ch 24- asepsis and infection control

The mother of a client who is acutely ill and is responding well to the antibiotic treatment states "I know this antibiotic will heal my child." The mother requires further education based on which statement? Select all that apply. - Antibiotics do not heal. - Antibiotics slow the growth or kill the microorganism. - The antibiotics help the body develop antigens. - Antibiotics prevent further damage to the system affected. - Antibiotics causes loose stools all the time.

- Antibiotics do not heal. - Antibiotics slow the growth or kill the microorganism. - Antibiotics prevent further damage to the system affected. Antibiotics cannot cure the client; at best, they slow the growth of or kill the infecting organism, which is necessary for clients to recover from infection. They control the size of the microbial population against which the client's immune system must contend. Antibiotics "buy time" during which the client's own immune system can mobilize. Eliminating the microbes may prevent further injury, but a return to normal depends on the body's healing capacity.

The nurse in the health center is conducting assessment related to risk for infection on different age clients. Which clients are at higher risk of acquiring infection? Select all that apply. - a 21-year-old client with a sprained left ankle - a 45-year-old female who is allergic to flu vaccine - a 5-month-old infant with low grade fever due to teething - the college football player involved in a car accident - the 65-year-old male suffering from diabetic foot ulcer

- a 45-year-old female who is allergic to flu vaccine - a 5-month-old infant with low grade fever due to teething - the 65-year-old male suffering from diabetic foot ulcer The immune system does not become fully operational until a baby reaches about 6 months of age. Before then, the infant's resistance to infection comes from the antibodies passed by way of the placenta and breast milk. The immune systems of older adults also may be impaired. Aging diminishes both nonspecific and specific defenses to microbial invasion. Metabolism, synthesis, and repair of body cells and tissues decrease.

The nurse is providing care to a hospitalized client and performs the following activities in the order listed. 1. The nurse properly identified the client. 2. The nurse cleaned the client's perineum due to urinary incontinence. 3. The nurse administered oral medications. 4. The nurse administered an intramuscular medication. 5. 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 administration of the intramuscular medication - before disposal of the soiled wound dressing - when exiting the room

- before administration of the oral medications - before administration of the intramuscular medication - before disposal of the soiled wound dressing - when exiting the room The nurse either washes or sanitizes the nurse's hands upon entry into a client's room and exit from the client's room. This is to prevent the transmission of germs from other sources to the client or from this client to others. The nurse performed many tasks while in the room. The nurse would cleanse the hands following cleaning the client's perineum due to incontinence. The nurse would want to ensure the hands are cleaned before handling any medications. Because the nurse administered the oral medications before the intramuscular medication, the nurse would clean the hands again. The nurse is going from a contaminated body site (mouth) to a clean body site (the IM injection). The nurse then changed the surgical dressing and would clean the hands after disposing of the soiled dressing materials.

A nurse is working with an 82-year-old client following gallbladder surgery who is NPO and has peripheral IV access in the right hand. The client is occassionally incontinent of urine. What nursing action has the greatest potential to reduce the client's risk of surgical complications? A- Encourage early ambulation B- Insert a Foley catheter C- Discontinue the client's IV access as soon as possible D- Change the client's surgical dressing at least q8h

A Ambulation helps to prevent the stasis of secretions that can lead to respiratory infections, among other benefits. In addition to promoting full function, ambulation can prevent the development of complications associated with bedrest or minimal activity. Occasional incontinence can increase the risk for UTI's, but indwelling catheters pose an even greater risk for infection. In general, surgical dressings should not be changed unnecessarily, due to the risk for wound disruption or infection. Peripheral IV's present a low risk for infection or complications.

A nurse is taking stock of the equipment in the room of an older adult client with pneumonia who has been on parenteral nutrition for a long time. Which equipment can transmit infection to older adult clients? A- indwelling catheter B- bath blanket C- face shields D- specimen containers

A Infections are often transmitted to older adult clients through equipment reservoirs (e.g., indwelling urinary catheters, humidifiers, and oxygen equipment) or through incisional sites, such as those for intravenous tubing, parenteral nutrition, or tube feedings. Use of proper aseptic techniques is essential to prevent the introduction of microorganisms. Bath blankets, face shields, and specimen containers are not part of the equipment reservoir that transmits infection easily, because they are disposed of immediately after one-time use.

The nurse is admitting a client who has been receiving prescribed antibiotics for pneumonia. The client reports experiencing loose, watery stools for the past 4 days. What would be the initial action for the nurse to take? A- implementing contact isolation B- informing the health care provider that the antibiotic should be changed C- instructing the client to collect a stool sample D- modifying the client's diet to clear liquids

A The client who has been taking antibiotics and reports experiencing loose, watery stool should be placed on contact isolation immediately, which can be implemented without a health care provider prescription. The nurse should suspect the client may have developed Clostridium difficile. C. difficile can develop with use of broad-spectrum antibiotics and is highly contagious. The priority is to prevent the transmission after implementing contact isolation. Then the nurse should contact the health care provider who may prescribe a stool sample. The nurse should not, however, suggest actions to the health care provider, such as changing the antibiotic or modifying the client's diet.

The nurse is receiving a confused client with a draining wound onto the medical-surgical unit. Which room assignment will the nurse make? A- into a private room B- with a client with pneumonia C- with a client with a myocardial infarction D- with another client with a draining wound

A The client with confusion and a draining wound would, as would other clients on the unit, benefit most from a private room. The client cannot be expected to assist in maintaining appropriate hygiene or environmental control, so placement with another client who has a susceptible condition is not appropriate.

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

A The first line of defense against infection is intact skin and mucous membranes covering body cavities. They are the most important barriers to infection, and when they are intact, infection is rare. Chemical composition aids these physical barriers further. For example, the acidic nature of the skin and vagina helps to kill potential invaders before they enter the body. Certain illness or treatments can interfere with the body's delicate balance, causing overgrowth of Candida fungus.

The mother of a newborn asks the nurse about her newborn's risk for infection. Which statement by the nurse would be most appropriate? A- "Your baby's resistance comes from the antibodies you passed on to him before birth and now with breast feeding." B- "It usually takes about a month or two until the baby's immune system to become completely functional." C- "Infections in newborns are rare because they have little difficulty localizing infections" D- "If you notice that the newborn has a fever, then you need to have him seen by the doctor fairly quickly."

A The immune system does not become fully operational until a baby reaches about 6 months of age (Shaw, Thalapial, Shaw, & Malla, 2007). Before then, the infant's resistance to infection comes from the antibodies passed by way of the placenta and breast milk. Newborns have difficulty localizing infections (preventing the spread of organisms from the site of contact). Their phagocytes have difficulty trapping microbes, and they do not produce enough antibodies. Newborns have immature thermoregulatory mechanisms and do not become febrile.

A nurse is caring for a 55-year-old postoperative client. The client returns to the ICU after surgery intubated and mechanically ventilated with a Salem sump nasogastric tube, a Foley catheter, and a PICC line in place. Based on the nurse's knowledge of the most common hospital-acquired infections, which apparatus is most important to remove first? A- urinary catheter B- PICC line C- Salem sump nasogastric tube D- endotracheal tube

A Urinary catheters account for the highest percentage (26%) of hospital-associated infections. The four most common types of HAIs are related to invasive devices or surgical procedures: catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), surgical site infection (SSI), and ventilator-associated events (VAEs). A peripherally inserted catheter is an invasive line. Nasogastric tubes and endotracheal tubes are not associated with

To eliminate needlesticks as potential hazards to nurses, the nurse should: A- place the uncapped needle on a tray and carry it to the medicine room for disposal. B- immediately deposit uncapped needles into a puncture-proof plastic container. C- stick the uncapped needle into a Styrofoam block and deposit it in a plastic container. D- slide the needle into the cap and deposit it in a puncture-proof plastic container.

B

After assessing a client's temperature, the nurse documents that the client has a fever that is categorized as being high-grade. Which reading would the nurse most likely have obtained in this client? A- 37.8 degrees C B- 39.2 degrees C C- 40.8 degrees C D- 36.8 degrees C

B A temperature elevation above 38.2C is considered a high-grade fever. A temperature greater than 40.5C is referred to as hyperpyrexia. A low-grade fever is a temperature that is slightly elevated, 37.1C to approximately 38.2C. A temperature between 35C and 36.8C is a subnormal temperature.

The nurse applies an alcohol-based hand rub upon entering the client's room. The client becomes upset stating, "You did not wash your hands!" Which response by the nurse is most appropriate? A- "Washing the hands with soap and water is not necessary." B- "Alcohol-based hand rub provides the greatest reduction in microbial counts on the skin." C- "I won't be touching you, so using the alcohol hand rub is the quickest method to perform hand hygiene." D- "We only wash our hands when they are visibly soiled."

B By explaining that alcohol-based hand rubs are effective in preventing the spread of microbes, the nurse directly addresses the client's concern. While washing with soap and water may not be necessary, it doesn't address the client's concern. Alcohol-based hand rub is an appropriate method for hand hygiene even when you plan to touch the client.

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? A- WBC of 7,500 mcL B- WBC of 25,000 mcL C- WBC of 5,500 mcL D- WBC of 10,500 mcL

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

B 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.

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? A- wear gloves when touching the client B- wear a mask and gown in the client's room C- avoid direct contact with the client D- perform hand hygiene before and after entering the client's room

D Hand hygiene is the most important way to prevent transmission of infection.

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? A- Clostridium difficile and diabetic ketoacidosis B- Reactive airway disease and exacerbation of chronic obstructive pulmonary disorder (COPD) C- Tuberculosis and pneumonia D- Appendectomy and a draining leg ulcer positive for methicillin-resistant Staphylococcus aureus

B 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.

When preparing to take a client's blood pressure, the nurse notes that the sphygmomanometer is visibly soiled. What is the correct action by the nurse? A- Discard the sphygmomanometer in the trash. B- Cleanse and disinfect the sphygmomanometer. C- Send the sphygmomanometer for sterilization. D- Use the sphygmomanometer.

B The nurse should cleanse and disinfect the sphygmomanometer. A sphygmomanometer is another name for a blood pressure cuff. As this equipment is used on the outside of the arm versus entering a sterile body part, there is no need to have the equipment sterilized. It would be inappropriate for the nurse to use the visibly soiled blood pressure cuff or to throw it in the trash.

The nurse removes personal protective equipment after caring for a client on transmission-based precautions. Which action by the nurse is correct? A- Remove the goggles before removing other equipment. B- Touch the inside of the gown and pull it away from the torso. C- Remove respirator at the doorway of the client's room. D- Slide one gloved hand under the other glove for removal.

B The outside of the equipment is considered contaminated. Removal follows a prescriptive sequence. Most personal equipment is removed at the door of the client's room. The contaminated glove grasps the other contaminated glove for removal. The nurse's clean hand reaches under the other glove for removal. Goggles are removed by holding the earpieces. Clean hands touch the inside of the gown for removal, pulling away from the torso. Roll these items up, inside out, for disposal. Grasp ties on mask on respirator for removal after leaving the room.

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? A- The resident microorganisms mutated and became virulent B- The client's immune system became further weakened C- The client's normal flora proliferated because of a nutritional deficit D- The client's normal flora began producing spores

B Unless the supporting host becomes weakened, normal flora remains controlled. If the host's defenses are weakened, as in cases of HIV/AIDS, even benign microorganisms can cause opportunistic infections. This phenomenon is not due to mutations, spore production or the direct effects of a nutritional deficit.

A client is being screened for a parasitic infection and the physician orders stool specimens. When explaining to the client about collecting the specimens, the nurse would inform the client that the specimens will be collected daily for: A- 2 days. B- 3 days. C- 4 days. D- 5 days.

B Usually when a client is being screened for a parasitic infection, stool specimens are collected daily for 3 days. Parasites lay eggs in the GI tract that can be detected on examination. Moving organisms can easily be detected in fresh specimens.

A nurse is preparing to obtain a specimen for an aerobic wound culture. The nurse would obtain the specimen from which area? A- Edge of the wound B- Area of active drainage C- Deep into the cavity D- Soiled dressing

B When obtaining a specimen for an aerobic wound culture, the nurse would obtain the specimen from deep in an area of active drainage. The specimen for an anaerobic culture is obtained from deep in the cavity to identify organisms that may grow where oxygen is not present. Cultures are not taken from the edges of the wound or from the soiled dressing.

The nurse is preparing to insert an intravenous catheter into a client. Which infection control procedure will the nurse use to ensure safe client care? A- Dip the IV catheter into an antiseptic before use. B- Clean the site with a disinfectant. C- Use a sterile intravenous catheter. D- Wear a mask and gown for the procedure.

C Any item entering sterile tissues or the vasculature must be sterile. Therefore, an IV catheter must be sterile. It should not be dipped in an antiseptic before use. A chemical used on lifeless objects is called a disinfectant, whereas one used on living objects is an antiseptic. The nurse would clean the IV site with an antiseptic, not a disinfectant, before insertion. An IV insertion does not require the nurse to wear a mask and gown.

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? A- Helminth B- Protozoa C- Healthcare-associated infection (HAI) D- Virus

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

A nurse has been exposed to feces while changing the linens of a client's bed. Which guideline is followed for performing handwashing after this client encounter? A- Use an alcohol-based hand rub to decontaminate the hands. B- Remove all jewelry, including wedding bands, before hand washing. C- Keep hands lower than elbows to allow water to flow toward fingertips. D- Pat dry with a paper towel, beginning with the forearms and moving down to fingertips.

C Handwashing, as opposed to hand hygiene with an alcohol-based rub, is required when hands are exposed to body fluids. Jewelry should be removed, if possible, and secured in a safe place, but a plain wedding band may remain in place. Wet the hands and wrist area, and keep hands lower than elbows to allow water to flow toward fingertips and pat hands dry with a paper towel, beginning with the fingers and moving upward toward forearms.

A client is scheduled to receive an immune globulin. When explaining this to the client, the nurse integrates knowledge that this action results in which type of immunity? A- Cellular B- Active C- Passive D- Humoral

C Passive immunity is given in the form of immune globulins and provides only temporary protection. Cellular immunity consists principally of T-lymphocyte activity; humoral immunity involves B lymphocytes that produce antibodies conveying specific resistance to many bacterial and viral infections. Active immunity is produced when the immune system is stimulated, naturally or artificially to produce antibodies.

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? A- wear gloves and a gown when transporting the specimen B- place each of the three sealed specimens in a separate paper bag C- place the specimens into plastic biohazard bags D- swab the outside of each specimen container with alcohol prior to transport

C Specimens should be placed in sealed plastic bags to prevent them from becoming contaminated or causing the transmission of infective microorganisms. Paper bags are not used for this purpose, and it is not customary to swab the outsides of specimen containers. Standard precautions should be implemented, but this does not necessitate the use of a gown in all cases.

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? A- Neutrophils B- Eosinophils C- T-lymphocytes D- Monocytes

C T-lymphocytes are important in synthesizing immunoglobulins. Neutrophils are phagocytes that ingest and break down foreign particles and act as an important link in generating fever. Eosinophils are involved in allergic reactions. Monocytes are scavenger cells that dispose of cellular debris.

A client comes to the emergency department reporting becoming very ill after consuming shrimp and lobster. How will the nurse document this condition? A- contagious disease B- infectious disease C- communicable disease D- noncommunicable disease

D A noncommunicable disease is caused by food or environmental toxin. Infectious disease, communicable disease, and contagious disease do not describe an illness that is contracted after eating food.

The nurse reminds the visitor of a client with an antibiotic-resistant infection that gloves are necessary. The visitor states, "I need to directly hold my loved one's hand without a barrier." What essential information does the nurse need to explain to the visitor to prevent transmission of the organism? A- "Your loved-one has an antibiotic-resistant infection which means that there are a limited number or no antibiotics available to treat it." B- "If you do not wear gloves you will also get the infection." C- "Your loved-one understands why you have to wear gloves because he or she has been educated about the infection and barrier precautions." D- "The glove is an important barrier in preventing the transmission of your loved-one's antibiotic-resistant infection to you or other people you come in contact with."

D Contact precautions, which are not optional, block transmission of pathogens by direct or indirect contact. Explaining that the loved-one understands is not teaching information. Educating the visitor about drug-resistant infections is important but does not explain how to prevent transmission of the infection. Telling the visitor that he or she will get the infection if the visitor does not wear gloves is incorrect, the visitor is at a greater risk of getting and spreading the infection. Wearing gloves decreases the chance of the contaminating organism to be spread to the visitors via hands or clothing.