Chapter 7: asepsis and infection control

7. What should the nurse be diligent in to provide a safe environment for the patient? a. Keeping a light on at night to prevent falls b. Hand hygiene between patient contacts c. Regulating the temperature to avoid drafts d. Changing the bed linen to diminish microorganisms

b. Hand hygiene between patient contacts

16. A nurse is observing isolation precautions by wearing a mask while performing complex patient care. How often should the nurse change masks? a. 5 to 10 minutes b. 10 to 20 minutes c. 20 to 30 minutes d. 30 to 40 minutes

c. 20 to 30 minutes The mask should be changed every 20-30 minutes and/or when they become moist.

8. What does the nurse describe when giving an example of a fomite vehicle? a. Rabid dog b. Person with AIDS c. Contaminated stethoscope d. Infected wound

c. Contaminated stethoscope If a vehicle is an inanimate (nonliving) object, it is called a fomite. Examples: *computers *medical records and charts *stethoscopes *thermometers *bandage scissors *used tissues *drinking glasses *needles *soiled dressings

6. What additional complication does a disease caused by a virus have compared to a disease caused by bacteria? a. Multiplies rapidly. b. Returns frequently. c. Is not killed by antibiotics. d. Is unable to be cultured.

c. Is not killed by antibiotics. Antibiotics do not alter the course of a disease caused by a virus.

33. What type of organism causes malaria? a. Bacterium b. Virus c. Protozoan d. Fungus

c. Protozoan Malaria is caused by the introduction of protozoa from the bite of a mosquito

27. What is the most dependable and practical method to use when sterilizing instruments for the operating room? a. Chemical solution b. Boiling water c. Steam under pressure d. Dry heat

c. Steam under pressure Steam under pressure is the most practical and dependable method for destruction of all microorganisms.

20. The infection control officer is observing hospital staff for appropriate use of aseptic technique. What observation demonstrates the need for more instruction on surgical asepsis? a. Facing the sterile field b. Placing a sterile dressing on a sterile field c. Touching the edges of the sterile field with sterile gloves d. Keeping gloved hands above the waist

c. Touching the edges of the sterile field with sterile gloves The edges of a sterile field are not considered sterile. 1-inch border around the drape must be considered contaminated

21. The nurse is pouring a sterile solution from a bottle. What direction should the label on the bottle be in for appropriate technique? a. Facing outward b. Covered c. Facing downward d. In the palm of the hand

d. In the palm of the hand The bottle should be held with the label in the palm of the hand.

29. The nurse is providing instruction to an anxious mother of a child with Rocky Mountain spotted fever. When discussing this diagnosis, what information will the nurse relay about this disease? a. It is extremely contagious among humans. b. It is contracted from handling unvaccinated animals. c. It is a hemolytic B Streptococcus infection spread by droplet transmission. d. It is a serious disease contracted from the bite of a tick.

d. It is a serious disease contracted from the bite of a tick. Rocky Mountain spotted fever is contracted through the bite of a tick vector. It is not contagious among humans. The ticks live on many different kinds of animals found in rural and wooded areas. Also live in common house pets. Don't crush or squeeze the tick on removal from the skin

1. What is true regarding surgical asepsis? a. It inhibits growth of pathogenic organisms. b. It is known as a cleaning technique. c. It includes hand hygiene. d. It is known as a sterile technique.

d. It is known as a sterile technique. Surgical asepsis is known as sterile technique. Complete removal of all microorganisms, including spores, from an object Inserts IV's, urinary catheters, suctions the patient's airway, applies sterile dressing

13. The nurse has completed a sterile procedure and is preparing to remove the soiled gloves. Place the steps in the correct order. 1. Grasp the outer surface of the glove 2. Place the glove in the hand that is still gloved 3. Peel the second glove off, turn inside out, and discard 4. Take fingers of bare hand and tuck inside remaining glove cuff.

1,2,4,3

10. The nurse is performing a surgical hand scrub. During a surgical hand scrub, how are the hands to be held? 1. Above the elbows 2. With the fingers pointing downward 3. Whichever way is convenient 4. Just below the waist

1. Above the elbows

16. A patient isolated for pulmonary tuberculosis is expressing anger at the nurse. What action by the nurse is most appropriate? (Select all that apply) 1. Provide a dark, quiet room to calm the patient. 2. Explain isolation procedures and provide meaningful stimulation 3. Reduce the level of precautions to keep the patient from becoming angry 4. Limit family and other caregiver visits to reduce the risk of spreading the infection 5. Talk with the patient about how they are feeling

2. Explain isolation procedures and provide meaningful stimulation

7. A middle-aged client is admitted to the hospital with cellulitis of the right foot. Three days later, the patient develops bacterial pneumonia. How would the patient's bacterial pneumonia be classified? 1. Acute primary 2. Health care - associated 3. Interstitial 4. Mycoplasmic

2. Health care - associated

6. A patient in isolation is experiencing signs of social deprivation. Which intervention by the nurse is appropriate? 1. Allow visitors to remove masks while in the patient's room 2. Leave the door of the negative - pressure room open slightly 3. Remind the patient that isolation is for his or her own benefit 4. Set specific times when the nurse will return to the patient's room

4. Set specific times when the nurse will return to the patient's room

39. The nurse reminds a group of nursing students that the type of asepsis that destroys all microorganisms and their spores is _______ asepsis.

Surgical Surgical asepsis destroys all microorganisms and their spores.

5. What bacterium is responsible for more diseases than any other organism? a. Staphylococcus b. Pseudomonas aeruginosa c. Haemophilus influenzae d. Streptococcus

The Streptococcus bacterium is responsible for more diseases than any other organism. Staphylococcus aureus (MRSA) has been proven responsible for a number of serious and sometimes fatal infections.

35. A nurse is performing an admission assessment on a patient with suspected tuberculosis. What is the greatest risk of exposure to tuberculosis? a. After a diagnosis is made b. Before a diagnosis is made c. After the patient has begun medication therapy d. After implementation of isolation precautions

b. Before a diagnosis is made The risk of exposure to tuberculosis is greatest before a diagnosis is made and isolation precautions are implemented. The best way to prevent the transmission is to quickly identify, isolate, and treat the patient. The nurse should suspect a patient has TB if the patient has respiratory symptoms that last longer than 2 weeks.

24. When assessing a patient for signs of an infection, the nurse recognizes which laboratory result as indicative of an infection? a. Lowered red blood cell count b. Increased white blood cell count c. Lowered white blood cell count d. Increased red blood cell count

b. Increased white blood cell count *pain *erythema (redness) *edema (swelling) *drainage or exudate *fever

19. The patient in isolation may experience psychological or emotional deprivation. What should the nurse do to help minimize these feelings? a. Be cheerful. b. Spend extra time with the patient. c. Protect the patient from additional infection. d. Answer the call light quickly

b. Spend extra time with the patient To minimize feelings of psychological or emotional deprivation, the nurse should spend extra time with the patient. Keep room clean and pleasant. Provide instructions about the rationale for the precautions to the patient and family members. Teach the family and visitors how to apply and dispose of any personal protective equipment

32. The nurse is providing teaching to elementary students regarding vectors. What example will the nurse provide as an example of a vector? a. Child with measles giving it to his sister b. Tick whose bite causes Lyme disease c. Woman with syphilis infecting her partner d. Dog whose bite causes rabies

b. Tick whose bite causes Lyme disease A vector is a person or animal not sick with the disease harboring an organism that is contagious. 1. Infectious agent: pathogen, microorganism 2. Reservoir: where the pathogen can grow: vector/carrier 3. Portal of exit (exit route): secretions, feces, blood urine 4. Mode (method) of transmission: vehicle: fomite: hands, contaminated food, air droplets, contaminated needle 5. Portal of entry (entrance): entrance through skin, mucus lining or mouth 6. Host: another person or animal that is susceptible to the pathogen

23. The nurse accidently spills blood from a specimen container. The first action the nurse takes is to don gloves. What should the nurse then spray the fluid with? a. Liquid detergent b. 20% bleach solution c. 10% bleach solution d. Warm soapy water

c. 10% bleach solution Any accidental body fluid spill should be cleaned up as soon as possible. The person cleaning the spill should wear gloves. One cup of bleach diluted with 10 cups of water should be used as a disinfectant to spray over the spill and clean up with paper towels. The paper towels should then be placed in the plastic-lined waste container.

10. The nurse prioritizes the care of four patients. Which patient has a systemic infection? a. 14-year-old with acute appendicitis b. 80-year-old with a urinary tract infection c. 40-year-old with AIDS d. 50-year-old with arthritis

c. 40-year-old with AIDS AIDS is a systemic viral infection. Acute appendicitis and urinary tract infections are local infections. Arthritis is not an infection. *fever *leukocytosis (WBC) *malaise (generalized discomfort) *anorexia *nausea *vomiting *and lymph node enlargement

31. The nurse is instructing a bioterrorism class regarding anthrax. How can anthrax be transmitted? a. From person to person b. Through microscopic skin punctures c. Through inhalation of the spores d. By exposure to animals that have anthrax

c. Through inhalation of the spores Spore-forming bacterium Bacillus anthracis causes acute infectious disease of anthrax. Infection occurs in three forms: *cutaneous (skin) *gastrointestinal *Inhalation Infection is diagnosed when B. Anthracis is detected in blood, skin lesions, or respiratory secretions by culture or measurement of specific antibodies in the blood of infected people

4. A patient with a respiratory infection reports that he is not yet on an antibiotic. The nurse explains that the health care provider is waiting on the results of the culture and sensitivity. What does this test determine? a. What media the bacteria requires to grow b. How fast the bacteria grow c. Which antibiotics stop bacterial growth d. When the bacteria colonize

c. Which antibiotics stop bacterial growth Sensitivity tests are done to determine which antibiotics will stop growth. Laboratory personnel transfer the specimens to a special culture medium that promotes growth. They then study the culture and identify the pathogens. The results of the sensitivity tests assist the practitioner in determining which antimicrobial (antibiotic) medication will inhibit the pathogens growth effectively. Takes up to 48-72 hours to complete

38. A patient is distressed that an antibiotic has not been effective for the control of the infection. The nurse explains that some bacteria are capable of defending against antibiotics by the formation of a _______.

capsule Some bacteria can protect themselves by the formation of a capsule of sticky protein that prevents antibiotics from entering the cell.

11. To practice strict surgical asepsis, the nurse: 1. Adheres to principles of sterile technique 2. Performs routine environmental cleaning 3. Disinfects surfaces that come into contact with body fluids 4. Maintains proper hand hygiene before and after patient care

1. Adheres to principles of sterile technique

3. The nurse is caring for the patient in isolation and plans to wear latex gloves. Which is an important consideration? 1. Assess the patient and the patient's record for potential latex allergy 2. Vinyl gloves actually provide higher barrier protection than latex 3. The cost of latex gloves is significantly higher than that of synthetic gloves 4. Latex gloves are so reliable as barriers that hand hygiene is not required.

1. Assess the patient and the patient's record for potential latex allergy

9. The nurse is planning care for several patients undergoing procedures. For which procedure will the nurse gather supplies to implement surgical asepsis? (Select all that apply) 1. Inserting an IV line 2. Performing perineal care 3. Performing oral care 4. Obtaining a sputum specimen 5. Inserting an indwelling catheter

1. Inserting an IV line 5. Inserting an indwelling catheter

19. The nurse is preparing to open the outer sterile wrap of a indwelling catheter tray. Which flap of the wrap (in which direction) should be opened first? 1. The flap that opens away front he nurse 2. The flap that opens to the left 3. The flap that opens to the right 4. The flap that opens toward the nurse.

1. The flap that opens away front he nurse

1. A young adult patient is admitted to a medical unit with the diagnosis of hepatitis A and placed in contact precautions. What is the primary goal of this action? 1. To prevent transmission of infectious microorganisms 2. To control the environment of the patient during hospitalization 3. To protect the patient from infectious microorganisms 4. To protect only the family from the transmission of the disease

1. To prevent transmission of infectious microorganisms

12. The student nurse is preparing to don sterile gloves. What action by the student indicates understanding of the needed procedure? 1. Touch only the inside surface of the first glove while pulling it onto the hand 2. Place the fingers of the dominant hand into the outside cuff of the first glove 3. Let the cuff of the glove roll up over the hand as it is being pulled onto the hand 4. Begin the procedure by pulling the first glove upward and over the non dominant hand.,

1. Touch only the inside surface of the first glove while pulling it onto the hand

20. The patient asks the nurse how his skin will be sterilized before his surgery. What is the best response by the nurse? 1. We will use alcohol to sterilize your skin 2. It is not possible to sterilize skin, but we will use antimicrobial solution to eliminate most microorganisms 3. There are a series of steps used in sterilizing your skin to prevent you from getting an infection 4. We will use Geraldine solution to sterilize your skin

2. It is not possible to sterilize skin, but we will use antimicrobial solution to eliminate most microorganisms

15. Which is a principle of surgical asepsis? 1. Any sterilized item is considered unsterile once it is allowed to fall below knee height 2. Sterile fields and sterilized items are no longer sterile if they contact a clean surface 3. A person not wearing sterile garments can come no closer to a sterile field than 3 feet 4. The form and back of a sterile gown being worn are considered sterile form shoulders to knees.

2. Sterile fields and sterilized items are no longer sterile if they contact a clean surface

4. The nurse is speaking with a patient about the need to prevent infection. The nurse recognizes the patient understands proper hand hygiene when the patient makes what statement? 1."the water i wash my hands with should be as hot as i can tolerate to kill all of the germs on my skin." 2. " if there isn't time to completely wash my hands, it will be all right to rinse them quickly in want water." 3. "After washing my hands with soap for at least 20 seconds, i will rinse them throughly under running water." 4. "I will put soap into a basin of warm water, lather my hands for 15 seconds,m and then rinse them in the basin."

3. "After washing my hands with soap for at least 20 seconds, i will rinse them throughly under running water."

18. The nurse is presenting an educational program on the CDC's hand hygiene recommendations for implementation in a hospital. Which statement by the nurse demonstrates an understanding of the CDC's recommendation? (Select all that apply) 1. Health care providers will wear gloves at all times when providing patient care 2. Disinfecting hands after glove removal is not necessary according to the guidelines 3. Alcohol-based hand cleaner is effective on hands that are not visibly soiled with blood and body fluids 4. It is necessary to remove waterless alcohol-based hand cleaner with paper towels to remove pathogens from hands 5. The nurse should use water and soap to wash hands after caring for a patient diagnosed with c.Diff

3. Alcohol-based hand cleaner is effective on hands that are not visibly soiled with blood and body fluids 5. The nurse should use water and soap to wash hands after caring for a patient diagnosed with c.Diff

2. The nurse is working in a clinical medical area with a census of 15. Each patient has a different illness. When planning care, the nurse recognizes which as the most important action to provide protection to each patient from health care-associated infections? 1. Wearing a gown 2. Placing each patient in isolation 3. Hand hygiene 4. Wearing gloves

3. Hand hygiene

14. To remove the gloves, what action is required of the nurse? 1. Pull each finger from each of the gloves first, than roll the glove back over the hand. 2. Remove the glove from the non dominant hand by reaching inside the glove and pulling it off 3. Remove one glove, then use the bare fingers to push the remains glove off from inside the cuff. 4. Hold both gloved hands under running water and roll the gloves down to keep microorganisms contained.

3. Remove one glove, then use the bare fingers to push the remains glove off from inside the cuff.

8. The student is reviewing sterile technique. When using the technique, the student nurse remembers to hold sterile objects in which location? 1. Close to shoulder level 2. Just below waist level 3. Over the patient's bed 4. Above waist level

4. Above waist level

5. The nursing instructor is discussing the chain of infection to a group of student nurses. What is the most important information about identifying the chain of infection for the health care provider? 1. Understating of the chain of infection allows for tests to be performed to assess resistance to communicable diseases. 2. Recognition of the chain of infection provides information about which patients will most benefit from isolation precautions 3. The need for antibiotic therapy can be determined by assessing the chain of infection 4. Points at which the infection can be stopped or prevented can be located by identifying the chains of infection

4. Points at which the infection can be stopped or prevented can be located by identifying the chains of infection

17. The nurse is assisting the physician with an irrigation of a draining abdominal wound by preparing the sterile tray. To maintain sterility of the tray which action by the nurse is correct? 1. Use sterile forceps while reaching across it to move the contents around 2. Wear clean gloves to open and touch the contents of the tray 3. Allow the open tray to stand unattended for 20 minutes then cover it with a towel 4. Put on sterile gloves before handling the contents to of the tray.

4. Put on sterile gloves before handling the contents to of the tray.

3. What bacteria can lie dormant when conditions for growth are not favorable? a. Residue b. Capsules c. Spores d. Flagella

C. Spores Spore remains dormant until environmental conditions become favorable for growth. Then the spore germinates and begins reproducing.

30. The emergency department nurse is assessing a puncture wound of the foot. What is the most likely type of infection in this wound? a. Aerobic bacterial infection b. Anaerobic bacterial infection c. Viral infection d. Fungal infection

b. Anaerobic bacterial infection An anaerobic bacterial infection is one that grows in an oxygenated environment.

34. A nurse is performing an admission assessment on a patient with suspected tuberculosis. What assessment findings by the nurse are consistent with tuberculosis? a. Hemoptysis b. Weight gain c. Night terrors d. Hypothermia

a. Hemoptysis Suspicious symptoms consistent with tuberculosis include fatigue, unexplained weight loss, dyspnea, fever, night sweats, and hemoptysis (a cough that can be productive of blood).

13. A health care worker is stuck by a needle left on the patient's bedside table. The staff member appropriately reports the needlestick. What will the indicated treatment be combatting? a. Hepatitis B b. Streptococcal infections c. Staphylococcal infections d. Influenza

a. Hepatitis B Workers who have had a needlestick need to complete an injury report and seek treatment in the event of exposure to hepatitis B.

37. What are some characteristics of microorganisms? (Select all that apply.) a. Involved in a life process of their own. b. Pathogens that cause disease. c. Nonpathologic organisms that cause disease. d. May be infectious. e. Can enter the body via skin, air, or blood.

a. Involved in a life process of their own. b. Pathogens that cause disease d. May be infectious. e. Can enter the body via skin, air, or blood. Microorganisms are involved in a life process of their own, pathogens cause disease, may be infectious, and can enter the body via skin, air, or blood. Nonpathologic organisms do not cause disease.

36. A person can spread a bacterial infection by which actions? (Select all that apply.) a. Kissing others b. Sneezing at work c. Donating blood d. Coming in contact with blood products e. Leaving used tissue on the lavatory

a. Kissing others b. Sneezing at work e. Leaving used tissue on the lavatory Bacteria can be spread by direct, indirect, or airborne transmission. Bacterial infections are transmitted from person to person by direct contact, by inhalation, and by indirect contact contact with articles contaminated with he pathogen. Some also are transmitted through the ingestion of contaminated food and drink.

18. The nurse is transporting a patient in respiratory isolation to the radiology department. What intervention should the nurse implement? a. Cover the patient with a sheet. b. Take the patient down the service elevator. c. Apply a mask to the patient. d. Call x-ray to come and get the patient.

c. Apply a mask to the patient. If a patient requiring respiratory isolation must be transported to another area, the patient must don a mask.

14. What technique should the nurse use when disposing of linens contaminated with feces? a. Don gown, gloves, and mask b. Wash hands for 5 minutes after disposal c. Don gloves only d. Double-bag the sheets

c. Don gloves only All health care workers should follow Standard Precautions to prevent infection from pathogens. Standard Precautions for the disposal of ordinary feces require only that the nurse don gloves. *blood *all body fluids secretions and excretions except sweat *nonintact skin *mucus membrane

12. The infection control health care provider plans an in-service on control of health care-associated infections. What should be the focus of this program? a. Observing nurses caring for patients b. Screening patients who are admitted to the hospital c. Educating hospital personnel about aseptic practices d. Discharging infectious patients from the hospital

c. Educating hospital personnel about aseptic practices Duties of the infection control health care provider include staff education on infection control. OSHA, hospital accrediting agencies, and hospital administration place stron emphasis on infection prevention and control

15. The nurse is instructing a patient about the most important preventive technique for breaking the chain of infection. What technique is the patient learning about? a. Sterilization b. Standard Precautions c. Hand hygiene d. Medical asepsis

c. Hand hygiene Hand hygiene is the most important preventive measure for interrupting the infection process.

9. The nurse is concerned when a patient admitted with a diagnosis of pneumonia suddenly develops a urinary tract infection (UTI). What type of infection is this UTI considered? a. Viral infection b. Bacterial infection c. Health care-associated infection d. Spore infection

c. Health care-associated infection More than 40 million people are admitted to hospitals each year and as many as 10% of them acquire a health care-associated infection while there. Criteria for health care-associated infections require that the infection manifest at least 48 hours after hospitalization or contact with another health agency. *CLABSI *CAUTI *SSI *VAP

26. Recognizing the stages of an infection assists the nurse in identifying the progression of an infection. What is the nonspecific to specific symptom stage of an infection? a. Convalescent b. Illness c. Prodromal d. Incubation

c. Prodromal The prodromal stage progresses from onset of nonspecific signs and symptoms to more specific signs and symptoms. *incubation period: known exposure: interval between entrance of pathogen into body and appearance of first symptom *prodromal stage: pre sickness: malaise, low-grade fever, fatigue *acute stage: sickness: S/S specific to type of infection, most contagious *convalescence: acute symptoms of infection disappear.

17. A major threat to health care workers is blood-contaminated sharps. What should the nurse use to discard the used syringe? a. Wastebasket b. Sink c. Puncture-proof container d. Disinfecting soap

c. Puncture-proof container

25. What can result from the nurse consistently performing hand hygiene and using sterile supplies when caring for patients in the hospital setting? a. Hospital stay is shortened b. Sense of self-worth is improved c. Risk of infection is reduced d. Nursing care needed is reduced

c. Risk of infection is reduced Hand hygiene is the most important measure for interrupting the infectious process.

28. What contribution did Joseph Lister introduce to medical practice? a. Isolation of infected patients b. Iodine and alcohol use as disinfectants c. The autoclave d. Aseptic technique

d. Aseptic technique Joseph Lister contributed to medical practice through the introduction of the aseptic technique.

2. What action exemplifies a nurse practicing medical asepsis in performing daily care? a. Lifting a sterile swab from a sterile field b. Using disposable sterile gowns c. Washing hands for 5 minutes between patients d. Keeping bed linens off the floor

d. Keeping bed linens off the floor Keeping the bed linens off the floor is an example of medical asepsis; all other options are examples of surgical asepsis.

11. What assessment does the nurse recognize as an inflammatory response in a surgical wound on the leg of a patient? a. A foul drainage is coming from the wound. b. The affected leg is cooler than the other leg. c. There are raised, red, pruritic welts on the leg. d. Rubor and edema appear around the wound.

d. Rubor and edema appear around the wound. Rubor and edema are two of the cardinal signs of an inflammatory response. Foul drainage suggests infection, the affected leg being cooler than the other leg suggests circulatory disorder, and raised, red, pruritic welts on the leg suggest allergy. *edema(swelling) *rubor (redness) *heat *pain or tenderness *loss of function in the affected body part

22. What is a method used to kill all microorganisms, including spores? a. Disinfecting b. Using an antiseptic c. Using chlorine bleach d. Sterilizing

d. Sterilizing Sterilization refers to methods used to kill all microorganisms and spores