4 - 2 Vectorborne

Question 1

11. A patient with chronic lymphatic filariasis is evaluated for lymphedema. Which imaging modality helps assess lymphatic obstruction and may guide treatment?
    A. Lymphoscintigraphy or ultrasound (Doppler/ultrasound evaluation of lymphatics)
    B. Plain chest x-ray only
    C. Upper GI endoscopy
    D. Bone scan

Answer 1

Lymphoscintigraphy and targeted ultrasound can assess lymphatic flow/obstruction and help plan management; chest x-ray/EGD/bone scan are not useful for lymphatic mapping.

Question 2

12. In a patient with suspected malaria, rapid diagnostic tests (RDTs) for HRP2 antigen are positive. What limitation must the clinician consider?
    A. HRP2 RDTs may remain positive for weeks after treatment and may miss some HRP2-deleted strains; microscopy/culture still needed for parasitemia and speciation
    B. RDTs always replace microscopy for speciation
    C. RDTs detect dengue only
    D. RDTs are reliable for bacterial sepsis

Answer 2

HRP2 RDTs are useful for quick detection of falciparum but can remain positive post-treatment and may miss parasites with HRP2 gene deletion; microscopic confirmation and quantification remain important.

Question 3

13. Which clinical presentation most suggests chikungunya rather than dengue in the acute phase?
    A. Severe debilitating symmetric polyarthralgia often outlasting the fever
    B. Early profuse bleeding and shock
    C. Massive hepatosplenomegaly only
    D. Night sweats and weight loss over months

Answer 3

Severe persistent joint pain that can be disabling is a hallmark of chikungunya; bleeding/shock point more toward severe dengue; chronic wasting is not typical acutely.

Question 4

14. A febrile patient has eosinophilia on CBC after travel to a tropical area. Which vector-borne infection should be strongly considered?
    A. Filarial infection (lymphatic filariasis) or other helminths
    B. Viral dengue only
    C. Malaria exclusively (always with eosinophilia)
    D. Bacterial pneumonia only

Answer 4

Eosinophilia is typical for helminthic infections such as filariasis; dengue and malaria do not typically cause eosinophilia.

Question 5

15. A newborn born to a mother with recent chikungunya infection develops fever and poor feeding. Which diagnostic approach is appropriate?
    A. Test neonate for chikungunya by PCR/serology and manage supportively; consider evaluation for vertical transmission complications
    B. Assume immunity and do nothing
    C. Test for malaria only
    D. Immediate empiric antimalarial therapy without testing

Answer 5

Vertical transmission can occur—PCR/serology in neonates is appropriate to detect infection; assumption of immunity or empiric antimalarials without evidence is inappropriate.

Question 6

16. A patient suspected of having dengue has a normal platelet count but increasing ALT/AST. What does this suggest about disease stage or severity?
    A. Hepatic involvement is possible even without early thrombocytopenia; transaminases may be elevated and correlate with severity in some cases
    B. Normal platelets always rule out dengue
    C. Elevated transaminases always indicate malaria
    D. AST/ALT are unaffected in arboviral infections

Answer 6

Dengue commonly causes transaminitis; platelets may not drop early—elevated liver enzymes can indicate hepatic involvement and correlate with more severe disease in some patients.

Question 7

17. A patient with chronic elephantiasis is evaluated for secondary bacterial infections. Which clinical/diagnostic feature will the nurse expect?
    A. Recurrent cellulitis episodes, local warmth, erythema, and systemic signs; wound cultures may identify bacterial pathogens
    B. Persistent high parasitemia on blood smear only
    C. Viral PCR positivity only
    D. Unrelated chest pain

Answer 7

Chronic lymphedema predisposes to recurrent cellulitis and skin infections; blood smears do not capture secondary bacterial superinfection.

Question 8

18. A febrile returning traveler presents with severe thrombocytopenia, mucosal bleeding, and hemoconcentration. Which immediate diagnostic step is most time-sensitive?
    A. Rapid dengue testing (NS1/PCR) and urgent hematologic monitoring for bleeding, plus fluid status assessment
    B. Urine pregnancy test only
    C. Skin biopsy only
    D. Routine cholesterol panel

Answer 8

In suspected severe dengue with bleeding, rapid dengue diagnostics and immediate monitoring of platelets, hematocrit, and volume status are time-sensitive to guide resuscitation.

Question 9

19. A patient with suspected lymphatic filariasis has a negative peripheral blood smear for microfilariae. What additional diagnostic options can support the diagnosis?
    A. Antigen detection assays (eg, circulating filarial antigen), ultrasonography for “filarial dance sign,” or repeated/timed smears
    B. Sputum AFB smear only
    C. Immediate MRI of brain only
    D. Skin prick allergy tests

Answer 9

Negative smears do not exclude filariasis; circulating antigen tests, ultrasound, or repeated/timed smears increase sensitivity.

Question 10

20. A patient with suspected severe malaria has normal peripheral smears but high clinical suspicion persists. What is the next best diagnostic step?
    A. Repeat thick smear and perform PCR or send for expert microscopy; consider starting empiric antimalarial therapy while repeating testing if severe disease suspected
    B. Dismiss malaria entirely
    C. Only order chest CT
    D. Begin antibiotics for bacterial pneumonia only

Answer 10

Malaria can be missed on a single smear; repeat smears, PCR, or expert review are indicated, and empiric antimalarials may be necessary if severe malaria is suspected.

Question 11

21. A patient in an area endemic for dengue and chikungunya has overlapping symptoms—fever, rash, arthralgia. Which diagnostic strategy best differentiates these infections?
    A. Use PCR/antigen detection (early) and IgM/IgG serology (later) for each virus, plus clinical feature weighting (prominent arthralgia favors chikungunya; plasma leakage favors dengue)
    B. Treat empirically for bacterial sepsis only
    C. Rely on CBC alone to differentiate
    D. Use stool culture

Answer 11

Differentiation relies on specific viral PCR/antigen and serology tests plus clinical features; CBC alone or stool cultures are inadequate.

Question 12

22. Which chest/abdominal imaging finding may be seen in severe dengue with plasma leakage?
    A. Pleural effusion and ascites on ultrasound or chest x-ray due to third-spacing
    B. Lobulated lung mass only
    C. Renal cysts exclusively
    D. Intracranial hemorrhage only

Answer 12

Pleural effusions and ascites reflect plasma leakage and are common imaging findings in severe dengue; the other options are not typical.

Question 13

23. A pregnant woman in a malaria area has fever; which diagnostic approach is preferred given pregnancy?
    A. Prompt blood smear (thick/thin) and rapid diagnostics; treat promptly if positive because malaria is dangerous in pregnancy
    B. Delay testing until postpartum
    C. Only test for dengue first
    D. Use only urine tests

Answer 13

Malaria in pregnancy is high risk; immediate blood smears and RDTs and timely treatment are critical—delaying testing is unsafe.

Question 14

24. A child with suspected dengue presents with vomiting, lethargy, and abdominal pain. Which bedside diagnostic or monitoring finding is most predictive of progression to severe dengue?
    A. Rapidly rising hematocrit with narrowing pulse pressure and progressive hypotension
    B. Mild cough only
    C. Elevated hemoglobin with normal vitals
    D. Isolated rash

Answer 14

A rising hematocrit with hemodynamic changes (narrow pulse pressure, hypotension) indicates plasma leakage and risk for shock—signals progression to severe dengue.

Question 15

25. A clinician suspects co-infection with malaria and dengue in a febrile traveler. Which diagnostic principle should guide testing?
    A. Test for both pathogens concurrently (blood smears/RDTs for malaria and NS1/PCR/serology for dengue) because co-infections occur and management differs
    B. Test for one and assume the other is absent
    C. Only test for filariasis first
    D. Wait one month before testing

Answer 15

Co-infections occur; concurrent testing for both malaria and dengue is warranted because management and complications differ.

Question 16

1. A patient with suspected severe dengue presents with hypotension and rising hematocrit. What is the nurse’s priority intervention?
   A. Initiate isotonic crystalloid fluids immediately
   B. Restrict fluids
   C. Administer IM injections
   D. Start diuretics

Answer 16

Severe dengue with hemoconcentration indicates plasma leakage and impending shock; priority is prompt isotonic fluid resuscitation. Diuretics and fluid restriction worsen shock; IM injections increase bleeding risk.

Question 17

2. A febrile patient is diagnosed with falciparum malaria and has altered mental status. What is the nurse’s priority?
   A. Maintain airway patency and prepare for immediate IV antimalarial therapy
   B. Delay treatment for test confirmation
   C. Provide NSAIDs only
   D. Observe overnight without intervention

Answer 17

Altered mental status in malaria = cerebral malaria, a medical emergency. Airway management and immediate IV antimalarial therapy are critical.

Question 18

3. A patient with chikungunya complains of debilitating joint pain. What is the most appropriate nursing intervention?
   A. Provide NSAIDs and supportive measures; encourage gentle ROM exercises
   B. Start high-dose steroids routinely
   C. Withhold pain management
   D. Start antibiotics

Answer 18

Chikungunya requires supportive care with NSAIDs for pain and inflammation. Steroids and antibiotics are not routine unless otherwise indicated.

Question 19

4. Which intervention is most appropriate to prevent mosquito bites in a dengue outbreak area?
   A. Use daytime protective measures and insect repellents containing DEET or picaridin
   B. Sleep without nets
   C. Avoid repellents in children
   D. Wear dark clothing only

Answer 19

Aedes mosquitoes bite during the day, so repellents and daytime protection are essential.

Question 20

5. A patient in the critical phase of dengue begins vomiting blood. What should the nurse do first?
   A. Notify the provider, prepare for blood products, and continue hemodynamic monitoring
   B. Encourage oral hydration alone
   C. Insert IM medications
   D. Start anticoagulants

Answer 20

GI bleeding requires urgent escalation: notify provider, prepare for blood transfusion, monitor vitals. IM injections and anticoagulants are contraindicated.

Question 21

6. A patient undergoing treatment for malaria begins to seize. What is the nurse’s immediate priority?
   A. Protect airway, prevent injury, and prepare for IV antimalarials and anticonvulsants
   B. Hold patient down
   C. Start oral meds
   D. Ignore unless prolonged

Answer 21

Seizures in malaria signal cerebral involvement. Airway protection and urgent treatment are essential.

Question 22

7. Which intervention is appropriate for a patient with acute lymphangitis from filariasis?
   A. Provide analgesics, warm compresses, hydration, and treat secondary bacterial infection if present
   B. Apply cold therapy only
   C. Restrict all movement
   D. Delay care until swelling resolves

Answer 22

Acute filarial lymphangitis is managed with warm compresses, pain control, hydration, and antibiotics if bacterial infection is suspected.

Question 23

8. A patient with malaria is receiving IV artesunate. What should the nurse monitor closely?
   A. Parasitemia levels, hemolysis risk, and signs of delayed hemolysis
   B. Sodium levels only
   C. Lung sounds exclusively
   D. Thyroid function

Answer 23

IV artesunate requires monitoring for parasite clearance and potential hemolysis (including delayed hemolysis).

Question 24

9. A patient with suspected severe dengue has a platelet count of 20,000/mm³. Which intervention is appropriate?
   A. Avoid IM injections and minimize invasive procedures
   B. Start heparin therapy
   C. Promote vigorous physical activity
   D. Insert arterial line immediately

Answer 24

Thrombocytopenia with bleeding risk requires avoiding unnecessary invasive procedures.

Question 25

10. A child diagnosed with malaria is vomiting and unable to tolerate oral medication. What should the nurse anticipate? A. Transition to parenteral antimalarial therapy B. Continue oral therapy regardless C. Use antiemetics only D. Delay all medications

Answer 25

Children with severe vomiting need parenteral therapy to ensure effective drug absorption.

Question 26

11. A patient presents with suspected dengue. Which intervention is essential before administering NSAIDs? A. Avoid NSAIDs due to bleeding risk; use acetaminophen instead B. Give ibuprofen immediately C. Combine NSAIDs with aspirin D. Give steroids

Answer 26

NSAIDs/aspirin increase bleeding risk; acetaminophen is preferred for fever/pain in dengue.

Question 27

12. A patient with filarial lymphedema asks how to prevent progression. What education is essential? A. Practice meticulous skin hygiene and daily lymphatic care B. Wear tight tourniquets C. Avoid washing the limb D. Drain edema at home with needles

Answer 27

Lymphatic filariasis requires daily hygiene, moisturization, elevation, exercise, and infection prevention. Needling is unsafe.

Question 28

13. A nurse monitors a malaria patient receiving oral therapy. Which finding indicates treatment failure? A. Persistent parasitemia on repeated smears after 48–72 hours B. Initial fever persisting for 24 hours only C. Mild fatigue D. Temporary nausea

Answer 28

Parasitemia persisting beyond 48–72 hours indicates drug resistance or failure, requiring regimen reassessment.

Question 29

14. What is the nurse’s priority when caring for a patient with severe dengue who is transitioning from the febrile to critical phase? A. Vigilant monitoring of fluid balance, hematocrit, urine output, and perfusion B. Withhold fluids completely C. Encourage IM injections for pain D. Rely only on fever curve

Answer 29

The febrile → critical transition is dangerous due to plasma leakage; careful monitoring prevents shock.

Question 30

15. A patient with chikungunya has persistent joint pain months after infection. Which intervention is appropriate? A. Encourage low-impact exercise, NSAIDs, and possibly rheumatologic referral B. Start long-term steroids without evaluation C. Avoid all movement permanently D. Withhold analgesics

Answer 30

Chronic chikungunya arthritis benefits from NSAIDs, gentle mobility, and specialist evaluation.

Question 31

16. After initiating artesunate, the nurse notes dark urine and jaundice several days later. What is the priority action? A. Evaluate for post-artesunate delayed hemolysis and obtain labs (Hgb, LDH, bilirubin) B. Continue therapy without evaluation C. Give high-dose steroids D. Perform chest x-ray only

Answer 31

Delayed hemolysis is a known complication; early recognition prevents severe anemia.

Question 32

17. A patient with severe malaria is receiving IV fluids. What is an important nursing consideration? A. Avoid fluid overload due to risk of pulmonary edema/ARDS B. Give unlimited fluids C. Use diuretics frequently D. Avoid monitoring lung sounds

Answer 32

Severe malaria patients are at risk for pulmonary edema, so fluid management must be cautious.

Question 33

18. A patient with filarial fever presents with axillary lymphadenitis. What intervention is appropriate? A. Provide analgesics, anti-inflammatory therapy, hydration, and assess for bacterial superinfection B. Apply ice only C. Withhold all medications D. Begin antimalarials

Answer 33

Acute adenolymphangitis needs anti-inflammatory therapy and supportive care, not antimalarials.

Question 34

19. A nurse caring for a dengue patient must administer IV fluids. What principle guides safe fluid therapy? A. Use minimally effective volumes to avoid fluid overload; adjust based on hematocrit and perfusion B. Use unlimited fluids to normalize BP quickly C. Aim for diuresis immediately D. Give colloids first-line

Answer 34

Overhydration can cause pulmonary edema in dengue; fluids must be controlled and titrated.

Question 35

20. A malaria patient develops hypoglycemia. What is the best intervention? A. Give IV dextrose and monitor glucose closely B. Restrict carbohydrate intake C. Encourage fasting D. Ignore unless unconscious

Answer 35

Malaria (especially with quinine/quinidine) can cause hypoglycemia, requiring prompt correction.

Question 36

21. A dengue patient reports severe abdominal pain. What is the nurse’s priority action? A. Assess for signs of plasma leakage or early shock and notify provider B. Provide antacids only C. Encourage spicy foods D. Reassure without assessment

Answer 36

Severe abdominal pain is a warning sign of severe dengue, requiring urgent evaluation.

Question 37

22. A patient receiving antimalarial therapy becomes oliguric. What should the nurse do? A. Evaluate renal function and notify provider; assess for acute kidney injury B. Provide diuretics without evaluation C. Increase exercise D. Ignore unless anuria occurs

Answer 37

Malaria (especially falciparum) can cause AKI; oliguria warrants immediate assessment.

Question 38

23. A patient with filarial lymphedema asks about exercise. What should the nurse teach? A. Gentle, regular movement enhances lymphatic flow and reduces swelling B. Avoid all exercise C. Only high-impact exercise helps D. Exercise increases parasite load

Answer 38

Lymphedema management includes gentle exercises to promote lymph flow.

Question 39

24. A patient with suspected severe chikungunya presents dehydrated. What should the nurse do? A. Encourage adequate hydration and monitor for kidney involvement B. Limit fluids C. Ignore hydration status D. Initiate anticoagulation

Answer 39

Hydration prevents renal complications and supports recovery.

Question 40

25. A child with severe dengue begins to show narrowing pulse pressure and tachycardia. What is the nurse’s best response? A. Prepare for aggressive but controlled IV fluid resuscitation and continuous hemodynamic monitoring B. Delay intervention until BP drops further C. Give IM medications D. Encourage oral fluids only

Answer 40

Narrowing pulse pressure is an early sign of shock; prompt IV fluid intervention is lifesaving.

Question 41

1. A patient is diagnosed with falciparum malaria and is unable to take oral medications due to persistent vomiting. Which treatment is most appropriate? A. IV artesunate therapy B. Oral chloroquine only C. Herbal supplements D. IM NSAIDs

Answer 41

Severe malaria or inability to tolerate oral therapy requires IV artesunate, the recommended first-line treatment. Oral agents or non-antimalarial medications will not treat the parasite effectively.

Question 42

2. A patient with mild dengue asks whether they can take ibuprofen for fever. What should the nurse teach? A. Avoid NSAIDs because of bleeding risk; use acetaminophen for fever and pain instead B. NSAIDs are preferred C. Aspirin is safe D. All fever reducers are contraindicated

Answer 42

Dengue increases bleeding risk; NSAIDs and aspirin must be avoided. Acetaminophen is the safe option for fever.

Question 43

3. A patient with lymphatic filariasis is prescribed DEC (diethylcarbamazine). What should the nurse monitor for during treatment? A. Mazzotti-type reactions caused by immune response to dying microfilariae B. Hyperthyroidism C. Hearing loss only D. Weight gain

Answer 43

DEC can trigger inflammatory reactions to dying parasites (fever, lymphangitis, rash) requiring monitoring and symptomatic management.

Question 44

4. A traveler diagnosed with malaria is prescribed primaquine. Which safety check is essential before administration? A. Screening for G6PD deficiency B. Checking for penicillin allergy C. Fasting blood glucose D. Hepatitis B status

Answer 44

Primaquine can cause hemolysis in G6PD deficiency, so testing is required before prescribing.

Question 45

5. A patient with chikungunya has severe joint pain persisting for weeks. Which treatment approach is appropriate? A. NSAIDs and supportive therapy; consider rheumatology referral if persistent B. High-dose antibiotics C. Long-term corticosteroids for all patients D. Stop all pain medication

Answer 45

Chikungunya management is supportive; NSAIDs and gentle activity are first-line. Chronic arthritis may require specialist referral.

Question 46

6. A patient being treated for malaria develops severe hypoglycemia. Which medication may be contributing? A. Quinine or quinidine therapy B. Acetaminophen C. Azithromycin D. Vitamin C

Answer 46

Quinine and quinidine increase insulin release → hypoglycemia, especially in pregnant women.

Question 47

7. A pregnant patient in a malaria-endemic region requires prophylaxis. Which medication is commonly used for intermittent preventive treatment in pregnancy (per WHO/CDC region guidelines)? A. Sulfadoxine-pyrimethamine (where resistance patterns allow) B. Tetracycline C. Primaquine D. Ivermectin

Answer 47

Sulfadoxine-pyrimethamine is used for intermittent preventive treatment in pregnancy (IPTp) in many regions where effective; primaquine is contraindicated in pregnancy.

Question 48

8. A patient with severe dengue develops fluid overload while receiving IV fluids. What is the correct nursing action? A. Reduce or stop fluids and reassess hemodynamics immediately B. Continue high-rate fluids C. Push more colloids immediately D. Add diuretics only

Answer 48

Dengue fluid therapy must be carefully titrated. Fluid overload requires reducing or stopping fluids, monitoring vitals, and notifying the provider.

Question 49

9. A malaria patient is started on artemisinin-based combination therapy (ACT). What is the rationale for using combination treatment? A. To reduce resistance and ensure parasite clearance B. For faster fever reduction only C. Because monotherapy is always harmless D. To reduce need for follow-up

Answer 49

ACTs pair artemisinins with partner drugs to prevent resistance, ensuring effective parasite clearance.

Question 50

10. A patient prescribed doxycycline for malaria prophylaxis asks how to take the medication. What is correct teaching? A. Take daily with food and avoid lying down immediately after; continue for 4 weeks after travel B. Take only when symptomatic C. Stop upon leaving endemic area D. Take with dairy products only

Answer 50

Doxycycline prophylaxis must be taken daily, with food, upright, and continued 4 weeks post-travel due to the parasite liver cycle.

Question 51

11. A patient with lymphatic filariasis is prescribed ivermectin. What is its primary therapeutic role? A. Reduces microfilariae levels to prevent transmission B. Kills adult worms instantly C. Restores lymphatic drainage D. Treats viral co-infections

Answer 51

Ivermectin rapidly reduces microfilariae, helping control transmission; it does not reliably kill adult worms.

Question 52

12. A patient with severe chikungunya asks for opioid analgesics due to chronic joint pain. Which response is appropriate? A. Use opioids cautiously and only if NSAIDs fail; consider rheumatology evaluation for chronic arthritic complications B. Start high-dose opioids immediately C. Avoid all pain therapy D. Opioids cure the infection

Answer 52

Opioids may be used cautiously for severe pain but treating inflammation and referring to specialists remains essential.

Question 53

13. A patient with falciparum malaria is switched to oral therapy after stabilization. What is the nurse’s priority instruction? A. Complete the full course of antimalarial therapy even if symptoms resolve B. Stop medication once fever breaks C. Take medications only when feeling fatigued D. Skip evening doses

Answer 53

Stopping antimalarials early leads to treatment failure and resistance; completing the full course is critical.

Question 54

14. A patient diagnosed with dengue requires pain control. Which medication should be avoided? A. Aspirin and NSAIDs B. Acetaminophen C. Oral hydration solutions D. Vitamin supplements

Answer 54

Aspirin and NSAIDs increase bleeding risk in dengue, so they must be avoided.

Question 55

15. A patient with chronic filarial lymphedema asks about long-term treatment. Which intervention is appropriate? A. Regular hygiene, limb elevation, compression therapy, and prophylactic antibiotics if recurrent infections occur B. Daily steroids for everyone C. High-protein diet only D. No long-term care needed

Answer 55

Chronic filariasis requires lymphedema management — hygiene, compression, elevation, exercise, and sometimes antibiotics to prevent cellulitis.