NU 231 chapter 24 - Asepsis and Infection Control - prep questions

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Which piece of personal protective equipment (PPE) should be removed first? Gown Gloves Respirator Goggles

The order for removal of PPE is gloves, goggles, gown, and respirator. If removal of PPE is not in that order, contamination of the nurse can occur.

Which client should the nurse determine is at greatest risk for vancomycin-resistant enterococci (VRE) infection? Client on a short course of vancomycin Client with a history of eczema Client receiving chemotherapy Client in the ICU for one day

Client receiving chemotherapy

The community nurse is educating a family about infection control measures. What teaching will the nurse include? Select all that apply. Wear personal protective equipment (PPE) when appropriate. Keep the entire living environment as clean as possible. Standard precautions should be used when family members have active infections. Hand hygiene is not needed in the home environment. Do not share drinking glasses with family members who are ill.

Wear personal protective equipment (PPE) when appropriate. Standard precautions should be used when family members have active infections. Do not share drinking glasses with family members who are ill. Keep the entire living environment as clean as possible.

A nurse is caring for four clients. Which client has the highest risk of infection? young woman with a history of scoliosis woman in second trimester of pregnancy older male with an enlarged prostate toddler with a benign heart murmur

older male with an enlarged prostate

During an interaction with a client who is HIV-positive, the nurse learns that the client has nonspecific symptoms such as nausea, fever, general weakness, and aches and pains. The nurse interprets these findings as reflecting which stage of the communicable period? Convalescent period Prodromal period Acute phase of illness Incubation period

Prodromal period

The nurse is caring for several clients assigned single rooms on a medical-surgical unit. In which client(s) can the nurse safely carry out hand hygiene using hand sanitizer instead of washing hands with soap and water? Select all that apply. The nurse has just completed documentation and is entering another client's room. The nurse is exiting a room after completed indwelling urinary catheter care. The nurse has entered the client's room to adjust settings on the intravenous pump. The nurse has assisted a client with changing and caring for a new colostomy. The nurse is going from one room to another to introduce themself at the start of the shift.

The nurse is going from one room to another to introduce themself at the start of the shift. The nurse has entered the client's room to adjust settings on the intravenous pump. The nurse has just completed documentation and is entering another client's room.

A new perioperative nurse is being educated regarding surgical asepsis. What observations by the preceptor would indicate that there is a need for reinforcement of the principles of asepsis? Select all that apply. The nurse disposes of an opened container of sterile saline after 24 hours. The nurse is talking with the scrub nurse over the sterile field. The nurse's back is facing the sterile field. The nurse keeps hands above waist level while donning sterile gloves. The nurse touches an unsterile object to the instrument tray.

The nurse's back is facing the sterile field. The nurse touches an unsterile object to the instrument tray. The nurse is talking with the scrub nurse over the sterile field.

The nurse is initiating isolation precautions for a client who has chronic Clostridium difficile infection. What should the nurse be sure to include with these precautions? be sure that there are gloves of various sizes and gowns for use recognize that this type of infection requires droplet precautions remind others to use a mask when caring for this client include a N95 respirator mask for health care staff entering the room

be sure that there are gloves of various sizes and gowns for use

The nurse is providing care to a client who is hospitalized for uncontrolled diabetes and performs the following activities. Which activity(ies) would it be recommended for the nurse to wear clean gloves? Select all that apply. taking the client's vital signs touching the identification band when verifying the client's name administering subcutaneous insulin based on the glucose level assisting the client to the bathroom performing a fingerstick to check the blood glucose level

performing a fingerstick to check the blood glucose level administering subcutaneous insulin based on the glucose level

The client presents to the Emergency Department reporting fever, chills, and a productive cough. The chest x-ray shows an area of infiltrate, and the primary care provider prescribes a broad spectrum antibiotic. Which client teaching statement from the nurse is most appropriate regarding the prescribed drug? "This antibiotic causes fewer side effects than a narrow spectrum antibiotic." "Pneumonia is usually caused by multiple organisms." "Drug resistance can develop when the wrong antibiotic is used for pneumonia." "This antibiotic is the best choice since the causative organism is not known."

"This antibiotic is the best choice since the causative organism is not known."

A nursing instructor is preparing a class to discuss the different types of white blood cells. What would the instructor most likely include as granulocytes? Select all that apply. Basophils T-Lymphocytes Monocytes Neutrophils Eosinophils

Basophils Neutrophils Eosinophils

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. removing the staples from a VRE-positive, postoperative client's incision without prior handwashing sending a VRE-positive client to the radiology department for a chest X-ray without a face mask delivering a meal tray to a VRE-positive client without first donning gloves and a gown

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.

A nurse is caring for a client with ringworm. Which microorganism causes ringworm in a client? Protozoans Rickettsiae Helminths Fungi

Fungi

A group of nursing students is reviewing the various white blood cells and how they function in infection. The students demonstrate understanding of the information when they identify which cell as important in synthesizing immunoglobulins? T-lymphocytes Monocytes Neutrophils Eosinophils

T-lymphocytes

The nurse is caring for a client who has an infection spread by respiratory droplets and is under droplet precautions. Which precautions should the nurse take? Ensure all visitors wash their hands upon entering the room Use a gown when within 3 ft (1 m) of the client Implement full isolation protocol while client is contagious Use a mask when within 3 ft (1 m) of the client

Use a mask when within 3 ft (1 m) of the client

A nurse is preparing an education plan for a client being discharged home after successful treatment for a wound infection. What would the nurse be least likely to include in the education plan? hand hygiene measures signs and symptoms of infection intravenous antibiotic administration vital sign monitoring

intravenous antibiotic administration

Which statement about neonatal development is accurate? Breast-fed infants do not become ill due to immunity. Neonates prefer sleeping and often refuse to eat. Neonates have defense to communicable disease. Neonates may have an infection without fever.

Neonates may have an infection without fever. Newborns have immature thermoregulatory mechanisms and do not become febrile.

The nurse is caring for a client with a cough and copious secretions. Before providing care, the nurse observes the licensed practical nurse (LPN) standing outside the client's room and donning personal protective equipment as shown above. How should the nurse best interpret the LPN's actions? Gloves should be worn while putting on a mask and goggles. The LPN is donning personal protective equipment appropriately. The LPN should put on goggles prior to putting on the mask. The LPN should don personal protective equipment inside the client's room.

This nurse is applying PPE correctly; PPE should be donned before entering this client's room, and it is appropriate to put on the mask before the goggles. Gloves are donned after the mask and goggles.

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? putting on gloves hand washing sterile technique signs of healing

hand washing Hand washing technique is the single most important procedure in reducing the spread of microorganisms from either the client to the surroundings or the surroundings to the client. A client does not need to learn a sterile technique for the abdominal incision. Most client procedures are related to clean handing and do not need gloves to be added to a dressing change. The nurse should review signs of infection and healing of the abdominal incision.

A nurse instructs a new mother on immunizations. An immunization produces: active immunity humoral immunity passive immunity antigen immunity

active immunity

Which are the names of the transmission-based precautions defined by the Centers for Disease Control and Prevention (CDC)? Select all that apply. contact precautions microbial precautions body fluid precautions airborne precautions droplet precautions respiratory precautions

airborne precautions droplet precautions contact precautions

A client is diagnosed with hepatitis C. What statement made by the client indicates that further education is required regarding the transmission of the virus? "I received a blood transfusion in 1989, which could be a factor in contracting the disease." "I probably got the virus when I sat on the toilet seat in a dirty bathroom." "I may have gotten the virus when I got a tattoo while I was in prison." "I can't transmit the virus other people if I shake their hands."

"I probably got the virus when I sat on the toilet seat in a dirty bathroom."

A nurse has finished giving care to a client who has a communicable respiratory infection. In which order should the personal protective equipment (PPE) be removed? 1. Gloves 2. Respirator 3. Gown 4. Goggles

1, 4, 3, 2

After meeting with the family to give an update on the surgical client, the nurse shakes their hands before leaving. Which method of hand hygiene is most appropriate following this encounter? Mixture of soap and alcohol-based hand rub techniques Soap and water hand washing technique Alcohol-based hand rub Scrubbing hands with soap, water, and brush

Alcohol-based hand rub

The nurse determines that which client is at greatest risk for a wound infection? A two-day postoperative client An infant with intact skin An older adult client with dry skin A client with a urinary catheter

A two-day postoperative client

The nurse is speaking to the physician regarding the client's frequent diarrhea episode since starting IV antibiotics. The nurse states "I am concerned that Mr. Clark has developed Clostridium Difficile infection". Which part of the SBAR communication will this statement fall into?

A= Assessment

A nurse has finished providing care for a client who is on contact precautions. When removing the protective gown, the nurse should take which action? Remove the gown before removing gloves. Perform hand hygiene before removing the gown. Avoid touching the outer surfaces of the gown. Remove the gown immediately after exiting the room.

Avoid touching the outer surfaces of the gown

A nurse has finished providing care for a client who is on contact precautions. When removing the protective gown, the nurse should take which action? Perform hand hygiene before removing the gown. Remove the gown immediately after exiting the room. Avoid touching the outer surfaces of the gown. Remove the gown before removing gloves.

Avoid touching the outer surfaces of the gown.

An older adult client has been receiving care in a two-bed room that he has shared with another older, male client for the past several days. Two days ago, the client's roommate developed diarrhea that was characteristic of Clostridium difficile. This morning, the client himself was awakened early by similar diarrhea. The client may have developed which type of infection? Iatrogenic Antibiotic-resistant Exogenous healthcare-associated Endogenous healthcare-associated

Exogenous healthcare-associated The client's suspected infection originated with another person (exogenous) and was contracted in the hospital (healthcare-associated). It was not the result of his treatment (iatrogenic) and C. difficile is not an antibiotic-resistant microorganism. Endogenous infections originate from within the organism and are not attributed to an external or environmental factor.

An older adult hospitalized client develops severe diarrhea from gram-negative rods that compromised the normal flora of the bowel. What is the cause of the infection?

Healthcare-associated infection (HAI) Gram-negative rods, which comprise much of the bowel's normal flora, are associated with healthcare-associated infections caused by self-contamination.

A nurse is applying the principles of standard precautions on a hospital unit. In which instances should the nurse perform hand hygiene? Select all that apply. Before touching a surface in a common area Immediately after touching a client Before performing a clean procedure Between each phase of a client's assessment After touching a client's surroundings

Immediately after touching a client Before performing a clean procedure After touching a client's surroundings

A client receiving multi-antibiotic treatment is reporting oral thrush and refuses to eat his meals. Which intervention must the nurse perform next? Encourage the client to brush his teeth 3 times a day. Assess for the expiration dates of the antibiotics being administered. Inform the client that the antibiotics will resolve this problem. Inform the physician about this finding.

Inform the physician about this finding

Following a demonstration to a family member on how to insert a straight catheter, the nurse instructs the family member to remove the gloves by inverting one glove into the other. Which step would the nurse instruct the family member to do next? Don a new pair of gloves to dispose of materials Wrap all used materials together and discard in biohazard container Use an appropriate lotion that does not interfere with antimicrobial effect of gloves or soaps Perform hand hygiene

Perform hand hygiene

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

Perform hand hygiene.

The nurse suspecting that a client has an infected surgical wound should assess for which sign? Select all that apply. Pain Redness Exudate Coolness Swelling

Redness Swelling Pain Exudate

Which action is the best example of a nurse donning/removing protective equipment properly? Donning gown after entering client's room Removing respirator after leaving client's room Removing gown after leaving client's room Donning respirator inside of client's room

Removing respirator after leaving client's room The best example of proper utilization of protective equipment is the removal of a respirator after leaving the client's room, as doing so prevents contact with airborne microorganisms. Gowns should be removed before leaving the client's room. Gowns and respirators should be donned prior to entering the client's room.

The client is an employee on the medical unit at the local children's hospital. The nurse is an occupational health nurse educating the client on various routes of exposure. The nurse knows that as a hospital employee, the client is most susceptible to infection by what mode of transmission? vehicle droplet contact airborne

contact

A student nurse is performing hand washing in the clinical setting. Which observation would require the nursing instructor to intervene? has manicured nails that are 1-in. (2.5-cm) long washes hands for 15 seconds wets hands and wrists drains hands lower than the wrist

has manicured nails that are 1-in. (2.5-cm) long

A nurse is assessing a client for signs and symptoms of infection. What would the nurse expect to asses? Select all that apply. absence of pain decreased pulse rate increased respiratory rate lymph node enlargement fever

increased respiratory rate lymph node enlargement fever

The nurse is educating a client and caregivers about recurrent infections the client has experienced. What priority intervention can the nurse include that is a first line of defense? the cell-mediated immune response staying home when sick early intervention with antibiotics low levels of flora intact skin and mucous membranes

intact skin and mucous membranes

A nurse has collected the blood, urine, and stool specimens of a client with meningococcal meningitis. Which precaution should the nurse take when transporting the specimens? wear gloves and a gown when transporting the specimen swab the outside of each specimen container with alcohol prior to transport place the specimens into plastic biohazard bags place each of the three sealed specimens in a separate paper bag

place the specimens into plastic biohazard bags

The nurse has worn a gown and gloves while caring for a client in contact isolation. How will the nurse appropriately remove this personal protective equipment (PPE)? remove gown, remove gloves, wash hands remove gloves, remove gown, wash hands remove gloves, wash hands, remove gown remove gown, wash hands, remove gloves

remove gloves, remove gown, wash hands

The nurse notes that the client's temperature is 101.2°F (38.4°C) at 8 a.m. Elevated temperature may be due to several factors. What could be the reason for this? loose stool recent bed bath very hot coffee respiratory infection

respiratory infection

The nurse has been collaborating with a colleague on a client's wound care, and the colleague is now removing gloves after completing the task. The nurse observes the colleague performing the above pictured action inside the client's room. What is the nurse's correct response? encourage the colleague to remove her gown before removing gloves assist the colleague with glove removal encourage the colleague to remove gloves outside the room take no further action

take no further action Gloves should be grasped by the cuff while being removed, and this action should be performed inside the client's room, prior to gown removal. Each member of the care team removes his or her own gloves.

In which order should the following steps for putting the first hand into a sterile glove be performed? 1. Carefully open the inner package. Fold open the top flap, then the bottom and sides. 2. Place the inner package on the work surface with the side labeled "cuff end" closest to the body. 3. With the thumb and forefinger of the nondominant hand, grasp the folded cuff of the glove for the dominant hand, touching only the exposed inside of the glove. 4. Keeping the hands above the waistline, lift and hold the glove up and off the inner package with fingers down. 5. Place the sterile glove package on a clean, dry surface at or above your waist. 6. Carefully insert dominant hand palm up into the glove and pull it on. 7. Open the outside wrapper by carefully peeling the top layer back and remove inner package, handling only the outside of it.

5, 7, 2, 1, 3, 4, 6

The charge nurse observes the licensed practical nurse (LPN) removing personal protective equipment (PPE). Which action by the LPN warrants intervention from the charge nurse? The LPN removes goggles while only touching the ear pieces. The LPN removes gloves by grasping the outside of one glove without touching the wrist with the gloved hand. The LPN removes the gown by rolling it into an inside out ball. The LPN removes the mask by untying the top of the mask first.

The LPN removes the mask by untying the top of the mask first. The face mask should be untied at the bottom first. This helps to prevent the top of the mask from flopping forward and potentially exposing the nurses face to the dirty side of the mask. To remove PPE goggles appropriately, the nurse should handle them by the earpieces to lift away from the face. Gloves should be removed without touching the hand to prevent contaminating the skin. Gowns should be rolled into an inside out ball when removed to prevent exposure from contaminated surfaces of the gown.

Which should be documented by the nurse? The fact that the nurse donned gloves two different times during a procedure The fact that sterile technique was used for a given procedure The fact that the nurse washed her hands before a procedure The specific items that the nurse transferred into a sterile field

The fact that sterile technique was used for a given procedure The fact that sterile technique was used for a given procedure should be documented, but the other items listed do not need to be documented, as they are standard procedure.

Routine nasal and rectal swabbing of a newly admitted hospital client has come back positive for methicillin-resistant Staphylococcus aureus (MRSA), indicating that the client is colonized with MRSA. The client is surprised at this finding, since he enjoys generally robust health. What should the client's nurse teach him about this diagnostic finding? "You may not develop any symptoms, but you will likely be given a round of antibiotics to eliminate these bacteria." "This finding becomes part of your medical record, but it is not a threat to the health of yourself or others." "This means that this organism in present on your skin, but it doesn't necessarily mean that you will become sick." "It's very fortunate that this was detected early, since this had the potential to make you very sick."

"This means that this organism in present on your skin, but it doesn't necessarily mean that you will become sick." MRSA colonization does not necessarily mean that an individual will become sick, but it does pose a threat of passing on MRSA to others. The MRSA documentation is part of the laboratory section but does not allow for the client and others to get the MRSA infection. Colonization does not necessitate antibiotic therapy. MRSA is present and does not always cause an infection.

The nurse educator is reminding a group of new nurses about precautions. Which statement by a new nurse requires further teaching by the nurse educator? "Wearing an N95 respirator is critical when I care for clients in droplet precautions." "It is important to refrain from recapping needles." "Masks, gloves, and gowns should be used to protect from infectious agents." "I will always wash my hands thoroughly and often."

"Wearing an N95 respirator is critical when I care for clients in droplet precautions." N95 respirators are used when caring for clients in airborne precautions; therefore this statement requires further teaching.

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.

Which client presents the most significant risk factors for the development of Clostridium difficile infection? A client with renal failure who receives hemodialysis three times weekly A 44-year-old client who is paralyzed and whose coccyx ulcer has required a skin graft A 30-year-old client who has recently contracted human immunodeficiency virus (HIV) after engaging in high-risk sexual behavior An 81-year-old client who has been receiving multiple antibiotics for the treatment of sepsis

An 81-year-old client who has been receiving multiple antibiotics for the treatment of sepsis Explanation: Two common factors that increase a persons risk of becoming infected with C difficile are age greater than 65 and current or recent use of antibiotics. In this scenario, old age and recent, long-term antibiotic therapy are significant risk factors for C. difficile infection. These supersede the risks posed by recent HIV infection, skin grafts, and hemodialysis.

A client is being admitted to the hospital for elevated temperature for the past 24 hours. He had his right knee replaced 4 days ago in the same facility. Which assessment is a priority for now? frequency of diarrhea episodes urine characteristics Homans sign Auscultate lung sounds.

Auscultate lung sounds After surgery, an elevated temperature may be normal initially, but if it continues, it may signal a possible infection. During the first postoperative day, an elevated temperature is most likely caused by the physiologic stress of surgery or by atelectasis. Fever during the second to fifth postoperative day most likely results from pneumonia. A fever on the second to eighth postoperative day suggests UTI. One occurring from the third to the 11th postoperative day often suggests a wound infection. A fever developing weeks or months after surgery may suggest a deep operative infection or infected prosthetic device.

While the nurse is conducting morning rounds, the nurse notices that the client's temperature has gradually increased for the past 3 days. Which assessment(s) should the nurse do next? Select all that apply. Check IV site for infiltration. Call the laboratory for blood culture test. Review how compliant the client has been with ambulation. Auscultate lung sounds. Check site of wound.

Auscultate lung sounds. Check site of wound. Check IV site for infiltration. Review how compliant the client has been with ambulation. Auscultation of breath sounds can help detect respiratory infections. Pneumonia can alter normal breath sounds, producing crackles (rales), rhonchi, and wheezes. Atelectasis, which can predispose a client to respiratory infection, is noted by crackles or diminished breath sounds. Determine whether the client is comfortable or in obvious pain. Detect any signs of fatigue in the client's posture and movement. Look for abnormal skin color, rashes or lesions, and any swelling and signs of inflammation.

When providing care to a incontinent client with a history of methicillin-resistant Staphylococcus aureus (MRSA), what is the priority goal for the nurse's observable intervention? (putting on gown) Providing a clean environment while providing client care Avoiding the introduction of microorganisms to the nurse's uniform Maintaining the cleanliness of the nurse's uniform Preventing the introduction of microorganisms to the client

Avoiding the introduction of microorganisms to the nurse's uniform

Nurses wear personal protective equipment (PPE) to protect themselves and clients from infectious materials. Which examples accurately represent the proper use of personal protective equipment in a health care agency? Select all that apply. To remove a gown, nurses should unfasten ties, if at the neck and back, and allow the gown to fall away from shoulders. Nurses should remove PPE at the doorway or in an anteroom, except for the respirator. Nurses may lower a mask around the neck when not being worn and bring it back over the mouth and nose for reuse. Nurses may use a waterproof gown more than one time. Nurses need only apply clean gloves when performing or assisting with invasive client procedures. During some care activities for an individual client, nurses may need to change gloves more than once.

During some care activities for an individual client, nurses may need to change gloves more than once. . Nurses should remove PPE at the doorway or in an anteroom, except for the respirator. To remove a gown, nurses should unfasten ties, if at the neck and back, and allow the gown to fall away from shoulders.

The nurse is caring for a client who has an intravenous (IV) catheter in place with a saline lock. The nurse is preparing to change the dressing to the IV site. After reviewing the image, what should the nurse do next? Cleanse the site under the intravenous site with an alcohol swab and proceed with using the same transparent dressing Remove the gloves then reapply the occlusive dressing to avoid the dressing sticking to the gloves Obtain a new intravenous dressing change kit Lift up the entire occlusive dressing then reapply the dressing 1 in (2.5 cm) higher

Obtain a new intravenous dressing change kit Once the dressing is contaminated, a new sterile dressing change kit must be obtained to avoid the transmission of infectious organisms to the intravenous site. Maintaining the effectiveness of clean technique (medical asepsis) and sterile contents depends on the effectiveness of both conscientious adherence to these guidelines by health care professionals. The other options do not adhere to medical asepsis. Harm to the client can result, due to an increase in the client's risk for an IV site infection.

The nurse is caring for a client who is hospitalized and has an indwelling urethral catheter. Which finding would most likely indicate the client has developed an infection? The nurse notes the client's urine is dark yellow with sediment. The client reports nausea and vomiting. The unlicensed assistive personnel (UAP) documents the client's oral temperature as 99°F (37.22°C) Urine culture is positive for vancomycin-resistant enterococci (VRE).

Urine culture is positive for vancomycin-resistant enterococci (VRE). Infections result from pathogens that produce illness after invading body tissues and organs. The client with the indwelling urethral catheter is at risk for developing an infection. The finding that would most likely indicate an infection would be a positive result. Nausea and vomiting, a fever, and dark yellow urine with sediment are possible signs of an infection, but each of these findings alone does not confirm an infection.

A nurse is in charge of care for a client who has methicillin-resistant Staphylococcus aureus (MRSA). Which guideline is accurate for using transmission-based precautions when caring for this client? Wear gloves whenever entering the client's room. Keep visitors 3 feet (1 m) from the client. Use respiratory protection when entering the room. Place the client in a private room that has monitored negative air pressure.

Wear gloves whenever entering the client's room Contact precautions are used for clients who are infected or colonized by a microorganism that spreads by direct or indirect contact, such as MRSA, vancomycin-resistant enterococci (VRE), or vancomycin-intermediate Staphylococcus aureus (VISA). Gloves should be worn when entering the client's room. Use of negative air pressure and respiratory protection are appropriate with airborne precautions. Keeping visitors 3 ft (1 m) away from the client is a droplet precaution.

The nurse is caring for a client with a surgical wound. Which action by the nurse best reduces the reservoir of infection? changing the soiled dressing applying a face mask with shield isolating the client's belongings wearing clean unsterile gloves when changing the dressing

changing the soiled dressing

When discontinuing use of a gown in the care of a client in droplet precautions, which method does the nurse use to dispose of this personal protective equipment (PPE)? fold soiled side to the outside and roll with inner surface exposed fold soiled side to the inside and roll with inner surface exposed fold soiled side to the outside and roll with outer surface exposed fold soiled side to the inside and roll with outer surface exposed

fold soiled side to the inside and roll with inner surface exposed To dispose of the gown, the nurse will fold the soiled side to the inside and roll with the inner surface exposed. The other answers are incorrect.

The nurse is caring for a client who has been hospitalized and placed in airborne precautions for a week. Which nursing intervention is appropriate to provide sensory stimulation? take the client outside for fresh air move the bed and furnishings to a different place in the room communicate with the client only through the intercom encourage family and friends to visit more often

move the bed and furnishings to a different place in the room To promote sensory stimulation, move the bed and furnishings around in the room. The client cannot be transported outside without risking infecting others. Family and friends may not be able to visit more without exposing themselves to infection or bringing further infection to the client. Communicating only through the intercom is not appropriate, as the client will still need hands-on care as well.

The nurse is providing care to a hospitalized client and performs the following activities in the order listed. The nurse properly identified the client. The nurse cleaned the client's perineum due to urinary incontinence. The nurse administered oral medications. The nurse administered an intramuscular medication. The nurse changed the surgical wound dressing. When is it necessary for the nurse to sanitize or wash the nurse's hands? Select all that apply. upon entry into the room before administration of the oral medications before disposal of the soiled wound dressing when exiting the room before administration of the intramuscular medication

upon entry into the room before administration of the oral medications before administration of the intramuscular medication when exiting the room

A team of nurses is caring for a client with tuberculosis. They have not been fitted for N95 respirators. How will the team proceed with care? utilize a powered air purifying respirator (PAPR) enter the room as normal but maintain a 3-foot (1-meter) distance from the client use a regular mask and continue to provide care as usual refrain from providing care until a nurse who has been fitted arrives

utilize a powered air purifying respirator (PAPR)

The client has asked the nurse to explain her WBC level of 8,000 cells/mm3. The nurse would identify the level of WBCs as: decreased stable elevated within normal limits

within normal limits A normal white blood cell count is 5,000 to 10,000 cells/mm3.


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