Asepsis and Infection Control

The nurse is reviewing discharge instructions for a client who was prescribed an antibiotic. Which statement by the client would require further teaching?

"Once I start feeling better, I should stop taking the antibiotic."

A pregnant woman with a history of genital herpes infection who is near term asks the nurse why she must have a cesarean section when she has not had an outbreak in a "long time". The nurse responds:

"You may have infection in your birth canal that you are unaware of." Viral diseases such as chickenpox or herpes simplex, acquired from the birth canal or from an infected sibling, can cause severe widespread disease.

The nurse is preparing to perform hand washing. Arrange the steps in the correct order.

-Turn on the faucet and adjust force and temperature of the water. -Wet the hand and wrist areas. -Apply soap product. -Wash the palms and back of the hands for at least 15 seconds. -Pat hands dry with a paper towel. -Turn the faucet off with a paper towel.

A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood?

1500

A nurse is preparing an operating room theatre for a surgical procedure. Which point regarding the principles of surgical asepsis should the nurse keep in mind when preparing sterilized surgical instruments?

A commercially packaged surgical item is not considered sterile if past expiration date

A nurse is conscientious about implementing the principles of asepsis while providing care for clients. The principles of asepsis include which of the following?

Blood and body fluids are major reservoirs for microorganisms.

The nurse is caring for a client with tuberculosis. The prior shift's nurse has placed the client in droplet precautions. Which is the appropriate nursing action?

Change to airborne precautions. p. 535

Which of the following clients should the nurse determine to be at the greatest risk for hospital-acquired infection (HAI)?

Client with a urinary catheter (While all of the clients are at risk for infection, the client at the greatest risk is the one with a urinary catheter. This is because catheter-associated urinary tract infections are the most common type of health care-associated infections, accounting for more than 30% of HAIs in acute care hospitals.)

The nurse is preparing a sterile field for a bedside procedure. During preparation, the client reaches over the field for the water pitcher. What would be the best action by the nurse?

Discard the supplies and field and prepare a new sterile field. p. 553-554

Prodromal stage of infection

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 patient often is unaware of being contagious.

Upon review of a client's microbiology culture results, the nurse recognizes which organism as indicative of normal flora?

Escherichia coli in the intestinal tract p. 534

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?

Exogenous healthcare-associated

Which piece of personal protective equipment (PPE) should be removed first?

Gloves

A nurse is taking care of a client with tuberculosis who has developed resistance to the ordered antibiotic. Which type of client is most likely at increased risk for infection?

Older adult p. 536-537

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

Pain Redness Exudate Swelling (Cardinal signs of infection include redness (heat), swelling, pain, and loss of function. As leukocytes and neutrophils enter the area, exudate made up of fluid, cells, and inflammatory by-products may be released by the wound. Warmth and heat at the site versus coolness are a sign of infection.)

An operating room (OR) nurse on the facility's infection control team notices that a coworker in the OR is wearing artificial nails. Which of the following is the appropriate action/response by the nurse?

Remind coworker that artificial nails increase infections

Which of the following is the best example of a nurse donning/removing protective equipment properly?

Removing respirator after leaving client's room

The nurse is aware that many products in the hospital have the potential to contain latex. Which piece of protective equipment is most likely to contain latex?

Surgical masks

A client has a diagnosis of HIV and has been admitted to the hospital with an opportunistic infection that originated with the client's normal flora. Why did this client most likely become ill from his resident microorganisms?

The client's immune system became further weakened

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

True p. 562

A nurse is providing care to a client who has Salmonella food poisoning. The nurse understands that this pathogen was transmitted by which mechanism?

Vehicle

A nurse is caring for a child who is hospitalized for diphtheria. Which guideline would be appropriate when caring for this client?

Wear PPE when entering the room for all interactions that may involve contact with the client. (The nurse should use respiratory protection when entering the room of the client with known or suspected tuberculosis (airborne infection).)

The nurse is assisting a client with a history of vancomycin resistant enterococcus (VRE). What precaution should the nurse implement?

contact precautions

A nurse is caring for a client with ringworm. Which microorganism causes ringworm in a client?

fungi

Correct removal of PPE

gloves, goggles, gown, and mask

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

hand washing (Hand washing technique is the single most important procedure in reducing the spread of microorganisms. The other options will be included in the teaching plan, but hand washing is the priority to teach the family member and client.)

A nurse is working with a new graduate nurse. The nurse states that she was exposed to a client's blood and that she was not wearing any PPE. Which would be considered significant blood exposures by occupational health? Select all that apply.

hep b hep c hiv

Fungi

include yeasts and molds, which cause infections in the skin, mucous membranes, hair, and nails

The process of infection

infectious agent a reservoir an exit route transmission mode entry portal susceptible host (The infectious process begins with an infectious agent. Then the infection needs a reservoir or place to grow. Once it grows, it needs a way out so that it can be transmitted. With transmission (e.g., sneezing), it needs an entry portal into a susceptible host.)

helminths

infectious worms that may or may not be microscopic. They include roundworms, tapeworms, and flukes.

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

into a private room p. 551

Vehicle transmission

involves the transfer of microorganisms by way of vehicles or contaminated items that transmit pathogens; for example, food can carry Salmonella.

Convalescent stage

may vary according to the severity of the infection and the patient's general condition. The signs and symptoms disappear, and the person returns to a healthy state; the recovery period from the infection.

Rickettsiae

microorganisms that resemble bacteria but cannot survive outside of another living species. They are responsible for Lyme disease.

A client comes to the emergency department reporting becoming very ill after consuming shrimp and lobster. How will the nurse document this condition?

noncommunicable disease

Aireborne

occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens.

Droplet Transmission

occurs when mucous membranes of the nose, mouth, or conjunctiva are exposed to secretions of an infected person who is coughing, sneezing, or talking.

The nurse is completing a sterile dressing change on a confused client. During the procedure, the client reaches down and touches the contents of the open dressing kit. What should the nurse do?

open a new sterile dressing kit

A 12-year-old is being hospitalized for pneumonia. The nurse receives the client's culture and sensitivity report on her tracheal aspirate. The client is infected with a strain of Streptococcus pneumonia, which is particularly prone to cause infections, also referred to as what?

pathogenic

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 gloves, remove gown, wash hands

Protozoans

single-celled animals classified according to their ability to move

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

the client who is 48-hours post-surgical procedure

full stage of illness

the presence of specific signs and symptoms; the type of infection determines the length of the illness and the severity of the manifestations.

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

use of one gown per person per shift

The nurse caring for a client after hip surgery enters the room to take the client's vital signs. Which precaution(s) should the nurse use? (Select ALL that apply.)

wash hands non-sterile gloves

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

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." (N95 respirators are used when caring for clients in airborne precautions)

Major reservoirs for microorganisms are:

Blood, body fluids, cells, and tissues

Which of the following masks should the nurse don when caring for a client with tuberculosis?

Filtered respirator

Stages of infection in order

Incubation period Prodromal stage Full stage of illness Convalescent period

A nurse changing the linens of a client bed is exposed to urine and performs hand hygiene. Which is a guideline for performing this skill properly following this client encounter?

Keep hands lower than elbows to allow water to flow toward fingertips. p. 559

When are peak levels drawn

Peak levels are drawn shortly after the drug is administered.

A nurse is caring for a client who is diagnosed with tuberculosis. Which nursing intervention promotes infection control based on nursing practice standards for safety?

The nurse places the client in a private room with monitored negative air pressure.

The nurse performs hand hygiene using soap and water before and after providing client care. Which nursing action is performed correctly according to the procedure?

The nurse washes at least 1 in (2.5 cm) above the area of contamination if present.

Ringworm

caused by a fungal infection.

noncommunicable disease

caused by food or environmental toxin

Direct contact transmission

involves body surface-to-body surface contact causing the physical transfer of organisms between an infected or colonized person and an infected host.

A nurse is caring for four clients. Which client has the highest risk of infection?

older male with an enlarged prostate

The nurse who is caring for a client in contact isolation is preparing to conduct an assessment. Which stethoscope will the nurse choose to auscultate the client's bowel sounds?

one that remains in the client's room

Which patient would the nurse consider the most infectious?

prodromal

Transient flora are most often found in:

the creases of your skin (Transient bacteria are few in number on clean and exposed areas of the skin and are attached to grease, fat, or dirt on the hands. Transient bacteria are found in greatest number under the fingernails.)

incubation

the interval between the pathogen's invasion of the body and the appearance of symptoms of infection. the organisms are growing and multiplying. The length of time spent in this stage may vary.