Infectious Disease Prevention and Control

MULTIPLE CHOICE

1. Which of the following is the number one cause of death worldwide?

a.
Chronic diseases (heart disease, cancer, stroke)
b.
Infectious diseases
c.
Injuries (accidental or purposeful)
d.
Terrorism

ANS: B

In countries with higher standards of living, where people live longer, chronic diseases—heart disease, cancer, and stroke—are the leading causes of death. Infectious diseases, however, are still the number-one cause of death worldwide.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 477

2. Which of the following places best describes where the incidence of Vancomycin-resistantStaphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising?

a.
Areas where people share dressing or bathing facilities
b.
Daycare centers and schools
c.
Long-term care facilities
d.
Senior citizen centers

ANS: A

Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus(MRSA) remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, and other close bathing areas.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 478

3. During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections?

a.
Active immunity
b.
Long-lasting immunity
c.
Natural immunity
d.
Passive immunity

ANS: D

Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a nonimmunized individual, such as the transfer of antibody by administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination.

DIF: Cognitive Level: Apply (Application) REF: p. 480

4. A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. “Why,” he asks, “should my tax dollars be used to pay for their children to be immunized?” Which of the following would be the best response by the nurse?

a.
“Immunizations are required by law, and if their parents can’t afford it, you and I will have to pay for it.”
b.
“It’s just the right thing to do.”
c.
“Only by making sure most kids are immunized can we stop epidemics that might hurt all of us.”
d.
“We’re a religious God-fearing community, and we take care of each other.”

ANS: C

Herd immunity is the resistance of a group of people to invasion and spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease.

DIF: Cognitive Level: Apply (Application) REF: p. 480

5. Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics?

a.
Agent
b.
Environment
c.
Host
d.
Agent and host

ANS: B

The antibiotic therapy eliminates a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman’s body, which causes a change in the vaginal environment and allows normally present fungi to proliferate, resulting in a yeast infection.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 480

6. Which of the following best represents an example of infectious disease spreading via a vector?

a.
Being bitten by an infected mosquito
b.
Disease spreading from infected mother to infant via the placenta
c.
A group of partygoers hugging and shaking hands
d.
Two persons, one of whom is infected, sharing a glass of soda

ANS: A

Vertical transmission is the passing of infection from parent to offspring via placenta. Horizontal transmission is the person-to-person spread of infection through (among other ways) contact. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, or other substance. Vectors include mosquitoes, which can transmit the infectious agent by biting the host.

DIF: Cognitive Level: Apply (Application) REF: p. 480

7. A nurse’s Mantoux test is positive for exposure to tuberculosis. Which of the following conclusions should be drawn by the nurse?

a.
The nurse has been exposed to tuberculosis.
b.
The nurse has tuberculosis.
c.
The positive test result probably is due to a problem in the testing process.
d.
The test is inaccurate and needs to be repeated.

ANS: A

An individual who tests positive has been exposed and may be infected, but if that person shows no clinical signs, the person is not diseased. Infection refers to the entry, development, and multiplication of the infectious agent in the susceptible host. Disease is one of the possible outcomes of infection. People with latent TB have no symptoms, are not infectious, and can continue on with life. They may develop active TB. A nurse who interacts with clients may receive INH for a year as a precaution.

DIF: Cognitive Level: Analyze (Analysis) REF: pp. 480-481

8. A student engages in unprotected sex under the influence of alcohol. The student decides to have an HIV test completed the next day. Which of the following results will most likely occur?

a.
The results will probably be negative for HIV.
b.
The results will probably be positive for HIV.
c.
The probability of disease is so low there is no reason to be tested.
d.
The test results won’t be reliable so soon after exposure.

ANS: D

It may take up to 6 months after exposure to the HIV virus before an HIV antibody test can test positive, although most infected people will test positive within 3 months. A negative test, therefore, is not a reliable indicator of infection status if exposure is very recent. The incubation period or the time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease may be between 10 and 15 years for AIDS.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 481

9. Which of the following data would most likely be collected in a syndromic surveillance system?

a.
Incidence of bioterrorism attacks
b.
Number of air travelers
c.
Incidence of school absenteeism
d.
Number of influenza vaccines administered

ANS: C

Syndromic surveillance systems use existing health data in real time to provide immediate analysis and feedback to those charged with investigation and follow-up of potential outbreaks. These systems incorporate factors such as the previously mentioned temporal and geographic clustering and unusual age distributions with groups of disease symptoms or syndromes (e.g., flaccid paralysis, respiratory signs, skin rashes, gastrointestinal symptoms) with the goal of detecting early signs of diseases that could result from a bioterrorism-related attack. Syndromic surveillance systems may include tracking emergency department visits sorted by syndrome symptoms as well as other indicators of illness including school absenteeism and sales of selected over-the-counter medications. In recent years, the tracking of cold medicines used to make crystal methamphetamine has received considerable attention.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 481-482

10. A community is experiencing an epidemic of the measles. The nurse is trying to determine if this problem is happening in other communities as well. Which of the following resources should the nurse use to answer this question?

a.
Centers for Disease Control and Prevention Weekly Report
b.
Communicable Diseases Weekly Report
c.
Morbidity and Mortality Weekly Report
d.
Weekly National Report of Communicable Diseases

ANS: C

Requirements for disease reporting in the United States are mandated by state rather than federal law. The list of reportable diseases varies by state. State health departments, on a voluntary basis, report cases of selected diseases to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The National Notifiable Diseases Surveillance System (NNDSS) data are collated and published weekly in the Morbidity and Mortality Weekly Report (MMWR).

DIF: Cognitive Level: Apply (Application) REF: p. 482

11. There is great concern in the nurse’s community over three local cases of West Nile virus. Which of the following actions should the nurse take to get the community involved in addressing this problem?

a.
Ask the state department of health for assistance
b.
Demand that everyone over age 65 become immunized immediately
c.
Encourage immunization of all children under 12
d.
Have an educational campaign to remove any containers of standing water

ANS: D

Periodic outbreaks of West Nile virus appear to result from a complex interaction of multiple factors, including weather—especially hot, dry summers followed by rain, which influences mosquito breeding sites and population growth. Removing standing water will remove mosquito breeding sites.

DIF: Cognitive Level: Apply (Application) REF: pp. 483-484

12. Which of the following is the most probable cause of the increase in new emerging infectious diseases?

a.
Activities or behavior of humans, including changes in the environment
b.
Increasing urbanization and growth in new housing materials
c.
New infectious agents are evolving throughout the world
d.
Overpopulation in many areas, creating a need to reduce global population

ANS: A

Most of the emergence factors are consequences of activities and behavior of the human hosts and of environmental changes such as deforestation, urbanization, and industrialization. For example, the rise in households with two working parents has increased the number of children in daycare, and with this shift has come an increase in diarrheal diseases such as shigellosis. Urbanization is not a problem, but increasing development into formerly unaffected areas such as rainforests is.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 484-485

13. Which of the following best describes the current goal in relation to communicable diseases?

a.
To control political borders so diseases cannot spread further
b.
To exterminate specific infectious agents one by one
c.
To expand health care facilities to improve infectious disease treatment
d.
To achieve worldwide immunization to control new cases

ANS: B

The goal of prevention and control programs is to reduce the prevalence of a disease to a level at which it no longer poses a major public health problem. In some cases, diseases may even be eliminated or eradicated. The goal of elimination is to remove a disease from a large geographical area (e.g., a country or region of the world), such as has been done with polio in the Americas. Eradication is the irreversible termination of all transmission of infection by extermination of the infectious agents worldwide, as has been done with smallpox.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 486

14. Which of the following biological warfare agents poses the greatest bioterrorism threat to a community?

a.
Anthrax
b.
Botulism
c.
Smallpox
d.
Tularemia

ANS: A

Because of factors such as the ability to become an aerosol, the resistance to environmental degradation, and a high fatality rate, inhalational anthrax is considered to have an extremely high potential for being the single greatest biological warfare threat.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 487-488

15. Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the United States?

a.
Answering parents’ questions about the safety and importance of vaccines today
b.
Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen
c.
“No shots, no school” legislation, which legally requires children be immunized before school
d.
Offering all immunizations to all children free of any charge

ANS: C

Vaccines are one of the most effective methods of preventing and controlling communicable diseases. Hopefully, all nurses answer questions, remind colleagues to think about immunizations whenever a child is seen, and encourage continuing free or low-cost immunization clinics. One of the most effective programs has been the “no shots, no school” legislation, which has resulted in the immunization of most children by the time they enter school.

DIF: Cognitive Level: Understand (Comprehension) REF: pp. 488-489

16. A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student’s cheeks. Which of the following actions should be taken by the college health nurse?

a.
Inform all students, staff, and faculty of a possible rubella epidemic
b.
Inform all students, staff, and faculty of a possible measles epidemic
c.
Reassure the student that it is just a bad cold and will soon pass
d.
Tell the student to take two acetaminophen and drink lots of fluids

ANS: B

Measles is an acute, highly contagious disease that, although considered a childhood illness, is often seen in the United States in adolescents and young adults. Symptoms include fever, sneezing, coughing, conjunctivitis, small white spots on the inside of the cheek (Koplik spots), and a red, blotchy rash beginning several days after the respiratory signs. Measles is serious. Around 10% of measles cases require hospital admission. It can lead to pneumonia and encephalitis, and it can kill. Persons who may have been exposed should be informed that anyone under 18 who has not received both immunization doses should receive measles vaccine.

DIF: Cognitive Level: Apply (Application) REF: p. 489

17. An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs further review on how Salmonella is spread?

a.
“Certain pets and farm animals may be Salmonella carriers.”
b.
“It is possible to transmit Salmonella by person-to-person contact.”
c.
“Salmonella may be spread by spores that form once contaminated blood is exposed to the air.”
d.
“Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs.”

ANS: C

Meat, poultry, and eggs are the foods most often associated with salmonellosis outbreaks. Animals are the common reservoir for the various Salmonella serotypes, although infected humans may also fill this role. Animals are more likely to be chronic carriers. Reptiles such as iguanas have been implicated as Salmonella carriers, along with pet turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person transmission is an important consideration in daycare and institutional settings. Anthrax (not Salmonella) forms spores when infected blood is exposed to air.

DIF: Cognitive Level: Apply (Application) REF: p. 493

18. Which of the following is the most common vector-borne disease in the United States?

a.
Babesiosis
b.
Ehrlichiosis
c.
Lyme disease
d.
Rocky Mountain spotted fever

ANS: C

All four are diseases borne by ticks as the vectors. Lyme disease became a nationally notifiable disease in 1991 and is now the most common vector-borne disease in the United States.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 494

19. A student complains to the college health nurse that her academic work has been going downhill because of lack of sleep. “My 3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn’t been sleeping well and keeps scratching her bottom. Hopefully, she’ll adapt to daycare soon.” Which of the following information should the nurse provide to the student?

a.
“Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime.”
b.
“Your daughter may have pinworms; let me teach you how to check for this.”
c.
“Perhaps your child is not developmentally ready for group play.”
d.
“Try to arrange more one-on-one time with your 3-year-old.”

ANS: B

Enterobiasis (pinworm infection) is the most common helminthic infection in the United States with about 42 million cases a year. This infection is seen most often among children in institutional settings. Pinworms cause itching, especially around the anus, which can result in a lack of sleep for both child and caregiver.

DIF: Cognitive Level: Apply (Application) REF: p. 496

20. Which of the following is the most common vector-borne disease worldwide?

a.
Dengue
b.
Malaria
c.
Onchocerciasis (river blindness)
d.
Yellow fever

ANS: B

Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion people at risk and more than 275 million cases reported each year. More than 1 million children die of malaria each year. Dengue is the second most common vector-borne disease.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 497

21. At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase “a virulent organism.” The nurse explains that this means the organism causing the disease is able to do which of the following?

a.
Bypass normal immunological response mechanisms
b.
Invade major organ systems
c.
Produce toxins and poisons that weaken the body
d.
Produce very severe physical reactions

ANS: D

Virulence is the ability to produce a severe pathological reaction.

DIF: Cognitive Level: Apply (Application) REF: p. 480

22. A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely taking?

a.
A client receives a tetanus booster every 10 years.
b.
A client receives a tetanus booster after stepping on a nail.
c.
A client receives tetanus immunoglobulin after stepping on a nail.
d.
A client with tetanus is given antibiotics and is placed on seizure precautions.

ANS: A

Tetanus boosters given before exposure are a measure of primary prevention because exposure has not yet occurred. If given after exposure (i.e., the client may be infected but disease has not developed), they are considered secondary prevention (similar to the textbook examples of immunoglobulin and rabies immunizations given after exposure). Immunoglobulin would be given if the client had not been previously immunized; however, this again is after exposure, so it is secondary prevention. Because the client has the condition, treatment is aimed at prevention of further injury.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 487

23. Which of the following infectious disease interventions best represents the use of secondary prevention?

a.
Clients with HIV infection are encouraged to use condoms to protect sexual partners.
b.
Clients with HIV infection are given medications to improve immunological response.
c.
Health care workers are encouraged to receive annual vaccinations for influenza.
d.
Health care workers are required to have a tuberculosis skin test or chest x-ray.

ANS: D

Tuberculosis screening for health care workers is an example of secondary prevention. TB skin tests and chest x-rays are methods of tuberculosis screening. Encouraging clients with HIV to use condoms is an example of primary prevention, because the goal is to prevent exposure to the partner. Encouraging annual influenza vaccinations is also an example of primary prevention. Giving clients with HIV medications is an example of tertiary prevention, because the goal is to reduce complications in those already having the infection.

DIF: Cognitive Level: Apply (Application) REF: p. 487

MULTIPLE RESPONSE

1. Six students order meals at a local restaurant. Which of the following students are at highest risk for illness? (Select all that apply.)

a.
The first student asks for a salad with chicken strips and dressing on the side.
b.
The second student asks for a hamburger, very rare.
c.
The third student orders a tuna salad sandwich with extra mayonnaise.
d.
The fourth student orders a breakfast meal with two very soft-poached eggs and toast.

ANS: B, D

Escherichia coli O157:H7 can produce a strong cytotoxin that can cause a potentially fatal hemorrhagic colitis. Hamburger is often involved in outbreaks, since the grinding process exposes pathogens on the surface of the whole meat to the interior of the ground meat, effectively mixing the once-exterior bacteria thoroughly throughout the hamburger so that searing the surface no longer suffices to kill all bacteria. Also, hamburger is often made of meat ground from several sources. The best protection against foodborne pathogens is to thoroughly cook food before eating it. Salmonella is also transmitted by undercooked foods such as eggs, poultry, dairy products, and seafood. Consequently, students eating very rare hamburger and undercooked eggs are at high risk.

DIF: Cognitive Level: Apply (Application) REF: pp. 493-494

2. Which of the following symptoms suggests smallpox as opposed to the more common and much less dangerous chickenpox? (Select all that apply.)

a.
Child appears only mildly ill until late stages in smallpox.
b.
Lesions appear in various stages in the same area of the body rather than all at once.
c.
Rash lesions are most abundant on the face and extremities, not on the trunk.
d.
Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever.

ANS: C, D

Symptoms of smallpox include rash lesions on face and extremities, rash that occurs 2 to 4 days after onset of fever, and vesicles that are deep seated.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 488

3. The advanced practice nurse explains that the client has an upper respiratory infection (URI) and suggests several measures that might make the client more comfortable. Which of the following best describes why the nurse doesn’t just prescribe antibiotics as the client repeatedly requests? (Select all that apply.)

a.
Antibiotics are expensive, whereas the support measures would be almost free of cost.
b.
Viral diseases are not affected by antibiotics.
c.
Clinics cannot afford to continually give antibiotics to anyone who asks for them.
d.
The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs.

ANS: B, D

Antibiotics are not effective against viral diseases, a fact found unacceptable to many clients looking for relief from the misery of a cold or flu. The inappropriate prescribing of antibiotics contributes to the growing problem of infectious agents that have developed resistance to once-powerful antibiotics.

DIF: Cognitive Level: Apply (Application) REF: p. 477