Monkeypox Virus: 2022 Outbreak Clinical Considerations and Stigma : Journal of the Association of Nurses in AIDS Care

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Monkeypox Virus: 2022 Outbreak Clinical Considerations and Stigma

Journal of the Association of Nurses in AIDS Care: November/December 2022 - Volume 33 - Issue 6 - p e37-e38
doi: 10.1097/JNC.0000000000000371


  • Read the articles on pages 657 and 668.
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Disclosure Statement: The authors and planners have disclosed that they have no financial relationships related to this article.

The author of the article, “Monkeypox Virus Outbreak 2022: Key Epidemiologic, Clinical, Diagnostic, and Prevention Considerations” discusses the off-label use of tecovirimat.


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DOI: 10.1097/JNC.0000000000000371

Learning Outcome: Seventy-five percent of participants will demonstrate competency in clinical reasoning regarding the 2022 monkeypox virus outbreak and its associated stigma by achieving a minimum score of 70% on the outcomes-based posttest.

Learning Objectives: After completing this continuing professional development activity, the participant will apply knowledge gained to a case scenario to:

  •    1. Identify the appropriate assessment guidelines for monkeypox.
  • 2. Choose the correct information to give patients about prevention and treatment.
  • 3. Define the elements of stigma associated with monkeypox.
  • 4. Select the appropriate actions for educating individuals about monkeypox.

Questions 1 through 10 are related to the article, “Monkeypox Virus Outbreak 2022: Key Epidemiologic, Clinical, Diagnostic, and Prevention Considerations”

Case-Based Scenario: Place yourself in the role of a nurse in a community health clinic. You are evaluating D.L., a 28-year-old man who is living with HIV and reports an exposure 3 days ago to a man who has just been diagnosed with monkeypox (MPX). Apply the knowledge and skills learned in the attached article to answer questions #1 through #10.

  • 1. D.L. is asymptomatic, but he asks you how long it will take for symptoms to appear, if he has been infected with MPX. You explain that
    • a. if he was infected, he would have some symptoms by now.
    • b. he could develop symptoms anytime from 5 to 21 days after exposure to the virus.
    • c. it generally takes as long as 1 to 2 months to develop the characteristic rash of MPX.
  • 2. D.L. tells you that he seems to get rashes frequently, so he wants to know what the MPX rash looks and feels like. You tell him that the MPX lesions
    • a. do not itch or hurt.
    • b. start out soft and puffy, like a hive.
    • c. are flat at first, with clear boundaries.
  • 3. D.L. asks if he will start feeling like he’s getting sick before he gets the rash. You explain that some people do develop symptoms before the rash, typically characterized by fatigue and
    • a. fever.
    • b. diarrhea.
    • c. headache.
  • 4. D.L. becomes increasingly concerned and says he wants to be tested to see if he is infected. You tell him that
    • a. testing will require a blood sample.
    • b. you will swab his nasal passages for the test.
    • c. you cannot test him until he develops lesions you can swab.
  • 5. D.L. says he wants to have a prescription for a drug he can take to prevent getting sick. You tell him that there is no approved preventive anti-viral drug available, but there is one that is investigational and can be prescribed for emergency use, but only if he does get sick. You tell him that drug is called
    • a. cidofovir.
    • b. tecovirimat.
    • c. brincidofovir.
  • 6. Because D.L. is within 4 days of exposure, you offer him the JYNNEOS vaccine, and he consents to receiving it. You tell him that side effects from the vaccine are typically mild and most often include
    • a. fatigue.
    • b. tremors.
    • c. dizziness.
  • 7. Despite D.L. receiving the vaccine, you advise him to take further precautionary measures, including
    • a. isolating immediately.
    • b. checking his temperature twice a day for 21 days.
    • c. beginning to take ibuprofen daily for at least three weeks.
  • 8. D.L. asks how long he will be contagious if he develops MPX. You explain that the virus can be transmitted to others
    • a. only while the blisters are draining fluid.
    • b. until he notices that no new blisters are appearing.
    • c. until all the scabs fall off and a fresh layer of skin has formed.
  • 9. Although D.L. will not be returning to his infected friend’s home until his friend has recovered completely, he is concerned about how his friend needs to “decontaminate” his living space. You tell him that one of the steps his friend must take is to
    • a. dust or sweep all surfaces in the home.
    • b. dispose of all his bed linens and towels in a sealed plastic bag.
    • c. launder all his clothing according to the manufacturer’s instructions.
  • 10. D.L. tells you he has one more question: “If I do get monkeypox and I do take the experimental antiviral drug, what about my ART?” Because D.L. takes doravirine as part of his antiretroviral therapy (ART), you explain that he will
    • a. may need a temporary increase in his doravirine dosage.
    • b. may need a temporary decrease in his doravirine dosage.
    • c. not need any changes to his ART.

Questions 11 through 20 are related to the article, “Combating Stigma in the Era of Monkeypox - Is History Repeating Itself?”

  • 11. According to Ducharme et al. (2022), people diagnosed with MPX describe feelings of
    • a. anger.
    • b. isolation.
    • c. helplessness.
  • 12. Link and Phelan (2001) stated that infection with the MPX virus causes a visible rash that can lead to which type of stigma specifically?
    • a. felt
    • b. tribal
    • c. enacted
  • 13. Ducharme et al. (2022) reported that people with MPX symptoms report being
    • a. clinically mishandled.
    • b. at high risk for suicidal ideation.
    • c. in denial about the possibility of having MPX.
  • 14. MPX-related stigma has potential job-related consequences because confirmed MPX cases require isolation for
    • a. 1 to 2 weeks.
    • b. 2 to 4 weeks.
    • c. 4 to 6 weeks.
  • 15. Using the label “MPX immune” about oneself
    • a. is inaccurate because no one is ever immune.
    • b. is unquestionably an indication of stigma.
    • c. can lead to stereotyping and judgment.
  • 16. Mintz & Moore (2022) stated that, for healthcare providers to obtain an accurate health history of a patient exposed to or infected with MPX, they should
    • a. assume a sex-positive attitude.
    • b. request an interview with the patient’s partner.
    • c. educate the patient about the risk factors in their lifestyle.
  • 17. Education campaigns about MPX should emphasize that
    • a. MPX is primarily sexually transmitted or limited to MSM.
    • b. being white can offer some protection from acquiring MPX.
    • c. anyone in close personal contact with MPX can acquire MPX.
  • 18. The Centers for Disease Control and Prevention (CDC) has stated that providers who wish to prescribe the experimental antiviral drug for treating MPX must
    • a. confirm that the patient is extremely ill.
    • b. request it through state and local health departments or the CDC.
    • c. first prescribe effective pain management and appropriate clinical care.
  • 19. It is essential that clinicians inform patients diagnosed with MPX that it is a reportable disease and that
    • a. it is necessary for the process of contact tracing to take place.
    • b. it is their prerogative to decline consent for reporting their infection.
    • c. other parts of their otherwise confidential health record must also be disclosed.
  • 20. When a stigmatizing incident occurs in a healthcare setting, it should be
    • a. minimized to avoid further stigmatization.
    • b. treated as a serious event and used for debriefing.
    • c. put into context as expected when an outbreak is new.

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