Chapter 15: Infection My Nursing Test Banks

Chapter 15: Infection

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. To educate patients on health promotion measures to minimize the effect of normal age-related changes in immunity, the geriatric nurse:

a.

describes the effects of low-dosage antibiotic therapy on opportunistic infections.

b.

reinforces the usefulness of lymphocyte counts to detect new infections.

c.

discusses the need for yearly flu immunization.

d.

stresses the importance of maintaining intact skin and mucous membranes.

ANS: D

The skin is the largest immunologically active system of the body and the bodys first line of defense. With aging, the skin becomes more fragile and susceptible to breakdown or abrasion, thus negatively impacting the natural defenses. A yearly flu vaccination is important, but is too narrow in scope to be the best answer. Using antibiotics for current infections is not health promotion. Lab work is used after infection is present or suspected.

DIF: Understanding (Comprehension) REF: Page 271 OBJ: 15-6

2. An older adult patient who is generally in good health starts experiencing numerous colds and now pneumonia. What factor from the nursing history most likely has placed the patient at increased risk for the development of these infections?

a.

A beloved pet died 6 months ago.

b.

The patient was diagnosed with osteoarthritis 5 years ago.

c.

The patient worked as an oncology nurse before retiring.

d.

The patients spouse is immunosuppressed.

ANS: A

Psychosocial factors may impact the immune status. These factors include chronic and acute stress, depression, bereavement, and social relationships. The other factors would not increase the patients risk for infection.

DIF: Remembering (Knowledge) REF: Page 272 OBJ: 15-3

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

3. An older patient smoked tobacco most of the adult life. When planning health promotion education for this patient, the nurse includes information that such smoking:

a.

may produce alterations in the immune response.

b.

is a risk factor for community-acquired pneumonia.

c.

decreases the production of an immunoglobulin called IgA.

d.

increases the risk of gastric cancer.

ANS: B

Although the major host factor associated with community-acquired pneumonia is advanced age, smoking, alcohol abuse, chronic lung disease, recent history of viral upper respiratory tract infection, and neurologic disease are other contributing factors.

DIF: Remembering (Knowledge) REF: Page 273 OBJ: 15-4

TOP: Teaching-Learning MSC: Physiologic Integrity

4. An older adult patient is experiencing problems with chewing while recovering from extensive oral surgery. The nurse best affects this patients risk for infection by:

a.

ordering a mechanical soft diet for the patient.

b.

monitoring the patient regularly for any low-grade fever.

c.

providing regular oral care with an antibiotic mouthwash.

d.

asking which flavors of protein supplement drink the patient would prefer.

ANS: D

Nutritional supplements for a patient with an eating disorder or dysfunction can decrease the patients susceptibility to infection by providing protein. The patient still may not be able to chew a mechanically soft diet. Oral care will help but will not decrease the problem. The patient needs protein, and it is best made available as a drink because of the chewing problems.

DIF: Applying (Application) REF: N/A OBJ: 15-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

5. The nurse caring for a cognitively impaired older adult admitted to an acute care facility best minimizes this particular patients risk for developing a nosocomial infection by:

a.

proper hand washing after each patient contact.

b.

admitting the patient to a private room.

c.

assigning staff to assist the patient with eating meals.

d.

screening visitors to minimize contract with pathogens.

ANS: C

Poor nutrition can contribute to a patients risks for developing a nosocomial infection, particularly among the older immunocompromised population. Many of the cognitively impaired older adults are already malnourished, so improving nutrition is a priority. Hand washing should occur before and after patient contact. A private room is not necessary. Screening visitors is not the best option; good nutrition will improve the patients immune status, although obviously ill visitors should not visit.

DIF: Applying (Application) REF: N/A OBJ: 15-2

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

6. An immunosuppressed older adult patient reports symptoms of fatigue, facial rash, intermittent low-grade fever, and painfully swollen finger joints. The nurse anticipates that diagnosis will be confirmed by:

a.

the presence of subcutaneous nodules on the hands.

b.

a positive antinuclear antibody (ANA) blood serum test.

c.

a liver biopsy that confirms cirrhosis.

d.

the presence of bilateral ocular scleritis.

ANS: B

The antinuclear antibody is one of the more specific tests for lupus; patients with lupus have a positive ANA test. The patient with an autoimmune disease is more susceptible to infection than others.

DIF: Remembering (Knowledge) REF: Page 273 OBJ: 15-1

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

7. The geriatric nurse identifies the patient with the greatest risk of immunosuppression as:

a.

having a roommate infected with MRSA.

b.

having numerous oral mucosal ulcers.

c.

receiving treatment for rheumatoid arthritis.

d.

being cognitively impaired.

ANS: C

Individuals receiving corticosteroids, such as for rheumatoid arthritis, have a diminished inflammatory process and decreased immunity. Open ulcers anywhere can lead to infection, but chronic steroid use places the patient at high risk. Patients with methicillin-resistant Staphylococcus aureus (MRSA) are in isolation. Being cognitively impaired does increase risk, but not as much as steroid use.

DIF: Remembering (Knowledge) REF: Page 274 OBJ: 15-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

8. The nurse caring for an older adult patient currently receiving traditional drug therapy for methicillin-resistant Staphylococcus aureus (MRSA) recognizes that the patient is at risk for developing:

a.

Clostridium difficile infection.

b.

vancomycin-resistant Enterococcus (VRE) infection.

c.

autoimmune hepatitis.

d.

systemic lupus erythematosus.

ANS: B

The antibiotic of choice for MRSA infection is vancomycin. However, exposure to vancomycin is a risk factor for the acquisition of VRE. C. difficile is possible when bowel flora are disturbed, as in during antibiotic therapy. Autoimmune hepatitis and lupus are not related.

DIF: Remembering (Knowledge) REF: Page 274 OBJ: 15-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

9. The nurse caring for an older adult patient being treated for influenza is especially careful to monitor and document assessment data related to:

a.

cognitive function.

b.

respiratory function.

c.

fluid intake.

d.

urinary output.

ANS: B

Pneumonia may follow influenza, so respiratory function must be assessed effectively.

The other assessments are not as high a priority.

DIF: Application (Applying) REF: N/A OBJ: 15-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

10. A patient who is currently being treated for rheumatoid arthritis exhibits symptoms suspicious of tuberculosis (TB). The nurse anticipates that:

a.

the symptoms are a result of the patients rheumatoid arthritis.

b.

the symptoms are actually side effects of corticosteroid therapy.

c.

a chest radiograph will definitively confirm a diagnosis of TB.

d.

a purified protein derivative (PPD) skin test will likely be negative.

ANS: D

Diminished inflammatory responses may lead to false-negative results for skin tests used in the diagnosis of disease, for example, the purified protein derivative (PPD) skin test for tuberculosis. These reduced responses are even more likely to occur in people who have diseases or drug treatments that further suppress the immune system.

DIF: Remembering (Knowledge) REF: Page 275 OBJ: 15-5

TOP: Nursing Process: Analysis MSC: Physiologic Integrity

11. The nurse wishes to control infection by manipulating the portal of entry. What action best demonstrates this process?

a.

Using sterile technique to insert a catheter

b.

Encouraging patients to eat high-protein meals

c.

Ensuring housekeeping keeps rooms clean

d.

Providing patients with vitamin supplements

ANS: A

Inserting a catheter can introduce microbes via the urinary meatus, the portal of entry. The other factors relate more to improving the status of the host and eliminating reservoirs.

DIF: Applying (Application) REF: N/A OBJ: 15-6

TOP: Nursing Process: Implementation MSC: Physiologic Integrity

12. A patient is hospitalized with a nonhealing leg ulcer. Lab work does not demonstrate anemia. What action by the nurse is best?

a.

Encourage the patient to choose high-protein meal items.

b.

Request a consultation with the registered dietician.

c.

Consult the physician regarding a serum zinc level.

d.

Consult the physician about adding an iron supplement.

ANS: C

Low levels of zinc can lead to poor wound healing, impaired cell-mediated immunity, and altered protein synthesis. Because other indicators of anemia are negative, the nurse should request a zinc level.

DIF: Applying (Application) REF: N/A OBJ: 15-2

TOP: Communication and Documentation MSC: Physiologic Integrity

13. An older patient is hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), for which the patient is on chronic steroid use. The patient also has a fresh dog bite on the arm, which is not reddened, swollen, and only slightly tender. The patient is afebrile, but the nurse finds the patient confused and agitated. What action by the nurse is most appropriate?

a.

Place the patient on fall precautions.

b.

Put a bed alarm on the patients bed.

c.

Call the rapid response team.

d.

Perform a sepsis screening exam.

ANS: D

Older adults have an age-related decrease in immune function, plus this patient is on medication that diminished immune responsiveness. With the fresh wound, the nurse would be concerned about sepsis. The patient may be septic without showing local or systemic signs of infection other than confusion. Fall precautions and bed alarms may be necessary. The rapid response team is not needed.

DIF: Applying (Application) REF: N/A OBJ: 15-1| 15-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

14. A patient claims that all food is bland since I got old. What suggestions does the nurse provide to this patient?

a.

Add extra salt to your food.

b.

Try eating some tart foods.

c.

Eat soft food with gravy.

d.

Drink high-protein shakes.

ANS: B

As people age, their taste discrimination diminishes. The older adult can be advised to add extra seasoning (not salt because of concerns with cerebrovascular disease), add tart tastes, use sauces, and substitute other meats for beef. Soft food with gravy would be a good suggestion for the patient with dysphagia but would not be well received by the patient with diminished taste because of the consistency.

DIF: Applying (Application) REF: N/A OBJ: 15-6

TOP: Teaching-Learning MSC: Health Promotion

15. A nurse has identified an older patient as being at high risk of infection. Which assessment data indicate that priority goals for this diagnosis have been met?

a.

The patient remains afebrile.

b.

The patients white blood cells (WBCs) are normal.

c.

The patient has no subjective complaints.

d.

The patients mental status is unchanged.

ANS: D

Older adults, with their diminished immune system, often do not develop classic signs or symptoms of infection, so a lack of fever and complaints and a normal white count do not eliminate the possibility the patient has an infection. Older adults frequently tend to have mental status changes with infection, so a normal mental status for the patient is a good sign that goals have been met.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 15-1

TOP: Nursing Process: Evaluation MSC: Physiologic Integrity

16. An older patient asks the nurse about taking Echinacea to prevent colds. What response by the nurse is best?

a.

Thats fine; its a very common herb.

b.

Older people should not use herbs.

c.

This herb may not be well produced.

d.

Echinacea has a deleterious effect on immunity.

ANS: C

Echinacea is a popular herb many people take to boost the immune system. However, herbs may not be produced consistently or tested thoroughly, so the patient is advised to speak to the provider about adding this herb. It has not been shown to be harmful to the immune system though.

DIF: Understanding (Comprehension) REF: Page 272 OBJ: 15-7

TOP: Teaching-Learning MSC: Physiologic Integrity

17. A student nurse is caring for a patient who has vancomycin-resistant enterococcus (VRE). What action by the student requires the nurse to intervene?

a.

Washes hands for 15 seconds prior to entering the room

b.

Takes own stethoscope and unit Glucometer in the room

c.

Helps transfer the patient into a private room for isolation

d.

Puts on gloves and a gown prior to changing the linens

ANS: B

Patients with VRE should be on isolation and have their own dedicated equipment. The nurse intervenes when the student starts to take his or her own stethoscope and the units Glucometer into the room. The other actions are appropriate.

DIF: Applying (Application) REF: N/A OBJ: 15-6

TOP: Communication and Documentation

MSC: Safe Effective Care Environment

MULTIPLE RESPONSE

1. The nurse caring for an older adult patient engages in appropriate cancer-related health screening when which of the following occur? (Select all that apply.)

a.

Preparing a patient for a lung biopsy

b.

Collecting a 24-hour urine specimen

c.

Assisting a patient schedule a mammogram

d.

Drawing blood for a prostate sensitive antigen (PSA) test

e.

Keeping a patient NPO for a bladder biopsy

ANS: A, C, D

Common types of cancer in older adults include lung cancer, breast cancer, and prostate cancer.

DIF: Remembering (Knowledge) REF: Page 273 OBJ: 15-1

TOP: Nursing Process: Implementation MSC: Health Promotion

2. The nurse is preparing an educational facts sheet on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) for older adults. What information does the nurse include? (Select all that apply.)

a.

Tainted blood transfusions are the greatest risk factor in older adults.

b.

Delayed recognition of HIV contributes to its poor prognosis.

c.

Twenty-five percent of AIDS cases in the United States are in persons older than 60.

d.

There is a short interval from HIV infection to AIDS in older adults.

e.

HIV and AIDS cases in this age cohort have stabilized since the late 1990s.

ANS: B, D

The low clinical suspicion of HIV infection and delayed recognition of AIDS-defining infections contribute to the poor prognosis of HIV infection in older adults. The aging immune system is not able to eliminate the HIV residing in macrophages, lymphoid tissue, or the brain. Because the immune systems regenerative capacity is diminished and not all replacement cells are fully functional, the disease progresses more rapidly than in a younger cohort. Tainted blood is not the primary means of infection in this cohort. About 31% of HIV cases are in older adults, and 17% of new HIV infections occur in people older than 50.

DIF: Remembering (Knowledge) REF: Page 274 OBJ: 15-4

TOP: Teaching-Learning MSC: Physiologic Integrity

3. The geriatric nurse caring for the older female immunosuppressed patient is particularly concerned when the patient reports which of the following? (Select all that apply.)

a.

Flulike muscle aching

b.

Burning upon urination

c.

Nausea

d.

Night sweats

e.

Constipation

ANS: A, B, D

Some of the more common infections in older adults include influenza (muscle aching), pneumonia, tuberculosis (night sweats), urinary tract infections (burning on urination), and shingles (herpes zoster). Nausea and constipation are not signs of these infections.

DIF: Applying (Application) REF: N/A OBJ: 15-6

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. The student learning about immunity understands that the chain of infection contains which parts? (Select all that apply.)

a.

Portal of entry

b.

Susceptible host

c.

Virulence factors

d.

Reservoir

e.

Decreased immunity

ANS: A, B, D

The chain of infection includes a portal of entry, a susceptible host, and a reservoir.

DIF: Remembering (Knowledge) REF: Page 270 OBJ: 15-6

TOP: Teaching-Learning MSC: Physiologic Integrity

5. A patient is receiving chemotherapy to treat cancer. What instructions does the nurse provide the patient and family to reduce the chance of infection? (Select all that apply.)

a.

Take a full bath everyday if possible.

b.

If you cant bathe, perform pericare.

c.

Avoid large crowds and ill people.

d.

You have to give away your pets.

e.

Eat high-calorie, high-protein food if able.

ANS: A, B, C, E

Patients who are immune-suppressed should perform meticulous hygiene, stay away from exposure to illness, and eat nutritiously to help protect them from infection. Giving away pets is not required, although a family member may need to take over pet care duties.

DIF: Understanding (Comprehension) REF: Page 276-7 OBJ: 15-6

TOP: Teaching-Learning MSC: Physiologic Integrity

6. The nurse studying immunity understands that which are age-related changes in immune system functioning? (Select all that apply.)

a.

Decreased number of lymphocytes

b.

Decreased number of T suppressor cells

c.

Atrophy of the thymic cortex

d.

Increased numbers of antibodies to self-antigens

e.

Decreased number of B cells

ANS: B, C, D

Several age-related changes to the immune system occur, including decreased number of T suppressor cells, atrophy of the thymic cortex, and increased numbers of antibodies to self-antigens. The numbers of lymphocytes and B cells do not change.

DIF: Remembering (Knowledge) REF: Page 271 OBJ: 15-1

TOP: Teaching-Learning MSC: Health Promotion

Leave a Reply