NURS 340: UNIT 11 - COMMUNICABLE DISEASES

A client has an infection caused by a pathogen but cannot transmit it to another person. Is the disease infectious, communicable, or both?

A nurse compares two pathogens. Pathogen A multiplies rapidly, while Pathogen B causes more severe illness and death. Which characteristics differ?

Pathogen A has greater infectivity; Pathogen B may have greater virulence.

A pathogen enters the body but rarely causes noticeable clinical illness. Which characteristic is low?

Pathogenicity — the ability to produce clinical disease after infection.

A patient develops severe poisoning from a microorganism's harmful substances. Which pathogen characteristic is involved?

Toxicity — the ability to produce a poisonous reaction.

A public health nurse investigates a disease that spreads efficiently from one person to another. Which characteristic is being assessed?

Communicability — the ability of an infectious agent to spread from one host to another.

A city experiences an increase in drug-resistant tuberculosis after years of inappropriate antibiotic use. What factor contributed to this threat?

Antimicrobial resistance, promoted by antibiotic misuse and overuse.

An infectious disease spreads rapidly after international travel brings infected people into multiple countries. Which global factor contributed to its emergence?

Transcontinental travel, which allows pathogens to cross geographic boundaries quickly.

A community has declining vaccination rates, and an outbreak affects people who cannot receive vaccines. What population-level protection has weakened?

Herd immunity. High community immunity helps protect susceptible individuals by reducing transmission.

A nurse investigates a foodborne outbreak. The contaminated food contains the pathogen, several malnourished people become ill, and improper refrigeration allows the organism to multiply. Identify the epidemiology triangle.

• Agent: The pathogen in the food.

• Host: The exposed, malnourished individuals.

• Environment: Improper refrigeration and food handling.

A healthy person receives antibodies after a possible rabies exposure. What type of immunity is this, and why is it temporary?

Artificial passive immunity. Ready-made antibodies provide immediate protection, but the recipient does not produce them independently.

An infant receives antibodies through breast milk. What type of immunity is this?

Natural passive immunity. Maternal antibodies provide temporary protection.

A person develops antibodies after receiving a vaccine. What type of immunity is this?

Artificial active immunity. Vaccination stimulates the person's immune system to produce its own antibodies and immune memory.

A child develops immunity after recovering from an infection. What type of immunity is this?

Natural active immunity. Exposure to the pathogen stimulates the child's own immune response.

A nurse explains why a vaccinated population can protect an immunocompromised person who cannot receive a particular vaccine. What concept is being described?

Herd immunity — reduced community transmission indirectly protects susceptible people.

A pregnant client transmits an infection to the fetus through the placenta. Which mode of transmission is involved?

Direct vertical transmission, from parent to child.

A nurse teaches a client that tuberculosis can spread through infectious particles suspended in the air. Which transmission route is involved?

Indirect airborne transmission.

Several people become ill after drinking water contaminated with the same pathogen. Which transmission route is most likely?

Indirect vehicle transmission, through a contaminated substance such as food or water.

A traveler develops a disease after being bitten by an infected mosquito. Which transmission route is involved?

Indirect vector transmission. The mosquito carries the pathogen between hosts.

A nurse identifies a client with a communicable disease and notifies exposed individuals so they can be evaluated. Which public health intervention is this?

Contact tracing. It identifies exposed people so they can receive testing, treatment, vaccination, or monitoring as appropriate.

A person may have been exposed to a dangerous communicable disease but has not been confirmed ill. Which intervention may restrict their movement during the incubation period?

Quarantine, when indicated by public health guidance. Isolation separates people who are infected from those who are not infected.

A health department receives routine reports of confirmed cases from healthcare facilities. Which surveillance method is being used?

Passive surveillance. Cases are reported through established reporting systems rather than actively sought by investigators.

A public health team visits a community and interviews residents to identify additional cases during an outbreak. Which surveillance method is this?

Active surveillance. Investigators actively search for cases.

Selected hospitals monitor meningococcal disease trends to identify changes in disease patterns. Which surveillance method is being used?

Sentinel surveillance. Selected sites monitor specific diseases or health trends.

A health department detects an unusual spike in flu prescriptions and flu-like symptoms through automated data systems. Which surveillance method is this?

Special (syndromic) surveillance. It detects unusual patterns of symptoms or related healthcare activity.

A community reports more cases of gastrointestinal illness than expected. What should investigators do before concluding that an outbreak exists?

Confirm the suspected outbreak and verify the diagnosis or establish a case definition.

An outbreak investigation team has confirmed an outbreak. What information should it organize to identify patterns?

Person, place, and time — who became ill, where cases occurred, and when they developed illness.

Investigators suspect a contaminated water supply is causing an outbreak. What should they do with this hypothesis?

Develop and evaluate the hypothesis, then implement appropriate control measures and communicate findings.

A nurse organizes a vaccination clinic to prevent influenza before people become ill. Which prevention level is this?

Primary prevention — preventing disease before it occurs.

A surveillance team identifies infected individuals early and reports cases to prevent further transmission. Which prevention level is this?

Secondary prevention — early detection and intervention to limit disease spread or progression.

A client with an established infection receives medication to treat the disease and prevent complications. Which prevention level is this?

Tertiary prevention, as classified in the provided lecture notes — treating established disease and reducing its consequences.

NCLEX-style: A nurse is investigating an outbreak associated with contaminated drinking water. Which intervention most directly targets the environmental component of the epidemiology triangle?

A. Improve access to nutritional counseling. B. Identify people with weakened immune systems. C. Provide a safe, uncontaminated water supply. D. Evaluate the pathogen's virulence.

Answer: C. Providing safe water interrupts the environmental conditions that allow transmission.

NCLEX-style: A health department wants to determine whether a disease is spreading among people who attended the same event. Which action is most appropriate?

A. Wait for routine reports without contacting anyone. B. Conduct active case finding and contact tracing. C. Monitor only selected hospitals for long-term trends. D. Begin treatment only after the outbreak ends.

Answer: B. Active case finding and contact tracing help identify cases and exposed people quickly.

NCLEX-style: A nurse administers immunoglobulin to a client after a high-risk exposure. Which statement demonstrates correct understanding?

A. “My body will immediately create long-lasting immune memory from these antibodies.” B. “These antibodies provide temporary protection because they were made outside my body.” C. “This is natural active immunity.” D. “I can no longer develop the infection.”

Answer: B. Passive immunity provides immediate but temporary protection and does not guarantee that infection will not occur.

NCLEX-style: A community has low vaccination coverage, and an outbreak threatens people who are unable to be vaccinated. Which public health action best addresses the underlying population risk?

A. Reduce disease reporting. B. Increase appropriate vaccination coverage. C. Stop monitoring exposed contacts. D. Focus exclusively on treating severe cases.

Answer: B. Increasing vaccination coverage strengthens herd immunity and reduces transmission.

NCLEX-style: A nurse is reviewing the epidemiology triangle for an outbreak. Which example represents the host?

A. A mosquito carrying a virus. B. Standing water where mosquitoes breed. C. An older adult with reduced immune function. D. A virus capable of causing disease.

Answer: C. The host is the person or animal susceptible to infection; age and immune function influence susceptibility.

Infectious, but not necessarily communicable. Infectious diseases are caused by pathogens; communicable diseases can spread between hosts.

A client has jaundice, dark urine, and clay-colored stools. What should the nurse suspect?

A client with hepatitis reports fatigue, nausea, decreased appetite, abdominal pain, and joint pain. Are these expected findings?

Yes. Hepatitis can cause flu-like symptoms, fatigue, nausea, poor appetite, abdominal pain, and joint pain.

Can a client with hepatitis transmit the virus without having symptoms?

Yes. Asymptomatic clients may still be contagious.

How can prolonged liver inflammation affect the liver?

Inflammation and necrosis can impair liver blood flow. Chronic inflammation may progress to cirrhosis, liver failure, and liver cancer.

Why can hepatitis cause clay-colored stools and dark urine?

Impaired bile pigment delivery to the intestine causes pale stools; increased bilirubin can cause dark urine and jaundice.

A client with suspected hepatitis has elevated ALT and AST. What does this indicate?

Liver cell injury. These enzymes support hepatic inflammation but do not identify the specific virus.

RiskFactors&Transmission

Several daycare children develop hepatitis after eating contaminated food. Which virus is most likely?

Hepatitis A (HAV) — spreads through the fecal–oral route via contaminated food or water, including shellfish.

A client shares needles while injecting drugs. Which hepatitis viruses are major concerns?

Hepatitis B and C — both can spread through infected blood.

A pregnant client has hepatitis B. What is the primary concern for the newborn?

Perinatal transmission from the infected mother. Infection acquired during infancy has a high risk of becoming chronic.

A client received an unscreened blood transfusion in 1990. Which hepatitis virus is a major concern?

Hepatitis C (HCV) — unscreened transfusions before 1992 are a risk factor.

A client with hepatitis B develops hepatitis D. What is the relationship between these viruses?

Hepatitis D requires hepatitis B infection and can worsen liver disease.

A traveler develops hepatitis after drinking contaminated water. Which viruses should the nurse consider?

Hepatitis A or E, both spread primarily through the fecal–oral route.

Which other histories increase hepatitis exposure risk?

Hemodialysis, unsanitary tattoos, needle sticks, unprotected sex, injectable drug use, travel to areas with poor sanitation, and crowded living conditions.

Diagnostics&LaboratoryFindings

A client has ALT 240 units/L and AST 190 units/L. What do these results suggest?

Liver cell injury. Normal ranges: ALT 4–36 units/L; AST 0–35 units/L.

A client's total bilirubin is 4.2 mg/dL. What finding might the nurse expect?

Jaundice and dark urine. Normal total bilirubin: 0.3–1.0 mg/dL.

Does a normal ALP level rule out hepatitis?

No. ALP may be normal or elevated. Elevated ALT and AST support liver cell injury. Normal ALP: 30–120 units/L.

Which test is associated with hepatitis A?

Anti-HAV antibodies.

A client's HBsAg is positive. What does this mean?

Current hepatitis B infection and potential infectiousness. The provider is responsible for reporting the positive result to the health department.

A client has positive anti-HCV antibodies. Why is HCV RNA PCR needed?

To determine whether current HCV infection is present and measure the amount of virus.

Which antibody tests are associated with hepatitis D and E?

Anti-HDV for hepatitis D; anti-HEV for hepatitis E.

What nursing care is required before a liver biopsy?

Explain the procedure, witness consent, and maintain NPO status from midnight, following prescribed instructions.

Treatment&NursingInterventions

Why might a client with acute hepatitis B receive supportive care instead of antivirals?

Acute hepatitis B is generally managed with supportive care. Chronic hepatitis B may require antiviral therapy.

Which medications may be used for chronic hepatitis B?

Tenofovir or entecavir and other prescribed antivirals.

Which medications may treat hepatitis C?

Glecaprevir/pibrentasvir or sofosbuvir/velpatasvir.

How is hepatitis E generally managed?

Supportive care.

A client has recent exposure to hepatitis A. What post-exposure interventions may be used?

Hepatitis A vaccination; immunoglobulin for selected clients, including those over 40, infants under 12 months, clients with chronic liver disease or immunosuppression, and those with vaccine allergy.

A client with hepatitis has nausea and poor appetite. What nutritional plan should the nurse recommend?

Small, frequent, high-calorie meals to support nutritional intake.

What should a client with hepatitis avoid during recovery?

Alcohol and unnecessary medications to reduce additional liver injury.

What home-care measures should the nurse teach a client with hepatitis?

Rest, eat small frequent high-calorie meals, practice hand hygiene, avoid alcohol and unnecessary medications, and follow virus-specific transmission precautions. Follow clinical guidance for sexual activity and testing.

Complications&Priorities

A client with chronic hepatitis develops confusion, asterixis, and fetor hepaticus. What complication is suspected?

Hepatic encephalopathy, associated with toxin accumulation, including ammonia, due to liver dysfunction.

A client with hepatitis develops new confusion and asterixis. What is the priority nursing action?

Escalate care immediately and assess neurologic status and airway safety. Encephalopathy can progress to seizures and coma.

A client develops severe liver failure within hours or days of hepatitis symptoms. What is this called?

Fulminant hepatitis — rapidly developing, severe liver failure requiring urgent supportive management.

What are the major complications of chronic hepatitis B, C, or D?

Chronic liver inflammation, cirrhosis, liver failure, hepatic encephalopathy, and liver cancer.

NCLEX-StyleMultiple-ChoiceQuestions

A client has jaundice, dark urine, clay-colored stools, and elevated ALT and AST. What is the best interpretation?

• A. The findings strongly suggest liver inflammation or injury.

• B. The findings confirm hepatitis A.

• C. The findings indicate normal bile flow.

• D. The findings rule out viral hepatitis.

Answer: A. These findings support hepatitis, but virus-specific testing is needed to identify the cause.

Which client has the greatest risk of fecal–oral hepatitis transmission?

• A. A client sharing injection equipment

• B. A client who ate contaminated shellfish

• C. A client who received an unscreened blood transfusion

• D. A client exposed to infected blood through a needle stick

Answer: B. Contaminated shellfish can transmit hepatitis A.

A client has positive anti-HCV antibodies. Which test best identifies current infection?

• A. Serum ALP

• B. Total bilirubin

• C. HCV RNA PCR

• D. Anti-HAV antibodies

Answer: C. HCV RNA PCR detects current viral RNA and measures the viral amount.

A client with chronic hepatitis develops confusion and asterixis. What should the nurse do first?

• A. Offer a snack and reassess tomorrow.

• B. Document the findings as expected.

• C. Encourage independent ambulation.

• D. Escalate care and assess neurologic and airway status.

Answer: D. These findings suggest hepatic encephalopathy, which can progress to seizures and coma.

Which client statement indicates a need for further teaching?

• A. "I will avoid alcohol while recovering."

• B. "I can take extra over-the-counter medications whenever I feel unwell."

• C. "I will eat small, frequent meals if I feel nauseated."

• D. "I will practice good hand hygiene."

Answer: B. Unnecessary medications may worsen liver injury.

A client's HBsAg is positive. How should the nurse interpret the result?

• A. Current hepatitis B infection and potential infectiousness

• B. Confirmed hepatitis C infection

• C. Immunity to hepatitis A

• D. No hepatitis B infection

Answer: A. HBsAg indicates current hepatitis B infection; the provider is responsible for reporting it.

Which client is at risk for hepatitis D?

• A. A client who drank contaminated water

• B. A client who ate contaminated shellfish

• C. A client with hepatitis B

• D. A client with hepatitis C but no hepatitis B

Viral hepatitis. Clay-colored stool is the hallmark sign; jaundice and dark urine are classic accompanying findings.

Which populations are at greatest risk for severe foodborne illness?

A nurse is teaching a food handler how to prevent cross-contamination. What should the food handler do?

Use separate utensils and equipment for raw and cooked foods, store foods separately, and sanitize surfaces.

A client leaves cooked food at room temperature for 3 hours. What should the nurse teach?

Refrigerate cooked food within 2 hours, preferably below 5°C (41°F). Keep hot food above 60°C (140°F).

How should a client safely thaw frozen food?

Thaw in the refrigerator or by another safe method, never at room temperature.

What are the five keys to safer food?

Keep clean; separate raw and cooked foods; cook thoroughly; maintain safe temperatures; use safe water and raw materials.

How should a client reduce foodborne illness risk when preparing produce and meat?

Wash produce, cook meat thoroughly, avoid unpasteurized milk, use safe water, and avoid expired foods.

Which agencies monitor foodborne disease outbreaks in the United States?

The FDA and CDC. The CDC monitors outbreaks through the Foodborne Disease Outbreak Surveillance System (FDOSS).

Which pathogens commonly cause foodborne illness?

Norovirus, Salmonella, Clostridium perfringens, Campylobacter, and Staphylococcus aureus.

Salmonellosis

A client develops diarrhea 24 hours after eating undercooked chicken. Which infection should the nurse suspect?

Salmonellosis. Symptoms typically begin 12–72 hours after exposure and last 4–7 days.

Which symptom is the main clinical finding in salmonellosis?

Diarrhea, often accompanied by other gastrointestinal symptoms.

A client with suspected salmonellosis asks to take loperamide (Imodium). What should the nurse teach according to the provided course notes?

Do not take antidiarrheal medications; slowing intestinal movement may prolong bacterial retention.

Which exposures increase the risk of salmonellosis?

Undercooked meat, eggs, or chicken; kitchen cross-contamination; and contact with chickens or reptiles.

How can a client reduce the risk of salmonellosis?

Cook foods thoroughly, wash raw produce, prevent cross-contamination, and practice safe food handling.

TyphoidFever

A traveler develops a fever of 104°F, vomiting, diarrhea, and a flat rose-colored rash after consuming contaminated water. Which illness is most likely?

Typhoid fever, caused by Salmonella Typhi.

How is typhoid fever transmitted?

Through food or water contaminated with infected feces or sewage.

Which findings are characteristic of typhoid fever?

High fever (103–104°F), nausea, vomiting, diarrhea, and a flat rose-colored rash.

A client has been exposed to typhoid fever. What should the nurse emphasize?

Prompt medical evaluation and appropriate antibiotic management. Exposure alone does not mean every person automatically requires antibiotics; management depends on the exposure and clinical guidance.

When should a client receive typhoid vaccination before travel?

Before potential exposure, according to the specific vaccine schedule. Protection is not 100%, and timing varies by vaccine type.

Dysentery:Shigella,Campylobacter,andAmebicDysentery

A client develops severe bloody diarrhea with mucus 36 hours after eating contaminated food abroad. What should the nurse suspect?

Dysentery, which may be caused by Shigella, Campylobacter, or Entamoeba histolytica.

What is the hallmark finding of dysentery?

Severe diarrhea containing blood or mucus.

What history is especially important when assessing a client with suspected dysentery?

Recent international travel and exposure to contaminated food or water.

When do dysentery symptoms typically begin, and how long may they last?

Onset: 24–48 hours after exposure. Duration: approximately 5–7 days, according to the provided notes.

What treatment may be required for dysentery?

Antibiotics may be needed, depending on the causative organism and clinical severity.

What should a nurse teach travelers to prevent dysentery?

Use safe drinking water, eat properly prepared foods, and avoid contaminated food and beverages.

ShigaToxin-ProducingE.coli

A client develops diarrhea after eating an undercooked hamburger. Several days later, the client develops signs of kidney injury. Which pathogen should the nurse suspect?

Shiga toxin-producing E. coli (STEC).

Which exposures increase the risk of STEC infection?

Undercooked ground beef, raw milk, unwashed produce, contaminated food or water, and contact with animals at petting zoos.

Why should clients with suspected STEC avoid antidiarrheal medications?

They may increase the risk of serious complications. Avoid antidiarrheals in suspected STEC infection.

Why are antibiotics generally avoided in STEC infection?

They may increase the risk of hemolytic uremic syndrome (HUS), a serious complication that can cause acute kidney injury.

What serious complication should the nurse monitor for in STEC infection?

Hemolytic uremic syndrome (HUS), which can cause severe kidney damage.

What is the main nursing priority when a client has suspected STEC infection?

Monitor hydration and kidney function, and promptly report reduced urine output or other signs of complications.

VibrioInfections

A client develops watery diarrhea and abdominal cramps after eating raw oysters. Which infection should the nurse suspect?

Vibriosis, potentially caused by Vibrio parahaemolyticus.

When do symptoms of Vibrio parahaemolyticus typically begin, and how long do they last?

Onset: 4–96 hours. Duration: 1–7 days.

Which symptoms are associated with Vibrio parahaemolyticus infection?

Watery diarrhea and abdominal cramps, sometimes with nausea, vomiting, fever, or headache.

Which clients should be especially cautious about raw seafood?

Pregnant people and individuals at increased risk of severe infection. Avoid raw or inadequately cooked seafood.

What should a client with an open wound avoid?

Swimming or wading in coastal water, because Vibrio bacteria can enter through open wounds.

How can clients prevent seafood-associated Vibrio infection?

Avoid raw seafood, cook seafood thoroughly, and keep open wounds out of coastal water.

Cholera

A traveler develops profuse, watery, milky-white stools after drinking contaminated water. Which disease should the nurse suspect?

Cholera, caused by Vibrio cholerae.

What is the hallmark stool finding in cholera?

Rice-water stools — profuse, pale, watery diarrhea.

When can cholera symptoms begin after exposure?

Approximately 4 hours to 5 days after exposure, according to the provided notes.

What is the priority treatment for cholera?

Rapid rehydration, usually with oral rehydration solution; severe dehydration may require intravenous fluids.

Why is rapid rehydration essential in cholera?

Profuse diarrhea can cause severe fluid and electrolyte loss, leading to hypovolemic shock if untreated.

How can cholera outbreaks be prevented?

Provide safe drinking water, proper sanitation, and prevent sewage from contaminating food and water.

What should a traveler know about the Vaxchora cholera vaccine?

It is an oral vaccine used before travel to certain cholera-risk areas. Follow current eligibility and timing recommendations; protection is not guaranteed.

Botulism

A client develops blurred vision, difficulty swallowing, dry mouth, and descending muscle weakness after eating improperly home-canned vegetables. What should the nurse suspect?

Botulism, caused by a toxin produced by Clostridium botulinum.

What is the hallmark clinical finding of botulism?

Descending, symmetrical flaccid paralysis in an alert client.

Why is botulism dangerous?

The toxin blocks nerve signals, causing progressive muscle weakness that can lead to respiratory failure.

A client with suspected botulism develops difficulty swallowing and breathing. What is the priority nursing action?

Protect the airway and support breathing immediately. Prepare for possible mechanical ventilation and urgent antitoxin treatment.

What treatment is available for foodborne botulism?

Botulinum antitoxin and supportive care, including respiratory support when needed. Early treatment is critical.

Why should infants not be given honey?

Honey can contain C. botulinum spores, which can cause infant botulism. Do not give honey to children under 12 months.

Which foods are associated with foodborne botulism?

Improperly home-canned or preserved foods, especially fruits and vegetables processed without adequate safety measures.

How long can recovery from botulism take?

Weeks to months, because nerve function may recover slowly.

What should the nurse teach about preventing botulism?

Use safe food-preservation methods, avoid improperly canned foods, and never give honey to infants under 12 months.

NCLEX-StyleMultiple-ChoiceQuestions

A client develops diarrhea 24 hours after eating undercooked chicken. The client asks for loperamide. Which response is most consistent with the provided course notes?

• A. Take loperamide after every loose stool.

• B. Avoid antidiarrheal medication and seek appropriate clinical guidance.

• C. Take antibiotics without an assessment.

• D. Stop drinking fluids until diarrhea resolves.

Answer: B. The notes advise avoiding antidiarrheals in salmonellosis; maintaining hydration is important.

A client develops bloody diarrhea after eating an undercooked hamburger. Which intervention should the nurse question?

• A. Monitoring urine output

• B. Assessing hydration status

• C. Administering an antidiarrheal medication

• D. Monitoring for kidney complications

Answer: C. Avoid antidiarrheals in suspected Shiga toxin-producing E. coli infection because of the risk of serious complications.

A traveler has a fever of 104°F and a flat rose-colored rash after drinking sewage-contaminated water. Which illness is most likely?

• A. Botulism

• B. Typhoid fever

• C. Cholera

• D. Salmonellosis

Answer: B. Typhoid fever is associated with high fever, a rose-colored rash, and contaminated food or water.

A client develops profuse rice-water stools after drinking contaminated water. What is the priority intervention?

• A. Restrict oral fluids.

• B. Administer an antidiarrheal.

• C. Begin rehydration therapy.

• D. Encourage raw seafood consumption.

Answer: C. Cholera can cause rapid, severe dehydration; prompt fluid and electrolyte replacement is essential.

A client presents with descending symmetrical flaccid paralysis but remains alert. Which condition is most likely?

• A. Dysentery

• B. Salmonellosis

• C. Cholera

• D. Botulism

Answer: D. Botulinum toxin blocks nerve signals, causing descending paralysis and potentially respiratory failure.

A pregnant client asks how to prevent Vibrio infection. Which statement demonstrates correct understanding?

• A. "Raw oysters are safe if they smell fresh."

• B. "I should avoid raw seafood and cook seafood thoroughly."

• C. "I can swim in coastal water with an open wound."

• D. "Refrigeration makes all contaminated seafood safe."

Answer: B. Avoid raw or undercooked seafood; proper cooking reduces infection risk.

A client with suspected STEC infection develops decreased urine output. What complication should the nurse suspect?

• A. Hemolytic uremic syndrome

• B. Infant botulism

• C. Typhoid rash

• D. Cholera vaccine reaction

Answer: A. HUS can cause acute kidney injury following STEC infection.

Which food-handling practice best prevents cross-contamination?

• A. Using the same cutting board for raw chicken and salad

• B. Leaving cooked food at room temperature for 4 hours

• C. Using separate utensils for raw and cooked foods

• D. Thawing meat on the counter overnight

Answer: C. Separating raw and cooked foods helps prevent pathogen transfer.

Young children, older adults, pregnant people, and debilitated or immunocompromised individuals.

What is a vector?

Which diseases are transmitted by ticks?

Lyme disease and Rocky Mountain spotted fever (RMSF).

Which diseases are transmitted by mosquitoes?

Malaria, yellow fever, West Nile virus, and Zika virus.

Which disease is associated with flea transmission?

Bubonic plague.

How can zoonotic diseases spread to humans?

Animal bites (rabies), inhalation of rodent excrement (hantavirus), or direct contact with infected animals or carcasses (tularemia).

LymeDisease

A client develops a bull's-eye rash, fever, and fatigue after hiking in a wooded area. Which disease should the nurse suspect?

Lyme disease, transmitted through an infected tick bite.

What findings occur during Stage 1 of Lyme disease?

Bull's-eye rash, fever, chills, fatigue, muscle and joint aches, and swollen lymph nodes.

A client with Lyme disease develops additional skin lesions, facial paralysis, and cardiac symptoms. Which stage is this?

Stage 2 — disseminated infection, which can affect the nervous and cardiovascular systems.

A client with untreated Lyme disease develops arthritis and joint pain. Which stage is most likely?

Stage 3 — late disease, associated with arthritis and arthralgia.

Which medications may treat early Lyme disease?

Doxycycline or amoxicillin, commonly for 10–14 days according to the provided notes; the regimen depends on the patient and clinical guidelines.

A nurse teaches a client how to remove an attached tick. What is the correct technique?

Use fine-tipped tweezers, grasp the tick close to the skin, and pull straight upward steadily. Clean the bite area afterward.

How should a removed tick be disposed of?

Place it in rubbing alcohol or a sealed bag, according to the provided notes.

Where should a client check for ticks after hiking?

Underarms, ears, belly button, behind the knees, hairline, between the legs, waist, and other body areas.

How can a client prevent Lyme disease?

Use insect repellent, wear protective clothing, treat clothing and gear with permethrin, stay in the center of trails, shower after outdoor activities, and check for ticks.

How should a client handle clothing after possible tick exposure?

Check clothing and tumble-dry on high heat for 10 minutes when appropriate. Shower soon after returning indoors and perform a full-body tick check.

Can ticks jump or fly onto people?

No. Ticks wait on grass and shrubs and attach when a host brushes against them.

RockyMountainSpottedFever(RMSF)

A client develops fever, severe headache, chills, and muscle pain after a tick bite. A rash appears at the wrists and ankles and spreads toward the trunk. What should the nurse suspect?

Rocky Mountain spotted fever (RMSF).

How does the RMSF rash typically differ from the classic Lyme disease rash?

RMSF: Rash often begins at the wrists and ankles and spreads toward the trunk, usually after fever begins.

Lyme disease: Classically causes an expanding bull's-eye rash.

What is the treatment for suspected RMSF?

Doxycycline. Treatment should begin promptly when RMSF is suspected; do not delay treatment while waiting for confirmation.

Which history is important when assessing suspected RMSF?

Tick exposure, outdoor activities, and geographic location, including areas such as North Carolina, Tennessee, Missouri, Arkansas, and Oklahoma.

WestNileVirus

A client reports a mosquito bite but has no symptoms. Does this rule out West Nile virus infection?

No. Most people infected with West Nile virus have no symptoms.

What proportion of West Nile virus infections cause fever?

Approximately 1 in 5 infected people develop a febrile illness.

What is the major concern with neuroinvasive West Nile virus?

Approximately 1 in 150 infected people develop neuroinvasive disease, which can affect the brain and nervous system. There is no specific antiviral treatment.

How can clients reduce the risk of West Nile virus?

Use insect repellent, wear long sleeves, and eliminate standing water where mosquitoes breed.

ZikaVirus

How is Zika virus transmitted?

Through infected mosquitoes, sexual contact, and transmission from a pregnant person to the fetus.

Why is Zika virus especially concerning during pregnancy?

It can cause severe fetal birth defects, including congenital brain abnormalities.

How long can Zika virus persist in semen according to the provided notes?

Up to 6 months. Follow current public health guidance on sexual transmission precautions after possible exposure.

What teaching is important for a client concerned about Zika exposure during pregnancy?

Prevent mosquito bites and follow clinical guidance about testing and sexual transmission precautions, because fetal infection can cause serious birth defects.

Plague

A client develops fever, chills, weakness, and painful, swollen lymph nodes after exposure to fleas and rodents. Which disease should the nurse suspect?

Bubonic plague, a bacterial infection commonly transmitted by infected fleas.

A client with plague develops pneumonia, chest pain, shortness of breath, and bloody sputum. Which form is present?

Pneumonic plague, which affects the lungs and can spread between people through respiratory droplets.

A client with plague develops fever, abdominal pain, shock, and gangrene of the fingers. Which form is most likely?

Septicemic plague, which can cause sepsis, disseminated intravascular coagulation (DIC), shock, and gangrene.

Which antibiotics may be used to treat plague?

Gentamicin or fluoroquinolones, depending on clinical circumstances and treatment guidelines. Treatment must begin promptly.

What precautions are required for pneumonic plague?

Droplet precautions until at least 48 hours of effective antibiotic therapy and clinical improvement, following current public health guidance. The provided notes specify 72 hours after antibiotics.

What precautions are needed for bubonic plague exposure?

Appropriate contact precautions and decontamination when indicated, following public health guidance and the nature of the exposure.

How can clients reduce the risk of plague?

Control rodents, prevent flea bites with appropriate repellent such as DEET, and wear gloves when handling potentially infected animals.

Is a plague vaccine routinely available in the United States?

No routinely available plague vaccine is licensed for general use in the United States, according to the provided notes.

Tularemia

A client develops progressive weakness after handling a dead rabbit. Which disease should the nurse suspect?

Tularemia, a bacterial zoonosis associated with infected rabbits and wild rodents.

How can tularemia spread to humans?

Direct contact with infected animals or carcasses, arthropod bites, or inhalation of contaminated particles.

Why is inhalational tularemia a public health concern?

Airborne exposure can cause severe illness, and the organism has potential for use as a bioterrorism agent.

What history is especially important when tularemia is suspected?

Handling dead rabbits or wild rodents, tick or deer-fly exposure, and possible airborne exposure.

Rabies

A client is bitten by a bat. What should the nurse advise?

Seek emergency medical evaluation immediately. Rabies post-exposure prophylaxis must begin promptly when indicated, before symptoms develop.

What treatment may be required after a potentially rabid animal bite?

Rabies vaccine and rabies immunoglobulin, depending on prior vaccination status and exposure assessment.

A client develops confusion, drooling, and intense fear of water. Which disease should the nurse suspect?

Rabies, which causes severe neurologic disease.

Why is rabies exposure an emergency even if the client feels well?

Once symptoms develop, rabies is almost always fatal. Post-exposure prophylaxis can prevent disease when administered promptly and appropriately.

How can rabies be prevented?

Vaccinate pets, avoid wild animals, and seek immediate assessment after possible exposure.

Hantavirus

A construction worker develops illness after disturbing rodent droppings in an enclosed building. Which infection should the nurse consider?

Hantavirus infection, which can spread through inhalation of particles contaminated with infected rodent urine, droppings, or saliva.

Which workers are at increased risk of hantavirus exposure?

Construction workers, cleaners, and others who disturb rodent-infested areas.

How should workers reduce hantavirus exposure when cleaning rodent-infested areas?

Avoid stirring up dust, use appropriate protective equipment, and follow public health cleaning guidance. Respiratory protection may be necessary depending on the exposure and task.

Why is hantavirus a serious concern?

It can cause severe, potentially fatal disease, including serious respiratory illness.

AvianInfluenza

What type of disease is avian influenza?

A zoonotic infection associated with influenza viruses that primarily infect birds. Exposure to infected birds or contaminated environments can pose a risk to humans.

NCLEX-StyleMultiple-ChoiceQuestions

A client develops a bull's-eye rash, fatigue, and joint pain after hiking. Which disease is most likely?

• A. Rabies

• B. Lyme disease

• C. Plague

• D. Hantavirus

Answer: B. Lyme disease is tick-borne and classically causes an expanding bull's-eye rash.

A client develops fever and a rash that begins at the wrists and ankles after a tick bite. Which medication should the nurse anticipate?

• A. Doxycycline

• B. Rabies immunoglobulin

• C. Antidiarrheal medication

• D. No treatment until the rash disappears

Answer: A. Doxycycline is the treatment of choice for suspected RMSF; treatment should not be delayed.

A client is bitten by a bat but has no symptoms. What is the priority action?

• A. Wait for symptoms to appear.

• B. Clean the wound and take no further action.

• C. Obtain immediate medical evaluation for rabies post-exposure prophylaxis.

• D. Schedule a routine appointment in 6 months.

Answer: C. Rabies prophylaxis must be initiated promptly when indicated, before symptoms develop.

A client develops pneumonia and bloody sputum after exposure to an infected animal in a plague-endemic area. Which precautions should the nurse initiate?

• A. Standard precautions only

• B. Droplet precautions

• C. No precautions

• D. Protective isolation only

Answer: B. Pneumonic plague requires droplet precautions and prompt antibiotic treatment.

A pregnant client asks why Zika prevention is important. Which response is best?

• A. Zika spreads only through contaminated food.

• B. Zika cannot cross from parent to fetus.

• C. Zika can cause severe fetal birth defects.

• D. Zika is transmitted only through tick bites.

Answer: C. Zika can be transmitted to the fetus and cause serious congenital abnormalities.

A worker develops progressive weakness after handling a dead rabbit. Which disease should the nurse suspect?

• A. Tularemia

• B. Lyme disease

• C. West Nile virus

• D. Typhoid fever

Answer: A. Tularemia is associated with exposure to infected rabbits and wild rodents.

A client cleans a rodent-infested building and disturbs dried droppings. Which infection is a major concern?

• A. Bubonic plague from mosquitoes

• B. Hantavirus from inhaled contaminated particles

• C. Lyme disease from fleas

• D. Rabies from contaminated water

Answer: B. Hantavirus can spread through inhalation of particles contaminated with infected rodent excretions.

Which finding is most characteristic of symptomatic rabies?

• A. Bull's-eye rash

• B. Rice-water stools

• C. Hydrophobia with confusion and drooling

• D. Rose-colored rash with high fever

Answer: C. Hydrophobia, neurologic changes, and excessive salivation are classic rabies findings.

A carrier that transmits an infectious agent, such as a tick, mosquito, or flea.

A client with HIV develops an opportunistic infection. Which infection is associated with this population?

Why are clients with HIV at increased risk for PCP?

Immunosuppression weakens the body's ability to fight opportunistic infections.

Toxoplasmosis

A pregnant client cleans a cat's litter box. Which parasitic infection is a concern?

Toxoplasmosis, caused by Toxoplasma gondii, which can spread through cat feces containing the parasite.

What should a pregnant client do to reduce toxoplasmosis risk?

Avoid handling cat litter when possible. If unavoidable, wear gloves and wash hands thoroughly; change litter daily.

Enterobiasis (Pinworm)

A child experiences intense itching around the anus at night. Which infection should the nurse suspect?

Enterobiasis (pinworm infection), characterized by nighttime or early-morning perianal itching.

How is pinworm infection transmitted?

By ingesting pinworm eggs from contaminated hands, bedding, surfaces, or objects.

What treatment should the nurse anticipate for pinworm infection?

Oral antihelminthic medication (vermicide) for the infected person and, when indicated, close household contacts.

What hygiene measures help prevent reinfection with pinworms?

Wash bedding and clothing, clean household surfaces, keep fingernails short, and practice thorough handwashing.

What complication can occur in girls with pinworm infection?

Worms may migrate into the vaginal tract, causing irritation.

Which children are at increased risk for pinworm infection?

Children in close-contact settings and those who share beds or have contact with contaminated objects.

Giardiasis

A client drinks untreated water while camping. Which protozoan infection should the nurse consider?

Giardiasis, caused by Giardia and transmitted through contaminated water or other fecal–oral exposure.

How can a client prevent giardiasis when camping or traveling?

Drink treated or properly filtered water and practice good hand hygiene.

Why can giardiasis occur in people living in the United States?

Previous exposure does not guarantee immunity. Anyone can become infected through contaminated water, food, or contact.

Ebola

A health care worker develops fever, muscle aches, and fatigue after caring for a client with Ebola. What is the nurse's concern?

Possible Ebola virus disease. Symptoms may progress from fever and aches to vomiting, diarrhea, hemorrhage, and shock.

How long is the incubation period for Ebola?

2–21 days after exposure.

When does a person with Ebola become contagious?

Once symptoms begin. The virus can spread through direct contact with infected blood, body fluids, or contaminated objects.

A client with suspected Ebola develops vomiting and diarrhea. What is the priority nursing concern?

Prevent transmission and support fluid balance. Severe fluid loss can lead to shock and organ failure.

What personal protective equipment is required when caring for a client with Ebola?

Appropriate impermeable protective clothing, multiple gloves, and respiratory and eye protection as indicated by protocol. A trained observer should supervise donning and doffing.

Why should PPE removal be supervised?

To prevent self-contamination from infected body fluids on protective equipment.

What treatment is used for Ebola?

Supportive care, including IV fluids, airway support, and organ support as needed. Approved monoclonal antibody treatments are available for Zaire ebolavirus.

Why must bodies of people who died from Ebola be handled carefully?

Dead bodies remain infectious and require specialized safe handling and disposal.

Which exposures increase the risk of Ebola?

Direct contact with infected body fluids, caring for infected people, handling infected remains, and residence in or travel to affected areas.

Mpox (Monkeypox)

A client develops a rash after direct contact with someone who has mpox. How is the virus transmitted?

Through direct contact with infectious lesions or body fluids, contaminated objects, and respiratory secretions during close contact.

When is a person with mpox considered contagious?

Until all lesions have healed, scabs have fallen off, and new skin has formed.

A client asks when mpox symptoms begin after exposure. What should the nurse explain?

Symptoms typically begin within 3–17 days, although the exact interval can vary. The rash and illness may last several weeks.

Which vaccines can protect against mpox?

JYNNEOS or ACAM2000, depending on eligibility and clinical guidance. JYNNEOS is a two-dose vaccine given 4 weeks apart.

Can mpox vaccination be given after exposure?

Yes. Post-exposure vaccination may help prevent or reduce illness when given promptly. People already diagnosed with mpox generally do not need vaccination for that same infection.

What teaching helps prevent mpox transmission?

Avoid close contact with infectious lesions, do not share contaminated bedding or clothing, and follow isolation guidance until lesions have fully healed.

NCLEX-Style Multiple-Choice Questions

A child has intense perianal itching at night. Which infection is most likely?

• A. Giardiasis

• B. Enterobiasis

• C. Toxoplasmosis

• D. PCP

Answer: B. Pinworms characteristically cause nighttime perianal itching.

A nurse cares for a client with suspected Ebola. Which action is most important to prevent occupational transmission?

• A. Remove PPE without assistance.

• B. Use standard precautions only.

• C. Follow strict infection-control precautions with supervised PPE removal.

• D. Delay isolation until symptoms worsen.

Answer: C. Ebola spreads through infected body fluids; proper PPE and supervised removal reduce exposure.

A pregnant client asks how to reduce toxoplasmosis risk. Which advice is best?

• A. Clean cat litter without gloves.

• B. Avoid handling cat litter when possible.

• C. Stop washing hands after handling animals.

• D. Share litter-cleaning duties without precautions.

Answer: B. Cat feces can contain Toxoplasma gondii; avoiding litter exposure reduces risk.

A client with mpox asks when isolation can end. Which response is best?

• A. When the fever resolves

• B. After 3 days of treatment

• C. When the rash begins to dry

• D. When all lesions have healed and new skin has formed

Answer: D. A person remains contagious until all lesions heal and new skin forms.

A client with HIV is at risk for an opportunistic lung infection. Which infection is associated with advanced immunosuppression?

• A. PCP

• B. Pinworm

• C. Tularemia

• D. Typhoid fever

Answer: A. PCP is an opportunistic infection associated with advanced HIV.

A client with suspected Ebola develops profuse diarrhea and vomiting. Which complication is the greatest immediate concern?

• A. Mild itching

• B. Fluid loss leading to hypovolemic shock

• C. Nighttime perianal itching

• D. Localized rash only

Answer: B. Severe fluid loss can lead to shock and organ failure.

Pneumocystis pneumonia (PCP), an opportunistic fungal infection commonly associated with advanced HIV.

Which vaccines are included in routine childhood immunization schedules?

Why do children need multiple doses and vaccine boosters?

To build, strengthen, or restore protective immunity when protection decreases over time or additional doses are needed.

AdultVaccinations

Which vaccines are emphasized for adults in the lecture?

Shingles, pneumococcal, Tdap, COVID-19, and annual influenza vaccination.

Which adults should receive particular attention for Tdap vaccination?

Pregnant clients during each pregnancy and people who care for or handle newborns, according to current recommendations and the lecture.

How often should adults receive the influenza vaccine?

Yearly.

What are the HPV vaccine recommendations in the provided reading?

Routine catch-up vaccination through age 26; ages 27–45 may receive it after shared clinical decision-making.

Which clients may need meningococcal vaccination?

College dormitory residents, military personnel, clients with HIV or sickle cell disease, travelers to hyperendemic areas, and other high-risk individuals, depending on the vaccine and current recommendations.

What is the difference between MenACWY and MenB vaccines?

MenACWY protects against meningococcal serogroups A, C, W, and Y. MenB protects against serogroup B.

VaccineEducation

How do vaccines protect the body?

They stimulate the immune system to develop protective immunity and immune memory against a specific pathogen.

Why might a client feel unwell after vaccination?

Expected immune responses can cause temporary soreness, fatigue, mild fever, or muscle aches.

Can vaccinated clients still develop the disease?

Yes. No vaccine is 100% effective, and protection varies by vaccine and individual.

What is the difference between active and passive immunity?

Active immunity: The person's immune system produces its own antibodies after vaccination or infection.

Passive immunity: Ready-made antibodies are received from another source; protection is temporary.

Which vaccines are live vaccines, and who should generally avoid them?

MMR, varicella, and live intranasal influenza vaccine. These are generally contraindicated during pregnancy and in severe immunocompromise.

A client has a mild common cold and is scheduled for vaccination. Should the vaccine automatically be postponed?

No. A mild illness is not usually a contraindication. Moderate or severe acute illness is a precaution.

A client previously experienced anaphylaxis after a vaccine. What should the nurse do before another dose?

Do not administer the implicated vaccine without specialist evaluation. Anaphylaxis to a vaccine or component may contraindicate further doses or other vaccines containing the same substance.

How can nurses improve vaccine compliance?

Provide clear education, address concerns, explain benefits and risks, check vaccination records, recommend needed doses, and arrange follow-up.

IsolationPrecautions

A client is diagnosed with active pulmonary tuberculosis. Which precautions are required?

Airborne precautions. Use an airborne infection isolation room and a fit-tested N95 or higher-level respirator.

A client has measles or chickenpox. Which precautions are required?

Airborne precautions.

A client is hospitalized with influenza. Which precautions are generally required?

Droplet precautions, in addition to standard precautions.

A client has pertussis. Which precautions are required?

Droplet precautions.

A client has shingles with fluid-filled vesicles. Which precautions apply?

Airborne and contact precautions for disseminated shingles or immunocompromised clients with localized shingles. For localized shingles in an immunocompetent client, cover lesions and follow facility-specific precautions.

A client has shingles with all lesions crusted over. What changes?

Transmission risk decreases substantially. In routine localized shingles, airborne and contact precautions can generally be discontinued once lesions are dry and crusted, according to infection-control guidance.

A client has suspected pneumonic plague. Which precautions should the nurse initiate?

Droplet precautions, maintained until at least 48 hours of effective antibiotic therapy and clinical improvement under current guidance. Follow your course notes if your exam specifically uses the 72-hour rule.

A client has Ebola. Which precautions are required?

Strict contact and appropriate droplet precautions, with enhanced PPE and infection-control procedures according to current public health guidance.

A client has COVID-19 and requires CPAP or BiPAP. What should the nurse remember?

Use appropriate respiratory precautions and follow facility policy for aerosol-generating procedures. COVID-19 precautions depend on current infection-control guidance and the care setting.

ReportingRequirements

A client has a positive hepatitis B surface antigen (HBsAg) result. Who is responsible for reporting it?

The provider is responsible for reporting the positive result to the state or local health department, as required by public health regulations.

A client is diagnosed with measles or tuberculosis. How quickly should the disease be reported according to the provided course notes?

Within 24 hours. Follow state and local reporting requirements.

Why must nurses know reportable diseases?

To support public health surveillance, outbreak detection, contact tracing, and timely infection-control measures.

NCLEX-StyleMultiple-ChoiceQuestions

A pregnant client asks whether she can receive the MMR vaccine. What is the best response?

• A. It is recommended during every trimester.

• B. It is a live vaccine and is contraindicated during pregnancy.

• C. It is safe only during the first trimester.

• D. It is required before every prenatal visit.

Answer: B. MMR is a live vaccine and is contraindicated during pregnancy.

A client has a mild runny nose but no significant illness and is scheduled for vaccination. What should the nurse do?

• A. Automatically cancel the vaccination.

• B. Explain that a mild cold is not usually a contraindication.

• C. Administer every live vaccine without screening.

• D. Delay all vaccines for 6 months.

Answer: B. Mild illness is generally not a reason to postpone vaccination.

A client asks about active immunity after vaccination. Which explanation is correct?

• A. Ready-made antibodies provide temporary protection.

• B. The immune system produces its own antibodies and immune memory.

• C. Vaccines provide lifelong protection in every person.

• D. Active immunity occurs only after receiving immunoglobulin.

Answer: B. Active immunity develops when the body's immune system responds to vaccination or infection.

A nurse is caring for a client with active pulmonary tuberculosis. Which intervention is appropriate?

• A. Use droplet precautions only.

• B. Use contact precautions only.

• C. Use airborne precautions and a fit-tested N95 or higher-level respirator.

• D. Use standard precautions only.

Answer: C. Pulmonary TB requires airborne precautions.

A client has a history of anaphylaxis to a vaccine component. What is the priority nursing action?

• A. Administer the same vaccine at half the dose.

• B. Administer it without assessment if the client has no symptoms today.

• C. Identify the implicated component and obtain appropriate clinical evaluation before further vaccination.

• D. Assume all vaccines are safe.

Answer: C. Anaphylaxis to a vaccine or component may contraindicate further doses or vaccines containing the same component.

A college student will live in a dormitory. Which vaccine should the nurse specifically review?

• A. Meningococcal vaccine

• B. Rabies vaccine for all students

• C. Yellow fever vaccine for all students

• D. No vaccines are needed after childhood.

Answer: A. Dormitory residence is a recognized risk factor for meningococcal disease.

Tetanus, measles, rubella, pertussis, diphtheria, influenza, polio, hepatitis A and B, mumps, varicella, Hib, meningococcal, HPV, rotavirus, and pneumococcal.