21. Principles of Disease

Match the following:

A frantic mother comes into your clinic because her two-year-old child has had a very high fever for two days now, with mild diarrhea and coldlike symptoms. As you consider the differential list, which is the most likely causative agent if the fever breaks and is replaced with a rash by tomorrow?

a. Human parvovirus B19

b. Hand, foot, and mouth disease

c. Roseola

d. Rubella

e. Measles

Your patient is reminiscing about her childhood diseases while reviewing her medical history. She claims she had a really bad case of rubella (German measles) when she was a child and that she was very sick. You think she is confusing it with rubeola (measles) because:

a. measles can cause congenital rubella syndrome.

b. German measles causes a mild rash and is not likely to make a patient very sick.

c. the largest concern is for secondary infections like pneumonia.

d. she didn’t mention Koplik’s spots in the mouth or raised lesions.

e. the raised red rash usually begins on the trunk and spreads from there.

A 65-year-old patient calls the nursing hotline to ask about some painful blisters arranged in a band on one side of his waist. After hearing about the lesions, you ask him if he had chickenpox as a child. This is because you feel you are hearing about a case of:

a. candidiasis.

b. measles.

c. herpes.

d. shingles.

e. rubella.

A vaccine against Listeria monocytogenes is a challenge to develop because

a. very few people get Listeria meningitis.

b. the antibody-mediated immune response is not effective against L. monocytogenes.

c. better prevention approaches exist, such as food preparation precautions.

d. vaccinations are not used for foodborne illness.

An HIV/AIDS patient is presenting with flulike symptoms, headache, fever, and disorientation. The MOST important piece of information a nurse must obtain for the patient is his or her

a. travel history, in and outside the United States.

b. diet for the last 3 days.

c. exposure to lakes or streams.

d. exposure to bats.

Which of the following symptoms would be most informative in terms of ruling out a prion disease as a differential diagnosis?

a. Nuchal rigidity

b. Hallucinations

c. Fatigue

d. Headache

Which one of the following measures is the most effective way to prevent viral infections of the digestive system?

a. Antibiotics

b. Thoroughly cooking food

c. Decontaminating water

d. Washing hands

e. Disinfecting bathroom surfaces

Which of the following does not fall into our current definition of TORCH infections?

a. Syphilis

b. Trichomoniasis

c. HIV

d. Rubella

e. Cytomegalovirus

Factors that contribute to vulvovaginal candidiasis include

a. low vaginal pH.

b. high nitrates in urine.

c. increased blood bilirubin levels.

d. increased estrogen levels.

e. taking a fluconazole drug.

A patient you are assessing reports an increase in vaginal discharge that has a foul odor, but she does not report other symptoms. The patient has been in a monogamous relationship for 3 years. Which of the following would be the most useful for this patient? Select all that apply. (NCLEX/HESI/TEAS)

a. Evaluate her urine for increased white blood cells.

b. Perform a Gram stain on the vaginal discharge.

c. Run a pregnancy test.

d. Test for an STI.

e. Perform a whiff test.

How do lactobacilli limit infections in the vagina? Select all that apply. (NCLEX/HESI/TEAS)

a. They competitively exclude potential pathogens.

b. They make hydrogen peroxide.

c. They ferment fructose to make lactic acid.

d. They lower the vaginal pH, which limits pathogen growth.

e. They increase the rate of vaginal mucus secretion.

A male patient is complaining of frothy discharge and painful urination. After negative NAAT testing, you will most likely prescribe (NCLEX/HESI/TEAS)

a. penicillin.

b. tetracycline.

c. a cephalosporin.

d. metronidazole.

You see a corkscrew-like bacterial cell under dark field microscopy. If the sample came from __________, it is likely __________.

a. genital lesions, leptospirosis

b. urine, gonorrhea

c. urine, syphilis

d. genital lesions, syphilis

e. vaginal discharge, chlamydia

Patients can contract chlamydia more than once because

a. it is so commonly antibiotic resistant.

b. long-term immunity is not established after infection.

c. it hides in neurons and reactivates, lysing cells.

d. it is sexually transmitted.

e. all of the above apply.