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Chapter 10- Mechanisms of Infectious Disease
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1.
Staphylococcus aureus commonly found in the skin, nares, and other body sites of patients without any signs and symptoms of infection is known as which of the following conditions listed below?
A)
An opportunistic infection
B)
A parasitic infestation
C)
Bacterial colonization
D)
A saprophytic infection
Ans:
C
Feedback:
The ongoing presence of bacteria in the body that do not cause infection is called colonization. Opportunistic infection by ordinarily nonpathogenic organisms can occur in immunosuppressed hosts. Parasitism is a condition in which the organism exists at the expense of, and without benefiting, the host. Saprophytes do not cause infection.
2.
Which of the following statements is an accurate descriptor of the role of viruses in human infections?
A)
Viruses have no genetic material of their own.
B)
Some viruses are capable of transforming normal host cells into malignant cells.
C)
Viruses are often implicated in cases of transmissible neurodegenerative diseases.
D)
Viruses require stimulation after a latent period before they are able to produce symptoms.
Ans:
B
Feedback:
Viruses that are categorized as oncogenic are able to induce malignancy in host cells. Viruses have limited genetic material (either RNA or DNA), but no virus lacks genetic material. Transmissible neurodegenerative disease is associated with prions. Not all viruses include a latent period.
3.
Which of the following types of pneumonia listed below is best characterized by an infective agent that produces sputum samples with a peptidoglycan cell wall, expresses endotoxins, replicates readily in broth and on agar, grows in clusters, has pili, and does not stain when exposed to crystal violet?
A)
Chlamydial
B)
Viral
C)
Mycoplasmal
D)
Bacterial
Ans:
D
Feedback:
Although chlamydiae, viruses, and mycoplasmas all can cause pneumonia, only bacteria have all of these characteristics. Chlamydiae and viruses are obligate intracellular organisms and therefore would grow only in cell culture, and mycoplasmas lack the peptidoglycan cell wall typical of bacteria.
4.
The nurse will most likely assess which of the following clinical manifestations in a client who was diagnosed with Creutzfeldt-Jakob disease?
A)
Change in behavior and memory and loss of coordination leading to encephalopathy
B)
Gastrointestinal problems like vomiting and diarrhea
C)
Muscle inflammation and edema, making movements very painful
D)
Projectile vomiting, hypertension, and drowsiness caused by elevated ICP
Ans:
A
Feedback:
Creutzfeldt-Jakob disease is collectively called transmissible neurodegenerative disease that is characterized by a slowly progressive, noninflammatory neuronal degeneration and leads to a loss of coordination, dementia, and death. With this disease, encephalopathy is the primary presenting factor. GI problems, muscle inflammation, and ICP are not clinical manifestations associated with this prion.
5.
The spirochete leptospires is primarily transmitted to farmers by
A)
an airborne mechanism.
B)
exposure to spores in the environment.
C)
direct contact with infected animals.
D)
a mosquito bite.
Ans:
C
Feedback:
The pathogenic leptospires infect a wide variety of wild and domestic animals. Infected animals shed the organisms into the environment through the urinary tract. Transmission to humans occurs by contact with infected animals or urine-contaminated surroundings. This spirochete is not transmitted by air, spores, or a fomite.
6.
The nurse knows which of the following statements best describes the characteristic trait of risckettsiae related to Rocky Mountain spotted fever? Rickettsiae
A)
are eukaryotic.
B)
have both RNA and DNA.
C)
have a distinct spiral-shaped morphology.
D)
are neither gram negative nor gram positive.
Ans:
B
Feedback:
Rickettsiae combine characteristics of bacteria and viruses. Rickettsiae are prokaryotic but not spiral shaped. Rickettsiae are able to be classified by Gram stain like other microorganisms.
7.
An 81-year-old female patient in a subacute medical unit of a hospital has developed an oral Candida albicans infection. Which of the following phenomena would the patient's nurse suspect as a key contributing factor to her infection?
A)
The moist and temperature-suited oral environment of the client's mouth
B)
The ability of fungi to remain latent until the host reaches an immunocompromised state
C)
Antibiotic therapy that eliminated normal bacterial flora
D)
The airborne communicability of yeast and molds and subsequent inhalation
Ans:
C
Feedback:
Elimination of bacterial flora that normally keeps colonizing fungi in check can induce the proliferation of fungi. The environment of the client's mouth provides a conducive environment but with an intact immune system is rarely a direct contributor to colonization. Latency is not a common trait of Candida albicans, and airborne transmission is not likely to be a causative factor.
8.
The nurse knows which of the following statements below is appropriate to be included in an education session for a 21-year-old male with a diagnosis of malaria?
A)
?Your infection likely began with the introduction of fertilized protozoal ova from a mosquito.?
B)
?The protozoa responsible have hijacked the genetic material of your cells in order to reproduce.?
C)
?You are very tired because the pathogens are utilizing the ATP that your own cells need.?
D)
?The infectious organisms are considered tiny, single-celled animals, given their complete eukaryotic machinery.?
Ans:
D
Feedback:
Protozoa possess full eukaryotic machinery including organelles and a nucleus. Ova are associated with helminthes, and protozoa do not utilize the host's genetic material for reproduction. Appropriation of ATP is associated with chlamydiae.
9.
The physician knows the client G1P0 has correctly understood the prenatal education regarding sexually transmitted infection as evidenced by which of the following statements listed below?
A)
?Gonorrhea and chlamydia out of the various infectious agents pose the greatest risks of transmission from mother to child.?
B)
?I know that my baby will need observation for HIV signs and symptoms in the weeks following my delivery.?
C)
?My baby could become infected either across the placenta or during the birth itself.?
D)
?If I receive prophylactic immunization, I will reduce my baby's chance of being born with an illness.?
Ans:
C
Feedback:
Vertical transmission may occur across the placenta in utero or during the birth event itself. Cytomegalovirus and HIV infections are the most common congenital infections. HIV signs and symptoms are not immediately apparent in the infant. Prophylactic immunization is not noted as a proven intervention for preventing vertical transmission.
10.
Which of the following procedures reduces the potential for infection primarily by addressing the portal of entry?
A)
Wiping down common areas with buffered bleach on a regular basis
B)
Wearing gloves when contact with blood or body fluids is anticipated
C)
Disposing of soiled clothing and bed linens in a dedicated receptacle
D)
Isolating patients who have antibiotic-resistant infections
Ans:
B
Feedback:
Wearing gloves specifically blocks the portal of entry to the health care worker through the use of a physical barrier. Bleaching and cleaning, as well as disposing of soiled linen, eliminate the source of infection by killing microorganisms, and isolating patients similarly addresses a source by minimizing contact with uninfected persons.
11.
A school-age child with a history of asthma has brought a note home from school stating that there has been one case of meningitis (Neisseria meningitides) in the school. Since the mother is a nurse, she is very concerned since she knows the portal of entry of this pathogen is
A)
by inhalation via the respiratory tract such as through breathing or yawning.
B)
by direct contact with a contaminated object such as a pencil.
C)
by ingestion such as when children share their drink with their friends.
D)
through a cut or abrasion that may occur on the playground.
Ans:
A
Feedback:
Neisseria meningitides is one of a number of pathogens that invade the body through the respiratory tract.
12.
Which of the following scenarios best describes an example of infection originating with a fomite?
A)
A client who contracted hepatitis C through sharing a contaminated syringe with an infected person
B)
A nurse with a positive tuberculin screening test (PPD) after admitting a patient diagnosed with tuberculosis (TB)
C)
A woman who contracted Lyme disease after a tick bite
D)
A man who has been diagnosed with trichinosis after eating undercooked pork
Ans:
A
Feedback:
An object that carries an infectious organism, such as a dirty syringe, is known as a fomite. Airborne contact with TB does not utilize a fomite. An infection via contact with an infected arthropod constitutes zoonosis. A person who consumes ova in undercooked meat acquires an infection by ingestion.
13.
The nurse knows which of the following statements listed below best matches the phase of the infectious process of food poisoning with a client with sudden, violent diarrhea and vomiting after consuming chicken and potato salad 8 hours ago at the beach on a hot day?
A)
Maximum impact of infectious process
B)
Insidious prodromal phase
C)
Sudden incubation of active replication
D)
Subacute prodromal phase
Ans:
A
Feedback:
The lack of prodrome and intense symptom onset typify a fulminant illness. The onset described does not characterize a prodromal phase or incubation.
14.
Which of the following infectious agents listed below would be a site-specific pathogen and not spread throughout the body via the circulatory system? A patient diagnosed with
A)
B. burgdorferi caused by a tick bite.
B)
Salmonella typhi related to ingestion of contaminated food or water.
C)
Helicobacter pylori diagnosed after an endoscopic procedure.
D)
N. meningitidis infection in a child in a daycare setting.
Ans:
C
Feedback:
H. pylori is an extreme example of a site-specific pathogen (localized infectious disease). The other three pathogens are called systemic pathogens because they can disseminate throughout the body via the circulatory system.
15.
A family consumed some undercooked hamburger at a picnic and has since developed bloody diarrhea. The nurse knows which of the following statements listed below is correct regarding the infectious process?
A)
Evasive factors that become more virulent by evading parts of the host's immune system
B)
Exotoxins that damage vascular endothelium causing bleeding and low platelet counts
C)
Adhesion factors that can anchor a pathogen firmly to the host tissue surfaces
D)
Invasive factors capable of destroying the cell membrane by utilization of enzymes
Ans:
B
Feedback:
Exotoxins can allow organisms to produce hemorrhagic colitis, which can be fatal. It is characterized by vascular endothelial damage, acute RF, and thrombocytopenia (low platelet counts). Toxic cell walls are classified as endotoxins. The ability to survive immune responses characterizes evasive factors. Adhesion factors and invasive factors are not involved in this situation.
16.
A patient diagnosed with H pylori asks the nurse, ?How an infection can occur in the stomach since it is an acid environment?? The nurse responds,
A)
?We have many infectious agents that can live in an acidic environment with a pH more than 8.0.?
B)
?H. pylori is a virus and is still being researched as to how it is able to survive in the stomach acids.?
C)
?H. pylori produces an enzyme called urease that converts gastric juices into ammonia, which neutralizes the acidic stomach environment.?
D)
?This parasite secretes an enzyme called coagulase, which protects the pathogen from the antibodies.?
Ans:
C
Feedback:
H. pylori, the infectious cause of gastritis and gastric ulcers, produces the urease enzyme on the outer cell wall. The urease converts gastric urea into ammonia, thus neutralizing the acidic environment of the stomach and allowing the organism to survive in this hostile environment.
17.
A client has a suspected infection by a particular microorganism in question that cannot be cultured. Which of the following processes listed below is most likely to result in an accurate diagnosis for the client?
A)
Observe directly for the presence or absence of specific antigens in the client's blood serum sample.
B)
Introduce cultured, marked antibodies to the client, and observe for a reaction with antigens in the client.
C)
Observe for a cytopathic effect on biopsy tissue samples from the client's mucosa.
D)
Release purified antigens into the client's circulation to observe whether the client has produced the relevant antibodies.
Ans:
B
Feedback:
The process described is direct antigen detection, which can indirectly implicate a microorganism that is unable to be cultured. Answer D describes the same process in reverse, while answers A and C do not describe existing diagnostic processes.
18.
A client has been diagnosed with herpes simplex virus. The client states that, ?modern medicine produces more and more antivirals every year, and so the treatment should be simple.? Which of the following statements listed below is the best response?
A)
?The recent rise of drug resistance has significantly hampered the elimination of viruses.?
B)
?The cell coat of viruses is particularly resilient to the available synthetic antivirals.?
C)
?The use of antivirals is severely limited by the unwanted adverse effects that they cause.?
D)
?Treatment options for viruses are often limited because what destroys viruses often damages your own body cells.?
Ans:
D
Feedback:
Viruses are difficult to treat because interference with their replication often requires interference with the body's cell replication processes. Although they do exist with antiviral treatments, drug resistance and side effects are phenomena more closely associated with antibacterials. Antivirals act upon DNA or RNA synthesis, not the cell wall.
19.
A client with a diagnosis of sepsis has received intravenous immune globulin (IVIG) as a partial treatment. The nurse knows which of the following client responses listed below would best suggest an accurate understanding of IVIG treatment?
A)
?These antibodies in the solution have been collected from individuals who have successfully fought off the same infection.?
B)
?The IVIG should help stimulate fever, inflammation, and tissue repair in the fight against the infection.?
C)
?A big part of my IVIG treatment is actually stimulating and supplementing my immune system to do the work itself.?
D)
?The main effect of IVIG is to cause my body to produce more white blood cells to fight infection.?
Ans:
C
Feedback:
IVIG involves infusion of pooled antibodies that supplement and stimulate the client's immune system to respond above and beyond its own capacities. It is not collected from individuals who have had similar infections. The primary effect of IVIG is not white blood cell production. Stimulation of fever, inflammation, and tissue repair are more closely associated with cytokine therapy.
20.
The nurse in the emergency department knows that clients exposed to Clostridium botulinum, an agent of bioterrorism, would likely be exhibiting which of the following clinical manifestations listed below?
A)
Blindness and respiratory distress
B)
Hemorrhage from all orifices resulting in signs of shock and coma
C)
Frothy, odiferous diarrhea and dehydration
D)
Muscle weakness in extremities eventually leading to paralysis of respiratory muscles
Ans:
D
Feedback:
Clostridium botulinum causes neuromuscular paralysis and is listed as a category A agent.
21.
Health care team members know recently that an increased incidence of infections such as West Nile virus and SARS does not match with previously established patterns. Which of the following phenomena constitutes the most significant contributor to the spread of new diseases in the United States?
A)
Drug resistance by bacterial and protozoal infections
B)
Increased ease and frequency of individual and group international travel
C)
Genetic variation and mutation by microorganisms
D)
Decreased living standards and public health standards in urban areas
Ans:
B
Feedback:
While drug resistance, lapses in public health, and genetic variation are all contributing factors in incidents of infection, the increase in new and global diseases is primarily attributed to the ease and frequency of individual and group international travel.
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