A smallpox outbreak has occurred, and victims are reporting to the hospital for treatment, which includes the smallpox vaccine. The nurse knows patients with what symptoms will be admitted?
A. Eczema, edema, and headache
B. Double vision, droopy eyelids, and difficulty swallowing
C. Fever, headache, and myalgia
D. Fatigue, dizziness, and muscle aches
Fever, headache, and myalgia
*Patients with smallpox will have high fever, headaches, myalgia, backache, malaise, vomiting, and delirium. They will develop a rash that contains firm, deep-seated vesicles or pustules all in the same stage of development on any one area of the body. Eczema, edema, and headache are not signs of smallpox. Fatigue, dizziness, and muscle aches are signs of a hemorrhagic fever. Double vision, droopy eyelids, and difficulty swallowing are signs of botulism.
A Comprehensive Metabolic Panel (CMP) consists of which group of tests?
A. Cholesterol, Lipoprotein, HDL, Triglycerides
B. Albumin, Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, AST, ALT, Alkaline Phosphatase, Total Protein, Total Bilirubin, Calcium
C. Potassium, Sodium, Chloride, CO2
D. AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin
Albumin, Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, AST, ALT, Alkaline Phosphatase, Total Protein, Total Bilirubin, Calcium
A Renal Function Panel consists of which of the following tests?
A. AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin
B. Cholesterol, Lipoprotein, HDL, Triglycerides
C. Potassium, Sodium, Chloride, CO2
D. Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium, Albumin, Phosphorus
A lipid panel consists of which of the following tests?
A. Potassium, Sodium, Chloride, CO2
B. AST, ALT, Alkaline Phosphatase, Total Protein, Albumin, Total Bilirubin, Direct Bilirubin
C. Cholesterol, Lipoprotein, HDL, Triglycerides
D. Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, Calcium, Albumin, Phosphorus
Move the terms into the correct empty boxes to complete the concept map.
Left to Right;
- Protozoa
- cause MALARIA
- RNA Viruses
- cause
HEMORRHAGIC FEVERS
- which may be transmitted via: VECTORS, DIRECT CONTACT, DROPLETS
- Gram negative bacteria
- cause:
- LYME DISEASE
- CAT SCRATCH DISEASE
- PLAGUE
- TULAREMIA
Anthrax is a good potential bioterrorism weapon because Bacillus anthracis is a spore-forming bacterium that initiates disease symptoms that mimic many other infections.
true
The patient asks the nurse what the risk of her child being HIV-positive. What is the best response by the nurse?
It is possible that HIV will be passed to your child, but you can decrease the likelihood of transmission by compliance with antiretroviral therapy
The patient states that she acquired HIV from a previous partner. What are the primary modes of HIV transmission?
sexual contact and blood
What is the most successful treatment during pregnancy to reduce transmission of HIV from mother to fetus?
protease inhibitors
When should the patient's newborn baby for HIV, assuming she does not breastfeed?
at birth and 1 month
The patient asks the nurse for information about preventing HIV transmission to her sexual partner. What is the best form of prevention for HIV transmission, assuming sexual abstinence is not an option?
use of barrier-method contraceptive
What group of protozoans does Plasmodium belong to?
apicomplexans (sporozoans)
Once characteristics of the Plasmodium life cycle is _____.
asexual division, called schizogony, occurs in liver
Why does malaria mainly occur in equatorial or tropical areas and rain forests.
that is a major habitat for mosquitoes that transmit the disease
There are ____ species of Plasmodium known to cause disease.
five
Genus of mosquito that transmits malaria
Anopheles
In the liver of a person infected with Plasmodium, you will see:
sporozoites from the mosquito turn into merozoites
After a merozoite from the liver enters a red blood cell, it will next turn into a(n):
ring trophozoite
The mosquito is infected with the malaria parasite when it ingests or draws in:
gametocytes
What structures found in the stomach on an infected mosquito turn into sporozoites, which then travel to the mosquito's salivary glands?
oocysts
The chills and fever seen in malaria patients happens at what point in the parasite's life cycle?
bursting of the red blood cells
The asexual phase of the life cycle of Plasmodium takes place in:
humans
The first place in the human body where the malaria parasite reproduces is the :
liver
Order the following choices to reflect the pathway of blood starting with deoxygenated blood from the body, through the heart and lungs, and ending with oxygenated blood to the body.
1 - superior vena cava
2 - right atrium and right ventricle
3 - pulmonary arteries to the lungs
4 - pulmonary veins from the lungs
5 - left atrium and left ventricle
6 - aorta
Like the nervous system, the cardiovascular and lymphatic systems are closed systems do not have normal access to microbes from the external environment.
true
Drag the descriptions or images to their correct category to examine the spectrum of cardiovascular and lymphatic system diseases caused by microorganisms.
PLAGUE:
- pneumonic and bubonic forms caused by Yersinia pestis
- transmitted by regurgitation of fleas when they bite new host organism
- inguinal bubo
MONONUCLEOSIS:
- most of the world is infect with agent, but timing of infection is related to severity of infection
- hallmark signs/symptoms
are fatigue, sore throat, and enlarged lymph nodes
LYME DISEASE:
- caused by Borrelia burgdorferi which is transmitted by ticks
- erythema migrans
TULAREMIA:
- causative agent is one of the most infectious bacteria known
- transmitted to humans from rabbits through aerosols or arthropod vectors
ENDOCARDITIS:
- subacute form cause by a-hemolytic streptococci that are typically normal biota
- acute form caused by Streptococcus species and Neisseria gonorrhoeae
Match the causative agent to the disease that it causes to test your understanding of cardiovascular system infections.
1) Plague - yersinia pestis
2) Tularemia - francisella tularensis
3) lyme disease - borrelia burgdorferi
4) infectious mononucleosis - epstein-barr virus
Choose the phrase that best describes septicemia.
occurs when microorganisms are actively multiplying in the blood
Examine the epidemiology of HIV infection and AIDs in the US and worldwide by completing each sentence.
1) Worldwide, it is estimated that 32-38 MILLION individuals are HIV+, with over 1 MILLION of these individuals living in the US.
2) 2.1 MILLION new infections occurred in 2013, but there has been a 19% DECREASE in new infections in the US in recent years.
3) In most parts of the world, HETEROSEXUAL intercourse is the primary mode of transmission for HIV, with rates increasing dramatically in adolescent and young adult FEMALE populations.
4) IN large metropolitan areas worldwide, infection from the use of contaminated NEEDLES during drug use is growing more rapidly than any other mode of transmission, which greatly influences the rate of sexual form of transmission as well.
5) Treatment of HIV-infected mothers with anti-HIV drugs has dramatically reduced the rate of VERTICAL transmission of HIV during pregnancy.
Select all of the statements that apply to the pathogenesis of malaria to test your understanding of this disease.
- hypoglycemia is a symptom due to parasite metabolism of glucose
- the liver and spleen become enlarged
- RBCs adhere to blood vessels in the brain
Label the image to review the general structure of HIV.
Left (top to bottom):
- GP-120
- integrase
- reverse transcriptase
- RNA strands
- protease
- capsid
Right (top to bottom):
- CCR-5 coreceptor
- CD4 receptor
Spread of HIV through heterosexual contact has significantly increased as compared to data from the start of the epidemic.
True or False
true
Select the phrases that apply to all of the following non-hemorrhagic fever diseases: brucellosis, Q fever, cat-scratch disease, and Rocky Mountain spotted fever
- caused by gram-negative bacterium
- most can be treated with doxycycline
The statements below describe the manifestations of specific diseases of the cardiovascular/lymphatic system. If patients presented with these signs and symptoms, how would you diagnose them as the treating physician?
ANTHRAX - state's senator's assistant opens an envelope containing white powder that aerosolized and she later develops pulmonary edema
RMSF - an ibm employee returns from a June team-building exercise in the mountains of NC, he develops flue-like symptoms followed by a rash on his wrist and ankles
INFECTIOUS MONONUCLEOSIS - a 17 year old boy develops a high fever, lethargy, sore throat and swollen glands, a blood count shows large atypical lymphocytes
MALARIA - a peace corps employee on a mission trip to Rwanda returns home and develops malaise and nausea followed by recurring chills, fever and sweating
Endocarditis is an infection of:
the inner lining of the heart
Based upon the patient's treatment in this case, it can be inferred that:
the infection is likely caused by a bacterium
What risk factors did Donna have that likely lead to this infection?
mitral valve abnormality and recent dental work
Contrast the 2 types of endocarditis by dragging the descriptions to the correct type.
ACUTE
ENDOCARDITIS:
- transmission is parenteral (injury, needles, surgery)
- most common agents are Staphylococcus aureus and pathogenic streptococci
- quick onset and high morality rate
- some of the causative agents have high levels of antibiotic resistance
SUBACUTE ENDOCARDITIS:
- caused by normal biota that enter bloodstream
- most common agents are oral streptococci
- slower onset
- prophylactic antibiotics are a key to prevention
What test performed on the patient would have helped to identify the causative agent of her infection?
blood culture
Which of the following was a SIGN of subacute endocarditis in Donna?
discoloration of nails
Which of the following is a likely causative agent in Donna's infection?
a) staphylococcus
aureus
b) streptococcus pneumonia
c) neisseria gonorrhoeae
d) streptococcus mutans (alpha-hemolytic streptococcus)
d
The vast majority of septicemias are caused by bacteria, therefore treatment should begin with broad-spectrum antibiotics.
true
Match the statement to the disease that it most accurately describes to test your understanding of cardiovascular system infections.
INFECTIOUS MONONUCLEOSIS - symptoms include sore throat, high fever, cervical lymphadenopathy, fatigue
LYME DISEASE - spirochete is transmitted by hard ticks and an early symptom is a lesion that looks like a bull's eye
PLAGUE - the bacterium is inject by the bite of a flea, enters the lymph, and is trapped in a lymph node where it results in a swollen necrotic lesion called a bubo.
TULAREMIA - bites by a vector are most common source of infection but many case result when the skin or eyes are inoculated through contact with infected animals such as rabbits
Drag the descriptions or images to their correct category to compare and contrast various hemorrhagic and nonhemorrhagic fever diseases.
Non-hemorrhagic Fever Diseases:
- rocky mountain spotted fever
- Brucellosis, associated w/
undulating fever
- Q fever caused by Coxiella burnetii, airborne transmission
- cat-scratch disease caused by Bartonella henselae
Hemorrhagic Fever Diseases:
- yellow fever caused by a virus transmitted by Aedes mosquitoes
- Ebola and Marburg diseases, caused by filloviruses, exhibiting high mortality rates
- Chikungunya, endemic to Africa and leading to arthritic symptoms
- dengue fever endemic to Southeast Asia and India
- Lassa fever cause by arenavirus; transmitted
vertically or by aerosolization of rat feces
Choose the phrase that best describes the virulence factor shared by the yellow fever, Dengue fever, Ebola, Marburg, and Lassa fever viruses to test your understanding of hemorrhagic fever diseases.
associated with disruption of clotting factors
The highest rate of HA-MRSA occurred in which part of the United States
the south
True or false: the sum of all H-MRSA cases seen in age groups from less than 1 year to 59 years of age did not exceed the number of cases seen in individuals age 60+.
true
Which of the following is a valid hypothesis to explain the high rate of HA-MRSA incidence in the 60+ years age group?
they suffer from more health problems and are hospitalized more often
True or false: broad-spectrum antibiotics are typically used on a severely ill patient if the causative agent has been accurately identified.
false
Based on the patient's diagnosis in this case, it can be inferred that:
bacteria are actively dividing and circulating in her bloodstream
true or false: chemotherapy often compromises the immune system,n increasing a patient's risk for developing infections.
true
Which is a correct statement regarding MRSA?
it is spread from hospital settings to communities where it is causing more infections today
Which of the following is a correct statement regarding MRSA infection?
they can lead to pneumonia, bone or blood infections
Although MRSA infections can occur anywhere, which individual would be most at risk for infection?
a high school wrestler
True or false: handwashing is one of the most effective prevention methods against the spread of MRSA.
true
Which test performed on the patient would have helped to identify MRSA as the causative agent in her case?
culture and sensitivity
The patient's infection appeared to be a case of catheter-associated sepsis. This would be classified as which type of infection?
HA-MRSA
Which of the following drugs would be used for treatment of this patient's infection?
Vancomycin
The blood is full of leukocytes, such as ____, which are responsible for specific immunity, and various phagocytes, which are critical to both nonspecific and specific immune responses.
lymphocytes
Label the image to review the anatomy of the heart.
Left (top to bottom):
- superior vena cava
- right atrium
- right ventricle
Right (top to bottom):
- left atrium
- left ventricle
- myocardium
- endocardium
- epicardium
According to the data presented, what are the most common causes of infective endocarditis?
bacteria
Which group of bacteria are the most likely cause of infective endocarditis?
gram-positive cocci
If you conducted a Gram stain on organisms growing in the blood cultures from the majority of these cases, what would you be likely to see under the microscope?
purple spherical bacteria
According
to this chart, what is the most common causative agent of endocarditis and according to your textbook, what type does it cause?
a) staphylococcus aureus; subacute
b) staphylococcus aureus; acute
c) streptococcus viridans; subacute
d) streptococcus viridans; acute
B
The bite of a tick can cause:
- lyme disease
- ehrlichiosis
- anaplasmosis
Please label this figure to demonstrate your understanding of the drugs that are used to treat those with HIV.
Top Left; drugs that prevent the virus from fusing with host cell membrane (fuzeon)
Top Right: drugs that block viral replication during viral DNA synthesis (AZT)
Middle: drugs that block the final assembly and maturation of new virus particles
Bottom: drugs that prevent viral insertion into host DNA
Select all of the phrases that apply to subacute endocarditis
- most often caused by low pathogenicity oral streptococci
- almost always preceded by some form of damage to heart valves
- prevention involves prophylactic therapy before invasive procedures
True or false: based upon these results, the pathogen appears to be a bacterium.
false
True or false: influenza can be completely ruled out due to the negative rapid test.
false
Based upon all of this information, what additional testing should be done on the patient to identify the pathogen most rapidly?
serological testing
Based upon all of
the information obtained through specimen testing, along with the patient's symptoms, the pathogen is most likely:
a) ebola
b) influenza A
c) epstein-barr
d) dengue fever
D
Based upon this identification, what was the most likely mode of transmission of this pathogen?
biological vector
true or false: the patient most likely contracted the infection while working in his own backyard.
false
Which form of treatment should be administered to the patient at this time?
a) Rifampin
b) Erythromycin
c) supportive care w/fluid replacement therapy
d) ribavirin
C
True or false: aspirin is used to control the patient's severe pain in cases of Dengue fever.
false
True or false: the patient could have been spared if he was up to date on his vaccinations.
false
The RN suspicious of an infection in the patient's blood. Which of the following terms is descriptive of an infection of the bloodstream?
septicemia
Which of the following is/are the most likely causative organism(s) for this patient's condition?
gram-negative or gram positive bacteria
The physician orders blood cultures, antibiotic therapy, oxygen administration, and a fluid bolus for blood pressure support. The RN most appropriately prioritizes these tasks in which order?
oxygen admin, fluid bolus, blood culture, antibiotic initiation
Which of the following drug therapies is ordered initially?
broad-spectrum antibiotic
Which of the following conditions occurs if the bloodborne bacteria colonize the heart valves, causing impaired cardiac function?
acute endocarditis
Choose the phrase that correctly describes acute endocarditis.
most often caused by Staphylococcus aureus
Drag the images to their corresponding statement to test your knowledge of statistical information related to pathogens of the cardiovascular and lymphatic systems.
2%-50% -- mortality rate for septicemia, even with available treatment
1% -- percentage of HIV+ individuals who are nonprogressors
90% -- percentage of world's population infected with EBV
20% -- percent reduction in childhood mortality from malaria due to bet-net use
What was the major key to diagnosis in Miguel's case?
bull's eye rash
Besides the cardiovascular system, what other major body system is greatly affected in untreated Lyme disease?
nervous
Lyme disease is endemic in what general area of the US?
northeast
The causative agent for Lyme disease is a _____ and the vector for transmission is a ____.
bacterium; tick
Place the steps in the correct order to review the cycle of Lyme disease in the northeastern US.
Top left around the circle to bottom left:
1) newly hatched larvae are infected
2) larvae molt into nymphs
3) nymphs feed on hosts
4) nymphs mature into mating adults
Drag the labels to complete each of the sentences that describe the progression of malaria.
1) Malaria is caused by protozoans in the genus PLASMODIUM, with 5 species largely responsible for the disease in humans. The life cycle of the parasite can be divided into two stages: the ASEXUAL phase that takes place in humans and the SEXUAL phase, which takes place in the MOSQUITO
2) The asexual phase begins when the human is bitten by an Anopheles mosquito, injecting the SPOROZOITES into the capillaries along with an anticoagulant. The cells circulate and enter the liver where they undergo SCHIZOGONY; a form of asexual division producing numerous MEROZOITES within the hepatocytes.
3) When the liver cell ruptures, thousands of merozoites enter the circulation where they infect erythrocytes and convert to TROPHOZOITES. Lysis of erythrocytes releases more merozoites, and this ERYTHROCYTIC phase is responsible for the synchronous symptoms seen in the infected host.
4) The Plasmodium life cycle cannot continue in the human, and the GAMETOCYTES pass back into the mosquito when if feeds on onfected blood
Which of the following diseases is characterized by the formation of a biofilm?
endocarditis
Complete the sentences to review the steps of the multiplication cycle of HIV. Then put the the sentences in the correct order.
1) To begin the multiplication cycle, HIV ABSORBS to receptors on the host cell
2) The virus then enters the cell through the process of ENDOCYTOSIS and then UNCOATS
3) The enzyme REVERSE TRANSCRIPTASE then converts viral RNA into DNA
4) The newly synthesized nucleic acid can enter the host cell genome through the action of the viral enzyme INTEGRASE, leading to a period called latency.
5) The integrated viral genome, or the PROVIRUS, can be reactivated leading to the production of viral mRNA
6) The viral mRNA can then be translated by the host cell, and newly assembled viruses can exit the host cell through the process of BUDDING.
HIV is a retrovirus in the genus Lentivirus. Which of the following is true of retroviruses?
- contain reverse transcriptase
- display structural features of enveloped RNA viruses
- catalyze DNA replication from RNA
Which of the following types of cells are infected and destroyed by HIV?
- B lymphocytes
-
T4 lymphocytes
- T4 monocytes
Which of the following statements by the patient demonstrates a proper understanding of the nurse's teaching about AIDS?
no cure for HIV
Once a diagnosis of HIV is confirmed,which of the following types of drug therapy would the nurse expect to be prescribed?
- prophylaxis for ADIs
- reverse
transcriptase inhibitor
- protease inhibitor
All of the following are essential education points by the RN, except:
restriction on blood donation until viral levels are undetectable
The drug AZT:
inhibits the enzyme reverse transcriptase.
Chemokines appear to inhibit HIV infection by
blocking the CXCR4 and CCR5 coreceptors.
An antiviral factor called ________ has been found in ________ cells.
CAF; CD8
Mutations that inactivate the CCR5 receptor make an individual more susceptible to AIDS.
false
It is hard to create a vaccine against HIV infection because the virus has a high mutation rate.
true
Match the causative agent to the disease that it causes to test your understanding of nonhemorrhagic fever diseases.
- Brucellosis - brucella abortus
- Q fever - coxiella burnetii
- Cat-scratch fever - bartonella henselae
- Rocky Mountain Spotted fever - rickettsia
rickettsii
Label the image with the microbes listed to review the spectrum of infectious diseases of the cardiovascular and lymphatic systems.
Left (top to bottom):
- nonhemorrhagic fever: brucella abortus, rickettsia rickettsii, bartonella henselae
- infectious mono: epstein-barr
- tularemia: francisella tularensis
- Lyme disease: borrelia burgdorferi
- hemorrhagic fever: yello fever, Ebola,
Chikungunya
Right (top to bottom):
- plague: yersinia pestis
- endocarditis: various bacteria
- septicemia: various bacteria & fungi
- malaria: plasmodium
- anthrax: bacillus anthracis
- HIV & AIDS: Human Immunodeficiency Virus 1/2
- chagas: trypanosoma cruzi
Select all of the descriptions that apply to the hemorrhagic disease yellow fever.
- caused by arbovirus
- virus
causes capillary fragility and disrupts blood clotting
- vector is mosquito
Which group of viruses does HIV belong to?
retroviruses
HIV, and related viruses such as HTLV, possess which unusually virally-encoded enzyme?
reverse transcriptase
Proteins that project or stick out from the envelope of HIV and attach or absorb to host cells are called:
spikes
HIV attaches to host cells by binding to:
receptors
If you look inside the core or capsid of HIV, you will find three enzymes: reverse transcriptase, integrase, and:
protease
In order to bind to a host cell, the spikes of HIV have to attach to:
CD4 and co-receptor
In order to make the second strand of DNA when HIV starts replicating inside of a cell:
the original HIV RNA is broken down and its DNA copy is the template for a second strand of DNA
The HIV proviral DNA inserted into the host cell's DNA is used to make:
both viral genome RNA and mRNA
The two viral proteins inserted into the host cell membrane as the virus leaves or buds out of the cell are gp41 and:
gp120
If you can block the effect of HIV protease, you will:
block cleavage of the HIV polyprotein into individual proteins
Which cells possess the receptor complex for gp120, resulting in their destruction and the overall loss of immune function seen in acquired immune deficiency syndrome?
Helper T cells and macrophages
The term "latent" is used to describe some of the HIV virus inside of infected host cells because:
double stranded viral DNA (provirus) is inserted into the host DNA
Choose the statement that describes the normal biota of the cardiovascular system in a healthy state to test your understanding of the cardiovascular system.
no microorganisms colonize the cardiovascular system
Drag and drop the labels into the correct empty boxes to complete the concept map.
Lymphocytes
-
T lymphocytes
-CD4 lymphocytes; CD8 lymphocytes -- infected by: HIV
- carries in capsid: REVERSE TRANSCRIPTASE
- enabling: LATENCY
- as a provirus, over time leads to loss of leukocytes: LEUKOPENIA
- results in loss of SPECIFIC IMMUNITY
- <200 cells/ml:AIDS
- leading to: OPPORTUNISTIC INFECTIONS - B lymphocytes
What is the cause of the cyclic nature of the woman's symptoms?
her symptoms reflect the synchronous rupture of RBCs
If the medical team had the ability to perform more thorough blood tests, what would the nurse expect to find?
hypoglycemia; decreased RBC count
Which part of the following medications would the nurse expect to be ordered for this patient?
Chloroquine
If pharmacological treatment is not successful, what may be the ultimate cause of death?
multiorgan failure
The nurse provides education to the woman's family regarding malaria prevention. All of the following are recommended, except:
washing all bedding and clothing in hot water
Label the image to examine the life and transmission cycle of Plasmodium.
Top to bottom:
1) asexual phase: blood is inoculated w/sporozoites
2) pre-erythrocytic development: schizogony occurs in liver cells generating numerous merozoites
3) Erythrocytic phase: merozoites in the bloodstream invade RBCs and convert to trophozoites, microgametocytes and microgametocytes
4) Sexual phase: fertilization of gametes occurs leading in the development of sporozoites
Select all of the statements that apply to HIV and AIDS.
- HIV can infect and/or destroy many of the very cells needed to combat it, including the helper class of lymphocytes, monocytes, macrophages and even B lymphocytes
- neonates who have escaped HIV prior to and during birth can still become infected through nursing
- ART, the use of multiple simultaneous antiretrovirals, has shown to be an effective treatment and
has reduced the rate of HIV drug resistance
Both innate and specific immune mechanisms protect the cardiovascular system.
True or False
true
Which of the following is the most likely cause of the patient's rash, based upon her reported history and symptoms?
lyme disease
The RN provides education for the patient regarding confirmation of the suspected diagnosis. Which of the following tests is most likely to be ordered?
antibody titer
What further symptoms can emerge if this disease is left untreated?
- arthritis
- neurological symptoms
- cardiac symptoms
Which of the following drug therapies is most effective in early treatment of this disease?
doxycycline and amoxicillin
The patient asks the RN how she may have acquired this disease. Which of the following is the most common vector?
ticks