[CD] EVAL EXAM

A. Administer varicella-zoster immune globulin to the client

While working in a pediatric clinic, you receive a telephone call from the parent of a 10-year-old who is receiving chemotherapy for leukemia. The client's sibling has chickenpox. Which of these actions will you anticipate taking next?

A. Administer varicella-zoster immune globulin to the client

B. Educate the parent about the correct use of acyclovir (Zovirax)

C. Prepare the client for admission to a private room in the hospital

D. Teach the parents regarding contact and airborne precaution

D. Limit the use of indwelling foley catheter (IFC)

Indwelling urinary catheters are the major risk factor for CAUTIs. Studies have shown that reducing unnecessary catheterization and promptly removing catheters when no longer essential can significantly lower CAUTI rates.

a. Adequate fluid intake: can promote bladder emptying and reduce UTI risk, it's not the single most impactful factor.

b. Perineal hygiene: for general infection prevention, but its effect on CAUTIs specifically is less significant compared to catheter use.

c. Dipstick urinalysis: Identifying asymptomatic bacteriuria through dipstick testing might not always translate to preventing symptomatic UTIs. Additionally, this approach wouldn't directly address the root cause of most CAUTIs, which is catheter use.

Which action will you take to most effectively reduce the incidence of hospital-associated urinary tract infections?

A. Ensure that clients have enough adequate fluid intake

B. Teach assistive personnel how to provide good perineal hygiene

C. Perform dipstick urinalysis for clients with risk factors for UTI

D. Limit the use of indwelling foley catheter (IFC)

C. Obtain wound cultures during dressing changes

The other choices require assessment, planning, and health education which require critical thinking, clinical judgement, and knowledge of RNs.

You are caring for a client who has been admitted to the hospital with a leg ulcer that is infected with vancomycin-resistant S. aureus (VRSA). Which of these nursing actions can you delegate to the nurse assistant?

A. Assess risk for further skin breakdown

B. Plan ways to improve the client's oral protein intake

C. Obtain wound cultures during dressing changes

D. Educate the client about home care of the leg ulcer

B. The new RN places a child who has chemotherapy-induced neutropenia into a negative-pressure room.

Chemotherapy-induced neutropenia is when the number of neutrophils drops fatally. Negative pressure rooms / isolation rooms keeps patients with infectious illnesses, or patients who are susceptible to infections from others, away from others. Air pressure inside the room is lower than outside the room. When the door is opened, contaminated air or particles from inside the room will not flow outside.

A. C. difficile precautions involve proper hand hygiene and disposable gowns, not necessarily goggles.

C. Placing two children with RSV in the same room significantly increases the risk of cross-transmission and potential worsening of infection for both children.

D. N95 is not necessary as pertussis transmission primarily occurs through close contact with coughing or sneezing

You are the pediatric unit charge nurse today and are working with a new RN. Which action by the new RN requires the most immediate action on your part?

A. The new RN wears goggles to change linens of a client who has diarrhea caused by C. difficile.

B. The new RN places a child who has chemotherapy-induced neutropenia into a negative-pressure room.

C. The new RN admits a new client with respiratory syncytial virus (RSV) infection to a room with another child who has RSV.

D. The new RN tells the nursing assistant to use an N95 respirator mask when caring for a child who has pertussis.

C. Ask the client about any recent travel to Asia or the Middle East

The client's clinical manifestations suggest possible avian influenza ("bird flu"). If the client has traveled recently in Asia or the Middle East, where outbreaks of bird flu have occurred, you will need to institute airborne and contact precautions immediately. The other actions may also be appropriate but are not the initial action to take for this client, who may transmit the infection to other clients or staff members.

A client comes to the outpatient clinic where you work complaining of abdominal pain, diarrhea, shortness of breath and epistaxis. Which of the following actions would you take first?

A. Screening clients for upper respiratory tract symptoms

B. Call an ambulance to take the client immediately to the hospital

C. Ask the client about any recent travel to Asia or the Middle East

D. Determine whether the client has had recommended immunizations

D. Place the client on contact and airborne precautions

a. Cultures: not the most urgent step. Delaying isolation to perform these tests could increase the risk of transmitting the highly contagious virus to other patients and healthcare personnel.

b. Normal saline infusion: wouldn't be the first priority when severe respiratory distress is the primary concern. Implementing isolation measures to prevent further spread of the virus takes precedence.

c. Methylprednisolone: not routinely recommended in the initial management of SARS and might even have detrimental effects like worsening viral replication. Implementing isolation for infection control remains the most critical immediate action.

A client who has recently traveled to China comes to the emergency department (ED) with increasing shortness of breath and is strongly suspected of having a severe acute respiratory syndrome (SARS). Which of these prescribed actions will you take first?

A. Obtain blood, urine, and sputum for cultures

B. Infuse normal saline at 100ml/hr

C. Administer methylprednisolone (Solu-Medrol) 1 gram/IV

D. Place the client on contact and airborne precautions

D. A client with a cough who may have Koch disease

Possible Koch disease (cough): aka Tuberculosis (TB) caused by Koch disease, is airborne. Implementing airborne precautions like masks and negative pressure rooms can effectively control potential spread if necessary. A semi-private room with appropriate precautions would likely be sufficient until a definitive diagnosis is established.

A. Toxic shock syndrome = critical care needed due to rapid progression and potential for organ failure; not contagious

B. C. difficile diarrhea = CONTACT PRECAUTION (hand hygiene)

C. Vancomycin-resistant Enterococcus (VRE): CONTACT PRECAUTION

Four clients with infections arrive at the emergency department with some existing infection, however, only one private room is available. Which of the following clients is the most appropriate to assign to the private room?

A. A client with toxic shock syndrome and a temperature of 102.4°F (39.1°C).

B. A client with diarrhea caused by C. difficile.

C. A client with a wound infected with VRE.

D. A client with a cough who may have Koch disease

A. A client who has a non-tunneled central line in the left internal jugular vein.

Non-tunneled central line: lack the antimicrobial properties and secure anchoring of tunneled lines, increasing the risk of bacterial migration along the catheter track.

Internal jugular vein: carries a higher risk of bloodstream infections due to its proximity to the face and mucous membranes, potential for bacterial contamination during insertion, and the presence of lymphatic channels.

B. Implanted port: are tunneled devices with lower infection risks than non-tunneled central lines. The subclavian vein location poses less risk than the internal jugular.

C. PICC line: are peripherally inserted central catheters placed in larger veins of the arm. Their location and less invasive nature generally result in lower infection rates.

D. Midline catheter: placed in forearm; shorter length; outside central circulation

You are caring for four clients who are receiving IV infusions of normal saline. Which client is at highest risk for bloodstream infections?

A. A client who has a non-tunneled central line in the left internal jugular vein.

B. A client with an implanted port in the right subclavian vein.

C. A client with a peripherally inserted central catheter (PICC) line in the right upper arm.

D. A client who has a midline IV catheter in the left antecubital fossa.

C. Administer metronidazole (Flagyl) 500 mg PO as ordered to the client

LPN/LVN scope of practice and education include administration of medications.

Assessment of hydration status, client and family education, and assessment of client risk factors for diarrhea should be done by the RN.

A client who has frequent watery stools and a possible Clostridium difficile infection is hospitalized with dehydration. Which nursing action should the charge nurse delegate to the nursing assistant?

A. Assess the client's hydration status

B. Explain the purpose of ordered stool cultures to the client and family

C. Administer metronidazole (Flagyl) 500 mg PO as ordered to the client

D. Review the client's medical history for any risk factors for diarrhea

B. Ensure that students are immunized according to national guidelines.

By ensuring students are vaccinated according to national recommendations, you contribute to herd immunity, significantly reducing the risk of disease transmission within the school population.

a. Written information: can raise awareness, but it may not translate into consistent behavioral changes needed to effectively prevent disease transmission.

c. Soap and water: alone is not sufficient to prevent all infectious diseases.

d. Covering coughs: is important, but it mainly helps minimize the immediate spread of airborne pathogens through droplets. Immunization offers broader and more long-term protection against a wider range of infectious diseases.

You are a school nurse. Which action will you take to have the most impact on the incidence of infectious disease in the school?

A. Provide written information about infection control to all patients.

B. Ensure that students are immunized according to national guidelines.

C. Make soap and water readily available in the classrooms.

D. Teach students how to cover their mouths when coughing.

A. Provide oxygen using a non-rebreather mask

WOF: Respiratory failure. The other choices can be delayed.

You are caring for a newly admitted client with increasing dyspnea and dehydration who has possible avian influenza (bird flu). Which of these prescribed actions will you implement first?

A. Provide oxygen using a non-rebreather mask

B. Infuse 5% dextrose in water at 75ml/hr

C. Administer the first dose of oseltamivir (Tamiflu)

D. Obtain blood and sputum specimens for testing

b. Place the client on contact precautions

Implementing contact precautions is crucial for preventing the spread of infection

a. Stool cultures: might be warranted later, it's not the first step.

C. Informing the physician allows for a proper diagnosis and initiates appropriate isolation measures based on the specific cause of the diarrhea. This should be done after B.

d. Handwashing instruction: is always important, but it wouldn't address the immediate concern of potentially serious diarrhea requiring medical evaluation.

A hospitalized 88-year-old client who has been receiving antibiotics for 10 days tells you that he is having frequent watery stools. Which action will you take first?

A. Obtain stool specimens for culture

B. Place the client on contact precaution

C. Notify the physician about the loose stools

D. Instruct the client about correct handwashing

C. Appropriate antibiotics have been given for 24 hours

CDC recommends discontinuing droplet precautions for meningococcal meningitis after 24 hours of appropriate antibiotic therapy. This timeframe allows sufficient time for the antibiotics to reduce the bacterial load and minimize the risk of transmission.

a. Pupil reactivity: wouldn't necessarily signal the absence of viable bacteria and the ability to transmit the infection.

b. Temperature: might indicate improvement, but it doesn't confirm clearance of the bacteria from the respiratory tract.

d. Clear cough: doesn't guarantee the absence of meningococcal bacteria in the respiratory secretions.

Which of the following information about a client who has meningococcal meningitis has the best indicator that you can discontinue droplet precautions?

A. Pupils are equal and reactive to light

B. Temperature is lower than 100°F (37.8°C)

C. Appropriate antibiotics have been given for 24 hours

D. Cough is productive of clear, non-purulent mucus

A. No negative-airflow rooms are available on the unit

Negative pressure rooms / isolation rooms keeps patients with infectious illnesses, or patients who are susceptible to infections from others, away from others. Air pressure inside the room is lower than outside the room. When the door is opened, contaminated air or particles from inside the room will not flow outside.

You are the charge nurse on the pediatric unit when a pediatrician calls wanting to admit a child with rubeola (measles). Which of these factors is of most concern in determining whether to admit the child to your unit?

A. No negative-airflow rooms are available on the unit

B. The infection control nurse liaison is not on the unit today

C. There are several children receiving chemotherapy on the unit

D. The unit is not staffed with the usual number of RNs

C. Escort the client to a decontamination room

Decontamination might be necessary depending on the exposure route and severity even though the diagnosis is not yet confirmed.

Assess symptoms: like skin lesions, fever, respiratory distress, or gastrointestinal distress is crucial for timely diagnosis and initiation of appropriate treatment. Delaying assessment could hinder prompt intervention and potentially worsen the client's condition.

A client who states that he may have been contaminated by anthrax arrives at the ED. The following actions are part of the ED protocol for possible anthrax exposure or infection. Which action will you take first?

A. Assess the client for signs of infection

B. Notify hospital security personnel about the client

C. Escort the client to a decontamination room

D. Administer ciprofloxacin (Cipro) 250 mg PO

B, C, E

These provide the necessary protection against direct contact with lesions and airborne transmission of the varicella-zoster virus (VZV).

A client has been diagnosed with disseminated herpes zoster. Which personal protective equipment (PPE) will you need to put on when preparing to assess the client? Select all that apply.

A. Goggles

B. Gown

C. Gloves

D. Shoe covers

E. N95 respirator

F. Surgical face mask

D. Ensure that dispensers for alcohol-based hand rubs are readily available in all client care areas of the hospital.

Adequate hand hygiene with alcohol-based hand rubs (ABHRs) is demonstrably the most effective single intervention for preventing HAIs.

a. Automatic antibiotic therapy: indiscriminately starting antibiotics due to colonization alone can contribute to antibiotic resistance, harm the client's microbiome, and not actually prevent HAIs.

b. MRSA screening: not routinely recommended by infection control guidelines due to potential for unnecessary isolation and resource utilization.

c. Requiring gowns for wound dressings: not universally required for all wound dressing changes. Hand hygiene remains the core measure for preventing HAI transmission during such procedures.

As the infection control nurse in an acute care hospital, which action will you take to most effectively reduce the incidence of health-care-associated infections?

A. Develop policies that automatically start antibiotic therapy for clients colonized by multidrug resistant organisms.

B. Screen all newly admitted clients for colonization or infection with MRSA.

C. Require nursing staff to don gowns to change wound dressings for all clients.

D. Ensure that dispensers for alcohol-based hand rubs are readily available in all client care areas of the hospital.

C. 3, 4, 5, 1, 2

Gloves: Remove and discard gloves first as they are the most contaminated item closest to the potential source of infection.

Goggles (if used): for additional splash protection, remove and discard them after gloves.

N95 respirator: without touching the front of the mask to avoid contaminating yourself or the environment.

Gown: by turning it inside out and rolling it up, ensuring the contaminated surface remains contained.

Hand hygiene: with soap and water or alcohol-based hand rub to remove any lingering pathogens.

You are preparing to leave the room after performing oral suctioning on a client who is on contact and airborne precautions. In which order will you perform the following actions?

1. Remove N95 respirator

2. Perform hand hygiene

3. Remove gloves

4. Take off goggles

5. Take off the gown

A. 1, 4, 5, 3, 2

B. 3, 5, 4, 1, 2

C. 3, 4, 5, 1, 2

D. 3, 4, 1, 5, 2

C. Gloves

E. Gown

MRSA = CONTACT precaution (contaminated wound or by sharing personal items)

You are preparing to change the linens on the bed of a client who has a draining sacral wound infected by MRSA. Which PPE items will you plan to use? Select all that apply

A. N95 respirator

B. Surgical Mask

C. Gloves

D. Goggles

E. Gown

C. Stocking the client's room with the needed PPE items.

D. Reminding visitors to wear a respirator mask, gloves, and gown.

E. Posting the precautions for protective isolation on the door of the client's room.

You are preparing to care for a 6-year-old who has just undergone allogeneic stem cell transplantation and will need protective environment isolation. Which nursing tasks will you delegate to a nursing assistant? Select all that apply.

A. Teaching the client to perform thorough hand washing after using the bathroom.

B. Talking to the family members about the reasons for the isolation.

C. Stocking the client's room with the needed PPE items.

D. Reminding visitors to wear a respirator mask, gloves, and gown.

E. Posting the precautions for protective isolation on the door of the client's room.

C. Droplet

The main mode of transmission for scarlet fever is through respiratory droplets expelled through coughing and sneezing. Droplet precautions include wearing a surgical mask during close contact, maintaining a minimum distance of 3 feet, and practicing good hand hygiene.

A 26-year-old client is diagnosed with scarlet fever. Which of the following is the most appropriate type of isolation for this client?

A. Airborne

B. Contact

C. Droplet

D. Standard

A. Must maintain a spatial distance of 3 feet

Droplet = 3 feet spacial distance

B. Measles = airborne precaution

C. N95 = airborne precaution

D. Gloves = contact precautions

A newly admitted client with streptococcal pharyngitis (tonsillitis) has been placed on droplet precaution. Which of the following statements indicates the best understanding for this type of isolation?

A. Must maintain a spatial distance of 3 feet

B. The client can be placed in a room with another client with measles (rubeola)

C. A special mask (N95) should be worn when working with the client

D. Gloves should be only worn when giving direct care

D. A pregnant woman with a blister-like rash on the face and is possibly having varicella.

Varicella is highly contagious especially for pregnant women and immunocompromised individuals (airborne). This involves placing the client in a single room with airborne precautions,wearing appropriate PPE, and notifying infection control personnel for further management.

A. Pertussis = droplet

B. TB is transmissible when a person has active TB disease (actively coughing)

C. MRSA require standard contact precaution

Malcolm is newly assigned as a triage nurse, on his first day of work, the following clients arrive at the ED. Which among the clients require the most rapid action to protect other clients in the ED from infection?

A. An infant with a runny nose and whose older brother has pertussis.

B. A travel blogger who needs tuberculosis testing after an exposure to a person with TB during his trip.

C. An elderly woman who has a history of a methicillin-resistant Staphylococcus aureus (MRSA) leg wound infection.

D. A pregnant woman with a blister-like rash on the face and is possibly having varicella.

C. Implement contact precautions when handling the client.

Applying contact precautions involves basic steps like wearing gloves and gowns, handwashing before and after contact with the client,and properly handling contaminated materials.

a. Interpreting laboratory results and making clinical decisions based on them require advanced medical knowledge and judgment.

b. Educating patients and families about infection control measures often involves detailed explanations and addressing individual concerns,better suited for a nurse with advanced communication skills.

d. Collaboration with other departments: involves discussing details about the client's condition and care plan, making it more appropriate for a nurse to handle.

A client with a vancomycin-resistant enterococcus (VRE) infection is admitted to the medical unit. Which action can be delegated to a nursing assistant who is assisting with the client's care?

A. Monitor the results of the laboratory culture and sensitivity test.

B. Educate the client and family members on ways to prevent transmission of VRE.

C. Implement contact precautions when handling the client.

D. Collaborate with other departments when the client is transported for an ordered test.

B. Disinfecting blood pressure cuffs after clients are discharged

follows standardized protocols and doesn't require complex medical knowledge. Experienced nursing assistants can effectively perform this task after proper training and supervision.

a. Screening for respiratory symptoms: requires more in-depth clinical assessment and judgment

c. Hand hygiene education: effectively involves understanding the rationale behind the steps and adapting instructions to different audiences. This level of patient education might be more appropriate for a nurse with advanced communication skills.

d. Asking medication history: including antibiotic duration, often requires understanding the purpose of the medication and its relationship to potential medical conditions.

Which of the following infection control activities should be delegated to an experienced nursing assistant?

A. Screening clients for upper respiratory tract symptoms

B. Disinfecting blood pressure cuffs after clients are discharged

C. Demonstrating correct handwashing techniques to client and family

D. Asking clients about the duration of antibiotic therapy

c. Immediately wash the hands with vigor

This is the first and most critical step to minimize the risk of infection from potential pathogens on the needle. Every second counts in reducing the potential viral or bacterial transmission through the open wound caused by the needle.

a. Looking up the policy on needle sticks: delaying handwashing for this purpose could compromise critical early prevention of infection.

b. Contacting employee health services: This is crucial, but delaying handwashing to initiate contact could still allow for potential pathogen entry.

d. Notifying the supervisor and risk management: are necessary for reporting and follow-up procedures

A nurse is stuck in the hand by an exposed needle. What immediate action should the nurse take?

a. Look up the policy on needle sticks

b. Contact employee health services

c. Immediately wash the hands with vigor

d. Notify the supervisor and risk management

a. DTaP

Fever, prolonged crying, and shaking spells: These are commonly reported side effects of the DTaP vaccine,especially in young infants. While other vaccines listed can also cause side effects, this specific combination of symptoms is more strongly associated with DTaP.

Age of the baby: The 2-month age falls within the typical timeframe for potential DTaP-related reactions.

Timing of the reaction: The mother reports the symptoms occurring 2 days after the vaccination, which aligns with the expected timeframe for DTaP side effects.

The mother of a 2 month-old baby calls the nurse 2 days after the first DTaP, IPV, Hepatitis B and HIB immunizations. She reports that the baby feels very warm, cries inconsolably for as long as 3 hours, and has had several shaking spells. In addition to referring her to the emergency room, the nurse should document the reaction on the baby's record and expect which of the following?

a. DTaP

b. Hepatitis B

c. Polio

d. H. Influenza

c. Stool examination

Schistosomes: These parasitic worms typically reside in the intestines or bladder, depending on the species. Their eggs are shed in either stool or urine.

Chest X-ray: helpful in detecting lung involvement in some advanced cases of schistosomiasis,it's not the primary diagnostic tool for identifying the parasite itself.

Urinalysis: can detect schistosome eggs in cases of urogenital schistosomiasis, but it isn't as sensitive as stool examination and might miss infections with species that primarily shed eggs in feces.

Platelet count: While low platelet count can be a potential symptom of schistosomiasis, it's not specific enough to serve as a diagnostic test for the parasite itself.

Which of the following will you advice the client to submit for in order to detect the presence of schistosomiasis organism

a. Chest x ray

b. Urinalysis

c. Stool examination

d. Platelet count

c. Infected female mosquito

Aedes poecillus

Filiarisis is transmitted to man through bites from

a. Snail

b. Infected male mosquito

c. Infected female mosquito

d. Rats

c. Microfilariae

microscopic larvae of filarial worms,a group of parasitic nematodes known for causing lymphatic filariasis and elephantiasis. Microfilariae have a characteristic morphology visible in blood smears or specific antigen detection tests. Their presence, even in seemingly healthy individuals, confirms active filarial infection, even if there are no symptoms yet.

b. Merozoites = stage of plasmodium (malaria)

A person may become asymptomatic but confirmatory test will reveal the presence of which of the following in the blood?

a. Cercariae

b. Merozoites

c. Microfilariae

d. Larvae

b. Washing the affected areas with soap and water

Regular and thorough washing of the affected areas with mild soap and water helps maintain good hygiene and prevents secondary bacterial infections. This is crucial for managing lymphedema, a common complication of filariasis, where swollen limbs are susceptible to skin infections.

a. Washing with alcohol: not the primary hygiene measure for filariasis. Using harsh substances like alcohol on affected areas can irritate the skin and potentially worsen lymphedema symptoms.

c. Boiling drinking water: doesn't directly address personal hygiene for filariasis patients.

d. Cleanliness of surroundings: help reduce the risk of mosquito breeding and potential reinfection in areas where filariasis is endemic. However, it's not the primary personal hygiene practice for the individual patient's affected areas.

Filiarisis patients are advised to observe personal hygiene by

a. Washing the affected part with alcohol

b. Washing the affected areas with soap and water

c. Boiling drinking water

d. Cleanliness of the surroundings

b. Aedes pocillius

Aedes aegypti = dengue

Plasmodium falciparum = malaria

Oncomelania quadrasi = snail; intermediate host for the Schistosoma worm (schistosomiasis)

The vector of filariasis is known as

a. Aedes egypti

b. Aedes pocillius

c. Plasmodium falciparum

d. Oncomelania quadrasi

c. Elephantiasis

This is a characteristic manifestation of chronic lymphatic filariasis, characterized by thickening and hardening of the skin and underlying tissues, most often affecting the legs and genitals. It develops due to long-term damage to the lymphatic system caused by the filarial worms.

a. Splenomegaly: can occur in some severe cases of filariasis, it's not a chronic symptom and usually resolves with treatment.

b. Chills and fever: acute symptoms associated with the inflammatory stage of filariasis infection.

d. Lymphadenitis: enlarged lymph nodes usually occurs during the acute phase of the infection and wouldn't be considered a chronic symptom in untreated filariasis.

Which of the following is considered chronic signs and symptoms of filariasis

a. Splenomegaly

b. Chills and fever

c. Elephantiasis

d. Lymphadenitis

b. Scabies.

Itchiness and eruptive lesions: classic symptoms of scabies, especially in areas like limbs and body folds where the scabies mite burrows and lays eggs.

Living in a tenement: Crowded living conditions increase the risk of scabies transmission through close skin-to-skin contact, which is common in tenements.

Anthrax: more commonly contracted through contact with infected animals or contaminated materials.

Psoriasis: can cause lesions and itching, it typically doesn't involve burrows or intense itching in body folds. It is not common in tenements.

Chickenpox: The description of eruptive lesions doesn't entirely match the typical vesicular blisters of chickenpox,and living in a tenement wouldn't necessarily suggest recent exposure to the varicella virus.

A client comes to the center consultation with the following complaints: itchiness and eruptive lesions of legs and arms especially body folds like breast groin. History reveals that she is living on a tenement. The nurse will suspect

a. Anthrax

b. Scabies

c. Psoriasis

d. Chickenpox

a. Anthrax

Uncontaminated wool or fur: Anthrax spores can remain dormant on animal products like wool and fur for years,leading to infection through contact.

Itching and papules: Cutaneous anthrax typically begins with itching and formation of papules at the inoculation site.

Papules to vesicles to black eschars: The papules progress to fluid-filled vesicles, eventually developing into characteristic black eschars due to tissue necrosis.

Scabies: This is caused by a mite and primarily presents with intense itching and burrowing in skin folds, not black eschars.

Psoriasis: This chronic skin condition involves red, scaly patches, not papules progressing to black eschars.

Chickenpox: This viral infection causes vesicular blisters that erupt and crust over, not black eschars.

This a cutaneous infection that can be contacted uncontaminated wool, fur. The exposed part of skin begins to itch and papules appear in the inoculation sites. The papules becomes vesicles and developed into black eschars

a. Anthrax

b. Scabies

c. Psoriasis

d. Chickenpox

c. HIV

gaunt = lean or haggard

Gaunt appearance, apprehension, maculopapular rash: can be non-specific symptoms of various illnesses, but they occur frequently in HIV-infected individuals, especially during the acute retroviral syndrome (primary HIV infection) phase.

Long duration of symptoms: further strengthens the possibility of HIV, as its progression can lead to various chronic symptoms over time.

Blood transfusion 2 years ago: carries a risk of HIV transmission if infected blood products are used. This history adds to the suspicion of HIV in this case.

Hepatitis A: GI symptoms like nausea, vomiting, and diarrhea

Hepatitis B: similar symptoms, but the long duration and history of blood transfusion make HIV a more likely suspect.

Anthrax: black eschars and the presence of chronic,non-specific complaints.

You happened to glace another client in the health center who appears gaunt looking apprehensive with maculopapular rashes. Upon history taking the patient has been experiencing loss of appetite, marked weight loss, fever, malaise, cough for long duration. History reveals that 2 years ago, the patient received blood transfusion because of surgery. The nurse will suspect

a. Hepa A

b. Hepa B

c. HIV

d. Anthrax

b. Sexual contact

Unpasteurized milk from infected cows can contain TB bacteria. While less common than airborne transmission, this can still be a source of infection, especially in countries where milk pasteurization is not common.

Tuberculosis is spread by the following except.

a. Droplet

b. Sexual contact

c. Direct or indirect contact with person or object contaminated with the organism

d. Drinking unpasteurized milk

a. Children under three years old

The age group with the highest risk for TB of developing the disease is between

a. Children under three years old

b. Children entering grade one

c. 8-12 years old

d. 13-15 years old

b. Ambulatory treatment

This means that patients can receive their treatment while living at home and going about their daily lives, as long as they follow the doctor's instructions and attend regular check-ups.

Confinement in the hospital (a) is only necessary in some cases, such as if the patient is severely ill, has drug-resistant TB, or is at high risk of spreading the disease to others.

Isolation (c) is no longer considered necessary for most TB patients, as the risk of transmission is greatly reduced with proper treatment.

Sheltered colonies (d) are no longer used in most countries.

The modern management of TB patient is

a. Confinement in the hospital

b. Ambulatory treatment

c. Isolation

d. Sheltered colony

d. 4 months daily administration of 1 tab of INH and cap Rifampicin in one dose

The continuation phase includes:

a. 1 month daily administration of 1 tab inh and 1 cap of rifampicin in one dose

b. 3 months daily administration of 2 tab INH and 1 cap rifampicin in one dose

c. 2 months administration of 1 tab INH and 1 tab PZA in one dose

d. 4 months daily administration of 1 tab of INH and cap Rifampicin in one dose

c. Drug resistant

When a patient's sputum smear remains positive after two months of DOT, HCP suspect drug-resistant TB and perform further tests to confirm the specific resistance pattern. This allows them to adjust the treatment regimen with appropriate drugs to effectively combat the resistant bacteria.

a. Defaulter: can significantly hinder treatment progress and lead to positive smears, in this case, the treatment is directly observed, minimizing the possibility of missed doses.

b. Drug sensitive: If the patient is infected with drug-sensitive TB, the standard DOT regimen should lead to negative smears within the first two months in most cases. A persistent positive smear suggests the bacteria might be resistant to the prescribed drugs.

d. Delinquent in taking the drugs: Similar to defaulters, DOT minimizes the chances of patients not taking their medication as instructed.

If the sputum is still smear positive at the end of second month of directly observed chemotherapy the midwife will suspect that the patient is

a. Defaulter

b. Drug sensitive

c. Drug resistant

d. Delinquent in talking the drugs

b. New pulmonary TB sputum positive

Category I treatment regimen is for patients who are considered

a. Relapsed cases

b. New pulmonary TB sputum positive

c. Newly diagnosed by smear negative for 3x

d. Not serious extra pulmonary cases

a. Extrapulmonary TB

Category II treatment regimen is specifically designed for re-treatment of tuberculosis (TB) patients. This means it's used for people who have previously received and completed treatment for TB but are now experiencing a relapse or failure of their initial treatment.

Extrapulmonary TB refers to tuberculosis infections that occur outside the lungs, like in the bones, joints, or lymph nodes. While category II regimens can be utilized for some specific types of extrapulmonary TB in re-treatment situations, generally, different TB treatment regimens are recommended for extrapulmonary TB compared to pulmonary TB. This is because the drugs and duration of treatment might differ based on the affected organ and severity of the infection.

Category II treatment regimen is directed towards client with the following condition except

a. Extrapulmonary TB

b. Previously treated patient with relapses

c. Previously treated patients with failures

d. None of the above

b. Malaria patient

Typhoid fever: can also cause splenomegaly

Cholera: primary affects the intestines, not spleen

H. fever: hepatomegaly

Which of the following patient is considered at a greater risk of developing splenomegaly?

a. Typhoid fever patient

b. Malaria patient

c. Cholera patient

d. H-fever patient

b. Anopheles mosquito

Culex mosquito = West Nile virus

Aedes aegypti = dengue fever, yellow fever

The vector responsible for the spread of malaria is

a. Culex mosquito

b. Anopheles mosquito

c. Flies

d. Aedes aegypti

b. Sabin

The polio vaccine containing live attenuated viruses was developed by

a. Salk

b. Sabin

c. Kock's

d. Saben

a. Cercaria

Cercaria: This is the free-swimming larval stage of the Schistosoma parasite that lives in freshwater and is responsible for infecting humans. They have forked tails and can penetrate the skin when someone comes into contact with contaminated water.

Lyssa = rabies

Bilharziasis: another term for Schistosomiasis

Poecilus = Aedes poecilus = filariasis

The infective stage of the Schistosoma is called

a. Cercaria

b. Lyssa

c. Bilhariasis

d. Poecilus

d. Praziquantel (biltricide)

Praziquantel is a highly effective, broad-spectrum anthelmintic (anti-worm) medication that acts against all five known species of Schistosoma parasites. It disrupts the parasite's calcium metabolism, leading to paralysis and death.

Chloroquine phosphates and Erythromycin: bacterial infections and not effective against Schistosoma parasites.

Hetrazan (diethylcarbamazine citrate): parasitic worms like filaria,

What is the drug of choice for schistosomiasis?

a. Chloroquine phosphates

b. Erythromycin

c. Hetrazan (diethylcarbamazine citrate)

d. Praziquantel (biltricide)

a. 1, 2, 3

Diarrhea, bloody stools: This is a common symptom of intestinal schistosomiasis, caused by eggs laid by the parasites damaging the intestinal wall.

Splenomegaly and inflamed liver: Chronic intestinal schistosomiasis can lead to enlarged spleen and liver due to inflammation and scarring caused by the parasite eggs.

Anemia and weakness: These are common symptoms of schistosomiasis due to blood loss from intestinal bleeding and decreased iron absorption caused by liver damage.

4 and 5 are symptoms of filariasis

Which of the following are the signs and symptoms of schistosomiasis?

1. Diarrhea, bloody stools

2. Splenomegaly and inflamed liver

3. Anemia and weakness

4. Epididymitis and orchitis

5. Lymphangitis and lymphadenitis

a. 1, 2, 3

b. 3, 4, 5

c. 2, 4, 5

d. 1, 3, 4

c. Hetrazan

Hetrazan (diethylcarbamazine citrate): This is the preferred drug for lymphatic filariasis, targeting both microfilariae (microscopic larvae) and adult worms. It works by paralyzing the parasites, eventually allowing the body's immune system to clear them.

The drug of choice in filariasis is

a. Praziquantel

b. Zovirax

c. Hetrazan

d. Penicillin