Chapter 24: Asepsis and Infection Control

Surgical asepsis is defined as:

Absence of all microorganisms

For which client would the use of standard precautions alone be appropriate?

An incontinent client in a nursing home who has diarrhea

About which public health principle should the nurse educate clients to prevent the spread of West Nile virus?

Avoid contact with mosquitos

The nurse is inserting an indwelling catheter. What steps will the nurse distinguish as priority in preventing an infection?

Create an area for sterile field and opening packages

A school nurse is conducting a program for the parents about common childhood illness. Which information do parents need to know about preventing childhood illness?

Early infection treatment is needed to prevent the spread of infection

The client is concerned about "catching the flu". What primary information can the nurse teach the client to best prevent the spread of infection?

Hand hygiene

The nurse prepares for a sterile procedure. Of those listed, what action does the nurse perform first?

Perform hand hygiene

Which is not appropriate regarding the use of gowns as PPE?

Use of one gown per person per shift

Infection occurs when the host is exposed to pathogens. What type of pathogen uses the cell's metabolism, and replicates itself while destroying the cell or changing the cell's genetic makeup?

Virus

The nurse applies an alcohol-based hand rub upon entering the client's room. The client becomes upset stating, "You did not wash your hands!" Which response by the nurse is most appropriate?

"Alcohol-based hand rub provides the greatest reduction in microbial counts on the skin"

An older adult client is admitted into the hospital due to tuberculosis. In addition to standard precautions, which transmission-based precautions should the nurse initiate?

Airborne

When an 86 y/o client reports an inability to concentrate, uneasiness, lightheadedness, weakness, muscle and joint discomfort, and demonstrates normal temperature, the clinic nurse recalls that:

An older adult can have an infection without a fever

The nurse is caring for a client admitted with tuberculosis. What would be the best action by the nurse?

Apply an N95 respirator when entering the room

The nurse is preparing to change a client's sterile dressing. Which action by the nurse would increase the risk for infection?

Applying a new dressing with the gloves that were used to remove the old dressing

The postoperative client refuses to do deep breathing, and he refuses to turn while in bed. He informs the nurse that it hurts for him to do both of these things. Which intervention should the nurse perform first?

Assess client's pain level and manage pain accordingly

The nurse is admitting a client who has a draining wound that is contaminated with staph. What type of precautions should the nurse initiate for this client?

Contact precautions

An acute medicine unit of a hospital currently has a number of clients who have tested positive for MRSA. Which measures should the nursing staff prioritize in preventing the spread of MRSA to clients who are currently MRSA-negative?

Diligent handwashing practices

The nurse has finished caring for a client on contact precautions. Which nursing action regarding the stethoscope used to auscultate this client's lung and bowel sounds is appropriate?

Disinfect it with alcohol swabs

Which nursing action carries the greatest likelihood of contributing to the spread of vancomycin-resistant enterococci (VRE)?

Emptying the foley catheter bag of a client with VRE and then helping the client in the next bed transfer to a chair without washing hands between contact

Which mask should the nurse don when caring for a client with tuberculosis?

Filtered respirator

The nurse is preparing discharge instructions for a family member who will be caring for a client with an abdominal incision. Which concept should be the priority in the teaching plan?

Hand washing

Which nursing action is a component of medical asepsis?

Handwashing after removing gloves

A physician performs a lumbar puncture and advises the nurse to send the obtained cerebrospinal fluid for Gram stains. The nurse understands that this type of testing is beneficial for which reason?

Helps to determine prescribed antibiotic therapy

What is the second line of defense in microbial invasion?

Inflammation

The nurse is receiving a confused client with a draining wound onto the med-surg unit. Which room assignment will the nurse make?

Into a private room

A nurse has been exposed to feces while changing the linens of a client's bed. Which guideline is followed for performing handwashing after this client encounter?

Keep hands lower than elbows to allow water to flow toward fingertip

An infection-control nurse is discussing needlestick injuries with a group of newly hired nurses. The infection control nurse informs the group that most needlestick injuries result from:

Recapping a needle

The nurse is caring for a client who has been placed in strict isolation. Which nursing action is appropriate?

Remove fresh fruit from the room

The nurse observes a UAP collecting a urine specimen from a client with Staph. Which action by the UAP would require the nurse to intervene?

Remove gloves and walk out of the room

The nurse is caring for assigned clients who are all stable. Which client should the nurse see first to minimize the spread of infection?

The client who is 48-hours postsurgical procedure

A nurse is in charge of care for a client who has MRSA. Which guideline is accurate for using transmission-based precautions when caring for this client?

Wear gloves whenever entering the client's room

Which care intervention should the nurse anticipate when providing care to a client admitted with possible TB?

Wearing a particular respirator for all care and interaction with this client

The nurse is reviewing the urine analysis results for the client who is confused and agitated. Which lab result clearly indicates urinary tract infection?

pH of 8.5

The nurse is reviewing the plan of care for assigned clients. Which client has the highest risk for developing an infection?

An older adult client with a history of heart failure

A nursing student is donning sterile gloves to perform routine tracheostomy care for a client. Which behavior by the student would require immediate intervention from the instructor?

Reaches down to pick up a sterile drape

Every 2 hours, the nurse turns and repositions the client who is experiencing frequent diarrhea. This action supports, among other things, infection prevention. Which assessment indicates that there is a positive outcome from this nursing care?

Skin is dry and intact

When the client who has been diagnosed with hepatitis B has been hospitalized, the type of isolation the nursing staff should observe is:

Standard precautions