NCLEX

NCLEX Case Study: Nursing Care of Patients With Infectious Diseases

By March 18, 2018 No Comments

Patients With Infectious Diseases

This Comprehensive Case Study Learning Path covering Nursing Care of Patients with Infectious Diseases for the NCLEX-RN® Examination is one in a series designed to assist you in achieving your goal of becoming a licensed Registered Nurse in N. America.

Beyond the exhaustive list of questions attached to a detailed rationales and answer explanations, this unique review presents a group of unfolding case studies that tell stories about real patients, clinical issues, and the role of the nurse in providing high-quality, safe care along with comprehensive NCLEX-RN Strategies and Exam Breakdown. It is now available with Answers and Rationales as part of our Fast Prep 30 day NCLEX-RN® Review Package geared and fine tuned for New Graduates, International Graduates and Repeat Test Takers alike.


Ada, a 23-year-old female, presents to the emergency room with complaints of a fever and rash that began about 2 days ago on her face, but has now progressed to cover most of her body.She recently travelled to India to visit family and returned 4 days ago.Ada never attended public school and did not receive her childhood immunizations. She is suspected of having measles (rubeola) and measles immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies are ordered.

Select all that apply:

Clinical manifestations of measles include:
A. Low-gradefever
B. Cough
C. Koplikspots
D. Runnynose
E. Red, watery eyes
F. Rash that begins on the face and spreads to the trunk and extremities

Ada’s test results are positive for both IgG and IgM antibodies, confirming that she does have measles.

Select all that apply:

Which of the following is accurate regarding measles?
A. Incubation period of 7 to 14 days
B. Contagious 4 days before to 4 days after rash appears
C. Verbal report of vaccination is acceptable evidence of immunity
D. More severe in the immunocompromised
E. Reportable communicable disease
F. Supportive treatment to alleviate symptoms

Ada likely contracted measles in India and may have infected others.The case should be reported to the Centers for Disease Control and Prevention (CDC) as well as the local health department for appropriate follow-up and disease containment. Hospital person- nel need to use proper isolation precautions to prevent the dissemination of measles.

Select all that apply:

The proper isolation precautions for measles:
A. Contact
B. Airborne
C. Droplet
D. Standard

Multiple-choice:

Which infection would require airborne precautions?
A. Varicella(chickenpox)
B. Anthrax
C. Neisseria meningitides (meningococcal infection)
D. Haemophilus influenzae type b

Select all that apply:

Airborne precautions include:
A. Airborne infection isolation room (AIIR)
B. N95respirator
C. Doorclosed
D. Disposable dishes

The nurse in the ED who completed Ada’s initial assessment before it was determined that Ada had measles (rubeola) was never immunized for measles and never contracted the virus.

Fill in the blanks:

The nurse who was never immunized for measles should be instructed to:

______________________________________________________________________
or
______________________________________________________________________

The nurse will be excluded from duty to prevent spread of the virus.

After caring for the patient, the nurse will remove personal protective equipment (PPE) in the designated area carefully to avoid self-contamination.

Ordering:

Place the steps for doffing personal protective equipment (PPE) in the correct order from 1 to 4:
______ Unfasten neck of gown, then waist ties; pull gown down from each shoulder.
______ Take elastic band of N95 respirator from behind the head, discard by holding the band.
______ Grab outside of glove with opposite gloved hand and peel off; hold removed glove in hand while pulling the second glove inside out over the first glove.
______ Remove the face shield by touching the clean earpieces or headband.

The nurses are discussing precautions used to prevent the transmission of infection.A student nurse states that she is not sure when to use standard precautions.

Select all that apply:

Standard precautions are used to:
A. Start an intravenous (IV) line
B. Care for a patient with Clostridium difficile
C. Empty a urinary catheter
D. Change a patient’s bed that is soiled with drainage
E. Administer medication down a gastrostomy tube
F. Change a dressing 24 hours after surgery

It is important to follow up with anyone who may have been exposed to measles. Individuals without adequate medical documentation of immunization, such as vacci- nation, laboratory titers, or a history of measles infection, should receive the measles, mumps, and rubella (MMR) vaccine or the measles immune globulin.


Layla, a 32-year-old female, presents to the ED with complaints of ongoing cough, nasal con- gestion, and myalgia that began about 24 hours ago and is progressively getting worse. She has no significant past medical history and takes no routine medications.Vital signs: Tem- perature, 101.8°F; BP, 120/74 mmHg; HR, 86; RR, 18; oxygen saturation, 96% on room air.

Select all that apply:

To minimize the risk of infection to others, the triage nurse would:
A. Provide the patient with tissues to cover the mouth and nose
B. Direct the patient to discard the tissues promptly after use
C. Place the patient before the other patients waiting for treatment
D. Instruct the patient to apply a surgical mask
E. Seat the patient 3 feet away from other patients
F. Educate the patient to wash his or her hands after contact with secretions

Layla’s symptoms are indicative of influenza and a rapid flu test is ordered.

Select all that apply:

Signs and symptoms of influenza include:
A. Fever
B. Myalgia
C. Nonproductivecough
D. Malaise
E. Productivecough
F. Nasal congestion and sore throat

Layla’s nasopharyngeal test is positive for influenza A. She asks about how the flu virus is spread and is concerned about infecting others.

Select all that apply:

Influenza can be contracted by:
A. Contact with virus-contaminated blood
B. Contact with virus-contaminated surfaces
C. Close proximity of a virus-infected person who coughs
D. Close proximity of a virus-infected person who sneezes

Layla will not be admitted and is discharged home on antiviral medication and given instructions on minimizing potential exposure to family members, friends, co-workers, and so on.

Multiple-choice:

What isolation precautions are required for the inpatient or outpatient management of patients with influenza?
A. Contact
B. Airborne
C. Droplet
D. Standard

The nurse is providing Layla with discharge teaching regarding ways to prevent transmission of the flu to others inside and outside of the home.

Select all that apply:

To minimize potential exposure of noninfected individuals to influenza, patient education would include:
A. Do not share eating utensils or linens
B. Avoid public places for 48 hours
C. Wear surgical mask while coughing
D. Cover nose and mouth to cough and sneeze
E. Wash hands with soap and water
F. Disinfect all contaminated surfaces

Layla is given a prescription for the antiviral Tamiflu (oseltamivir) and asks the nurse how the medication works.

Multiple-choice:

Which statement by the nurse demonstrates correct teaching about the antiviral drug Tamiflu?
A. “It is used to treat, not prevent, influenza.”
B. “It is only active against influenza type A virus.”
C. “It should be started within 48 hours of symptom onset.”
D. “It should never be given to a pregnant patient.”

Layla is encouraged to drink plenty of fluids, rest, and take Tylenol (acetaminophen) as needed for fever or muscle aches.The nurse also stresses the importance of yearly influenza vaccines.

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