A pregnant woman who was tested and diagnosed
with HIV infection is very upset. What should the The woman is afraid she may get HIV from her
nurse teach this patient about her baby's risk of bisexual husband. What should the nurse include
being born with HIV infection? when teaching her about preexposure prophylaxis
(select all that apply)?
A. "The baby will probably be infected with HIV."
B. "Only an abortion will keep your baby from A. Take fluconazole (Diflucan).
having HIV." B. Take amphotericin B (Fungizone).
C. "Treatment with antiretroviral therapy will C. Use condoms for risk-reducing sexual relations.
decrease the baby's chance of HIV infection." D. Take emtricitabine and tenofovir (Truvada)
D. "The duration and frequency of contact with the regularly.
organism will determine if the baby gets HIV E. Have regular HIV testing for herself and her
infection." husband.

C. "Treatment with antiretroviral therapy will C. Use condoms for risk-reducing sexual relations.
decrease the baby's chance of HIV infection." D. Take emtricitabine and tenofovir (Truvada)
regularly.
On average, 25% of infants born to women with E. Have regular HIV testing for herself and her
untreated HIV will be born with HIV. The risk of husband.
transmission is reduced to less than 2% if the
infected pregnant woman is treated with Using male or female condoms, having monthly
antiretroviral therapy. Duration and frequency of HIV testing for the patient and her husband, and the
contact with the HIV organism is one variable that woman taking emtricitabine and tenofovir regularly
influences whether transmission of HIV occurs. has shown to decrease the infection of heterosexual
Volume, virulence, and concentration of the women having sex with a partner who participates
organism as well as host immune status are in high-risk behavior. Fluconazole and amphotericin
variables related to transmission via blood, semen, B are taken for Candida albicans, Coccidioides
vaginal secretions, or breast milk. immitis, and Cryptococcosus neoformans, which
are all opportunistic diseases associate with HIV
A 25-year-old male patient has been diagnosed with infection
HIV. The patient does not want to take more than
one antiretroviral drug. What reasons can the nurse The nurse was accidently stuck with a needle used
tell the patient about for taking more than one drug? on an HIV-positive patient. After reporting this,
what care should this nurse first receive?
A. Together they will cure HIV.
B. Viral replication will be inhibited. A. Personal protective equipment
C. They will decrease CD4+ T cell counts. B. Combination antiretroviral therapy
D. It will prevent interaction with other drugs C. Counseling to report blood exposures
D. A negative evaluation by the manage
B. Viral replication will be inhibited.
B. Combination antiretroviral therapy
The major advantage of using several classes of
antiretroviral drugs is that viral replication can be Postexposure prophylaxis with combination
inhibited in several ways, making it more difficult antiretroviral therapy can significantly decrease the
for the virus to recover and decreasing the risk of infection. Personal protective equipment
likelihood of drug resistance that is a major problem should be available although it may not have
with monotherapy. Combination therapy also delays stopped this needle stick. The needle stick has been
disease progression and decreases HIV symptoms
reported. The negative evaluation may or may not Transmission of HIV from an infected individual to
be needed but would not occur first. another most commonly occurs as a result of

The HIV-infected patient is taught health promotion a. unprotected anal or vaginal sexual intercourse.
activities including good nutrition; avoiding b. low levels of virus in the blood and high levels of
alcohol, tobacco, drug use, and exposure to CD4+ T cells.
infectious agents; keeping up to date with vaccines; c. transmission from mother to infant during labor
getting adequate rest; and stress management. What and delivery and breastfeeding.
is the rationale behind these interventions that the d. sharing of drug-using equipment, including
nurse knows? needles, syringes, pipes, and straws

A. Delaying disease progression Correct answer: a

B. Preventing disease transmission Rationale: Unprotected sexual contact (semen,
C. Helping to cure the HIV infection vaginal secretions, or blood) with a partner
D. Enabling an increase in self-care activities
During HIV infection
A. Delaying disease progression
a. the virus replicates mainly in B-cells before
These health promotion activities along with mental spreading to CD4+ T cells.
health counseling, support groups, and a therapeutic b. infection of monocytes may occur, but antibodies
relationship with health care providers will promote quickly destroy these cells.
a healthy immune system, which may delay disease c. the immune system is impaired predominantly by
progression. These measures will not cure HIV the eventual widespread destruction of CD4+ T
infection, prevent disease transmission, or increase cells.
self-care activities d. a long period of dormancy develops during which
HIV cannot be found in the blood and there is little
The patient is admitted to the ED with fever, viral replication
swollen lymph glands, sore throat, headache,
malaise, joint pain, and diarrhea. What nursing Correct answer: c
measures will help identify the need for further
assessment of the cause of this patient's Rationale: Immune dysfunction in HIV disease is
manifestations (select all that apply)? caused predominantly by damage to and destruction
of CD4+ T cells (i.e., T helper cells or CD4+ T
A. Assessment of lung sounds lymphocytes)
B. Assessment of sexual behavior
C. Assessment of living conditions Which statements accurately describe HIV infection
D. Assessment of drug and syringe use (select all that apply)?
E. Assessment of exposure to an ill person
a. Untreated HIV infection has a predictable pattern
B. Assessment of sexual behavior of progression.
D. Assessment of drug and syringe use b. Late chronic HIV infection is called acquired
immunodeficiency syndrome (AIDS).
With these symptoms, assessing this patient's sexual c. Untreated HIV infection can remain in the early
behavior and possible exposure to shared drug chronic stage for a decade or more.
equipment will identify if further assessment for the d. Untreated HIV infection usually remains in the
HIV virus should be made or the manifestations are early chronic stage for 1 year or less.
from some other illness (e.g., lung sounds and e. Opportunistic diseases occur more often when the
living conditions may indicate further testing for CD4+ T cell count is high and the viral load is low
TB).
Correct answers: a, b, c

Rationale: The typical course of untreated HIV

infection follows a predictable pattern. However, onset of HIV infection-related symptoms and
treatment can significantly alter this pattern, and opportunistic diseases.
disease progression is highly individualized. Late
chronic infection is another term for acquired Opportunistic diseases in HIV infection
immunodeficiency syndrome (AIDS). The median
interval between untreated HIV infection and a a. are usually benign.
diagnosis of AIDS is about 11 years. b. are generally slow to develop and progress.
c. occur in the presence of immunosuppression.
A diagnosis of AIDS is made when an HIV-infected d. are curable with appropriate drug interventions.
patient has
Correct answer: c
a. a CD4+ T cell count below 200/µL.
b. a high level of HIV in the blood and saliva. Rationale: Management of HIV infection is
c. lipodystrophy with metabolic abnormalities. complicated by the many opportunistic diseases that
d. oral hairy leukoplakia, an infection caused by can develop as the immune system deteriorates (see
Epstein-Barr virus. Table 15-10).

Correct answer: a Which statement about metabolic side effects of

ART is true (select all that apply)?
Rationale: AIDS is diagnosed when an individual
with HIV infection meets one of several criteria; a. These are annoying symptoms that are ultimately
one criterion is a CD4+ T cell count below 200 harmless.
cells/L. Other criteria are listed in Table 15-9. b. ART-related body changes include central fat
accumulation and peripheral wasting.
Screening for HIV infection generally involves c. Lipid abnormalities include increases in
triglycerides and decreases in high-density
a. laboratory analysis of blood to detect HIV cholesterol.
antigen. d. Insulin resistance and hyperlipidemia can be
b. electrophoretic analysis for HIV antigen in treated with drugs to control glucose and
plasma. cholesterol.
c. laboratory analysis of blood to detect HIV e. Compared to uninfected people, insulin resistance
antibodies. and hyperlipidemia are more difficult
d. analysis of lymph tissues for the presence of HIV
RNA. Correct answers: b, c, d

Correct answer: c Rationale: Some HIV-infected patients, especially

those who have been infected and have received
Rationale: The most useful screening tests for HIV ART for a long time, develop a set of metabolic
detect HIV-specific antibodies disorders that include changes in body shape (e.g.,
fat deposits in the abdomen, upper back, and breasts
Antiretroviral drugs are used to along with fat loss in the arms, legs, and face) as a
result of lipodystrophy, hyperlipidemia (i.e.,
a. cure acute HIV infection. elevated triglyceride levels and decreases in high-
b. decrease viral RNA levels. density lipoprotein levels), insulin resistance and
c. treat opportunistic diseases. hyperglycemia, bone disease (e.g., osteoporosis,
d. decrease pain and symptoms in terminal disease. osteopenia, avascular necrosis), lactic acidosis, and
cardiovascular disease.
Correct answer: b

Rationale: The goals of drug therapy in HIV

infection are to (1) decrease the viral load, (2)
maintain or raise CD4+ T cell counts, and (3) delay
Which strategy can the nurse teach the patient to d. Standard precautions
eliminate the risk of HIV transmission?
Standard precautions are indicated for prevention of
a. Using sterile equipment to inject drugs transmission of HIV to the health care worker. HIV
b. Cleaning equipment used to inject drugs is not transmitted by casual contact or respiratory
c. Taking zidovudine (AZT, ZDV, Retrovir) during droplets. HIV may be transmitted through sexual
pregnancy intercourse with an infected partner, exposure to
d. Using latex or polyurethane barriers to cover HIV-infected blood or blood products, and perinatal
genitalia during sexual contact transmission during pregnancy, at delivery, or
though breastfeeding.
Correct answer: a
Rationale: Access to sterile equipment is an A 52-year-old female patient was exposed to human
important risk-elimination tactic. Some immunodeficiency virus (HIV) 2 weeks ago through
communities have needle and syringe exchange sharing needles with other substance users. What
programs (NSEPs) that provide sterile equipment to symptoms will the nurse teach the patient to report
users in exchange for used equipment. Cleaning that would indicate the patient has developed an
equipment before use is a risk-reducing activity. It acute HIV infection?
decreases the risk when equipment is shared, but it
takes time, and a person in drug withdrawal may a. Cough, diarrhea, headaches, blurred vision,
have difficulty cleaning equipment. muscle fatigue
d. Night sweats, fatigue, fever, and persistent
What is the most appropriate nursing intervention to generalized lymphadenopathy
help an HIV-infected patient adhere to a treatment c. Oropharyngeal candidiasis or thrush, vaginal
regimen? candidal infection, or oral or genital herpes
d. Flu-like symptoms such as fever, sore throat,
a. "Set up" a drug pillbox for the patient every swollen lymph glands, nausea, or diarrhea
week.
b. Give the patient a video and a brochure to view d. Flu-like symptoms such as fever, sore throat,
and read at home. swollen lymph glands, nausea, or diarrhea
c. Tell the patient that the side effects of the drugs
are bad but that they go away after a while. Clinical manifestations of an acute infection with
d. Assess the patient's routines and find adherence HIV include flu-like symptoms between 2 to 4
cues that fit into the patient's life circumstances. weeks after exposure. Early chronic HIV infection
clinical manifestations are either asymptomatic or
Correct answer: d include fatigue, headache, low-grade fever, night
Rationale: The best approach to improve adherence sweats, and persistent generalized lympadenopathy.
to a treatment regimen is to learn about the patient's Intermediate chronic HIV infection clinical
life and assist with problem solving within the manifestations include candidal infections, shingles,
confines of that life. oral or genital herpes, bacterial infections, Kaposi
sarcoma, or oral hairy leukoplakia. Late chronic
The nurse is providing postoperative care for a 30- HIV infection or acquired immunodeficiency
year-old female patient after an appendectomy. The syndrome (AIDS) includes opportunistic diseases
patient has tested positive for human (infections and cancer).
immunodeficiency virus (HIV). What type of
precautions should the nurse observe to prevent the The nurse is monitoring the effectiveness of
transmission of this disease? antiretroviral therapy (ART) for a 56-year-old man
with acquired immunodeficiency syndrome (AIDS).
a. Droplet precautions What laboratory study result indicates the
b. Contact precautions medications have been effective?
c. Airborne precautions
d. Standard precautions a. Increased viral load
b. Decreased neutrophil count
c. Increased CD4+ T cell count ANS: A
d. Decreased white blood cell count After an initial positive EIA test, the EIA is
repeated before more specific testing such as the
c. Increased CD4+ T cell count Western blot is done. Viral cultures are not usually
part of HIV testing. It is not appropriate for the
Antiretroviral therapy is effective if there are nurse to predict the time frame for AIDS
decreased viral loads and increased CD4+ T cell development. The Western blot tests for HIV
counts. antibodies, not for AIDS.

A 62-year-old patient has acquired A patient who has a positive test for human
immunodeficiency syndrome (AIDS), and the viral immunodeficiency virus (HIV) antibodies is
load is reported as undetectable. What patient admitted to the hospital with Pneumocystis jiroveci
teaching should be provided by the nurse related to pneumonia (PCP) and a CD4+ T-cell count of less
this laboratory study result? than 200 cells/L. Based on diagnostic criteria
established by the Centers for Disease Control and
a. The patient has the virus present and can transmit Prevention (CDC), which statement by the nurse is
the infection to others. correct?
b. The patient is not able to transmit the virus to
others through sexual contact. a. "The patient meets the criteria for a diagnosis of
c. The patient will be prescribed lower doses of an acute HIV infection."
antiretroviral medications for 2 months. b. "The patient will be diagnosed with
d. The syndrome has been cured, and the patient asymptomatic chronic HIV infection."
will be able to discontinue all medications. c. "The patient has developed acquired
immunodeficiency syndrome (AIDS)."
a. The patient has the virus present and can transmit d. "The patient will develop symptomatic chronic
the infection to others. HIV infection in less than a year."

In human immunodeficiency virus (HIV) infections, ANS: C

viral loads are reported as real numbers of Development of PCP meets the diagnostic criterion
copies/μL or as undetectable. "Undetectable" for AIDS. The other responses indicate earlier
indicates that the viral load is lower than the test is stages of HIV infection than is indicated by the PCP
able to report. "Undetectable" does not mean that infection.
the virus has been eliminated from the body or that
the indivi A patient with a positive rapid antibody test result
for human immunodeficiency virus (HIV) is
A patient who has vague symptoms of fatigue, anxious and does not appear to hear what the nurse
headaches, and a positive test for human is saying. What action by the nurse is most
immunodeficiency virus (HIV) antibodies using an important at this time?
enzyme immunoassay (EIA) test. What instructions
should the nurse give to this patient? a. Teach the patient about the medications available
for treatment.
a. "The EIA test will need to be repeated to verify b. Inform the patient how to protect sexual and
the results." needle-sharing partners.
b. "A viral culture will be done to determine the c. Remind the patient about the need to return for
progression of the disease." retesting to verify the results.
c. "It will probably be 10 or more years before you d. Ask the patient to notify individuals who have
develop acquired immunodeficiency syndrome had risky contact with the patient.
(AIDS)."
d. "The Western blot test will be done to determine ANS: C
whether acquired immunodeficiency syndrome After an initial positive antibody test, the next step
(AIDS) has developed." is retesting to confirm the results. A patient who is
anxious is not likely to be able to take in new
information or be willing to disclose information drops to 2% when ART is used. Perinatal
about HIV status of other individuals. transmission can occur at any stage of HIV
infection (although it is less likely to occur when
A patient who is diagnosed with acquired the viral load is lower). ART can safely be used in
immunodeficiency syndrome (AIDS) tells the nurse, pregnancy, although some ART drugs should be
"I feel obsessed with thoughts about dying. Do you avoided.
think I am just being morbid?" Which response by
the nurse is best? Which patient exposure by the nurse is most likely
to require postexposure prophylaxis when the
a. "Thinking about dying will not improve the patient's human immunodeficiency virus (HIV)
course of AIDS." status is unknown?
b. "It is important to focus on the good things about
your life now." a. Needle stick with a needle and syringe used to
c. "Do you think that taking an antidepressant might draw blood
be helpful to you?" b. Splash into the eyes when emptying a bedpan
d. "Can you tell me more about the kind of thoughts containing stool
that you are having?" c. Contamination of open skin lesions with patient
vaginal secretions
ANS: D d. Needle stick injury with a suture needle during a
More assessment of the patient's psychosocial status surgical procedure
is needed before taking any other action. The ANS: A
statements, "Thinking about dying will not improve Puncture wounds are the most common means for
the course of AIDS" and "It is important to focus on workplace transmission of blood-borne diseases,
the good things in life" discourage the patient from and a needle with a hollow bore that had been
sharing any further information with the nurse and contaminated with the patient's blood would be a
decrease the nurse's ability to develop a trusting high-risk situation. The other situations described
relationship with the patient. Although would be much less likely to result in transmission
antidepressants may be helpful, the initial action of the virus.
should be further assessment of the patient's
feelings.
STDs
A pregnant woman with a history of asymptomatic
chronic human immunodeficiency virus (HIV) A nurse is teaching a client with genital herpes.
infection is seen at the clinic. The patient states, "I Education for this client should include an
am very nervous about making my baby sick." explanation of:
Which information will the nurse include when
teaching the patient? a) why the disease is transmittable only when
visible lesions are present.
a. The antiretroviral medications used to treat HIV b) the need for the use of petroleum products.
infection are teratogenic. c) the option of disregarding safer-sex practices
b. Most infants born to HIV-positive mothers are now that he's already infected.
not infected with the virus. d) the importance of informing his partners of the
c. Because she is at an early stage of HIV infection, disease.
the infant will not contract HIV.
d. It is likely that her newborn will become infected D
with HIV unless she uses antiretroviral therapy
(ART) Katrina Sterrett, a 26-year-old preschool teacher, is
being seen by a physician who is part of the
ANS: B internist group where you practice nursing. She is
Only 25% of infants born to HIV-positive mothers undergoing her annual physical and is having many
develop HIV infection, even when the mother does lab tests done as a condition of her employment and
not use ART during pregnancy. The percentage upcoming wedding. She is returning for her results
and is devastated to learn that she has the sexually- c) 25 to 29 years
transmitted infection, gonorrhea. What would d) 30 to 45 years
contribute to her ignorance of her condition? B

a) Being asymptomatic A 16-year-old patient comes to the free clinic and is

b) All options are correct diagnosed with primary syphilis. The patient states
c) Being sexually inactive that she contracted this disease by holding hands
d) Knowing the signs and symptoms of STIs with someone who has syphilis. What is the most
appropriate nursing diagnosis for this patient?
A
a) Alteration in comfort related to impaired skin
Within the free clinic where you practice nursing, integrity
you hold weekly sexual education classes open to b) Fear related to complications
the public. Within the classroom, you communicate c) Noncompliance with treatment regimen related to
the CDC's numbers for the incidence of STIs and age
their impact upon public health. Which is the d) Knowledge deficit related to modes of
fastest-spreading bacterial STI in the United States? transmission

a) Gonorrhea D
b) Chlamydia
c) Herpes simplex 1 A 22-year-old patient has presented to her primary
d) HPV care provider for her scheduled Pap smear.
Abnormal results of this diagnostic test may imply
B infection with:

A nurse is caring for a client diagnosed with a a) human papillomavirus (HPV).

chlamydia infection. The nurse teaches the client b) Chlamydia trachomatis.
about disease transmission and advises the client to c) Candida albicans.
inform his sexual partners of the infection. The d) Trichomonas vaginalis.
client refuses, stating, "This is my business and I'm
not telling anyone. Beside, chlamydia doesn't cause A
any harm like the other STDs." How should the
nurse proceed? A female college student is distressed at the recent
appearance of genital warts, an assessment finding
a) Do nothing because the client's sexual habits that her care provider has confirmed as attributable
place him at risk for contracting other STDs. to human papillomavirus (HPV) infection. Which of
b) Educate the client about why it's important to the following information should the nurse give the
inform sexual contacts so they can receive patient?
treatment.
c) Inform the health department that this client a) "It's important to start treatment soon, so you will
contracted an STD. be prescribed pills today."
d) Inform the client's sexual contacts of their b) "I'd like to give you an HPV vaccination if that's
possible exposure to chlamydia. okay with you."
c) "There is a chance that these will clear up on
B their own without any treatment."
d) "Unfortunately, this is going to greatly increase
A nurse is teaching a health class to a group of your chance of developing pelvic inflammatory
clients likely to be at highest risk for gonorrhea. disease."
What is the age range of the clients?
C
a) 60 to 70 years
b) 15 to 24 years
A client is being treated for gonorrhea. Which agent After teaching a group of students about sexually
would the nurse expect the physician to prescribe? transmitted infections (STIs), the instructor
determines that additional teaching is necessary
a) Tetracycline when the students identify which STI as curable
b) Ceftriaxone with treatment?
c) Penicillin
d) Levofloxacin a) Syphillis
b) Gonorrhea
B c) Chlamydia
d) Genital herpes
A client with a history of HSV-2 infection asks the
nurse about future sexual activity. Which of the D
following responses would be most appropriate?
A student nurse is caring for a male patient
a) "Inform all potential sexual partners about the diagnosed with gonorrhea. The patient is receiving
infection, even if it is inactive.". ceftriaxone and doxycycline. The nursing instructor
b) "Use a condom during sexual activity if the asks the student why the patient is receiving two
infection becomes active again." antibiotics. What is the student nurse's best
c) "If the infection has healed, you probably don't response?
have to use a condom."
d) "Refrain from all sexual activity until you don't a) "This combination of medications will eradicate
have another outbreak for a year." the infection faster than a single antibiotic."
b) "Many people infected with gonorrhea are
A infected with chlamydia as well."
c) "The combination of these two antibiotics
A male client reports urethral pain and a creamy reduces the risk of reinfection."
yellow, bloody discharge from the penis. The nurse d) "There are many resistant strains of gonorrhea, so
associates these characteristics with which of the more than one antibiotic may be required for
following sexually transmitted infections? successful treatment."

a) Gonorrhea B
b) Candidiasis
c) Chancroid A client is diagnosed as being in the primary stage
d) Trichomoniasis of syphilis? Which of the following would the nurse
expect as a finding?
A
a) Palmar rash
A client with primary syphilis is allergic to b) Development of gummas
penicillin. The nurse would expect the physician to c) Development of central nervous system lesions
order which agent? d) Genital chancres

a) Podophyllum resin D
b) Tetracycline
c) Ceftriaxone The nurse is preparing a presentation for a local
d) Acyclovir community group about sexually transmitted
infections (STIs). Which of the following would the
B nurse expect to include as the most common STI in
the United States?

a) Chlamydia
b) Syphilis
c) Genital herpes b) 75%
d) Gonorrhea c) 50%
d) 25%
A
B
A patient has herpes simplex 2 viral infection
(HSV-2). The nurse recognizes that which of the A nurse is teaching a community health class of
following should be included in teaching the women and explains that a sexually transmitted
patient? infection (STI) is associated with an increased risk
of infertility in women. Which of the following
a) The virus causes "cold sores" of the lips. STIs would the nurse identify?
b) Treatment is focused on relieving symptoms.
c) The virus may be cured with antibiotics. a) Herpes simplex
d) The virus when active may not be contracted b) Syphilis
during intercourse. c) Chlamydia
d) Gonorrhea
B
C
A male patient comes to the clinic and is diagnosed
with gonorrhea. Which symptom most likely An instructor is teaching a group of students about
prompted him to seek medical attention? the incidence of sexually transmitted infections
(STIs) and those that must be reported by law. The
a) Painful red papules on the shaft of the penis instructor determines that the students have
b) Foul-smelling discharge from the penis understood the information when they state that
c) Rashes on the palms of the hands and soles of the which STI must be reported?
feet
d) Cauliflower-like warts on the penis a) Syphilis
b) Condylomata acuminata
B c) Genital herpes
d) Hepatitis B
Max Thornton, a 24-year-old chef, is being seen by
a physician at the urology group where you practice A
nursing. He has developed a painless ulcer on his
penis and is rather concerned about his health. The A client with genital herpes asks the nurse about
urologist will be communicating his diagnosis of what to expect with the infection. Which of the
syphilis and prescribing treatment. What is the following responses would be most appropriate?
typical span of time between infection and
developing symptoms with syphilis? a) Once you take the medication, the infection will
be gone for good.
a) 14 days b) You might have to try several different
b) 21 days medications before finding one that works.
c) 35 days c) Even though you don't have symptoms, you
d) 28 days could still spread the infection.
B d) You can expect other outbreaks, each of which
will be longer than the first.
A client is diagnosed with chlamydia and is
distraught. "How can I have this problem? I don't C
have any symptoms!" she says. The nurse teaches
the client that the percentage of women with When obtaining the health history from a client,
chlamydia who are asymptomatic is as high as which factor would lead the nurse to suspect that
the client has an increased risk for sexually
a) 100% transmitted infections (STIs)?
 The nurse is gathering data from a male client who
a) Hive-like rash for the past 2 days is suspected of having gonorrhea. Which of the
b) Clear vaginal discharge following would the nurse most likely find?
c) Weight gain of 5 lbs in one year
d) Five different sexual partners a) Testicular pain
b) Purulent rectal discharge
D c) Pain on urination
d) Skin rash
The nurse is giving a presentation about chlamydia
to a group of adult women. The nurse would C
emphasize the need for annual screening for this
infection in all sexually active women younger than A nurse is assisting with a physical examination of
which age? a male client. Which of the following signs and
symptoms is most clearly suggestive of primary
a) 26 genital herpes?
b) 35
c) 18 a) Emergence of hard, painless nodules on the shaft
d) 32 of the penis
b) Presence of purulent, whitish discharge from the
A penis
c) Production of cloudy, foul-smelling urine
A nurse is assessing a woman with vaginal d) Itching, pain, and the emergence of pustules on
discharge. The nurse suspects bacterial vaginosis the penis
when the client states which of the following?
D
a) "The discharge is yellowish but thin."
b) "I noticed a strange fishy odor during my A nurse is providing care to a client with chlamydia.
period." The nurse anticipates that the client will also receive
c) "The discharge looks almost like cottage cheese." treatment for which of the following?
d) "I've been experiencing some really intense
itching." a) Mycoplasma
b) Trichomoniasis
B c) Human papillomavirus
d) Gonorrhea
A nurse is developing a plan of care for a female
client experiencing her first outbreak of genital D
herpes. Which nursing diagnosis would the nurse
most likely identify as the priority? When teaching a patient infected with HIV
regarding transmission of the virus to others, which
a) Acute pain related to the development of the of the following statements made by the patient
genital lesions would identify a need for further education?
b) Deficient knowledge related to the disease and its
transmission A) "I will need to isolate any tissues I use so as not
c) Ineffective coping related to the increased stress to infect my family."
associated with the infection B) "I will notify all of my sexual partners so they
d) Hyperthermia related to body's response to an can get tested for HIV."
infectious process C) "Unprotected sexual contact is the most common
mode of transmission."
A D) "I do not need to worry about spreading this
virus to others by sweating at the gym."

A
A hospital has seen a recent increase in the in patient teaching?
incidence of hospital-acquired infections (HAIs).
Which of the following measures should be A) "While being treated for the infection, you will
prioritized in the response to this trend? not be able to pass this infection on to your sexual
partner."
A) Use of gloves during patient contact B) "While you're taking your antibiotics, you will
B) Frequent and thorough hand washing need to abstain from participating in sexual activity
C) Prophylactic, broad-spectrum antibiotics or drinking alcohol."
D) Fitting and appropriate use of N95 masks C) "It's important to complete your full course of
antibiotics in order to ensure that you become
B resistant to reinfection."
D) "The symptoms of gonorrhea will resolve on
Standard precautions should be used when their own, but it is important for you to abstain from
providing care for sexual activity while this is occurring."

A) All patients regardless of diagnosis. B

B) Pediatric and gerontologic patients.
C) Patients who are immunocompromised. Screening for chlamydia is recommended for young
D) Patients with a history of infectious diseases. women because

A A) Chlamydia is frequently comorbid with HIV.

B) Chlamydial infections may progress to sepsis.
A patient comes to the clinic after being informed C) Untreated chlamydial infections can lead to
by a sexual partner of possible recent exposure to infertility.
syphilis. The nurse will examine the patient for D) Chlamydial infections are treatable only in the
which of the following characteristic findings of early stages of infection.
syphilis in the primary clinical stage?
C
A) Chancre
B) Alopecia A 30-year-old female patient has sought care
C) Condylomata lata because of the recent appearance of itchy lesions on
D) Regional adenopathy her vulva, some of which have recently burst. The
patient's description of her problem would lead you
A to first suspect

Teaching for patients with a sexually transmitted A) HIV.

disease (STD) would include (select all that apply) B) Gonorrhea.
C) Chlamydia.
A) Treatment of sexual partner is important. D) Genital herpes.
B) Douching may help provide relief of itching.
C) Cotton undergarments are preferred over D
synthetic materials.
D) Sexual abstinence is indicated during the The physical assessment and history of a 29-year-
communicable phase of the disease. old female patient are indicative of human
E) Condoms should be used during as well as after papillomavirus (HPV) infection. You would
treatment during sexual activity. perform patient teaching related to

A,C,D,E A) Gardasil.
B) Antibiotic therapy.
A 22-year-old male is being treated at a college C) Wart removal options.
health care clinic for gonorrhea. Which of the D) Treatment with antiviral drugs.
following teaching points should the nurse include C
A client is diagnosed as being in the primary stage When developing the plan of care for a client with a
of syphilis? Which of the following would the nurse primary immunodeficiency, which nursing
expect as a finding? diagnosis would be the priority?

a) Development of gummas a) Risk for infection related to altered immune cell

b) Palmar rash function
c) Genital chancres b) Impaired skin integrity related to persistent deep
d) Development of central nervous system lesions skin abscesses
c) Anxiety related to an inherited disorder
C d) Grieving related to the poor prognosis of the
condition
A client with genital herpes simplex infection asks
the nurse, "Will I ever be cured of this infection?" A
Which response by the nurse would be most
appropriate? A group of students are reviewing class material on
sexually transmitted infections in preparation for a
a) "All you need is a dose of penicillin and the test. The students demonstrate understanding of the
infection will be gone." material when they identify which of the following
b) "There is a new vaccine available that prevents as the cause of condylomata?
the infection from returning."
c) "Once you have the infection, you develop an a) Human papilloma virus
immunity to it." b) Haemophilus ducreyi bacillus
d) "There is no cure, but drug therapy helps to c) Herpes virus
reduce symptoms and recurrences." d) Treponema pallidum

D A

A client visits the nurse complaining of diarrhea After teaching a client with immunodeficiency
every time they eat. The client has AIDS and wants about ways to prevent infection, the nurse
to know what they can do to stop having diarrhea. determines that teaching was successful when the
What should the nurse advise? client states which of the following?

a) Reduce food intake. a) "I will clean my kitchen counter with hot water."
b) Encourage large, high-fat meals. b) "Alcohol is good to clean any skin areas that are
c) Avoid residue, lactose, fat, and caffeine. dry or chafed."
d) Increase the intake of iron and zinc. c) "I should avoid eating cooked fruits and
vegetables."
C d) "I should avoid being around other people who
have an infection."
A client is prescribed didanosine (Videx) as part of
his highly active antiretroviral therapy (HAART). D
Which instruction would the nurse emphasize with
this client? A 45-year-old waitress with a history of IV drug use
also is HIV-positive. She has been following her
a) "You should take the drug with an antacid." antiretroviral medication regimen faithfully and is
b) "It doesn't matter if you take this drug with or doing well. She's attending college to get a social
without food." work degree and is focused on a bright future. In
c) "Be sure to take this drug about 1/2 hour before her regular CD counts, what factor will indicate she
or 2 hours after you eat." has progressed from HIV to AIDS?
d) "When you take this drug, eat a high-fat meal
immediately afterwards." a) CD count > 200/mm
C b) CD count > 100/mm
c) CD count < 200/mm suspect a primary immunodeficiency?
d) CD count < 100/mm
a) Superficial wound on the child's left leg
C b) History of fungal diaper rash
c) Ten ear infections in the past year
A patient comes to the free clinic complaining of d) Weight within age-appropriate parameters
urethral discharge. On assessment, the nurse notes
that the patient is feverish. During the assessment, C
the patient admits to having unprotected sex. The
nurse suspects the patient may have a diagnosis of A student nurse is doing clinical hours at an
what? OB/GYN clinic. The student is helping to develop a
plan of care for a patient with gonorrhea has
a) HIV presented at the clinic. The student knows that the
b) Chlamydia care plan for this patient should be include what in
c) Syphilis the treatment of gonorrhea?
d) Gonorrhea
a) Concurrent treatment for chlamydia
D b) Avoidance of the use of tampons
c) Vaginal smears every 6 months
A female client with an anal gonorrheal infection d) Radiation therapy to destroy cancerous cells
experiences painful bowel elimination and a
purulent rectal discharge. The nurse would expect to A
find which of the following once the microorganism
disseminates throughout the body? A nurse is teaching a client with genital herpes.
Education for this client should include an
a) Painful joints explanation of:
b) Intermenstrual bleeding
c) Sore throat a) why the disease is transmittable only when
d) Painful urination visible lesions are present.
b) the need for the use of petroleum products.
A c) the option of disregarding safer-sex practices
now that he's already infected.
Which information would be most appropriate for a d) the importance of informing his partners of the
nurse to provide to a client who has never used a disease.
condom?
D ~ Importance of informing his partners of the
a) A condom can be used, even if it is old, so long disease.
as the pack is unopened.
b) A new condom should be used for each sex act. Clients with genital herpes should inform their
c) Cheap condoms of any brand can be used based partners of the disease to help prevent transmission.
on monetary constraints. Petroleum products should be avoided because they
d) A fresh condom should be unrolled over a limp can cause the virus to spread. The notion that
penis before it becomes erect. genital herpes is only transmittable when visible
lesions are present is false. Anyone not in a long-
B term, monogamous relationship, regardless of
current health status, should follow safer-sex
A mother brings her young child to the clinic for an practices.
evaluation of an infection. The mother states, "He's
been taking antibiotics now for more than 2 months A 22-year-old patient has presented to her primary
and still doesn't seem any better. It's like he's always care provider for her scheduled Pap smear.
sick." During the history and physical examination, Abnormal results of this diagnostic test may imply
which of the following would alert the nurse to infection with:
a) human papillomavirus (HPV). teaching should focus on the various options for
b) Chlamydia trachomatis. physically removing the warts.
c) Candida albicans.
d) Trichomonas vaginalis. A 21-year-old college student has come to see the
nurse practitioner for treatment of a vaginal
A ~ human papillomavirus (HPV) infection. Physical assessment reveals inflammation
of the vagina and vulva, and vaginal discharge has a
Although a Pap smear does not test directly for cottage cheese appearance. These findings are
HPV, dysplasia of cervical cells is strongly consistent with:
associated with HPV infection. An abnormal Pap
smear is not indicative of chlamydial infection, a. candidiasis
trichomoniasis, or candidiasis. b. trichomoniasis
c. bacterial vaginosis
A female college student is distressed at the recent d. Chlamydia
appearance of genital warts, an assessment finding
that her care provider has confirmed as attributable A ~ The signs and symptoms of candidiasis include
to human papillomavirus (HPV) infection. Which of inflammation of the vagina and vulva and a cottage
the following information should the nurse give the cheese appearance to the vaginal discharge
patient?

a) "It's important to start treatment soon, so you will

be prescribed pills today." TUBERCULOSIS
b) "I'd like to give you an HPV vaccination if that's
okay with you." The nurse suspects that a client is at risk for
c) "There is a chance that these will clear up on tuberculosis. Which risk factor should the nurse
their own without any treatment." assess in this client? (Select all that apply.)
d) "Unfortunately, this is going to greatly increase
your chance of developing pelvic inflammatory A. Sharing clothes with an infected individual
disease." B. Living in a poorly ventilated environment
C. Using injection drugs
C ~ There is a chance that these will clear up on D. Being an immigrant to the United States
their own without any tx E. Having a compromised immune system
Genital warts may resolve spontaneously, although
this does not preclude recurrence. Pharmacologic Answer: B, C, D, E
treatments are topical and vaccination is ineffective
after infection has occurred. HPV infection is not The nurse prepares educational material on the
correlated with pelvic inflammatory disease (PID). development of tuberculosis for a group of new
nurses. In which order should the nurse explain the
The physical assessment and history of a 29-year- disease process develops?
old female patient are indicative of human - (1) WBCs surround bacteria
papillomavirus (HPV) infection. You would - (2)Tubercle forms and caseous necrosis occurs
perform patient teaching related to -(3)Droplet nuclei enter the lungs and the bacteria
multiply
A) Gardasil. -(4)Scar tissue forms around tubercle and the lesion
B) Antibiotic therapy. calcifies
C) Wart removal options. -(5)Mycobacterium tuberculosis in droplet nuclei
D) Treatment with antiviral drugs. enter the air
5, 3, 1, 2, 4,
C ~ Wart removal options
The HPV vaccine (Gardasil) is ineffective in cases A client has a 6-mm area that is slightly red and soft
of existing HPV, whereas neither antiviral nor to the touch at the site of a PPD (Mantoux) test.
antibiotic drugs are effective treatments. Patient Which finding should the nurse document for this
client? The nurse in a community clinic is asked to
determine which clients require tuberculosis testing.
A. Negative response Which individual should the nurse recommend for
B. Positive response if the client had an abnormal this screening? (Select all that apply.)
chest x-ray
C. Positive response A. An individual with close contacts who already
D. Indeterminate response have or are suspected to have tuberculosis
B. An individual who is a resident or staff member
answer: A of a long-term residential facility
C. An individual who had the bacille Calmette-
An older adult client experiencing a cough, Guérin (BCG) vaccine
hemoptysis, night sweats, anorexia, and weakness D. An individual that has had PPD
reports being told of having tuberculosis when E. An individual infected with HIV or at high risk
younger. Which reason should the nurse suspect is for HIV infection
responsible for the client's current symptoms?
Answer: A, B, E
A. New-onset tuberculosis
B. Reactivation tuberculosis As the nurse reviews the history of a client admitted
C. Skeletal tuberculosis in labor, the nurse notes that the client has inactive
D. Dormant tuberculosis tuberculosis. Which should the nurse include in the
plan of care for this client?
Answer: B
A. The client will be allowed to breastfeed the
A client with tuberculosis experiences shortness of infant.
breath, hypoxia, cyanosis, and subcutaneous B. Once delivered, the infant will be placed on
emphysema. Which pathophysiologic change prophylactic treatment.
should the nurse suspect as causing this client's C. Direct contact should be avoided until the client
symptoms? is noninfectious.
D. Pharmacologic therapy for the client should be
A. Rupture of tuberculosis lesion initiated immediately.
B. Encapsulation of the bacilli
C. Reactivation tuberculosis Answer: A
D. Miliary tuberculosis
The nurse is caring for a child diagnosed with
answer: A tuberculosis infection. Which risk factor should the
nurse identify that would greatly increase the risk
The infection control nurse is teaching the staff at a for progression to disease? (Select all that apply.)
long-term care facility after a recent outbreak of
tuberculosis. Which element of infection control A. Presence of HIV infection
should the nurse include in the teaching? (Select all B. Genetic factors
that apply.) C. Age less than 2 years
D. Virulence of the organism
A. Implementation of universal screening E. Magnitude of the infection
B. Use of airborne precautions
C. Treatment of clients with suspected or confirmed Answer: A, C
disease
D. Administration of the bacille Calmette-Guérin The nurse visits the home of a client with
(BCG) vaccine to residents tuberculosis. Which action should the nurse teach
E. Identification of infected individuals family members to take during the first 2 weeks of
treatment to prevent the spread of the infection to
Answer: B, C, E other family members?
A. Be compliant with the medication regimen. The nurse instructs a client with tuberculosis on the
B. Ensure that housemates of the client are tested medication rifampin. Which client statement
and receive prophylactic treatment if indicated. indicates teaching has been effective? (Select all
C. Use disposable tissues to contain respiratory that apply.)
secretions.
D. Emphasize the importance of maintaining good A. "I should take rifampin on an empty stomach."
general health through diet and exercise. B. "I need to monitor my vision daily by reading a
newspaper."
Answer: C C. "I should not take aspirin while I am taking
rifampin."
The nurse is providing care to a client who has been D. "I should not be frightened if my urine changes
diagnosed with tuberculosis. Which diagnostic test to an orange-red color; it is a normal side effect."
should the nurse expect to be prescribed prior to E. "I need to take pyridoxine (vitamin B6) along
initiating antibiotic treatment? (Select all that with the rifampin."
apply.)
Answer: A, C, D
A. Polymerase chain reaction (PCR)
B. Intradermal PPD (Mantoux) test The nurse is planning care for a client who is
C. Sputum culture homeless. The client is prescribed four drugs to
D. Tine test treat tuberculosis. Which action should the nurse
E. Sputum smear take to ensure compliance with this medication
therapy? (Select all that apply.)
Answer: A, C, E
A. Ask the healthcare provider to consider
The public health nurse is training a nurse on hospitalizing the client for initial treatment to
tuberculin skin testing. Which information about the ensure compliance.
Mantoux test should the public health nurse include B. Work collaboratively with other healthcare team
in the training? (Select all that apply.) members to identify barriers or challenges.
C. Tailor teaching concerning the drugs to the needs
A. "PPD (0.1 mL) is injected intradermally into the of the client.
dorsal aspect of the forearm." D. Assess the client's understanding of the disease
B. "The test is read within 48 to 72 hours." process, and identify misperceptions and emotional
C. "This test is less accurate than the T-SPOT test." reactions.
D. "Ten tuberculin units are injected." E. Reduce the number of drugs and the duration of
E. "Diameter of induration is recorded in taking the medicine to accommodate the client's
millimeters." transient situation.

Answer: B, E Answer: B, C, D

The nurse is preparing teaching for a client newly The nurse is identifying interventions for a client
diagnosed with tuberculosis. Which drug generally with tuberculosis. Which nursing intervention
used in initial treatment should the nurse include in should the nurse identify to address the risk of
the session? (Select all that apply.) infecting others? (Select all that apply.)

A. Isoniazid A. Providing verbal and written instructions about

B. Amikacin when to take the medications
C. Pyrazinamide B. Informing all personnel who have contact with
D. Rifampin the client of the diagnosis
E. Ethambutol C. Teaching the client how to avoid transmitting the
disease to others
Answer: A, C, D, E D. Assessing self-care abilities and support systems
E. Teaching the client why it is important to comply
with prescribed treatments for the whole course of The nurse is assessing a client with tuberculosis.
therapy Which should the nurse focus on during this
assessment? (Select all that apply.)
Answer: B, C, E
A. Presence of cough
The nurse is reviewing data collected during the B. Difficulty breathing
assessment of a client with tuberculosis. Which C. Skin color
nursing diagnosis should the nurse select for this D. Carbon dioxide level
client? (Select all that apply.) E. Nasal congestion

A. Infection, Risk for Answer: A, B, C

B. Health: Community, Deficient
C. Resilience, Impaired The right forearm of a client who had a purified
D. Fatigue protein derivative (PPD) test for tuberculosis is
E. Resilience, Impaired reddened and raised about 3mm where the test was
given. This PPD would be read as having which of
Answer: A, B, C, D the following results?

The nurse is preparing a plan of care for a client A) Indeterminate

diagnosed with tuberculosis. Which goal and B) Needs to be redone
outcome should the nurse identify for this client? C) Negative
(Select all that apply.) D) Positive

A. The client will demonstrate behaviors that reduce C

the risk of spreading the disease to others.
B. The client with active tuberculosis complies with This test would be classed as negative. A 5 mm
prescribed therapies, symptoms resolve, and chest raised area would be a positive result if a client was
x-rays improve. HIV+ or had recent close contact with someone
C. The client with latent infection completes diagnosed with TB. Indeterminate isn't a term used
therapy and does not develop active tuberculosis. to describe results of a PPD test. If the PPD is
D. The client will have the resources necessary to reddened and raised 10mm or more, it's considered
obtain required supplies and medications. positive according to the CDC.
E. The client will articulate required treatment and
follow-up care. A client with primary TB infection can expect to
develop which of the following conditions?
Answer: A, D, E
a) Active TB within 2 weeks
The nurse instructs a client with tuberculosis on b) Active TB within 1 month
prescribed medication. Which finding should the c) A fever that requires hospitalization
nurse instruct the client to report to the healthcare d) A positive skin test
provider? (Select all that apply.)
d)
A. Yellow tint to sclera
B. Sudden weight gain A primary TB infection occurs when the bacillus
C. Hemoptysis has successfully invaded the entire body after
D. Orange tint to sweat entering through the lungs. At this point, the bacilli
E. Chest pain are walled off and skin tests read positive. However,
all but infants and immunosuppressed people will
Answer: A, B, C, E remain asymptomatic. The general population has a
10% risk of developing active TB over their
lifetime, in many cases because of a break in the
body's immune defenses. The active stage shows
the classic symptoms of TB: fever, hemoptysis, and C)
night sweats.
The sputum culture for Mycobacterium tuberculosis
A client was infected with TB 10 years ago but is the only method of confirming the diagnosis.
never developed the disease. He's now being treated Lesions in the lung may not be big enough to be
for cancer. The client begins to develop signs of seen on x-ray. Skin tests may be falsely positive or
TB. This is known as which of the following types falsely negative.
of infection?
A client with a positive Mantoux test result will be
a) active infection sent for a chest x-ray. For which of the following
b) primary infection reasons is this done?
c) super infection
d) tertiary infection A
To confirm the diagnosis
a) B
To determine if a repeat skin test is needed
Some people carry dormant TB infections that may C
develop into active disease. In addition, primary To determine the extent of the lesions
sites of infection containing TB bacilli may remain D
inactive for years and then activate when the client's To determine if this is a primary or secondary
resistance is lowered, as when a client is being infection
treated for cancer. There's no such thing as tertiary
infection, and superinfection doesn't apply in this C)
case.
If the lesions are large enough, the chest x-ray will
A client has active TB. Which of the following show their presence in the lungs. Sputum culture
symptoms will he exhibit? confirms the diagnosis. There can be false-positive
and false-negative skin test results. A chest x-ray
A) Chest and lower back pain can't determine if this is a primary or secondary
B) Chills, fever, night sweats, and hemoptysis infection.
C) Fever of more than 104*F and nausea
D) Headache and photophobia A chest x-ray should a client's lungs to be clear. His
Mantoux test is positive, with a 10mm if induration.
B) His previous test was negative. These test results
are possible because:
Typical signs and symptoms are chills, fever, night
sweats, and hemoptysis. Chest pain may be present A
from coughing, but isn't usual. Clients with TB He had TB in the past and no longer has it.
typically have low-grade fevers, not higher than B
102*F. Nausea, headache, and photophobia aren't He was successfully treated for TB, but skin tests
usual TB symptoms. always stay positive
C
Which of the following diagnostic tests is definitive He's a "seroconverter", meaning the TB has gotten
for TB? to his bloodstream
A D
Chest x-ray He's a "tuberculin converter," which means he has
B been infected with TB since his last skin test
Mantoux test
C D)
Sputum culture
D A client with a positive skin test for TB isn't
Tuberculin test showing signs of active disease. To help prevent the
development of active TB, the client should be sent home, although he'll continue to take the
treated with isoniazid, 300 mg daily, for how long? antitubercular drugs for 9 to 12 months.

A A client is diagnosed with active TB and started on

10 to 14 days triple antibiotic therapy. What signs and symptoms
B would the client show if therapy is inadequate?
2 to 4 weeks
C A
3 to 6 months Decreased shortness of breath
D B
9 to 12 months Improved chest x-ray
C
D) Nonproductive cough
D
Because of the increased incidence of resistant Positive acid-fast bacilli in a sputum sample after 2
strains of TB, the disease must be treated for up to months of treatment
24 months in some cases, but treatment typically
lasts for 9-12 months. Isoniazid is the most common D)
medication used for the treatment of TB, but other
antibiotics are added to the regimen to obtain the Continuing to have acid-fast bacilli in the sputum
best results. after 2 months indicated continued infection.

A client with a productive cough, chills, and night A client diagnosed with active TB would be
sweats is suspected of having active TB. The hospitalized primarily for which of the following
physician should take which of the following reasons?
actions?
A
A To evaluate his condition
Admit him to the hospital in respiratory isolation B
B To determine his compliance
Prescribe isoniazid and tell him to go home and rest C
C To prevent spread of the disease
Give a tuberculin test and tell him to come back in D
48 hours and have it read To determine the need for antibiotic therapy
D
Give a prescription for isoniazid, 300 mg daily for 2 C)
weeks, and send him home
The client with active TB is highly contagious until
A) three consecutive sputum cultures are negative, so
he's put in respiratory isolation in the hospital.
The client is showing s/s of active TB and, because
of the productive cough, is highly contagious. He A community health nurse is conducting an
should be admitted to the hospital, placed in educational session with community members
respiratory isolation, and three sputum cultures regarding TB. The nurse tells the group that one of
should be obtained to confirm the diagnosis. He the first symptoms associated with TB is:
would most likely be given isoniazid and two or
three other antitubercular antibiotics until the A
diagnosis is confirmed, then isolation and treatment A bloody, productive cough
would continue if the cultures were positive for TB. B
After 7 to 10 days, three more consecutive sputum A cough with the expectoration of mucoid sputum
cultures will be obtained. If they're negative, he C
would be considered non-contagious and may be Chest pain
D A nurse is caring for a client diagnosed with TB.
Dyspnea Which assessment, if made by the nurse, would not
be consistent with the usual clinical presentation of
B) TB and may indicate the development of a
concurrent problem?
One of the first pulmonary symptoms includes a
slight cough with the expectoration of mucoid A
sputum. Nonproductive or productive cough
B
Isoniazid (INH) and rifampin (Rifadin) have been Anorexia and weight loss
prescribed for a client with TB. A nurse reviews the C
medical record of the client. Which of the Chills and night sweats
following, if noted in the client's history, would D
require physician notification? High-grade fever

A D)
Heart disease
B The client with TB usually experiences cough (non-
Allergy to penicillin productive or productive), fatigue, anorexia, weight
C loss, dyspnea, hemoptysis, chest discomfort or pain,
Hepatitis B chills and sweats (which may occur at night), and a
D low-grade fever.
Rheumatic fever
The nurse obtains a sputum specimen from a client
C) with suspected TB for laboratory study. Which of
the following laboratory techniques is most
Isoniazid and rafampin are contraindicated in clients commonly used to identify tubercle bacilli in
with acute liver disease or a history of hepatic sputum?
injury.
A
A client who is HIV+ has had a PPD skin test. The Acid-fast staining
nurse notes a 7-mm area of induration at the site of B
the skin test. The nurse interprets the results as: Sensitivity testing
C
A Agglutination testing
Positive D
B Dark-field illumination
Negative A)
C
Inconclusive The most commonly used technique to identify
D tubercle bacilli is acid-fast staining. The bacilli have
The need for repeat testing a waxy surface, which makes them difficult to stain
in the lab. However, once they are stained, the stain
A) is resistant to removal, even with acids. Therefore,
tubercle bacilli are often called acid-fast bacilli.
The client with HIV+ status is considered to have
positive results on PPD skin test with an area Which of the following family members exposed to
greater than 5-mm of induration. The client with TB would be at highest risk for contracting the
HIV is immunosuppressed, making a smaller area disease?
of induration positive for this type of client.
A
45-year-old mother
B B)
17-year-old daughter
C A positive PPD test indicates that the client has
8-year-old son been exposed to tubercle bacilli. Exposure does not
D necessarily mean that active disease exists.
76-year-old grandmother
INH treatment is associated with the development
D) of peripheral neuropathies. Which of the following
interventions would the nurse teach the client to
Elderly persons are believed to be at higher risk for help prevent this complication?
contracting TB because of decreased
immunocompetence. Other high-risk populations in A
the US include the urban poor, AIDS, and minority Adhere to a low cholesterol diet
groups. B
Supplement the diet with pyridoxine (vitamin B6)
The nurse is teaching a client who has been C
diagnosed with TB how to avoid spreading the Get extra rest
disease to family members. Which statement(s) by D
the client indicate(s) that he has understood the Avoid excessive sun exposure
nurses instructions? Select all that apply.
B)
A
"I will need to dispose of my old clothing when I INH competes with the available vitamin B6 in the
return home." body and leaves the client at risk for development
B of neuropathies related to vitamin deficiency.
"I should always cover my mouth and nose when Supplemental vitamin B6 is routinely prescribed.
sneezing."
C The nurse should include which of the following
"It is important that I isolate myself from family instructions when developing a teaching plan for
when possible." clients receiving INH and rifampin for treatment for
D TB?
"I should use paper tissues to cough in and dispose
of them properly." A
E Take the medication with antacids
"I can use regular plate and utensils whenever I B
eat." Double the dosage if a drug dose is forgotten
C
B, D, and E Increase intake of dairy products
D
A client has a positive reaction to the PPD test. The Limit alcohol intake
nurse correctly interprets this reaction to mean that D)
the client has:
INH and rifampin are hepatotoxic drugs. Clients
A should be warned to limit intake of alcohol during
Active TB drug therapy. Both drugs should be taken on an
B empty stomach. If antacids are needed for GI
Had contact with Mycobacterium tuberculosis distress, they should be taken 1 hour before or 2
C hours after these drugs are administered. Clients
Developed a resistance to tubercle bacilli should not double the dosage of these drugs because
D of their potential toxicity. Clients taking INH should
Developed passive immunity to TB avoid foods that are rich in tyramine, such as cheese
and dairy products, or they may develop 30. What is the purpose of cleaning a wound with
hypertension. hydrogen peroxide

The public health nurse is providing follow-up care It increase the oxygen, which makes the would
to a client with TB who does not regularly take his aerobic which would kill the bacteria
medication. Which nursing action would be most
appropriate for this client? 31. Would that kill endospores

A No
Ask the client's spouse to supervise the daily
administration of the medications. 32. What type of immunity is provided by tetanus
B antitoxin
Visit the clinic weekly to ask him whether he is
taking his medications regularly. Artificial passive immunity
C
Notify the physician of the client's non-compliance 33. Does tetanus vaccine provide lifelong immunity
and request a different prescription. No, need booster shots every 10 years
D
Remind the client that TB can be fatal if not taken 34. The name of the toxin that Clostridium tetani
properly. produces
Tetanospasmin
A)
35. What is the effect of tetanospasmin on the
muscles
Directly observed therapy (DOT) can be
implemented with clients who are not compliant Constant muscle contraction without opposing
with drug therapy. In DOT, a responsible person, muscles relaxing
who may be a family member or a health care
provider, observes the client taking the medication. 36. Tetanus is often misdiagnosed as what disease
Visiting the client, changing the prescription, or during the prodromal stage
threatening the client will not ensure compliance if Migraine
the client will not or cannot follow the prescribed
treatment. 37. Tetanus is commonly known as another
condition because muscle spasm in the face, what is
The Causative agent of Tuberculosis is said to be: the name of this condition
A
Mycobacterium Tuberculosis Lockjaw
B
Hansen's Bacilli 38. What is another word for sarcastic grin
C Risus sardonicus
Bacillus Anthracis
D 39. What is the name of the condition when a
Group A Beta Hemolytic Streptococcus person's back begins to bow
A) Opisthotonus

40. People with tetanus commonly die of what

TETANUS
Respiratory distress (drowning in their own vomit)
29. Why is it important that for a person to develop
tetanus, that the microbe enter parentally 41. What demographic of people die because dirty
instruments are used to perform circumcisions
Because it is an anaerobic organism Infants (commonly known as tetanus neonatorum)
42. What is put on the wound to cause tetanus Antibodies are able to be produced for any tetanus
neonatorum case after receive a tetanus toxoid until after a span
of
Dirt, dung and ash
10 years
43. Where is Clostridium tetani naturally found
Young Children should be given __________ of
Soil or dirt Tetanus Toxoid. Typically, the doses begin at ages
_________ months and are completed by ________
44. Is tetanus sporadic or epidemic in America months
4 doses, 2-3, 18
Sporadic
Booster shots are given before entering school at
45. What has made tetanus sporadic in America ______
11-12 years of age
Vaccination
Public health Department recommends
46. Are antibiotics used in the treatment of tetanus administering both ________ and ______ when
Yes, along with hydrogen peroxide and antitoxin treating a patient with teanus

A acute, often fatal disease caused by a toxin Toxoid and TIG (Tetatnus Immunglobulin)
produced from a bacterium
Tetanus Will remove toxin that is already in blood stream
TIG
The bacterium that produces the toxin which causes
Tetanus Occasionally, a patient may experience a bad
reaction to a immune globulin. This most likely
Clostridium tetani occurs when the immunoglobulin is administrated
from
Symptoms of Tetanus
a non-human source
muscle stiffness in neck and jaw (lockjaw)
TIG by passive immunization only lasts
Clostridium tetani usually enters the body through a
3 weeks
Wound
In 7-10 days by first active immunization,
Toxins of Tetanus are produced and spread into the Lasts 10 years

bloodstream In 3-5 days by active booster immunization,

Incubation period of Tetanus Lasts 10 years

3 to 21 days Protective level antitoxin from a toxoid vaccine but

eventually memory cells create
Tetanus is not contagious from
Person to Person Antibodies for Tetanus

Vaccine that consists of a formaldehyde treated

toxin
Tetanus toxoid
A 12 year old girl received some deep cuts falling A 25 year old man who recently sustained a severe,
on the playground, and her parents took her to the dirty cut on his foot has never received any
hospital. She hadn't been immunized against immunizations. He has never received any
tetanus. To provide her with protection against the immunization. he had tetanus when he was 7 years
possibility of tetanus now, and in the future, how do old and was treated with penicillin and tetanus
you think the hospital staff should treat her? antiserum (human), and recovered. Which of the
following do you think would be the best was for
Give separate injections of tetanus toxoid and him to be treated now?
tetanus antitoxin, one in each arm
He should get the tetanus antiserum (human) plus
In which pairs will the first substance function as an tetanus toxoid, because he has no immunity to
antigen to elicit a potentially beneficial immune tetanus
response and the second substance function as an
antigen to produce a potentially dangerous immune A patient has an order for the Varicella vaccine. It is
response? most important for the nurse to assess the patient for

Toxoid and tetanus antiserum from a horse

A. use of high dose systemic steroids in the past
Your watching the "the crocodile hunter" and month.
Steve's just been bitten by a deadly Australian B. allergy to aspirin.
brown snake, the second most deadly snake in the C. allergy to eggs.
world. Terri rushes him to the hospital so he can be D. history of hypertension.
treated with antivenom (antiserum), but the only
type available is from horses. What is the most A
important thing that needs to be taken into account
before given the antiserum? A patient with AIDS was cut by a rusty piece of
metal while walking outside. He recalls that his last
His history of passive immunizations tetanus booster was over 20 years ago. Which
immunization therapy will he receive at this time?
A typical secondary response is characterized by a
change in antibody level. The type of change differs A. He cannot receive any type of immunization
from primary response, since it is usually... therapy.
B. Tetanus immunoglobulin
faster, higher, and also longer lasting C. Tetanus toxoid, adsorbed
D. Tetanus and diphtheria toxoid (Td) booster
The type of immunity to tetanus a person has after
treatment with tetanus antisera is... B

adaptive (acquired) and due to the activity of Parent reluctant to vaccinate a child since the
antibodies (antibody-mediated) majority of his friends have been vaccinated;
therefore, no need to vaccinate. As the nurse you:
Bacteria on your unbroken or intact skin will not
usually produce disease because your skin provides A. File a report with DHS
protection. the immunity provided by your skin is... B. Understand that organisms which cause disease
are still prevalent in the environment and may cause
innate and nonspecific illness in this child
C. Counsels parents that their decision may result in
Serum sickness can be a serious problem with legal action.
which of the following procedures? D. Notifies the school system that the child is not in
passive immunization against tetanus using compliance
antiserum from a horse
B
A breastfed newborn is provided immunity by non-pathogenic
which immunoglobulins? Select all that apply: D. A substance which destroys invading organisms

A. IgG C
B. IgM
C. IgA A healthy patient says "Will my immune system be
D. IgE weaker by relying on a vaccine for protection" You
E. IgD respond:

A and C A. The immune system only works in healthy

people
As a Student Nurse you ask the instructor where to B. Vaccines only work for a limited time
find accurate information regarding immunizations. C. The immune system makes antibodies against a
The instructor recommends: germ whether the germ is encountered naturally or
via vaccine
A. Look each drug up in PDR D. Exposure to the natural disease strengthens the
B. Look to CDC website immune system better than a vaccine.
C. Call the drug reps
D. Ask a physician or pharmacist. C

B As a nurse in a primary care office you realize that

Tdap and DTaP are interchangeable for the 6 week
JW is exposed to organism that causes disease. to 6 y/o child
Prescriber prescribes an immunoglobulin to prevent
illness. This is an example of: A. True
B. False
A. Passive Immunity
B. Active Immunity B
C. Acquired Immunity
D. Herd Immunity A patient is to receive medication at 5 mcg/kg/day.
The patient weighs 198 pounds. How many
A micrograms of medication will this patient receive
each day?
PT asks you how to be protected against a particular
disease. You explain acquired/active immunity to A. 450 mcg
the PT in the following way EXCEPT: B. 900 mcg
C. 1000 mcg
A. PT develops the disease D. 225 mcg BID
B. A live, attenuated vaccine is given
C. A vaccine is given produced from killed A
organisms
D. An Immunoglobulin is given A patient will be receiving aldesleukin [IL-2]
(Proleukin), 600,000 IU/kg every 8 hours for 14
D doses. The patient weighs 220 pounds. How many
IU of medication will this patient receive per dose?
You explain to a pt that a vaccine is:
A. 300 million units
A. A medication that prevents an immune response B. 60 million units
B. A serum protein noted with immunologic C. 120 million units
deficiencies. D. 240 million units
C. A suspension of bacteria and viruses that are
B
Two patients arrive at the clinic; one is a young boy The nurse is reviewing the information about the
with sickle cell anemia, and another is a 57-year-old herpes zoster vaccine (Zostavax) before
woman with early stages of Hodgkin's disease. The administering the dose. Which statements about the
nurse notices that both patients need the same vaccine are true? (Select all that apply.)
vaccine. What vaccine would that be?
A. It is a one-time vaccine.
A. Varicella virus vaccine (Varivax) B. The vaccine is recommended for patients 50
B. Herpes zoster vaccine (Zostavax) years of age and older.
C. Hepatitis B virus vaccine, inactivated C. The vaccine is given to children to prevent
(Recombivax HB) chickenpox.
D. Haemophilus influenzae type b (Hib) vaccine D. It is used to prevent postherpetic neuralgia.
E. It is contraindicated in patients who have already
D had shingles.
F. The vaccine is used to prevent reactivation of the
The nurse is reviewing principles of immunization. zoster virus that causes shingles.
What type of immunization occurs when antibodies
pass from mother to infant during breastfeeding or A, B, F
through the placenta during pregnancy?
A health care worker will be receiving hepatitis B
A. Artificial active immunization immunoglobulin (BayHep B), 0.06 mg/kg IM now
B. Attenuating immunization and repeated in 30 days as part of hepatitis B
C. Natural passive immunization prophylaxis after a needle stick accident. The
D. Artificial passive immunization patient weighs 264 pounds. How many milligrams
will the patient receive for each dose? (Record
C answer using one decimal place.)

A sanitation worker has experienced a needle stick A. 6.9 mg

by a contaminated needle that was placed in a trash B. 7.0 mg
can. The employee health nurse expects that which C. 7.1 mg
drug will be used to provide passive immunity to D. 7.2 mg
hepatitis B infection?
D
A. Haemophilus influenzae type b (Hib)
B. Varicella virus vaccine (Varivax)
C. Hepatitis B immunoglobulin (BayHep B) COMMON CHILD
D. Hepatitis B virus vaccine (inactivated)
(Recombivax HB) IMMUNIZATION
C

The nurse is reviewing the health history of a new Which statement MOST accurately describes the
patient who may need immunizations. Active pharmacodynamics of vaccines?
immunizations are usually contraindicated in which
patients? (Select all that apply.) A. Vaccines work by stimulating the humoral
immune system.
A. Patients with a febrile illness >103 B. Vaccines provide IgG antibodies to protect
B. Children younger than 1 year of age against infection.
C. Elderly patients C. Vaccines prevent the formation of antibodies
D. Patients who are immunosuppressed against a specific antigen.
E. Those receiving cancer chemotherapy D. Vaccines work by suppressing the amino acid
A, D, E immunoglobulin sequence.
A. Vaccines work by stimulating the hormonal Soreness at the injection site is a common adverse
immune system effect of tetanus toxoid.

Vaccines work by stimulating the humoral immune An allergy to which substance is a contraindication
system, which synthesizes immunoglobulins. They to the administration of an immunizing drug?
also stimulate the formation of antibodies against
their specific antigen, providing active immunity. A. Soy
B. Egg
What is the priority nursing assessment to monitor C. Corn
when administering vaccinations? D. Wheat

A. Myalgias B.Egg
B. Anaphylaxis Contraindications to the administration of
C. Symptoms of infection immunizing drugs include allergy to the
D. Pain at the injection site immunization itself or allergy to any of its
components, such as eggs or yeast.
B. Anaphylaxis
The current immunization for tetanus and diphtheria
Anaphylaxis is a potential life-threatening adverse toxoids and pertussis, Tdap, is administered to
reaction to vaccines. Pain and myalgias can occur people in which age range?
but are not life threatening.
A. Younger than 6 years of age
Administration of which substance provides passive B. 11 years of age and older
immunity? C. Any age range
D. In the first 2 years of life
A. Vaccines
B. Toxoids B. 11 years of age and older
C. Antitoxins Currently, DTaP is the preferred preparation for
D. Immunoglobulins primary and booster immunization against these
diseases in children from 6 weeks to 6 years of age
D. Immunoglobulins unless use of the pertussis component is
Vaccines, antitoxins, and toxoids provide active contraindicated. Tdap is the recommended vaccine
immunity by stimulating the humoral immune for adolescents and adults, those over the age of 11
system. Immunoglobulins provide passive years.
immunity by giving the patient substances to fight
specific antigens. Which vaccination was developed to prevent
bacterial meningitis caused by Haemophilus
What teaching would the nurse provide to a client influenzae?
receiving tetanus toxoid?
A. Preener
A. "You will have lifetime immunity from this B. Gardasil
injection." C. Hepatitis B vaccine
B. "Soreness at the injection site is a common D. Hib conjugate vaccine
reaction."
C. "This medication must be repeated weekly for 4 D. Hib conjugate vaccine
weeks." H. influenzae type b (Hib) (HibTITER, ActHIB,
D. "Increase fluid and fiber in your diet to prevent Liquid PedvaxHIB) vaccine is a noninfectious,
constipation." bacteria-derived vaccine. Before this vaccine was
developed, infections caused by Hib were the
B. Soreness at the injection site is a common leading cause of bacterial meningitis in children 3
reaction months to 5 years of age.
Which vaccination is marketed and recommended D. "Taking the flu vaccine each year allows you to
in the prevention of a virus that is known to cause build your immunity to a higher level each time."
cervical cancer?
B. "Each year a new vaccine is developed based on
A. Herpes zoster vaccine (Zostavax) the flu strains that are likely to be in circulation."
B. Papillomavirus vaccine (Gardasil)
C. Pneumococcal vaccine (Prevnar 13) when assessing a patient who will be receiving a
D. Hepatitis B virus vaccine (Recombivax HB) measles vaccine, the nurse will consider which
condition to be a potable contraindication?
B. Papillomavirus Vaccine
Human papillomavirus virus (HPV) is a common A. Anemia
cause of genital warts and cervical cancer. The HPV B. Pregnancy
vaccine (Gardasil, Cervarix) is the first and only C. Ear infection
vaccine known to prevent cancer. D. Common Cold
B. Pregnancy
The anthrax vaccine is recommended for which
groups of people? (Select all that apply.) When giving a vaccine to an infant, the nurse will
tell the mother to expect which adverse effect?
A. Military personnel
B. Veterinarians A. Fever over 101F
C. Workers who process imported animal hair B. Rash
D. Emergency department health care providers C. Soreness at the injection site
A , B, C D. Chills

People at risk for exposure to the anthrax bacterium C. Soreness at the injection site
include military personnel, veterinarians, and
workers who process imported animal hair. A 28 year old patient is in the urgent care center
after stepping on a rusty tent nail. The nurse
The nurse is reviewing the Centers for Disease evaluates the patient's immunity status and notes
Control recommendations for vaccines. The that the patient thinks she had her tetanus booster
pneumococcal vaccine (Pneumovax 23) is about 10 years ago, just before starting college.
recommend for which group Which immunization would be most appropriate at
this time?
A. Newborn infants
B. Patients who are immunosuppressed A. Immunoglobulin Intravenous
C. Patients who are transplant candidates B. DTap
D. Smokers between 19 and 64 years old C. Tdap
D. No immunizations necessary
D. Smokers between the age of 19 and 64
C. Tdap
During a routine checkup a 72 year old patient is
advised to receive a influenza vaccine injection. He the nurse is providing teaching after an adult
questions this saying "I had one last year. Why do I receives a booster immunization. Which adverse
need another one?" What is the nurses best reaction will the nurse immediately report to the
response? health care provider? (select all that apply)

A. "The effectiveness of the vaccine wears off after A. swelling and redness at injection site
6 months." B. Fever of 100f
B. "Each year a new vaccine is developed based on C. joint pain
the flu strains that are likely to be in circulation." D. Heat over injection site
C. "When you reach 65 years old, you need booster E. Rash over the arms, back and chest
shots on an annual basis." F. Shortness of breath
C, E, F 2. A woman who is pregnant tells the nurse she has
not had any vaccines but wants to begin so she can
An animal control officer was bitten by a stray dog protect her unborn child. Which vaccine(s) may be
that showed signs of rabies. Which statement by the administered to this patient?
nurse is correct regarding the treatment for rabies
prophylaxis? a.
Gardasil vaccine
A. "you will receive treatment if you begin to show b.
symptoms of rabies." Trivalent influenza vaccine
B. "you will receive one oral dose of medication c.
today, and one more in 1 week." MMR vaccine
C. "you will need to receive 3 subcutaneous d.
injections over the next week." Varivax vaccine
D. "you will need to receive 5 intramuscular
injections over the next 28 days." ANS: B
The influenza vaccine is recommended for pregnant
D. You will need to receive 5 intramuscular women and should be given. Gardasil is given to
injections over the next 28 days young women who are not yet sexually active. The
MMR is contraindicated because rubella can cause
1. The nurse is discussing vaccines with the mother serious teratogenic effects. Varivax is
of a 4-year-old child who attends a day care center contraindicated during pregnancy.
that requires the DTaP vaccine. The mother, who is
pregnant, tells the nurse that she does not want her 3. A 4-year-old child is receiving amoxicillin
child to receive the pertussis vaccine because she (Amoxil) to treat otitis media and is in the clinic for
has heard that the disease is "not that serious" in a well-child checkup on the last day of antibiotic
older children. What information will the nurse therapy. The provider orders varicella (Varivax);
include when discussing this with the mother? mumps, measles, and rubella (MMR); inactivated
polio (IPV); and diphtheria, tetanus, and acellular
a. pertussis (DTaP) vaccines to be given. Which action
If she gets the vaccine, both she and her 4 year-old by the nurse is correct?
child will be protected.
b. a.
If the 4-year-old child contracts pertussis, it can be Administer the vaccines as ordered.
passed on to her newborn. b.
c. Discuss giving the MMR vaccine in 4 weeks.
The vaccine will not be given to her child while she c.
is pregnant. Hold all vaccines until 2 weeks after antibiotic
d. therapy.
Vaccinating the 4-year-old will provide passive d.
immunity for her unborn child. Recommend aspirin for fever and discomfort.

ANS: B ANS: A
Even though pertussis is not as serious in older Antibiotic therapy is not generally a
children, it is important to vaccinate children to contraindication to the use of vaccines. Vaccines
prevent the spread of the disease to infants and may be given in cases of mild acute illness or
others who are not immunized and who are at risk during the convalescent phase of an illness. All four
for significant morbidity and mortality from this vaccines may be given. If the MMR or other live
disease. Vaccinating the mother will not protect the virus vaccine is not given the same day as the
4-year-old from getting pertussis. The DTaP varicella vaccine, administration of the two
vaccine may be given to children whose mothers are vaccines should be separated by at least 4 weeks.
pregnant. Vaccinating the child does not confer Aspirin should not be given because of the
passive immunity to the unborn child. increased risk of Reye's syndrome.
4. A patient is preparing to travel with a 4-year-old 6. A young adult patient is in the clinic to receive a
child to India in 10 days and is in the clinic to tetanus vaccine after sustaining a laceration injury.
receive typhoid vaccines. Which vaccines will be The nurse learns that the patient, who works in a
given to the parent and child? day care center, has not had any vaccines for more
than 10 years. Which vaccine will the nurse expect
a. to administer?
Four capsules of live, oral vaccine to both patients
b. a.
Four capsules of live, oral vaccine for the parent DT
and the IM polysaccharide vaccine for the child b.
c. DTaP
Four capsules of live, oral vaccine for the child and c.
the IM polysaccharide vaccine for the parent Td
d. d.
IM polysaccharide for both patients Tdap

ANS: D ANS: D
While the live, oral vaccine may be given to Persons who work with children should receive
patients older than 6 years, each capsule must be acellular pertussis vaccine. The Tdap is given to
taken 48 hours apart with the last capsule given 1 adults. The DTaP is given to children up to age 6.
week prior to travel. There would not be enough The DT and Td do not contain pertussis.
time to complete the regimen since the patients
leave in 10 days. Children under age 6 cannot 7. The nurse is preparing to administer rotavirus
receive the oral vaccine. vaccine to a 4-month-old infant. The nurse notes
that the infant received Rotarix vaccine at 2 months
5. A 48-month-old child is scheduled to receive the of age. The nurse will plan to administer
following vaccines: MMR, Varivax, IPV, and
DTaP. The child's parents want the child to receive a.
two vaccines today and the other two in 1 week. To Rotarix today.
accommodate the parents' wishes, the nurse will b.
administer Rotarix today and again at age 6 months.
a. c.
the DTaP and Varivax today and the MMR and IPV Rota Teq today.
in 1 week. d.
b. Rota Teq today and again at age 6 months.
the IPV and MMR today and the Varivax and DTaP ANS: A
in 1 week. Patients receiving Rotarix receive 2 doses at age 2
c. and 4 months only.
the MMR and DTaP today and the Varivax and IPV
in 1 week. 8. A provider has ordered Gardasil to be given to a
d. prepubertal 9-year-old female. The parent asks the
the MMR and Varivax today and the DTaP and IPV nurse if this vaccine can be postponed until the
in 1 week. child is in high school. The nurse will tell the parent
that Gardasil
ANS: D
If the MMR or other live virus vaccine is not given a.
the same day as the varicella vaccine, is less effective in older adolescents.
administration of the two vaccines should be b.
separated by at least 4 weeks. In the incorrect is more effective if given before sexual activity
answers, the two live virus vaccines are given only begins.
one week apart. c.
is more effective if given prior to the hormonal
changes of puberty. compresses. Aspirin is contraindicated in children
d. because of its association with Reye's syndrome.
is not effective if given after the onset of menses. Since these are not serious adverse effects, they do
ANS: B not need to be reported to VAERS. It is not
Gardasil is most effective when the client is not yet necessary to schedule a clinic visit.
sexually active.
11. The provider orders Zostavax for a 60-year-old
9. Which is an example of acquired passive patient. The patient reports having had chicken pox
immunity? as a child. Which action will the nurse take?

a. a.
Administration of IgG to an unimmunized person Administer the vaccine as ordered.
exposed to a disease b.
b. Counsel the patient that the vaccine may cause a
Administration of an antigen via an immunization severe reaction because of previous exposure.
c. c.
Inherent resistance to a disease antigen Hold the vaccine and notify the provider of the
d. patient's history.
Immune response to an attenuated virus d.
Request an order for a Varivax booster instead of
ANS: A the Zostavax.
Passive immunity occurs without stimulation of an
immune response. Acquired immunity requires ANS: A
administration of immune globulin. Inherent Zostavax is given to boost the immunity to
resistance to a disease antigen describes the state of varicella-zoster virus among recipients. It is not
natural immunity, not acquired passive immunity. likely to cause severe reaction secondary to prior
The other answers involve stimulation of an exposure, since the immune response in most
immune response. recipients has declined. Zostavax, not Varivax, is
approved for this use.
10. The parent of a 12-month-old child who has
received the MMR, Varivax, and hepatitis A
vaccines calls the clinic to report redness and
swelling at the vaccine injection sites and a
temperature of 100.3° F. The nurse will perform
which action?

a.
Recommend aspirin or an NSAID for pain and
fever.
b.
Recommend acetaminophen and cold compresses.
c.
Report these adverse effects to the Vaccine Adverse
Event Reporting System (VAERS).
d.
Schedule an appointment in clinic so the provider
can evaluate the child.

ANS: B

These are common, minor side effects of vaccines

and can be treated with acetaminophen and cold