A faith community nurse is educating new nurses about legal issues.
Which of the following statements by a new nurse indicates an understanding of the teaching?

Choice A rationale

Gonorrhea is a reportable STI in most jurisdictions because of its high transmissibility and potential for serious complications, such as pelvic inflammatory disease and infertility. Public health surveillance is essential for tracking incidence, identifying outbreaks, and implementing control measures to prevent further spread within the community, thereby protecting public health.

Choice B rationale

Genital herpes, caused by the herpes simplex virus, is generally not a nationally notifiable disease. While it is a common STI, its chronic and recurrent nature does not pose the same acute public health risk as reportable STIs. Individual management and prevention education are prioritized over widespread public health surveillance for this condition.

Choice C rationale

Human papillomavirus (HPV) is not a nationally reportable disease in the United States. While certain high-risk types are linked to cervical and other cancers, the widespread nature of the virus and the availability of a preventative vaccine make public health reporting less critical for acute disease control.

Choice D rationale

Trichomoniasis is a very common curable STI but is typically not a reportable disease. Although it can increase the risk of other STIs, it is not subject to the same public health surveillance and mandatory reporting requirements as more dangerous or rapidly spreading infections like gonorrhea or syphilis.

Rationale for correct answers:

Hemolytic uremic syndrome (HUS) is a triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. It typically follows infection with Shiga toxin-producing E. coli O157:H7, especially in children after ingestion of undercooked beef. Bloody diarrhea and abdominal pain are hallmark prodromal symptoms. Lab findings in HUS include:

• Hemoglobin ↓ (<11 g/dL in toddlers)
• Platelets ↓ (<150,000/mm³)
• Creatinine ↑ (>0.5 mg/dL in toddlers)
• LDH ↑ due to hemolysis
• Schistocytes on peripheral smear

Rationale for incorrect Response 1 options:

A. Acute rheumatic fever is a post-streptococcal autoimmune condition affecting joints, heart, and CNS. It does not present with diarrhea or hemolysis.

B. Toxic epidermal necrolysis is a severe mucocutaneous reaction, often drug-induced, with widespread epidermal detachment—not associated with diarrheal illness.

D. Acute appendicitis presents with localized right lower quadrant pain, fever, and vomiting, not bloody diarrhea or hemolytic anemia.

Rationale for incorrect Response 2 options:

A. Post-streptococcal infection causes rheumatic fever or glomerulonephritis, not HUS.

C. Viral enteritis (e.g., rotavirus) causes watery diarrhea without blood or hemolysis.

D. Parasitic infection (e.g., Giardia) causes prolonged watery diarrhea, not bloody diarrhea or HUS.

Take-home points:

• HUS should be suspected in children with bloody diarrhea post E. coli O157:H7 exposure.
• Differentiate HUS from appendicitis, rheumatic fever, and viral/parasitic gastroenteritis based on clinical and lab findings.
• Early recognition is critical to prevent renal failure; monitor CBC, creatinine, and urinalysis.
• Avoid antibiotics and antidiarrheals in suspected E. coli O157:H7 to reduce HUS risk.