Chapter 24 - Asepsis and Infection Control
The nurse is educating a client with human immunodeficiency virus (HIV) about ways the virus can be transmitted. Which statements made by the client demonstrates the education provided was effective? Select all that apply. (A) "I may transmit the virus to my child during pregnancy and childbirth." (B) "I may transmit the virus if I share needles with another person." (C) "If someone uses the bathroom after I have been on the toilet, he or she can catch the virus." (D) "If someone is exposed to my blood, I may transmit the virus to him or her." (E) "If I sweat at the gym and someone touches me, he or she can contract the virus."
(A) "I may transmit the virus to my child during pregnancy and childbirth." (B) "I may transmit the virus if I share needles with another person." (D) "If someone is exposed to my blood, I may transmit the virus to him or her."
The client is concerned about "catching the flu." What primary information can the nurse teach the client to best prevent the spread of infection? (A) Hand hygiene (B) Avoid crowded areas and people who have the flu (C) Good nutrition and getting enough rest (D) How to properly wear a mask during flu season
(A) Hand hygiene
A nurse has been exposed to urine while changing the linens of a client's bed. Which guideline is followed for performing hand hygiene after this client encounter? (A) Pat dry with a paper towel, beginning with the forearms and moving down to the fingertips. (B) Remove all jewelry, including wedding bands, before hand washing. (C) Keep hands lower than elbows to allow water to flow toward fingertips. (D) Use an alcohol-based hand rub to decontaminate the hands.
(C) Keep hands lower than elbows to allow water to flow toward fingertips.
Several family members are visiting a client with an antibiotic-resistant infection who has been placed on contact precautions. When the nurse teaches the visitors about wearing gloves and gowns, a family member states, "I don't want to wear those. I can't catch anything just by holding my loved one's hand." What is the best response to educate the family about infection transmission? (A) "I understand; wearing these items is not pleasant but it really isn't optional." (B) "If you don't come into contact with anything with your body, you may wear gloves only, as long as you wash your hands after removing the gloves." (C) "Wearing the gloves and gown prevents sharing additional microorganisms with the client." (D) "These barriers help prevent the transmission of infection to you or other people."
(D) "These barriers help prevent the transmission of infection to you or other people."
The nurse is preparing to perform handwashing. Place the following steps in the correct order. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left.
1. Turn on the faucet and adjust force and temperature of the water. 2.Wet the hand and wrists. 3. Apply soap. 4. Wash the palms and backs of the hands for at least 20 seconds. 5. Pat the hands dry. with a paper towel. 6. Turn the faucet off with a paper towel.
Personal protective equipment (PPE) is used in health care facilities to protect the staff from potentially infected clients. True/False
True
A client is to have an indwelling urinary catheter inserted. Which precaution is followed during this procedure? (A) Droplet precautions (B) Surgical asepsis technique (C) Medical asepsis technique (D) Strict reverse isolation
(B) Surgical asepsis technique
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 client's immune system became further weakened (B) The client's normal flora proliferated because of a nutritional deficit (C) The client's normal flora began producing spores (D) The resident microorganisms mutated and became virulent
(A) The client's immune system became further weakened
The nurse is preparing to apply a prescription ointment to the client's wound. After reviewing the image, what is the most important step for the nurse to take? (A) Apply a 1-in (2.5 cm) layer of the ointment to the site using the index finger (B) Use a sterile cotton-tipped applicator to apply the prescription to the site (C) Place sterile 4 x 4 gauze on the wound and secure the dressing with dressing with paper tape (D) Put soiled dressing change supplies in the client's bathroom garbage and double bag
(B) Use a sterile cotton-tipped applicator to apply the prescription to the site
The nurse is caring for an older adult with streptococcal pneumonia. Which precautions will the nurse begin? (A) none (B) droplet (C) airborne (D) contact
(B) droplet
The nurse and a colleague have admitted a client who is on contact precautions. The nurse and colleague are removing their personal protective equipment and the nurse sees the colleague perform the pictured action (taking the gloves off by pulling on the gloves by the fingers). What is the nurse's most appropriate response? (A) take no action at this time (B) encourage the colleague to remove the glove by grasping the cuff (C) maintain a distance of at least 5 ft (1.5 m) from the colleague (D) teach the colleague why the gloves should be removed outside the room
(B) encourage the colleague to remove the glove by grasping the cuff
A client has an inguinal hernia repair and later develops a methicillin-resistant Staphylococcus aureus (MRSA) infection. What is the most important factor to prevent this infection? (A) increased vitamin C (B) surgical asepsis (C) decreased antibiotics (D) increased T cells
(B) surgical asepsis
An experienced nurse is teaching a student nurse about the proper use of hand hygiene. Which guideline should the nurse provide to the student? (A) Hand lotions should not be used after hand hygiene. (B) The use of gloves eliminates the need for hand hygiene. (C) Hand hygiene is needed after contact with objects near the client. (D) The use of hand hygiene eliminates the need for gloves.
(C) Hand hygiene is needed after contact with objects near the client.
The nurse must assign a room for a client admitted with endocarditis and methicillin-resistant Staphylococcus aureus (MRSA) in the blood. A client with which diagnosis can share a room with this client? (A) Coronary artery bypass grafting (B) Clostridium difficile and colitis (C) MRSA in the wound (D) Vancomycin-resistant enterococci and urinary tract infection
(C) MRSA in the wound
The nurse is caring for a client with full-thickness (third-degree) burns. What aseptic intervention(s) would the nurse implement for this client when admitted to the general medical unit? Select all that apply. (A) Allow the client to only ingest fresh fruits or vegetables, no canned or prepackaged food products. (B) Permit flowers only if the containers have plaster wrapping around the base. (C) Restrict visitors to family members who are not ill. (D) Instruct all staff, the client, and family members to practice strict and meticulous hand washing. (E) Place the client in a private room with protective isolation.
(C) Restrict visitors to family members who are not ill. (D) Instruct all staff, the client, and family members to practice strict and meticulous hand washing. (E) Place the client in a private room with protective isolation.
In which situation is an alcohol-based rub not the appropriate option for hand hygiene? (A) When the nurse is caring for a client with an active infection (B) When the nurse leaves the room of an immunocompromised client (C) When the nurse's hands are visibly soiled (D) When the nurse anticipates contact with the client's skin
(C) When the nurse's hands are visibly soiled
The nurse is caring for a client with tuberculosis. Which precautions will the nurse select for this client? (A) contact (B) standard (C) airborne (D) droplet
(C) airborne
The nurse is caring for a client who developed pneumonia while hospitalized. How will the nurse document this condition? (A) contagious disease (B) infectious disease (C) health care-associated infection (HCAI) (D) community-acquired infection
(C) health care-associated infection (HCAI)
The nurse is receiving a confused client with a draining wound onto the medical-surgical unit. Which room assignment will the nurse make? (A) with another client with a draining wound (B) with a client with pneumonia (C) into a private room (D) with a client with a myocardial infarction
(C) into a private room
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. (A) 5, 7, 2, 1, 3, 4, 6 (B) 5, 1, 2, 7, 3, 4, 6 (C) 5, 2, 7, 1, 3, 4, 6 (D) 5, 3, 4, 7, 2, 1, 6
(A) 5, 7, 2, 1, 3, 4, 6
The nurse is donning a pair of sterile gloves. The nurse correctly dons the first glove, but inadvertently inserts the thumb and index finger into the thumb hole of the second glove. The glove remains intact. Which action is most appropriate? (A) Continue to don the glove, then use the other gloved hand to carefully insert the finger into the proper hole. (B) Don a second pair of sterile gloves over the first pair. (C) Use only the correctly gloved hand to perform the sterile procedure while making sure the other hand does not contaminate the sterile field. (D) Leave both the thumb and finger in the thumb hole and perform the procedure to the best of the nurse's ability.
(A) Continue to don the glove, then use the other gloved hand to carefully insert the finger into the proper hole.
The nurse is setting up a sterile field to perform a catheterization when the client touches the end of the sterile field. What would be the nurse's next appropriate action? (A) Discard the sterile field and supplies and start over. (B) Call for help and ask for new supplies. (C) Proceed with the procedure since it was only touched by the client. (D) Change the sterile field, but reuse the sterile equipment.
(A) Discard the sterile field and supplies and start over.
The nurse is caring for a client who developed a urinary tract infection while hospitalized. What intervention(s) will the nurse initiate to care for this health care-associated infection? Select all that apply. (A) Move client to a private room for safety precautions (B) Transmission-based precautions including proper disinfecting of equipment (C) Move client to an airborne infection isolation room (D) Standard precautions such as gloves and hand hygiene (E) Wear mask, eye protection, and gown for all client contact
(A) Move client to a private room for safety precautions (B) Transmission-based precautions including proper disinfecting of equipment (D) Standard precautions such as gloves and hand hygiene
A nurse is providing care to several clients. The nurse performs handwashing with soap and water instead of an alcohol-based hand sanitizer for a client infected with which pathogen? Select all that apply. (A) Norovirus (B) E. coli (C) Staphylococcus aureas (D) Candida albicans (E) Clostridium difficile
(A) Norovirus (E) Clostridium difficile
For which client would the use of standard precautions alone be appropriate? (A) an incontinent client in a nursing home who has diarrhea (B) a child with chickenpox who is treated in the emergency room (C) a client with TB who needs medications administered (D) a client with diphtheria who needs p.m. care
(A) an incontinent client in a nursing home who has diarrhea
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? (A) change to airborne precautions (B) change to standard precautions (C) continue with droplet precautions (D) change to contact precautions
(A) change to airborne precautions
The nurse is preparing a client in airborne precautions for severe acute respiratory syndrome (SARS) to be transported to radiology. Which intervention will the nurse select to transport the client? Select all that apply. (A) cover the client with a sheet during transport (B) place a mask on the patient (C) prepare the transport stretcher with a clean sheet (D) refuse to transport the client (E) communicate about precautions with the health care team
(A) cover the client with a sheet during transport (B) place a mask on the patient (E) communicate about precautions with the health care team
The nurse who is caring for a client in contact isolation is preparing to conduct an assessment. How will the nurse listen to the client's heart? (A) stethoscope that remains in the client's room (B) stethoscope that hangs outside the client's room (C) stethoscope that has been purchased by the client (D) stethoscope belonging to the nurse
(A) stethoscope that remains in the client's room
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) endotracheal tube (D) Salem sump nasogastric tube
(A) urinary catheter
Which is not appropriate regarding the use of gowns as PPE? (A) use of a new gown each time the nurse enters the room (B) use of paper or cloth gowns (C) donning a gown when splashing (D) use of one gown per person per shift
(A) use of a new gown each time the nurse enters the room
The nurse is caring for a client admitted with tuberculosis (TB). What would be the best action by the nurse? (A) Have the client wear a mask during care. (B) Apply a nonparticulate (N-95) respirator when entering the room. (C) Wear a mask with face shield during invasive procedures. (D) Wear a protective gown and gloves with any direct contact.
(B) Apply a nonparticulate (N-95) respirator when entering the room.
When preparing a sterile field, the nurse notes that the bottle of sterile saline was opened 48 hours ago and is half full. What action does the nurse take to ensure that the saline used is sterile? (A) Use the saline for the procedure and discard the remaining amount because it has been 48 hours since opening. (B) Discard the bottle and get a new one because the saline has expired. (C) Since the bottle has been open, previously used, and unexpired, "lip" it by pouring a small amount into a waste container or waste cup. (D) Pour the saline into a sterile container on the sterile field by holding it 6 in (15 cm) above the container.
(B) Discard the bottle and get a new one because the saline has expired.
The nurse needs to place gauze from a wrapped item into the sterile field. Which action does the nurse take? (A) Lay the item in an open package on the 1-in (2.5 cm) border. (B) Drop the item from 6 in (15 cm) above the sterile field. (C) Extend the sterile field b laying the open package beside it. (D) Remove the gauze from the package with one sterile hand.
(B) Drop the item from 6 in (15 cm) above the sterile field.
A child who appears to have a cold sneezes repeatedly in the waiting room without covering the mouth. Which action should the nurse take? (A) Have all clients in the waiting room don face masks. (B) Give the child a box of tissues and ask to cover the face with a tissue every time he sneezes. (C) Ask the child to stay at least 2 feet (0.6 meters) away from all other clients. (D) Ask the parent to take the child home.
(B) Give the child a box of tissues and ask to cover the face with a tissue every time he sneezes.
What is an accurate guideline for the use of PPE? (A) Put on PPE after entering the client's room. (B) Replace gloves if they are visibly soiled. (C) When wearing gloves, work from "dirty" areas to "clean" ones. (D) Substitute personal glasses for protective eyewear, if desired.
(B) Replace gloves if they are visibly soiled.
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? (A) The nurse keeps visitors 3 feet away from the infected person. (B) The nurse places the client in a private room with the door open. (C) The nurse places the client in a private room with monitored negative air pressure. (D) The nurse uses droplet precautions when providing care for the client.
(B) The nurse places the client in a private room with the door open.
A nursing student is donning sterile gloves to perform routine tracheostomy care for a client. Which behavior by the student would require immediate intervention from the instructor? (A) washes hands for 20 seconds with soap and water (B) reaches down to the bed to pick up a sterile drape (C) picks up the glove at the folder edge with the thumb and forefinger (D) stretches the glove over the hand without touching the unsterile area
(B) reaches down to the bed to pick up a sterile drape
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) Send the sphygmomanometer for sterilization. (C) Cleanse and disinfect the sphygmomanometer. (D) Use the sphygmomanometer.
(C) Cleanse and disinfect the sphygmomanometer.
What is the primary purpose for the demonstrated glove application (pulling the gloves over the PPE gown)? (A) Anchor gown sleeves (B) Help adjust for glove size (C) Cover exposed wrist skin (D) Minimize risk of a glove tear
(C) Cover exposed wrist skin
The nurse is inserting an indwelling catheter. What steps will the nurse distinguish as priority in preventing an infection? (A) Wash the perineal area with soap and water (B) Place water-soluble lubricant on catheter tip prior to insertion (C) Create an area for sterile field and opening packages (D) Ensure opening port of the catheter is closed
(C) Create an area for sterile field and opening packages
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? (A) Give the client the water pitcher and continue preparation. (B) Remove the supplies from the field and replace with new supplies. (C) Discard the supplies and field and prepare a new sterile field. (D) Educate the client on sterile fields and continue preparing for the procedure.
(C) Discard the supplies and field and prepare a new sterile field.
To eliminate needlesticks as potential hazards to nurses, the nurse should: (A) stick the uncapped needle into a Styrofoam block and deposit it in a plastic container. (B) slide the needle into the cap and deposit it in a puncture-proof plastic container. (C) immediately deposit uncapped needles into a puncture-proof plastic container. (D) place the uncapped needle on a tray and carry it to the medicine room for disposal.
(C) immediately deposit uncapped needles into a puncture-proof plastic container.
The nurse notices a student preparing to enter the room of a client with pulmonary tuberculosis with only gloves on. What is the appropriate nursing intervention? (A) offer the student a mask (B) teach that a gown and shoe coverings must be worn in addition to gloves (C) remind the student that a fitted N95 respirator is required (D) do nothing, as the precautions observed are appropriate
(C) remind the student that a fitted N95 respirator is required
The nurse is discussing antiviral medication with a client diagnosed with human immunodeficiency virus (HIV). Which client statement indicates a need for further teaching? (A) "The antiviral medication will stop the virus from multiplying." (B) "I will need to take the antiviral medication every day." (C) "The antiviral medication will limit the viral load in my body." (D) "The antiviral medication will cure the virus from my body."
(D) "The antiviral medication will cure the virus from my body."
Which practice is a correct application of infection control practices? (A) A nurse dons a pair of gloves prior to any client contact. (B) A nurse rinses hands thoroughly after the application of an alcohol-based hand rub. (C) A nurse uses an alcohol-based hand rub each time that the nurse's hands are visibly soiled. (D) A nurse performs hand washing each time the nurse removes a pair of gloves
(D) A nurse performs hand washing each time the nurse removes a pair of gloves
About which public health principle should the nurse educate clients to prevent the spread of West Nile virus? (A) Use a face mask when in crowds (B) Use hand sanitizer after touching any public surface (C) Self-quarantine yourself for 2 weeks if you feel ill (D) Avoid contact with mosquitoes
(D) Avoid contact with mosquitoes
A nurse is implementing the principles of surgical asepsis while inserting a client's indwelling urinary catheter. Which action should the nurse perform? (A) Consider the outer 3-in edge of a sterile field to be contaminated. (B) Consider the outside of the sterile package to be partially sterile. (C) Open sterile packages so that the first edge of the wrapper is directed toward you. (D) Hold sterile objects above waist level to prevent accidental contamination.
(D) Hold sterile objects above waist level to prevent accidental contamination.
The nurse is caring for a client who has been placed in strict isolation. Which nursing action is appropriate? (A) Allow many family members to visit at once. (B) Deliver flowers and balloons to the room. (C) No special precautions are required. (D) Remove fresh fruit from the room.
(D) Remove fresh fruit from the room.
A client has tested positive for methicillin-resistant Staphylococcus aureus after being swabbed on admission to the hospital. Bacterial resistance to antibiotics is an example of: (A) Aerobic activity (B) Means of transmission (C) Spore production (D) Survival adaptation
(D) Survival adaptation
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? (A) The nurse rinses thoroughly with water flowing away from the fingertips. (B) The nurse uses about 2 tsp (10 ml) of liquid soap to wash hands. (C) The nurse uses soap and cold water to wash hands. (D) The nurse washes at least 1 in (2.5 cm) above the area of contamination if present.
(D) The nurse washes at least 1 in (2.5 cm) above the area of contamination if present.
Personal protective equipment (PPE) is used in health care facilities for primarily which reason? (A) To protect clients from becoming infected by staff members (B) To protect the hospital from legal liability (C) To protect staff members from becoming infected by clients (D) To protect both the staff and clients from becoming infected by one another
(D) To protect both the staff and clients from becoming infected by one another
A nurse is providing care to a client who has Salmonella food poisoning. The nurse understands that this pathogen was transmitted by which mechanism? (A) Airborne (B) Droplet (C) Direct contact (D) Vehicle
(D) Vehicle
The nurse is reviewing the plan of care for assigned clients. Which client has the highest risk for developing an infection? (A) a middle-age adult who takes prescribed medication to control blood pressure (B) an adolescent who has a right radial fracture (C) a school-age child who is current with immunizations (D) an older client with a history of heart failure
(D) an older client with a history of heart failure
When a nurse picks up a client's contaminated tissue without gloves and fails to wash the hands sufficiently, the nurse provides for the client's organisms to be spread by which type of transmission? (A) vehicle (B) vector (C) airborne (D) contact
(D) contact
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? (A) adult (B) pregnant woman (C) child (D) older adult
(D) older adult
The nurse observes an unlicensed assistive personnel (UAP) collecting a urine specimen from a client with Staphylococcus aureus infection. Which action by the UAP would require the nurse to intervene? (A) applies a mask with a face shield (B) asks the client to state name and date of birth (C) performs hand hygiene before donning gloves (D) removes gloves and walks out of the room
(D) removes gloves and walks out of the room
