Chapter 24: Asepsis and Infection Control PrepU

A nurse is reviewing a client's complete white blood cell (WBC) count and differential. The nurse determines that the client is experiencing neutropenia based on which absolute neutrophil count? -1,100 cells/mm3 -1,500 cells/mm3 -800 cells/mm3 -1,800 cells/mm3

800 cells/mm3 Neutropenia is present when the absolute neutrophil count (ANC) falls to fewer than 1,000 cells/mm3. Therefore, a result of 800 cells/mm3 indicates neutropenia.

What is the second line of defense in microbial invasion? -Disease -Infection -Inflammation -Disability

Inflammation The inflammatory response makes up the second line of defense to microbial invasion.

A nurse is applying the principles of Standard and Contact Precautions in the care of a hospital client. Which action violates these principles? -The nurse performs hand hygiene after touching the client's surroundings. -The nurse removes her gown and then removes her gloves. -The nurse applies nonmedicated hand cream after performing hand hygiene. -The nurse performs hand hygiene before putting on gloves.

The nurse removes her gown and then removes her gloves. Gloves should be removed prior to a gown. Hand hygiene is necessary before applying gloves and after touching a client's surroundings. The use of moisturizers is acceptable.

The nurse is caring for a client who developed pneumonia while hospitalized. How will the nurse document this condition? -infectious disease -health care-associated infection (HAI) -community-acquired infection -contagious disease

health care-associated infection (HAI) HCAI, the most common adverse event in hospitals, are acquired within healthcare facilities. Community-acquired infections occur in the community. Infectious and contagious can be acquired in any setting.

The nurse observes a member of the nursing assistive personnel who is removing personal protective equipment (PPE) in the client's room, as seen in the image above. What education should the nurse provide to this member of the care team? -"Avoid touching the outside of your gown when removing it." -"It's best to let me assist you with removal of your gown." -"You should remove your mask before you remove your gown." -"Whenever possible, remove your PPE outside the client's room."

"Avoid touching the outside of your gown when removing it." To prevent contamination, the outside of a gown should not be handled during removal. Gown removal should take place in the client's room, and the mask is not normally removed first. Assistance is not usually required with removal of a gown.

A client who has had repeated infections asks the nurse what he can do to improve his ability to resist infection. Which suggestion would be least appropriate for the nurse to give? "Limit your intake of water each day to about 4 to 5 glasses." "Make sure to get enough sleep at night." "Keep your skin well-moistened with creams" "Try to eat lots of fruits and vegetables."

"Limit your intake of water each day to about 4 to 5 glasses." Measures to prevent infection include keeping skin moist with creams and adequate hydration, including 8 glasses of water per day, getting enough sleep, and eating foods rich in vitamins and minerals.

The friend of a long-term care client comes to visit despite having an upper respiratory infection. What health teaching will the nurse share with the visitor? -"If you wash your hands before coming in contact with your friend you will prevent infection during your visit." -"You should not visit your friend if you have an infection of any kind because your friend may also get sick." -"Please get a mask from the staff upon entry and use a mask along with hand hygiene when visiting to prevent the spread of infection to your friend and others." -"As long as you cough and sneeze into the bend of your elbow you won't spread the infection to your friend."

"Please get a mask from the staff upon entry and use a mask along with hand hygiene when visiting to prevent the spread of infection to your friend and others." Visitors with respiratory infections need to wear a mask until their symptoms have subsided. The other options do not control transmission of airborne or droplet infections. Hand hygiene is appropriate and should be encouraged but used alone it won't prevent the spread of an airborne or droplet infection.

A client admitted for fever, crackles in the lungs, and cough asks the nurse, "If they do not know what type of bacteria caused my pneumonia, why are they giving me these antibiotics?" What is the appropriate response by the nurse? -"We give antibiotics to treat the virus that are causing your the pneumonia." -"We are giving you broad spectrum antibiotics because they are active for many types of bacteria." -"You cannot be admitted to the hospital with pneumonia without receiving some sort of antibiotics." -"The antibiotics we are giving you will boost your immune system and help fight off whatever pathogen is presen

"We are giving you broad spectrum antibiotics because they are active for many types of bacteria." Many bacteria are susceptible to broad-spectrum antibiotics and prior to the diagnosis of a specific bacteria, a broad-spectrum antibiotic will be prescribed to help eradicate the present bacteria until a culture result is returned. A client may be admitted to the hospital with pneumonia without receiving antibiotics, although it is likely that an antibiotic will be given at some point during hospitalization. Antibiotics do not boost the immune system and may destroy normal healthy flora. Antibiotics are used to treat bacterial infections, not viral infections; antibiotics do not kill viruses.

The nurse is caring for a client on the unit. During change of shift, another nurse is observed doing what is pictured in the image. What is the most important reason this technique does not adhere to the standards of care for dressing changes? -Promotes coolness to the site, which further constricts blood flow -Increases the risk of infection by contaminating the wound -Causes an uncomfortable sensation to the client's skin -Reduces itching to the wound as it is healing

Increases the risk of infection by contaminating the wound Using the mouth to blow air into a wound bed or to dry the wound edges does not adhere to the standards of care or of ethics for nurses. This action will increase the risk of wound contamination and the wound is more likely to become infected as our mouths and the air we blow out harbors many kinds of bacteria that can adhere to the wound and increase the risk for infection and contamination. Every effort should be taken into consideration to use sterile equipment, solutions and medical aseptic, or clean technique to remove old dressings. Coolness to a site decreases blood flow and to heal a wound more blood flow to the site assists with healing and reducing the risk of infection. Blowing on a wound bed may cause a uncomfortable sensation to the skin or funny sensation but it will not reduce the risk of the infection. The effect of the blowing sensation and contaminants in to the wound bed demonstrates non-adherence to the standards of safe and effective wound care and management.

A client has a diagnosis of HIV. Which statement would concern the nurse? -I often spend time with and hug my young nieces and nephews. -I enjoy preparing meals for my family. -My dog likes to roam the neighborhood and often eats from garbage cans. -I use the same bathroom as the rest of my family.

My dog likes to roam the neighborhood and often eats from garbage cans. HIV is a viral infection that impairs the immune system, making individuals with the virus more likely to acquire infectious diseases. A dog who roams the neighborhood and eats from garbage cans is likely to pick up a bacterial infection, which can easily be spread to the individual with HIV. The virus is spread through exposure to blood and body fluids of an infected person. Using the same bathroom as family members, preparing their meals, or hugging them does not place them at risk for being infected with the virus.

The nurse prepares for a sterile procedure. Of those listed, what action does the nurse perform first? -Check that the packaged kit is dry and unopened. -Put on personal protective equipment, if required. -Perform hand hygiene. -Set up a work area at waist level.

Perform hand hygiene. When preparing for a sterile procedure, the nurse will perform hand hygiene followed by any personal protection equipment, if required. Next, the nurse confirm the client's identity with the order and explains the procedure to the client. Then, the nurse the will check that the sterile package or kit is dry and unopened as well as the expiration date. Next, the nurse will set up a work area at waist level or higher followed by opening the outside package and remove the kit.

A client is to have an indwelling urinary catheter inserted. Which precaution is followed during this procedure? -Surgical asepsis technique -Strict reverse isolation -Droplet precautions -Medical asepsis technique

Surgical asepsis technique Surgical asepsis technique is the technique followed to insert an indwelling urinary catheter. Surgical asepsis techniques, used regularly in the operating room, labor and delivery areas, and certain diagnostic testing areas, are also used by the nurse at the client's bedside. Procedures that involve the insertion of a urinary catheter, sterile dressing changes, or preparing an injectable medication are examples of surgical asepsis techniques. An object is considered sterile when all microorganisms, including pathogens and spores, have been destroyed. Medical asepsis, or clean technique, involves procedures and practices that reduce the number and transfer of pathogens. Medical asepsis procedures include performing hand hygiene and wearing gloves. Strict reverse isolation is an isolation technique where the client is protected from the nurse, other health care providers, and visitors. A client that has immune system disorders, in which the client might not be able to fight off an organism, would be kept in an environment to minimize exposure to the organism. Droplet precaution is a technique where appropriate personal protective equipment (PPE) is worn so as not to carry the organism via droplet from exposed client to others.

A client has tested positive for methicillin-resistant Staphylococcus aureus after being swabbed on admission to the hospital. Bacterial resistance to antibiotics is an example of: -Spore production -Survival adaptation -Aerobic activity -Means of transmission

Survival adaptation An example of adaptation for survival is the development of antibiotic-resistant bacterial strains of Staphylococcus aureus, Enterococcus faecalis, E. faecium, and Streptococcus pneumoniae. Bacterial resistance is not demonstrated by aerobic activity. Spore production is another form of adaptation. Means of transmission is a component of the chain of infection, not an example of bacterial resistance.

Personal protective equipment (PPE) is used in health care facilities for primarily which reason? -To protect both the staff and clients from becoming infected by one another -To protect clients from becoming infected by staff members -To protect the hospital from legal liability -To protect staff members from becoming infected by clients

To protect both the staff and clients from becoming infected by one another

What is the most common client site for development of healthcare-associated infections (HAI)? -Urinary tract -Respiratory tract -Bloodstream -Surgical wound

Urinary tract The urinary tract is the most common site for healthcare-associated infections (HAI).

A client with cancer has been receiving chemotherapy for the past few weeks. The nurse is concerned about infection and is reviewing the white blood cell count (WBC) in the chart. Which result supports this concern? -WBC of 7,500 mcL -WBC of 25,000 mcL -WBC of 5,500 mcL -WBC of 10,500 mcL

WBC of 25,000 mcL Leukocytes, also called white blood cells (WBCs), and the inflammatory response make up the second line of defense to microbial invasion. A normal WBC count is 5,000 to 10,000 cells/mm3. A count above this range is indicative of infection.

The nurse is preparing to change a client's sterile dressing. Which action by the nurse would increase the risk for infection? -describing each step verbally to the client before performing the dressing change -ensuring that the surface where the sterile field will be set up is dry -applying a new dressing with the gloves that were used to remove the old dressing -checking that the sterile dressing packages are intact before opening

applying a new dressing with the gloves that were used to remove the old dressing Gloves should be changed after removing the old dressing prior to putting on a sterile dressing, because the microorganisms from the old dressing can be transferred to the new dressing. The nurse should explain the procedure to the client before beginning and not during. The nurse should avoid talking over a sterile field as well as turning his or her back on sterile field to discuss the procedure with the client. The nurse should check that the packages are intact, ensure that the surface is dry, and open all packages before donning sterile gloves.

The nurse and a colleague have admitted a client who is on contact precautions. The nurse and colleague are removing their personal protective equipment and the nurse sees the colleague perform the pictured action. What is the nurse's most appropriate response? -maintain a distance of at least 5 ft (1.5 m) from the colleague -encourage the colleague to remove the glove by grasping the cuff -teach the colleague why the gloves should be removed outside the room -take no action at this time

encourage the colleague to remove the glove by grasping the cuff The colleague should grasp the outside of one glove with the opposite gloved hand and peel the glove off, turning it inside out while peeling it off. The glove should not be pulled by the fingers, because this is unlikely to remove the glove and it may snap back. Personal protective equipment should normally be removed while inside the room, and there is no need to maintain a wide distance from the colleague.

A physician performs 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 -permits selection of antibiotic concentration -helps in reducing proliferation of multidrug-resistant organisms -narrows the therapeutic range to avoid prolonged use

helps to determine prescribed antibiotic therapy Gram staining helps to order antibiotic therapy while waiting for specific culture results, whereas minimum inhibitory concentration permits selection of antibiotic concentration, helps in reducing proliferation of multidrug-resistant organisms, narrows the therapeutic range, and avoids prolonged use.

A nurse is working with a 55-year-old woman diagnosed with human immunodeficiency virus (HIV). This nurse has another client that day who has an upper respiratory infection. What is the most important thing the nurse can do to prevent the client with HIV from acquiring the upper respiratory infection? -perform hand hygiene before and after entering the client's room -wear gloves when touching the client -wear a mask and gown in the client's room -avoid direct contact with the client

perform hand hygiene before and after entering the client's room Hand hygiene is the most important way to prevent transmission of infection.

A client is experiencing generalized weakness and body aches. In the progress of infection, the client is in the: -prodromal period -convalescent period -incubation period -acute period

prodromal period The prodromal period is characterized by nonspecific symptoms such as nausea, fever, general weakness, or aches and pains.

The nurse notices a student preparing to enter the room of a client with pulmonary tuberculosis with only gloves on. What is the appropriate nursing intervention? -offer the student a mask -remind the student that a fitted N95 respirator is required -teach that a gown and shoe coverings must be worn in addition to gloves -do nothing, as the precautions observed are appropriate

remind the student that a fitted N95 respirator is required A fitted N95 respirator must be worn in addition to other precautions when caring for clients with pulmonary tuberculosis. The other answers do not recommend the appropriate precautions that must be used for this type of infection.

A 70-year-old client with chronic obstructive pulmonary disease (COPD) has a respiratory infection being treated with antibiotics. He is also taking oral corticosteroids to assist in decreasing the inflammation in the lungs. The client is prone to: -purpura. -respiratory distress. -superinfection. -nausea and vomiting.

superinfection. Drug therapy can cause defects in the host's response to infection. Steroids, chemotherapy, antimetabolites, and inappropriate or prolonged use of antibiotics can increase the risk of infection.

A nurse is palpating the cervical lymph nodes of a client with a suspected upper respiratory infection. Which finding would help to support the suspicion of an infection? -tenderness -0.5 cm in diameter -soft to touch -mobile

tenderness Normally, cervical lymph nodes are smaller than 1 cm in diameter, soft, and mobile. Tenderness on palpation would suggest a problem, such as infection.

A pediatric client's caregiver states, "I will never give my child vaccinations." What is the priority nursing response? -"Has your child received any previous vaccinations?" -"Transmission of certain diseases is halted with vaccination." -"Vaccinations prevent disease." -"Help me understand your thoughts about vaccinations."

"Help me understand your thoughts about vaccinations." Seeking to understand the caregiver's perspective helps the nurse to collect assessment data and create a therapeutic relationship of trust. The nurse could then collect assessment data regarding past vaccines and provide appropriate teaching.

The nurse is caring for a client who is to have a sterile dressing change to a wound. A student nurse enters the client's room and notices the nurse preparing the sterile field. After reviewing the image, which response by the student nurse to the nurse is the most accurate understanding of this procedure? -"It is okay to turn the drape on the other side." -"Using either side of the drape is okay, as long as you do not contaminate the sterile supplies on the field." -"The way you are doing it helps to minimize contamination of the non-waterproof side." -"I use my whole hand to touch the non-waterproof surface before placing the sterile equipment on it."

"The way you are doing it helps to minimize contamination of the non-waterproof side." The sterile drape is to be positioned with the drape on work surface with the moisture-proof side down. It is important that only a sterile object touch another sterile object. Unsterile touching results in contamination of the sterile field. If this occurs, the procedure should be started again with new supplies. It is not okay to turn the drape on the other, non-waterproof side. This action will increase the risk for contamination.

The nurse has admitted a client on airborne precautions onto the medical-surgical unit. When the client asks, "When will these airborne precautions be removed?" what is the appropriate nursing response? -"When your sputum culture is negative." -"Until you leave the hospital." -"Only until you begin to feel better." -"For 2 days as you get settled onto the unit."

"When your sputum culture is negative." The client will be on airborne precautions until a sputum culture is negative. The other answers are incorrect.

The nurse is educating a client with human immunodeficiency virus (HIV) about ways the virus can be transmitted. Which statements made by the client demonstrates the education provided was effective? Select all that apply. -"I may transmit the virus to my child during pregnancy and childbirth." -"I may transmit the virus if I share needles with another person." -"If someone is exposed to my blood, I may transmit the virus to him or her." -"If I sweat at the gym and someone touches me, he or she can contract the virus." -"If someone uses the bathroom after I have been on the toilet, he or she can catch the virus.

-"If someone is exposed to my blood, I may transmit the virus to him or her." -"I may transmit the virus to my child during pregnancy and childbirth." -"I may transmit the virus if I share needles with another person." The client has demonstrated that an understanding of the transmission of the virus may occur through exposure to blood, during pregnancy and childbirth, and through sharing of needles. Transmission of the virus does not occur through sweat or by exposure on a toilet seat. The virus is fragile and does not live on inanimate objects.

The nurse is caring for a postoperative client in contact isolation. Which actions should the nurse employ to reduce the spread of disease? Select all that apply. -Place used syringes and uncapped needles in a puncture-resistant -container after use. -Use sealed items from the client's room when caring for other clients. -Instruct the client to ambulate in the hall several times a day. -Wear clean gloves when performing a sterile dressing change. -Wash hands after removing gloves before leaving the client's room.

-Wash hands after removing gloves before leaving the client's room. -Place used syringes and uncapped needles in a puncture-resistant container after use. Limiting the spread of disease when a client is in contact isolation includes using gloves and washing hands before leaving the client's private room. The nurse should wear sterile gloves when performing a sterile dressing. The nurse follows standard precautions by placing used syringes and uncapped needles into a puncture-resistant container. Although the client is postoperative, the client is in contact isolation, so the nurse needs to instruct the client to remain in the room to prevent spread of the infection to others through contact. The nurse cannot use items from the client's room, including sealed items, because of the risk of spreading the infection through contact.

Which client would the nurse consider the most infectious? -A client who is in the full stage of illness -A client who is in the prodromal stage -A client who is in the convalescent period -A client who is in the incubation period

A client who is in the prodromal stage The client is most infectious during the prodromal stage of the illness. Early signs and symptoms of disease are present, but these are often vague and nonspecific, ranging from fatigue and malaise to a low-grade fever. This period lasts from several hours to several days. During this phase, the client often is unaware of being contagious. As a result, the infection spreads. The incubation period is the interval between the pathogen's invasion of the body and the appearance of symptoms of infection. During this stage, the organisms are growing and multiplying. The length of incubation may vary. The presence of specific signs and symptoms indicates the full stage of illness. The type of infection determines the length of the illness and the severity of the manifestations. The convalescent period is the recovery period from the infection. Convalescence may vary according to the severity of the infection and the client's general condition. The signs and symptoms disappear, and the person returns to a healthy state.

What is an accurate guideline for removing soiled gloves after client care? -Use the nondominant hand to grasp the opposite glove, near the cuffed end on the outside exposed area. -After removing the first glove, slide the fingers of the ungloved hand between the remaining glove and the wrist and pull the glove straight off, with the contaminated area on the outside. -Remove the glove on the nondominant hand by pulling it straight off, keeping the contaminated area on the outside. -After removing the glove on the nondominant hand, hold the removed glove in the remaining gloved hand.

After removing the glove on the nondominant hand, hold the removed glove in the remaining gloved hand. When removing gloves, the dominant hand is used to grasp the opposite glove near the cuff end on the outside exposed area. It is pulled off and inverted, with the contaminated area on the inside. The removed glove is held in the remaining gloved hand. Then, the fingers of the ungloved hand are slid between the remaining glove and the wrist, and the glove is pulled off and inverted.

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 -Place water-soluble lubricant on catheter tip prior to insertion -Ensure opening port of the catheter is closed -Wash the perineal area with soap and water

Create an area for sterile field and opening packages Pathogens require a portal of entry to cause infection. Insertion of an indwelling urinary catheter is a sterile technique; any contamination could cause a portal of entry. Using water-soluble lubricant on catheter tip prior to insertion is correct but will not prevent an infection nor will closing the opening port. Likewise, washing the perineal area with soap and water will reduce microorganisms but will not prevent infection alone.

When preparing a sterile field, the nurse notes that the bottle of sterile saline was opened 48 hours ago and is half full. What action does the nurse take to ensure that the saline used is sterile? -Since the bottle has been open, previously used, and unexpired, "lip" it by pouring a small amount into a waste container or waste cup. -Pour the saline into a sterile container on the sterile field by holding it 6 in (15 cm) above the container. -Discard the bottle and get a new one because the saline has expired. -Use the saline for the procedure and discard the remaining amount because it has been 48 hours since opening.

Discard the bottle and get a new one because the saline has expired. Once a bottle of sterile saline is open, the contents must be used within 24 hours of opening. Lipping the opening of the bottle and pouring the saline into a sterile container by holding it 6 in (15 cm) above the container would be appropriate, but contents in the bottle are expired. The nurse should discard the bottle and get a new one.

Nurses working in bed management are assigning clients from the emergency room to semiprivate rooms. Clients with which two diagnoses are appropriate to room together, based on safety and infection control standards? -Reactive airway disease and exacerbation of chronic obstructive pulmonary disorder (COPD) -Tuberculosis and pneumonia -Appendectomy and a draining leg ulcer positive for methicillin-resistant Staphylococcus aureus -Clostridium difficile and diabetic ketoacidosis

Reactive airway disease and exacerbation of chronic obstructive pulmonary disorder (COPD) Reactive airway disease and exacerbation of COPD are both medical diagnoses and not communicable conditions. Clients with these conditions can room together. C. difficile requires contact isolation and is contagious. Diabetic ketoacidosis is considered a medical diagnosis and requires standard precautions. A surgical incision from an appendectomy is considered clean. A draining leg ulcer can transmit an infection to a client with a clean surgical incision. In both of these cases, rooming these clients together violates infection control standards. Tuberculosis requires airborne precautions and pneumonia requires standard precautions. Based on the mode of transmission of tuberculosis, these clients cannot room together.

The nurse is preparing a sterile field for a dressing change. How would the nurse add paper-wrapped sterile items to the sterile field? -Open the package away from the field. -While wearing sterile gloves, unwrap the package and add to the field. -Separate the sealed flaps and drop contents onto field. -Set up another sterile field for the additional items.

Separate the sealed flaps and drop contents onto field. Once a sterile field is set up, only sterile items can be placed on the field. To add paper-wrapped sterile items, after performing hand hygiene, the nurse would open the items by separating the sealed flaps and dropping the contents onto the sterile field. Wearing sterile gloves to open the package would containment the gloves. Opening the package away from the field would containment the sterile field. It is not necessary to set up a separate sterile field.

The nurse is teaching a new nurse about preparing a sterile field. Which action made by the new nurse would indicate further teaching is required? -The sterile field is set up at waist level. -The top flap of the package is opened away from the new nurse's body. -The new nurse touches 1.5 in (4 cm) from the outer edges. -Direct visualization of the sterile field is maintained.

The new nurse touches 1.5 in (4 cm) from the outer edges. Only the outer 1 in (2.5 cm) of the sterile package is safe to touch. In this case, the nurse touches 1.5 in (4 cm), which is inside the sterile field. It is necessary to call for help if supplies are needed before leaving the sterile field unattended and never turn away from a prepared field so direct visualization is imperative to protect the sterility. The top flap of the sterile packaging should always be opened away from the body.

Personal protective equipment (PPE) is used in health care facilities to protect the staff from potentially infected clients. -True -False

True PPE protects both the health care worker and clients from infection. It use interrupts the chain of infection.

Which client would require a negative flow room? -a 3-year-old with influenza A and a productive cough -a 21-year-old man with latent tuberculosis who is postoperative following repair of a femoral fracture -a 4-year-old boy with meningitis -an 81-year-old man with active tuberculosis and a productive coug

an 81-year-old man with active tuberculosis and a productive cough Active tuberculosis always requires a negative flow room.

The nurse is reviewing the plan of care for assigned clients. Which client has the highest risk for developing an infection? -a school-age child who is current with immunizations -a middle-aged adult who takes prescribed medication to control blood pressure -an adolescent who has a right radial fracture -an older adult client with a history of heart failure

an older adult client with a history of heart failure Many factors affect the risk for infection, including age, sex, race, and heredity. Neonates and older adults, especially those who have pre-existing illnesses, appear to be more vulnerable to infection. School-age children are exposed to potential infections, but immunizations protect the child. An adolescent with a fracture or middle-aged adult taking medication to control blood pressure could develop an infection, but these clients are not at the highest risk.

The most lethal infection in an older adult client is: -optic. -urinary. -otic. -skin.

urinary. Urinary tract infections and respiratory infections are most common and most lethal for older adult clients.