60 Item Medical Surgical Nursing : Musculoskeletal Examination Answers 1. A client is 1 day postoperative after a total hip replacement.

The client should be placed in which of the following position? a. Supine b. Semi Fowler's c. Orthopneic d. Trendelenburg 2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make? a. Observe the color of the fingers b. Palpate the radial pulse under the cast c. Check the cast for odor and drainage d. Evaluate the response to analgesics 3. After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for: a. An anaphylactic reaction to the dye b. Inflammation from the extravasation of fluid during injection. c. Fluid overload from the volume of the infusions d. A normal reaction to the stress of the diagnostic procedure. 4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician? a. Moderate pain, as reported by the client b. Report, by client, the heat is being felt under the cast c. Presence of slight edema of the toes of the casted foot d. Onset of paralysis in the toes of the casted foot 5. Which of these nursing actions will best promote independence for the client in skeletal traction? a. Instruct the client to call for an analgesic before pain becomes severe. b. Provide an overhead trapeze for client use c. Encourage leg exercise within the limits of traction d. Provide skin care to prevent skin breakdown. 6. A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis. a. The client reports pain in the affected leg b. A large hematoma is visible in the affected extremity c. The affected extremity is shortenend, adducted, and extremely rotated d. The affected extremity is edematous. 7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan? a. b. c. d. Order a trapeze to increase the client's ambulation Maintain the client in a flat, supine position at all times. Provide pin care at least every hour Remove traction weights for 20 minutes every two hours.

c. Intermittent weights d. 5lb weight limit 10. In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position? a. Supine c. Sim's b. Prone d. Lithotomy 11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is: a. b. c. d. It will be very painful for the client The soft tissue around the site will be damaged Displacement can occur with flexion It will pull the hip out of alignment

12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a: a. b. c. d. Trochanter roll by the knee Sandbag to the lateral calf Trochanter roll to the thigh Footboard

13. A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to: a. Leave the pillow as his stump is elevated b. Remove the pillow and elevate the foot of the bed c. Leave the pillow and elevate the foot of the bed d. Check with the physician and clarify the orders 14. A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to: a. b. c. d. Protect the skin with lotion Keep the client pulled up in bed Pad the top of the splint with washcloths Provide a footplate in the bed

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to: a. Reduce fever b. Reduce the inflammation of the joints c. Assist the client's range of motion activities without pain d. Prevent extension of the disease process 16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is: a. Ability to ambulate sooner b. Less change of phantom limb sensation c. Dressing changes are not necessary d. Better fit of the prosthesis 17. One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to: a. Cough and deep breathe b. Turn himself in bed c. Perform biceps exercise d. Wiggle his toes 18. The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to: a. Get the client up in a chair after dangling at the bedside. b. Use a walker for balance when getting the client out of bed c. Have the client put minimal weight on the affected side when getting up d. Practice getting the client out of bed by having her

8. To prevent foot drop in a client with Buck's traction, the nurse should: a. Place pillows under the client's heels. b. Tuck the sheets into the foot of the bed c. Teach the client isometric exercises d. Ensure proper body positioning. 9. Which nursing intervention is appropriate for a client with skeletal traction? a. Pin care b. Prone positioning

slightly flex her hips 19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to: a. Anchor the traction b. Prevent footdrop c. Keep the client from sliding down in bed d. Prevent pressure areas on the foot 20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the: a. Client's position b. Rope/pulley system c. Amount of weight d. Point of friction 21. When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by: a. Elevating the foot of the bed b. Elevating the head of the bed c. Application of the pelvic girdle d. Lowering the head of the bed 22. After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for: a. Increase in the temperature b. Change in color c. Edema d. Movement 23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for: a. Urinary retention b. Bladder distention c. Weight gain d. Bower evacuation 24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has a. Headaches b. Tarry stools c. Blurred vision d. Decreased appetite 25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to a. b. c. d. Read a story and act out the part Watch a puppet show Watch television Listen to the radio

c. Adults between the ages 60 to 75 years d. Positive testing for human leukocyte antigen (HLA) DR4 allele 28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods? a. Proper body alignment b. Elevating the part c. Prone lying positions d. Positions of flexion 29. After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching? a. "I will take my vitamins while I am on this drug" b. "I must not drink any alcohol while I'm taking this drug" c. I should brush my teeth after every meal" d. "I will continue taking my birth control pills" 30. When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess? a. Anemia c. Weight loss b. Osteoporosis d. Local joint pain 31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? a. At bedtime c. Immediately after meal b. On arising d. On an empty stomach 32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following? a. b. c. d. Hepatotoxicity Renal toxicity Gastrointestinal bleeding Nausea and vomiting

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following? a. b. c. d. A developing infection Bleeding in the operative site Joint dislocation Glue seepage into soft tissue

34. Which of the following would the nurse assess in a client with an intracapsular hip fracture? a. Internal rotation c. Shortening of the affected leg b. Muscle flaccidity d. Absence of pain the fracture area 35. Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc? a. Informing the client that the procedure is painless b. Taking a thorough history of past surgeries c. Checking for previous complaints of claustrophobia d. Starting an intravenous line at keep-open rate 36. Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site? a. Elevate the stump b. Reinforcing the dressing c. Calling the surgeon

26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses: a. b. c. d. Limited motion of joints Deformed joints of the hands Early morning stiffness Rheumatoid nodules

27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching? a. History of Epstein-Barr virus infection b. Female gender

d. Drawing a mark around the site 37. A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first? a. Tell the client it is impossible to feel the pain b. Show the client that the toes are not there c. Explain to the client that the pain is real d. Give the client the prescribed narcotic analgesic 38. The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches? a. Abdominal exercises b. Isometric shoulder exercises c. Quadriceps setting exercises d. Triceps stretching exercises 39. The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas? a. Axillae b. Elbows c. Upper arms d. Hands 40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following? a. Hemorrhage b. Infection c. Deformity d. Shock 41. The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect? a. b. c. d. Killing of microorganisms Reduction in itching Relief of muscle spasms Decrease in nervousness

embolus? a. Acute respiratory distress syndrome b. Migraine like headaches c. Numbness in the right leg d. Muscle spasms in the right thigh 46. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following? a. Pulmonary emboli b. Osteomyelitis c. Fat emboli d. Urinary tract infection 47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely? a. b. c. d. Formation of scar tissue interfering with absorption Development of pus leading to ischemia Production of bacterial growth by avascular tissue Antibiotics not being instilled directly into the bone

48. Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury? a. Homan's sign c. Tenderness b. Pain d. Leg girth 49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority? a. Allergy to iodine or shellfish b. Ability of the client to remain still during the procedure c. Whether the client has any remaining questions about the procedure d. Whether the client wishes to void before the procedure 50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client? a. Divertional activity deficit b. Powerlessness c. Self care deficit d. Impaired physical mobility 51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions? a. The gallium will be injected intravenously 2 to 3 hours before the procedure b. The procedure takes about 15 minutes to perform c. The client must stand erect during the filming d. The client should remain on bed rest for the remainder of the day after the scan 52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection? a. Coolness and pallor of the extremity b. Presence of a "hot spot" on the cast c. Diminished distal pulse d. Dependent edema 53. The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device? a. Massage the skin of the right leg with lotion every 8 hours b. Give pin care once a shift c. Inspect the skin on the right leg at least once every 8 hours d. Release the weights on the right leg for range of motion

42. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following? a. Expected common side effects b. Hypersensitivity reactions c. Possible habituating effects d. Hemorrhage from GI irritation 43. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first? a. b. c. d. The area proximal to the fracture The actual fracture site The area distal to the fracture The opposite extremity for baseline comparison

44. A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure? a. Rales c. Generalized edema b. Jaundice d. Dark, scanty urine 45. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat

exercises daily 54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the: a. Left leg and right crutch then right leg and left crutch b. Crutches and then both legs simultaneously c. Crutches and the right leg then advance the left leg d. Crutches and the left leg then advance the right leg 55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the: a. b. c. d. Left hand and placing the cane in front of the left foot Right hand and placing the cane in front of the right foot Left hand and 6 inches lateral to the left foot Right hand and 6 inches lateral to the left foot

56. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a: a. Pillow to keep the right leg abducted during turning b. Pillow to keep the right leg adducted during turning c. Trochanter roll to prevent external rotation while turning d. Trochanter roll to prevent abduction while turning 57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint: a. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting b. Apply an Ace wrap around the dressing and put ice on the knee while sitting c. Lift the client to the bedside change leaving the CPM machine in place d. Obtain a walker to minimize weight bearing by the client on the affected leg 58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately: a. Calls the physician b. Rewrap the stump with an elastic compression bandage c. Applies ice to the site d. Applies a dry sterile dressing and elevates it on a pillow 59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to: a. Wear a clean nylon stump sock daily b. Toughen the skin of the stump by rubbing it with alcohol c. Prevent cracking of the skin of the stump by applying lotion daily d. Using a mirror to inspect all areas of the stump each day 60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client? a. Uric acid level of 8 mg/dl b. Calcium level of 9 mg/dl c. Phosphorus level of 3 mg/dl d. Uric acid level of 5 mg/dl

1. Ms. X is diagnosed with acquired immunodeficiency syndrome (AIDS). The nurse caring for this patient is aware that for a patient to be diagnosed with HIV she should have which condition? a. Infection of HIV, have a CD4+ T-cell count of 500 cells/microliter, history of acute HIV infection b. Infection with Tuberculosis, HIV and cytomegalovirus c. Infection of HIV, have a CD4+ T-cell count of >200 cells/microliter, history of acute HIV infection

d. Infection with HIV, history of HIV infection and T-cell count below 200 cells/microliter 2. The nurse observes precaution in caring for Mr. X as HIV is most easily transmitted in: a. Vaginal secretions and urine b. Breast milk and tears c. Feces and saliva d. Blood and semen 3. Nurse Jaja is giving an injection to Ms. X. After giving an injection, the nurse accidentally stuck her finger with the needle when the client became very agitated. To determine if the nurse became infected with HIV when is the best time to test her for HIV antibodies? a. Immediately and repeat the test after 12 weeks b. Immediately and repeat the test after 4 weeks c. After a week and repeat the test in 4 months d. After a weeks and repeat the test in 6 months 4. The blood test first used to identify a response to HIV infection is: a. Western blot b. ELISA test c. CD4+ T-cell count d. CBC 5. What is the main reason why it is difficult to develop a vaccine against HIV? a. HIV is still unknown to human b. HIV mutates easily c. HIV spreads rapidly throughout the body d. HIV matures easily 6. Human Immunodeficiency virus belongs to which classifications? a. Rhabdovirus b. Rhinovirus c. Retrovirus d. Rotavirus 7. Which organ is responsible for stimulating the production of red blood cells? a. Yellow marrow b. Red marrow c. Spleen d. Kidney 8. In anemia, which of the following blood components is decreased? a. Erythrocytes b. Granulocytes c. Leukocytes d. Platelets 9. The precursor of red blood cells is called: a. T cells b. B cells c. Stem cells d. Macrophage 10. In erythropoiesis, the sequence of erythrocyte formation is chronologically described in which option? a. Stem cells, erythroblast, reticulocyte, erythrocytes b. Stem cells, reticulocyte, erythroblast, erythrocytes c. Erythroblast, stem cells, reticulocyte, erythrocytes d. Erythroblast, reticulocyte, stem cells, erythrocytes 11. Which of the following is true of red blood cell? a. It is nucleated. b. It has a lifespan of 100 days c. Its production and formation depends on the action of the kidney d. It is produced in the yellow marrow 12. Which type of immunoglobulin passes or crosses the placenta starting at the first trimester of pregnancy? a. IgG b. IgA c. IgM d. All of these 13. The first immunoglobulin produced by the body when the neonate is distressed, has acquired an infection or is challenged is: a. IgG b. IgA c. IgM d. All of these 14. Which of the following is essential for the hemoglobin synthesis during RBC production? a. Folic Acid b. Iron c. Vitamin B12 d. All of these 15. The age group most at risk for developing anemia is: a. 20-25 years old b. 26-32 years old c. 40-50 years old d. >65 years old 16. Decreased number of platelets is called: a. Thrombectomy b. Thrombocytopenia c. Thrombocytopathy d. Thrombocytosis

17. To improve the platelet count of a patient with an idiopathic thrombocytopenicpurpura, this medication should be given: a. Vitamin K b. Methotrexate c. Corticosteroid d. Acetylsalicylic Acid 18. B-cells are involved in which of the following types of immunity? a. Humoral immunity b. Cell-mediated immunity c. Antigen-mediated immunity d. All of these 19. What is the life span of normal platelets? a. 3-4 months b. 1-2 months c. 1-3 days d. 7-10 days 20. A patient is diagnosed with a systematic lupus erythematous (SLE). SLE primarily attacks which tissues? a. Heart b. Lung c. Nerve d. Connective 21. A sign of neurologic involvement in SLE is manifested by: a. CVA b. Infection c. Psychosis d. Facial tic 22. A classic sign of SLE is: a. Rashes over the cheeks and nose b. Weight loss c. Vomiting d. Difficulty urinating 23. A laboratory test result that supports the diagnosis of SLE is: a. Leukocytosis, elevated BUN and CREA b. Pancytopenia, elevated antinuclear antibody (ANA) titer c. Thrombocytosis, elevated ESR d. None of these 24. Which food should a client with leukemia avoid? a. Wheat bread b. Steak c. Orange d. All of these 25. The average length of time from HIV infection to the development of AIDS is? a. Less than 3 years b. 5-7 years c. 10 years d. More than 10 years 1. Answer C. The three criteria for a client to be diagnosed with AIDS are the following: HIV positive CD4+ T-cell count below 200 cells/microliter Have one or more specific conditions that include acute infection of HIV 2. Answer D. Keyword: MOST EASILY. Rationale: HIV is MOST EASILY transmitted in blood, semen and vaginal secretions. However, it has been noted to be found in fecal materials, urine, saliva, tears and breast milk. 3. Answer A. Keyword: BEST TIME. Rationale: To determine if a preexisting infection is present a test should be done immediately and is repeated again in 3 months time (12 weeks) to detect seroconversion as a result of the needle stick. 4. Answer B. Keyword: FIRST. Rationale: The ELISA test is the first screening test for HIV. A Western blot test confirms a positive ELISA test. Other blood tests that support the diagnosis of HIV include CD4+ and CD8 + counts, CBC, immunoglobulin levels, p24 antigen assay, and quantitative ribonucleic acid assays. 5. Answer B. Keyword: MAIN REASON. Rationale: HIV was identified in 1983, thus, A is incorrect. By 1988 two strains of HIV existed, HIV-1 and HIV-2. Viruses spread rapidly and mature easily but these factors dont affect the potential for development against HIV. Mutating too easily makes it hard to create a vaccine against it. 6. Answer C. Rationale: HIV is a retrovirus that has a ribonucleic acid dependent reverse transcriptase. 7. Answer D. Keyword: STIMULATING THE PRODUCTION OF RBC. Rationale: Kidneys produce and release the hormone erythropoietin that is responsible for initiating the production of RBCs in the red marrow, thus, the correct answer is D. The Red Marrow is the site of RBC production. The spleen is responsible for removing the damage RBC. 8. Answer A. Rationale: Anemia is characterized by a decreased in the number of RBCs. 9. Answer C. Keyword: PRECURSOR. Rationale: the precursor of RBC is the stem cells in the red marrow. 10. Answer A. Rationale: Stem cells erythroblast- reticulocyte erythrocytes. Erythropoietin is the hormone that stimulates red blood cell production in the red marrow. Mature red blood cells are formed from stem cells in the bone marrow. With the presence of erythropoietin, red cell pathway starts to form proerythroblast from stem cells. At this point the cell still contains

nucleus. However, as the development progresses the nucleus becomes smaller and the cytoplasm becomes basophilic due to the presence of ribosome, thus the cell is now called basophilic erythroblast. As the cell becomes older it also becomes smaller and eventually when it begins to produce hemoglobin it is now termed as polychromatic erythroblast. Later on the cytoplasm will become more eosinophilic and the cell is now called orthochromatic erythroblast, which will then extrude its nucleus as the cells slowly fill with hemoglobin before entering the circulation as reticulocytes. Reticulocytes will mature to form the anucleated red blood cells. 11. Answer C. Keyword: TRUE. Rationale: Kidneys produce and release the hormone erythropoietin that is responsible for initiating the production of RBCs in the red marrow. Red blood cells are anucleated cells (without nucleus) and have a life span of 120 days or 4 months. 12. Answer A. Keyword: PASSES/CROSSES THE PLACENTA. Rationale: There is only one immunoglobulin that passes or crosses that placenta, the IgG. IgG starts to cross the placenta at the first trimester of pregnancy. However, the largest amount of IgG transfer is noted during the third trimester of pregnancy. This type of immunoglobulin provides the fetus a passive immunity to possible bacterial and viral infections. However, the passive immunity it provides is only temporary. The immunity gradually disappears at about 6 to 8 months of life. The gradual disappearance of passive immunity, leads to the gradual production of larger quantities of immunoglobulin to replace the IgG from the mother. 13. Answer C. Keyword: FIRST IMMUNOGLOBULIN PRODUCED BY THE BODY. Rationale: IgM is the first immunoglobulin produced by the body when the neonate is distressed, has acquired an infection or is challenged. When a newborn is exposed to environmental antigens, production of IgM rapidly increases. This type of immunoglobulin provides protection from gram-negative bacteria. IgM cannot cross the placental barrier. In cases where large amount of IgM is found in the placenta, possible exposure to infection in the utero is probable 14. Answer B. Keyword: HEMOGLOBIN SYNTHESIS. Rationale: Dietary elements are essential for RBC production. The following are needed by the red marrow to produce erythrocytes: Iron for hemoglobin synthesis Folic Acid for DNA synthesis Vitamin B12 for DNA synthesis 15. Answer D. Keyword: MOST AT RISK. Rationale: The elderly are most at risk for anemia often due to financial concerns affecting protein intake or poor dentition that interferes with chewing meat. 16. Answer B. Keyword: DECREASED NUMBER OF PLATELETS. Rationale: thrombocytopenia is a decreased number of platelets. Thrombocytosis is an excess in the number of platelets. Thrombocytopathy is a platelet dysfunction. Thrombectomy is the surgical removal of a thrombus. 17. Answer C. Rationale: TO IMPROVE PLATELET COUNT. Rationale: Corticosteroid therapy can decrease antibody production and phagocytosis of the antibody-coated platelets, retaining more functioning platelets. Methotrexate can cause thrombocytopenia. Vitamin K is used to treat an excessive anticoagulable state from warfarin overload, and ASA decreases platelet aggregation. 18. Answer A. Keyword: B-CELLS. Rationale: B-Cells are responsible for humoral or immunoglobulin mediated immunity. T-cells are responsible for cell-mediated immunity. There is such thing as antigen-mediated immunity. 19. Answer D. Rationale: The life span of a normal platelet is 710 days. However, in idiopathic thrombocytopenia the life span is reduced to 1-3 days. 20. Answer D. Keyword: PRIMARILY. Rationale: SLE is a chronic, inflammatory, autoimmune disorder affecting primarily the connective tissues. It also affects the skin and kidneys and may affect the pulmonary, cardiac, neural and renal systems. 21. Answer C. Keyword: NEUROLOGICAL INVOLVEMENT. Rationale: neurologic involvement may be shown by: Psychosis Seizures Headaches 22. Answer A. Keyword: CLASSIC SIGN. Rationale: Although all these symptoms can be signs of SLE, the classic sign is the butterfly rash over the cheeks and nose. 23. Answer B. Keyword: SUPPORTS THE DIAGNOSIS. Rationale: lab findings for clients with SLE usually show: Pancytopenia Elevated ANA titer Decreased serum complement levels 24. Answer C. Keyword: AVOID. Rationale: a low-bacteria diet would be indicated. Raw fruits and vegetables are excluded in the clients diet. 25. Answer C. Keyword: AVERAGE LENGTH OF TIME. Rationale: epidemiologic studies show the average time from initial contact with HIV to the development of AIDS is 10 years.

1. The nurse is aware that the following findings would be further evidence of a urethral injury in a male client during rectal examination? a. A low-riding prostate b. The presence of a boggy mass c. Absent sphincter tone d. A positive Hemoccult 2. When a female client with an indwelling urinary (Foley) catheter insists on walking to the hospital lobby to visit with family members, nurse Rose teaches how to do this without compromising the catheter. Which client action indicates an accurate understanding of this information? a. The client sets the drainage bag on the floor while sitting down. b. The client keeps the drainage bag below the bladder at all times. c. The client clamps the catheter drainage tubing while visiting with the family. d. The client loops the drainage tubing below its point of entry into the drainage bag. 3. A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this client? a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) smear annually. b. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. d. The human papillomavirus (HPV), which causes condylomata acuminata, cant be transmitted during oral sex. 4. A male client with bladder cancer has had the bladder removed and an ileal conduit created for urine diversion. While changing this clients pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should nurse Katrina conclude? a. The skin wasnt lubricated before the pouch was applied. b. The pouch faceplate doesnt fit the stoma. c. A skin barrier was applied properly. d. Stoma dilation wasnt performed. 5. The nurse is aware that the following laboratory values supports a diagnosis of pyelonephritis? a. Myoglobinuria b. Ketonuria c. Pyuria d. Low white blood cell (WBC) count 6. A female client with chronic renal failure (CRF) is receiving a hemodialysis treatment. After hemodialysis, nurse Sarah knows that the client is most likely to experience: a. hematuria. b. weight loss. c. increased urine output. d. increased blood pressure. 7. Nurse Lea is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention? a. Rashes on the palms of the hands and soles of the feet b. Cauliflower-like warts on the penis c. Painful red papules on the shaft of the penis d. Foul-smelling discharge from the penis 8. Nurse Agnes is reviewing the report of a clients routine urinalysis. Which value should the nurse consider abnormal? a. Specific gravity of 1.03 b. Urine pH of 3.0 c. Absence of protein d. Absence of glucose 9. A male client is scheduled for a renal clearance test. Nurse Maureen should explain that this test is done to assess the kidneys ability to remove a substance from the plasma in: a. 1 minute. b. 30 minutes. c. 1 hour. d. 24 hours. 10. A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should: a. keep the clients knee on the affected side bent for 6 hours. b. apply pressure to the puncture site for 30 minutes. c. check the clients pedal pulses frequently. d. remove the dressing on the puncture site after vital signs stabilize. 11. A female client is admitted for treatment of chronic renal failure (CRF). Nurse Juliet knows that this disorder increases the clients risk of: a. water and sodium retention secondary to a severe decrease in the glomerular filtration rate. b. a decreased serum phosphate level secondary to kidney failure. c. an increased serum calcium level secondary to kidney failure. d. metabolic alkalosis secondary to retention of hydrogen ions. 12. Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female clients uremia. Which finding signals a significant problem during this procedure?

a. Potassium level of 3.5 mEq/L b. Hematocrit (HCT) of 35% c. Blood glucose level of 200 mg/dl d. White blood cell (WBC) count of 20,000/mm3 13. For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important? a. Encouraging coughing and deep breathing b. Promoting carbohydrate intake c. Limiting fluid intake d. Providing pain-relief measures 14. A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure? a. Phosphate binders b. Insulin c. Antibiotics d. Cardiac glycosides 15. A client comes to the outpatient department complaining of vaginal discharge, dysuria, and genital irritation. Suspecting a sexually transmitted disease (STD), Dr. Smith orders diagnostic tests of the vaginal discharge. Which STD must be reported to the public health department? a. Chlamydia b. Gonorrhea c. Genital herpes d. Human papillomavirus infection 16. A male client with acute pyelonephritis receives a prescription for co-trimoxazole (Septra) P.O. twice daily for 10 days. Which finding best demonstrates that the client has followed the prescribed regimen? a. Urine output increases to 2,000 ml/day. b. Flank and abdominal discomfort decrease. c. Bacteria are absent on urine culture. d. The red blood cell (RBC) count is normal. 17. A 26-year-old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent, urgent voiding of small amounts of urine. Shes placed on trimethoprim-sulfamethoxazole (Bactrim) to treat possible infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely medication prescribed? a. nitrofurantoin (Macrodantin) b. ibuprofen (Motrin) c. acetaminophen with codeine d. phenazopyridine (Pyridium) 18. A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the nurse is aware that the functions of the three lumens include: a. Continuous inflow and outflow of irrigation solution. b. Intermittent inflow and continuous outflow of irrigation solution. c. Continuous inflow and intermittent outflow of irrigation solution. d. Intermittent flow of irrigation solution and prevention of hemorrhage. 19. Nurse Claudine is reviewing a clients fluid intake and output record. Fluid intake and urine output should relate in which way? a. Fluid intake should be double the urine output. b. Fluid intake should be approximately equal to the urine output. c. Fluid intake should be half the urine output. d. Fluid intake should be inversely proportional to the urine output. 20. After trying to conceive for a year, a couple consults an infertility specialist. When obtaining a history from the husband, nurse Jenny inquires about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility? a. Chickenpox b. Measles c. Mumps d. Scarlet fever 21. A male client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region, which radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site? a. Kidney b. Ureter c. Bladder d. Urethra 22. A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis sessions. Typically, dialysis equilibrium syndrome causes: a. confusion, headache, and seizures. b. acute bone pain and confusion. c. weakness, tingling, and cardiac arrhythmias. d. hypotension, tachycardia, and tachypnea.

23. Dr. Marquez prescribes norfloxacin (Noroxin), 400 mg P.O. twice daily, for a client with a urinary tract infection (UTI). The client asks the nurse how long to continue taking the drug. For an uncomplicated UTI, the usual duration of norfloxacin therapy is: a. 3 to 5 days. b. 7 to 10 days. c. 12 to 14 days. d. 10 to 21 days. 24. Nurse Joy is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultrahigh-frequency sound waves to shatter renal calculi. The nurse should instruct the client to: a. limit oral fluid intake for 1 to 2 weeks. b. report the presence of fine, sandlike particles through the nephrostomy tube. c. notify the physician about cloudy or foul-smelling urine. d. report bright pink urine within 24 hours after the procedure. 25. A client is frustrated and embarrassed by urinary incontinence. Which of the following measures should nurse Bea include in a bladder retraining program? a. Establishing a predetermined fluid intake pattern for the client b. Encouraging the client to increase the time between voidings c. Restricting fluid intake to reduce the need to void d. Assessing present elimination patterns 1. Answer B. When the urethra is ruptured, a hematoma or collection of blood separates the two sections of urethra. This may feel like a boggy mass on rectal examination. Because of the rupture and hematoma, the prostate becomes high riding. A palpable prostate gland usually indicates a nonurethral injury. Absent sphincter tone would refer to a spinal cord injury. The presence of blood would probably correlate with GI bleeding or a colon injury. 2. Answer B. To maintain effective drainage, the client should keep the drainage bag below the bladder; this allows the urine to flow by gravity from the bladder to the drainage bag. The client shouldnt lay the drainage bag on the floor because it could become grossly contaminated. The client shouldnt clamp the catheter drainage tubing because this impedes the flow of urine. To promote drainage, the client may loop the drainage tubing above not below its point of entry into the drainage bag. 3. Answer A. Women with condylomata acuminata are at risk for cancer of the cervix and vulva. Yearly Pap smears are very important for early detection. Because condylomata acuminata is a virus, there is no permanent cure. Because condylomata acuminata can occur on the vulva, a condom wont protect sexual partners. HPV can be transmitted to other parts of the body, such as the mouth, oropharynx, and larynx. 4. Answer B. If the pouch faceplate doesnt fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin. A lubricant shouldnt be used because it would prevent the pouch from adhering to the skin. When properly applied, a skin barrier prevents skin excoriation. Stoma dilation isnt performed with an ileal conduit, although it may be done with a colostomy if ordered. 5. Answer C. Pyelonephritis is diagnosed by the presence of leukocytosis,hematuria, pyuria, and bacteriuria. The client exhibits fever, chills, and flank pain. Because there is often a septic picture, the WBC count is more likely to be high rather than low, as indicated in option D. Ketonuria indicates a diabetic state. 6. Answer B. Because CRF causes loss of renal function, the client with this disorder retains fluid. Hemodialysis removes this fluid, causing weight loss. Hematuria is unlikely to follow hemodialysis because the client with CRF usually forms little or no urine. Hemodialysis doesnt increase urine output because it doesnt correct the loss of kidney function, which severely decreases urine production in this disorder. By removing fluids, hemodialysis decreases rather than increases the blood pressure. 7. Answer D. Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes. 8. Answer B. Normal urine pH is 4.5 to 8; therefore, a urine pH of 3.0 is abnormal. Urine specific gravity normally ranges from 1.002 to 1.035, making this clients value normal. Normally, urine contains no protein, glucose, ketones, bilirubin, bacteria, casts, or crystals. Red blood cells should measure 0 to 3 per high-power field; white blood cells, 0 to 4 per high-power field. Urine should be clear, its color ranging from pale yellow to deep amber. 9. Answer A. The renal clearance test determines the kidneys ability to remove a substance from the plasma in 1 minute. It doesnt measure the kidneys ability to remove a substance over a longer period. 10. Answer C. After renal angiography involving a femoral puncture site, the nurse should check the clients pedal pulses frequently to detect reduced circulation to the feet caused by vascular injury. The nurse also should monitor vital signs for evidence of internal hemorrhage and should observe the puncture

site frequently for fresh bleeding. The client should be kept on bed rest for several hours so the puncture site can seal completely. Keeping the clients knee bent is unnecessary. By the time the client returns to the short-procedure unit, manual pressure over the puncture site is no longer needed because a pressure dressing is in place. The nurse shouldnt remove this dressing for several hours and only if instructed to do so. 11. Answer A. A client with CRF is at risk for fluid imbalance dehydration if the kidneys fail to concentrate urine, or fluid retention if the kidneys fail to produce urine. Electrolyte imbalances associated with this disorder result from the kidneys inability to excrete phosphorus; such imbalances may lead to hyperphosphatemia with reciprocal hypocalcemia. CRF may cause metabolic acidosis, not metabolic alkalosis, secondary to inability of the kidneys to excrete hydrogen ions. 12. Answer D. An increased WBC count indicates infection, probably resulting from peritonitis, which may have been caused by insertion of the peritoneal catheter into the peritoneal cavity. Peritonitis can cause the peritoneal membrane to lose its ability to filter solutes; therefore, peritoneal dialysis would no longer be a treatment option for this client. Hyperglycemia occurs during peritoneal dialysis because of the high glucose content of the dialysate; its readily treatable with sliding-scale insulin. A potassium level of 3.5 mEq/L can be treated by adding potassium to the dialysate solution. An HCT of 35% is lower than normal. However, in this client, the value isnt abnormally low because of the daily blood samplings. A lower HCT is common in clients with chronic renal failure because of the lack of erythropoietin. 13. Answer C. During the oliguric phase of ARF, urine output decreases markedly, possibly leading to fluid overload. Limiting oral and I.V. fluid intake can prevent fluid overload and its complications, such as heart failure and pulmonary edema. Encouraging coughing and deep breathing is important for clients with various respiratory disorders. Promoting carbohydrate intake may be helpful in ARF but doesnt take precedence over fluid limitation. Controlling pain isnt important because ARF rarely causes pain. 14. Answer D. Cardiac glycosides such as digoxin should be withheld before hemodialysis. Hypokalemia is one of the electrolyte shifts that occur during dialysis, and a hypokalemic client is at risk for arrhythmias secondary to digitalis toxicity. Phosphate binders and insulin can be administered because they arent removed from the blood by dialysis. Some antibiotics are removed by dialysis and should be administered after the procedure to ensure their therapeutic effects. The nurse should check a formulary to determine whether a particular antibiotic should be administered before or after dialysis. 15. Answer B. Gonorrhea must be reported to the public health department. Chlamydia, genital herpes, and human papillomavirus infection arent reportable diseases. 16. Answer C. Co-trimoxazole is a sulfonamide antibiotic used to treat urinary tract infections. Therefore, absence of bacteria on urine culture indicates that the drug has achieved its desired effect. Although flank pain may decrease as the infection resolves, this isnt a reliable indicator of the drugs effectiveness. Cotrimoxazole doesnt affect urine output or the RBC count. 17. Answer D. Phenazopyridine may be prescribed in conjunction with an antibiotic for painful bladder infections to promote comfort. Because of its local anesthetic action on the urinary mucosa, phenazopyridine specifically relieves bladder pain. Nitrofurantoin is a urinary antiseptic with no analgesic properties. While ibuprofen and acetaminophen with codeine are analgesics, they dont exert a direct effect on the urinary mucosa. 18. Answer A. When preparing for continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution. 19. Answer B. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. For example, fluid intake that is double the urine output indicates fluid retention; fluid intake that is half the urine output indicates dehydration. Normally, fluid intake isnt inversely proportional to the urine output. 20. Answer C. Mumps is the most significant childhood infectious disease affecting male fertility. Chickenpox, measles, and scarlet fever dont affect male fertility. 21. Answer A. The most common site of renal calculi formation is the kidney. Calculi may travel down the urinary tract with or without causing damage and may lodge anywhere along the tract or may stay within the kidney. The ureter, bladder, and urethra are less common sites of renal calculi formation. 22. Answer A. Dialysis equilibrium syndrome causes confusion, a decreasing level of consciousness, headache, and seizures. These findings, which may last several days, probably result from a relative excess of interstitial or intracellular solutes caused by rapid solute removal from the blood. The resultant organ swelling interferes with normal physiologic functions. To prevent this syndrome, many dialysis centers keep first-time sessions short and use a reduced blood flow rate. Acute bone pain and confusion are associated with aluminum intoxication, another potential complication of dialysis. Weakness, tingling, and cardiac arrhythmias suggest hyperkalemia, which is associated with renal failure. Hypotension, tachycardia, and tachypnea signal hemorrhage, another dialysis complication.

23. Answer B. For an uncomplicated UTI, norfloxacin therapy usually lasts 7 to 10 days. Taking the drug for less than 7 days wouldnt eradicate such an infection. Taking it for more than 10 days isnt necessary. Only a client with a complicated UTI must take norfloxacin for 10 to 21 days. 24. Answer C. The client should report the presence of foulsmelling or cloudy urine. Unless contraindicated, the client should be instructed to drink large quantities of fluid each day to flush the kidneys. Sandlike debris is normal due to residual stone products. Hematuria is common after lithotripsy. 25. Answer D. The guidelines for initiating bladder retraining include assessing the clients intake patterns, voiding patterns, and reasons for each accidental voiding. Lowering the clients fluid intake wont reduce or prevent incontinence. The client should actually be encouraged to drink 1.5 to 2 L of water per day. A voiding schedule should be established after assessment.

What is the primary reason for which antibiotics are prescribed for sore throats even when the cause is likely not from a bacterial infection? Top of Form

Measles: PARAMYXO VIRUS German measles: TOGA VIRUS Chicken pox: VARICELLA ZOSTER VIRUS Herpes zoster: HERPES ZOSTER VIRUS Scarlet fever: Group A HEMOLYTIC STREPTOCOCCUS Scabies: SARCOPTES SCABIEI (itch mite) Bubonic plague: YERSINIA PESTIS Diphtheria: KLEBS LOEFFLER Pertussis: BORDETELLA PERTUSSIS Tuberculosis: MYCOBACTERIUM TUBERCULOSIS Typhoid: SALMONELLA TYPHI Cholera: VIBRIO CHOLERA Amoebiasis: ENTAMOEBA HYSTOLITICA Leptospirosis: LEPTOSPIRA Spirochete Schistosomiasis: Schistosoma japonicum Gonorrhea: N. GONORRHEAE Syphilis: TREPONEMA PALLIDUM Chlamydia: C. trachomatis, T. vaginalis Genital herpes: HERPES SIMPLEX 2 CD PHARMACOLOGY Malaria: CHLOROQUINE Schistosomiasis: PRAZIQUANTEL Scabies: EURAX/ CROTAMITON Chicken pox: ACYCLOVIR/ZOVIRAX Tuberculosis: R.I.P.E.S. Pneumonia: COTRIMOXAZOLE; Procaine Penicillin Helminths: MEBENDAZOLE; PYRANTEL PAMOATE

A)Patients demand drugs when they see a doctor

B)Untreated Strep throat can lead to rheumatic fever

C)Untreated Strep throat can lead to antibiotic resistance

COMMUNICABLE DISEASE Infectious Agent or its toxic products - AGENT Directly or Indirectly - MODE OF TRANSMISSION Person, Animal or Intermediate Vector HOST Environment - ENVIRONMENT ECOLOGIC TRIAD OF DISEASE Agent element, substance, animate or inanimate that may serve as stimulus to initiate a disease process Host organism that provides nourishment for another organism Environment physical (climate), biological (plants & animals) CONTAGIOUS VS. INFECTIOUS Contagious Diseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary host Infectious Diseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane. NOTE: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS CONTAGIOUS What is Infection? INFECTION - "the state or condition in which the body or part of the body is invaded by a pathogenic agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects which are injurious" Infectious Agent A. RESIDENT ORGANISMS deeply seated in the epidermis, not easily removed by simple handwashing, Ex: Staphylococci B. TRANSIENT ORGANISM represent recent contamination, survive for a limited period of time, acquired during contact with the infected colonized patient or environment, easily removed by good handwashing Ex: ( Klebsiella & Pseudomonas) Infectious Agent Bacteria heama organism, systemic Virus nuero organism, systemic Fungi skin organism, local Protozoa GI organism, local Infectious Agent FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE Pathogenicity ability to cause a disease Infective dose no of organism to initiate infection Virulence ability to enter or move through tissues Specificity ability of the organism to develop antigens STAGES OF INFECTIOUS PROCESS Means of Transmission 1. CONTACT - most common means of transmitting microorganisms from one person to another.

D)Untreated Strep throat can lead to cellulitis Bottom of Form Answer B - Physicians are faced with difficult decisions when it comes to the treatment of sore throats. While it has been estimated that only 10% of office visits for sore throat are caused by bacteria, physicians fear rheumatic fever and poststreptococcal glomerulonephritis, which are serious complications of untreated Strep throat. The risk of antibiotic resistance increases each time an antibiotic is prescribed, but in the case of Strep throat, the potential complications for the patient outweigh the risk of resistance developing in this case. While doctors may succumb to the pressures of patients requesting medication, it is not the primary reason that they are prescribed. Strep throat does not usually lead to cellulitis.

Communicable Disease Nursing DRUG OF CHOICE Tetanus: PEN G Na; DIAZEPAM (Valium) Meningitis: MANNITOL (osmotic diuretic); DEXAMETHASONE (anti-inflammatory); DILANTIN/PHENYTOIN (anti-convulsive); PYRETINOL/ENCEPHABO L (CNS stimulant) Rabies Vaccines: LYSSAVAC, VERORAB Immunoglobulins: ERIG or HRIg DIAGNOSTIC TESTS Tetanus: WOUND CULTURE Meningitis: LUMBAR PUNCTURE Encephalitis: EEG Polio: EMG; Muscle testing Rabies: Brain biopsy (Negri bodies) Fluorescent rabies antibody test Dengue: TOURNIQUET test (Rumpel lead) Malaria: Malarial smear; QBC (Quantitative Buffy Coat) Scarlet: DICK'S TEST; SCHULTZ-CHARLTON TEST Diphtheria: SCHICK'S TEST; Moloney's Test Pertussis: Nasal swab; agar plate Tuberculosis: MANTOUX test Leprosy: SLIT SKIN SMEAR Pinworm: SCOTCH TAPE SWAB Typhoid: WIDAL'S test HIV/AIDS: ELISA; WESTERN BLOT; PCT: Polymerase Chain Reaction Test CAUSATIVE AGENTS Tetanus: CLOSTRIDIUM TETANI Meningococcemia: NEISSERIA MENINGITIDIS Rabies: RHABDOVIRUS Poliomyelitis: LEGIO DEBILITANS (Type I Brunhilde); (Type II Lansing); (Type III Leon) Dengue Fever: ARBOVIRUSES (Chikunggunya); (Onyong-nyong); (West Nile); (Flaviviruses) (Common in the Phil.) Malaria: PLASMODIUM (protozoa) P. Falciparum (most fatal); P. Vivax P. Malariae; P. Ovale Filariasis: WUCHERERIA BANCROFTI; BRUGIA MALAYI Leprosy: MYCOBACTERIUM LEPRAE

A. Direct Contact (person to person) occurs when one person touches another best vehicle is the Hands especially those of the Health Care workers Indirect Contact (inanimate object) - occurs when a person touches an inanimate object contaminated by an infected patient 2. AIRBORNE - droplet, dust, organisms in env. 3. VECTOR - insects or animals 4. VEHICLE - food (salmonella), water (shigellosis), blood (Hepa B), medication ( contaminated infusion) PREVENTION OF COMMUNICABLE DISEASE Prevention is worth a pound than cure PREVENTION OF COMMUNICABLE DISEASE Health Education primary role of the nurse Specific Protection- handwashing, use of protective devices Environmental Sanitation clean and conducive for health Definition of Prevention Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention A Dictionary of Epidemiology, Fourth Edition by John M. Last Prevention of Needlestick Injuries Dispose Used Needles in Puncture Proof Needle Containers Dont Recap Needles (Unless using the One-handed Technique) Use Gloves When Handling Needles (Wont Prevent Injuries but May Lessen Chance of Transmitting Diseases) CONTROL OF C0MMUNICABLE DIESEASE 1. Notification 2. Epidemiological Investigation 3. Case finding; early dx and prompt treatment 4. Isolation and Quarantine 5. Disinfection; disinfestation 6. Medical Asepsis a. Handwashing b. Concurrent disinfection c. Personal protective equipments (PPEs) d. Barrier Cards/Placarding Objectives of CCD Restoration of health, reduce deaths and disability Interpretation of control measures to IFC for practice to prevent spread of CD. Promotion of health and prevention of spread of CD Diseases that require weekly monitoring: 1. Acute flaccid paralysis (AFP) polio 2. Measles 3. Severe acute diarrhea (SAD) 4. Neonatal tetanus 5. AIDS Diseases that require reporting w/in 24 hrs 1. Acute flaccid paralysis (AFP) polio 2. Measles Diseases targeted for eradication 1. Acute flaccid paralysis polio 2. Neonatal tetanus 3. Measles 4. Rabies Epidemiology Study of the occurrence and distribution of diseases in the population Patterns of occurrence of disease frequency of disease occurrence Sporadic On and off occurrence of the disease Most of the time it is not found in the community One or two cases that occur are not related Endemic Persistently present in the community all year round Ex: malaria in Palawan Epidemic An unexpected increase in the number of cases of disease Pandemic Epidemic of a worldwide proportions Time Related Patterns of Occurrence cyclical variation

a periodic increase in the number of cases of a disease a seasonal disease, an increase is expected or there is usual increase- dengue fever during rainy seasons are increased but it is not considered an epidemic because it is expected to rise at this particular time hot spot-a rising increase that may lead to an epidemic Time Related Patterns of Occurrence Short time fluctuation A change in the frequency of occurrence of a disease over a short period of time Maybe (+) or (-) Secular variation A change in the frequency of occurrence of a diseae taking place over a long period of time Ex: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden repport of cases in 2001 due to mutant restraints. b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of today Types of Epidemiology Descriptive Epidemiology - concerned with disease frequency & distribution Analytic Epidemiology Is a study of the factors affecting occurrence and distribution of the disease. Ex. Epidemiologic investigation Therapeutic/Clinical Study of the efficacy of a treatment of a particular disease Ex. Clinical trial of a newly proposed therapeutic regimen Evaluation Epidemiology Study of the over-all effectiveness of a total/ comprehensive public health program. Ex. Evaluation of the under five clinic Note: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatment Types of Epidemiologic Data Demographic data Demography is the study of population groups Ex. Population size and distribution Vital Statistics Environmental data Health services data Ex. Ratio between nurse and the population being served Ex. Degree of utilization of health facility/ service Epidemiologic Investigation 1st step- Statement of the problem 2nd step- Appraisal of facts describing the epidemic in terms of time, place, person. 3rd step- formulation of hypothesis 4th step-Testing the hypothesis 5th step- Conclusion and recommendation TERMS Disinfection pathogens but not spores are destroyed Disinfectant substance use on inanimate objects Concurrent disinfection ongoing practices in the care of the patient to limit or control the spread of microorganisms. Terminal disinfection practices to remove pathogens from the patients environment after his illness is no longer communicable FACTORS AFFECTING ISOLATION Mode of Transmission Source Status of the clients defense mechanism Ability of client to implement precautions ISOLATION EPI Launched by DOH in cooperation with WHO and UNICEF last July 1976 Objective reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseases PD No. 996 (Sept. 16, 1076) Providing for compulsary basic immunization for infants and children below 8 y/o PP No. 6 (April 3, 1996) Implementing a United Nations goal on Universal Child Immunization by 1990 RA 7846 (Dec. 30, 1994) immunization hepa B PD No. 4 (July 29, 1998) Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign Legislation, Laws affecting EPI Proclamation No. 46 polio eradication project Proclamation No. 1064 AFP surveillance Proclamation No. 1066 National Neonatal Tetanus Elimination Campaign

EPI BCG - TB DPT Diptheria, Pertussis, Tetanu OPV - Poliomyletis Hepatitis B Measles Immunization Contraindications -conditions that require hospitalization For DPT 2 and 3 history of seizures/ convulsions within 3 days after the first immunization with DPT Nursing responsibility: ask how the child reacts to the first dose For infant BCG clinical AIDS The following conditions are NOT contraindications: Fever up to 38.5 C Simple or mild acute respiratory infection Simple diarrhea without dehydration Malnutrition (it is indication for immunization) Schedule of immunization Infant BCG 0 to 11 months or 0 to 1 year at birth 0.05 ml (dose) ID, right arm School entrance BCG When the child enters Grade 1 with or without scar on the right arm then still go on with the vaccination except if he is repeating Grade 1 Schedule of immunization DPT 3 doses, 4 weeks or 1 month interval Target age: 1 to 11 months but child is eligible up to 6 years If 7 years old and above DT only not P 0.5 ml, IM, vastus lateralis Schedule of immunization OPV 3 doses, 4 weeks/1 month Target population: same as above, eligibility until Grade 6 2-3 drops, oral route *Feb 8-March 8: Oplan Polio Revival Drive No side effect, but advise the mother to avoid feeding the child for 30 minutes after the vaccine, if vomits within the 30 minute period, repeat the vaccination Schedule of immunization Hepa B 3 doses, 4 weeks Can be given at birth Target age 1 to 11 months 0.5 ml, IM, vastus lateralis Patient may experience local tenderness Schedule of immunization Measles 9 to 11 months Most babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off, other virus if it still active it will kill the vaccine 0.5 ml, subcutaneous, any arm Measles Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles) Immunization Fully Immunized Child when he received all the antigens that should be given in the first year of life (1 dose BCG, MV; 3 doses DPT, OPV, HB) Completely Immunized Child All vaccines given but went beyond 0ne year of age