ATI CHP 16,17,&19

A nurse is reviewing hand hygiene techniques with a group of AP. Which of the following instructions should the nurse include when discussing handwashing?

Wash hands with soap and water for at least 15 secs. Use a clean paper towel to turn off hand faucets

A nurse is orienting a new AP to the unit, which of the following actions should the nurse identify as an indication that the AP needs further instruction?

Washes hands for 10 seconds

A nurse Is contributing to the plan of care for a client who is being admitted to the facility with a suspected diagnosis of pertussis. Which of the following interventions should the nurse include?

Wear a mask when providing care within 3 ft of the client. Place a surgical mask on the client of transportation to another dept is unavoidable. Wear a gown when performing care that might result in contamination from secretions.

A nurse is reinforcing teaching with a group of AP about hand hygiene. Which of the following statements by an AP should the nurse identify as an indication that the AP requires further teaching?

"As long as I change my gloves between clients, it is not necessary to wash my hands"

A nurse is reinforcing teaching with a client about hand hygiene. Which of the following client statements indicates a need for further teaching?

"I should wash my hands until they appear clean"

A nurse is reinforcing teaching with a new group of AP about the importance of hand hygiene. Which of the following statements should the nurse take?

"Make sure clients wash their hands before they eat"

A nurse is preparing to exit the room of a client who has a draining wound that contains methicillin- resistant Staphylococcus aureus (MRSA) and requires contact precautions. Identify the sequence the nurse should follow to remove personal protective equipment (PPE) after caring for this client.

1) remove gloves 2)remove eyewear 3)remove gown 4) remove mask

A nurse is wearing sterile gloves in prep for performing a sterile procedure. Which of the following objects can the nurse tough without breaking sterile technique (Select all that apply) A. bottle containing sterile solution B. edge of sterile drape at the base of the field C. inner wrapping of an item on the sterile field D. irrigation syringe on the sterile field E. one gloved hand with the other gloved hand

C, D, E

A nurse is preparing to provide morning hygiene care for a client who has Alzheimer's disease. The client becomes agitated and combative with the nurse approaches him. Which of the following actions should the nurse plan to take?

Calmly ask the client if he would like to listen to some music.

A nurse is preparing a sterile field. Which of the following actions should the nurse take first?

Center the sterile pack on the work surface

A nurse is reinforcing infection control practices for hand hygiene with a group of unit nurses. Which of the following should the nurse reinforce in the teaching?

Change gloves between tasks on the same client

A nurse is providing hygiene care for a client who is immobilized. Which of the following actions should the nurse take?

Check bed linens when removing them for personal items. Keep the baths water temperature between (110-115)F. Shave the clients hair in the direction of the hair growth

The nurse prepares to bathe and change the bed linens of a client with localized herpes zoster. The lesions are open and draining a scant amount of serous fluid. Which precaution should the nurse ensure is followed by all health care workers?

Contact precauctions

A nurse is caring for a client who requires contact precautions. Which of the following actions should the nurse take?

Dedicate equipment and supplies for use with the client.

A nurse assisting with the admission of a client who has meningococcal pneumonia. Which of the following isolation precautions should the nurse initiate?

Droplet precautions

A charge nurse is reviewing with a newly hired nurse the difference in manifestations of a localized versus a systemic infection. Which of the following are manifestations of a systemic infection?

Fever Malaise Increase in pulse and respiratory rate

While disposing of a needle after administering a subcutaneous injection to the client, a nurse punctures her finger. Which of the following actions should the nurse take first?

Flush and wash the exposed area with warm soapy water

A nurse is caring for a client who has multiple myeloma and has a WBC count of 1,800/mm. Which of the following food items brought by the family should the nurse prohibit from being given to the client?

Fresh fruit basket

A nurse observed an AP entering the room of a client who is under contact precautions without wearing personal protection (PPE) which of the following actions should the nurse take?

Give the AP the appropiate PPE

A nurse inserts an indwelling urinary catheter for a client who is preoperative. Three days later, the client develops a urinary tract infection. The nurse should Identify that the client has which of the following types of infections?

Health care- associated (HAI)

A nurse is caring for a client who reports a severe sore throat, pain when swallowing and swollen lymph nodes. The client is experiencing which of the following stages of infection?

Illness

A nurse reinforcing teaching with a client who has neutropenia as a result of radiation therapy for the treatment of lung cancer. Which of the following should the nurse plan to include in the teaching?

Increase fluid intake by drinking bottled water

The nurse is caring for a child who has sustained a severe burn injury. In caring for this child, the nurse understands that this patient is at which risk and /or problems?

Increased risk for infection Impaired skin integrity

A nurse is reinforcing teaching with a client about treatment of methicillin-resistant Staphylococcus aureus (MRSA). Which of the following information should the nurse include in her teaching?

Infections become resistant to high doses of antibiotics

A nurse is assisting with the admission of a child who has pertussis. Which of the following actions should the nurse take?

Initiate a droplet precaution

A nurse is caring for a client who requires droplet precautions. Which of the following personal protective equipment is should the nurse wear when setting up the clients meal tray in the patients room?

Mask

The nurse is caring for a hospitalized child with a diagnosis of measles (Rubeola). In preparing to care for the child, which supplies should the nurse bring to the child's room to prevent the transmission of the virus?

Mask, gown, gloves and goggles

A nurse has completed care procedure for a client who requires airborne precautions. Which of the following items of personal protective equipment (PPE) should the nurse remove last?

N95 mask

When entering a clients room to change a surgical dressing, a nurse notes that the client is coughing and sneezing. Which of the following actions should the nurse take when preparing the sterile field?

Place a mask on the client to limit the spread of micro-organisms into the surgical wound

A nurse in a long term facility is observing an AP changing the linen for a client who has fecal incontinence. Which of the following actions indicates that the AP understands the principles of infection control?

Places clean linen that has touched the floor in the soiled bag

A nurse is caring for a client who has severe acutely respiratory syndrome (SARS). The nurse knows that health care professionals are required to report communicable and infectious diseases. Which of the following illustrates the rationale for reporting?

Planning and evaluating control and prevention strategies. Determining public health priorities Ensuring proper medical treatment Monitoring for common source outbreak.

A nurse is reinforcing discharge teaching with a client who is immunocompromised. Which of the following instructions should the nurse include in the teaching?

Restrict visitor with active infections Instruct the client to eat cooked foods

A nurse is reinforcing discharge teaching with a client who has AIDS. Which of the following statements should the nurse male regarding home infection control?

Soak sponges used for cleaning in a bleach solution after use.

A nurse is caring for a client who has a Clostridium difficile infection. Which of the following agents should the nurse use for hand hygiene?

Soap and water

A nurse has removed a sterile pack from its outside cover and placed it on a clean work surface in preparation for an invasive procedure. Which of the following flaps should the nurse unfold first?

The flap farthest away from the body

A nurse has prepared a sterile field for assisting a provider with a chest tube insertion. Which of the following events should the nurse recognize as contaminating the sterile field?

The nurse moistens a cotton ball with sterile normal saline and places it on the sterile field. The procedure is delayed 1 hr because the provider receives an emergency call. The nurse turns to speak to someone who enters through the door behind the nurse.

A nurse on a medical unit is reinforcing teaching with a group of AP about handling clients bed linens safely. Which of the following instructions should the nurse include?

Tie linen bags securely at the top

A nurse is caring for a client who has had a cough for 3 weeks and is beginning to cough up blood. The client has manifestations of which of the following conditions?

Tuberculosis

A nurse in a long term care facility is caring for a client who is unresponsive. When preforming oral hygiene for the client, which of the following actions should the nurse take?

Turn the client on his side before starting oral care

A nurse is assisting with a presentation to the public about preventive measures for contacting WEST NILE VIRUS. I'm order to avoid transmission of the disease, which of the following instructions should the nurse include?

Use mosquito repellant