Chapter 28: Infection Prevention and Control

The nurse manager is evaluating current infection control data for the intensive care unit. The nurse compares past patient data with current data to look for trends. The nurse manager examines the chain of infection for possible solutions. Arrange these items in the proper order. (All answers are utilized.) a. A mode of transmission b. An infectious agent or pathogen c. A susceptible host d. A reservoir or source for pathogen growth e. A portal of entry to a host f. A portal of exit from the reservoir

ANS: B, D, F, A, E, C

The nurse is assessing a new patient admitted to home health. To decrease the risk of infection, which of these questions would be most appropriate to ask? (Select all that apply.) a. "Will you demonstrate how to wash your hands?" b. "Do you have a working refrigerator?" c. "Can you explain the risk for infection in your home?" d. "What are the signs and symptoms of infection?" e. "Who runs errands for you?" f. "Are you able to walk to the mailbox?"

ANS: A, B, C, D

The nurse is caring for a patient who needs a protective environment. The nurse has provided the care needed and is now leaving the room. Select the correct order for removal of the personal protective equipment and associated tasks. (All answers are utilized.) a. Remove eyewear/face shield and goggles. b. Perform hand hygiene. c. Remove gloves. d. Untie gown, allow gown to fall from shoulders, and do not touch outside of gown; dispose of properly. e. Remove mask by strings; do not touch outside of mask. f. Dispose of all contaminated supplies and equipment in designated receptacles. g. Leave room and close the door.

ANS: C, A, D, E, B, G, F

The nurse is admitting a patient with an infectious disease process. What question would be appropriate for a nurse to ask this patient? a. "Do you have a chronic disease, and how long have you had it?" b. "Do you have any children living in the home?" c. "What is your marital status—single, married, or divorced?" d. "Do you have any cultural or religious beliefs that will influence your care?"

ANS: A

The nurse is changing linens for a postoperative patient and feels a stick in her hand. A nonactivated safe needle is noted in the linens. This scenario would indicate that the nurse may be at risk for a. Hepatitis B. b. Clostridium difficile. c. Methicillin-resistant Staphylococcus aureus. d. Diphtheria.

ANS: A

Which of these interventions would take priority and should be included in a plan of care for a patient who presents with pneumonia? a. Observe the patient for decreased activity tolerance. b. Assume that the patient is in pain and treat accordingly. c. Maintain the temperature at 65 F. d. Provide the patient ice chips as requested.

ANS: A

A female adult patient presents to the clinic with reports of a white discharge and itching in the vaginal area. During the health history, which of these questions should the nurse prioritize? a. "When was the last time you visited the physician?" b. "Has this condition affected your eating habits?" c. "What medications are you currently taking?" d. "Are you able to sleep at night?"

ANS: C

The nurse is caring for a patient with pneumonia with a new nurse in orientation. Which of the following statements by the new nurse would indicate an understanding of the nature of this condition? a. "An infectious disease like pneumonia may not pose a risk to others." b. "We need to isolate the patient in a negative pressure room." c. "The patient will not be able to return home." d. "Clinical signs and symptoms are not present in pneumonia."

ANS: A Infections are infectious or communicable. Infectious diseases may not pose a risk for transmission to others, although they are serious for the patient.

The nurse is caring for a patient who has cultured positive for Clostridium difficile. Which of the following nursing actions would be appropriate given this organism? a. Instruct assistive personnel to use soap and water rather than sanitizer to clean hands. b. Place the patient on Droplet Precautions. c. Wear an N95 respirator when entering the patient room. d. Teach the patient cough etiquette.

ANS: A Instruct assistive personnel to use soap and water rather than sanitizer to clean hands.

The nurse is caring for a patient on the medical-surgical unit. The nurse and the physician have completed an invasive procedure. What is the next step in handling the instruments used during the procedure? a. Don gloves, gather instruments, place in transport carrier, and send to central sterile for cleaning and sterilization. b. Don gloves, gather instruments, place in transport carrier, and send to central sterile for cleaning and disinfection. c. Don gloves, gather instruments, place in transport carrier, and send to central sterile for cleaning and boiling. d. Don gloves, gather instruments, place in transport carrier, and send to central sterile for cleaning.

ANS: A Instruments need to be cleaned and sterilized. Disinfecting, boiling, or cleaning is not utilized on critical items that will be reused on patients in the hospital environment. Items that are used on sterile tissue or in the vascular system present a high risk of infection if they become contaminated with bacteria.

The nurse is inserting a peripherally inserted central catheter (PICC) into the patient. Aware of the potential for health care-associated infection, the nurse is careful to a. Prepare the skin with 2% chlorhexidine gluconate. b. Select a catheter of appropriate size for the appropriate vein. c. Use nonallergenic tape and dressings on the patient. d. Utilize local anesthetic on the site as ordered.

ANS: A One of the sites for health care-associated infection is the bloodstream. Bloodstream infection can be caused by improper care of the needle insertion site. Two percent chlorhexidine gluconate is an antiseptic solution that when applied properly and allowed to dry reduces microbial counts at the insertion site.

Which interventions utilized by the nurse would indicate the ability to recognize the inflammatory response? a. Rest, ice, compression, and elevation b. Turn, cough, and deep breathe c. Orient to date, time, and place d. Passive range-of-motion exercises

ANS: A One sign of the inflammatory response, particularly after an injury, is swelling or edema. Resting the affected injured area, using ice as ordered, wrapping the area to provide support—particularly if it is an extremity—and elevating the injured area will help to decrease swelling or edema.

The nurse is caring for a patient in the hospital. The nurse observes the nursing assistant turning off the handle faucet with his hands. What professional practice supports the need for follow-up with the nursing assistant? a. The nurse is responsible for providing a safe environment for the patient. b. This is a key step in the procedure for washing hands. c. Allowing the water to run is a waste of resources and money. d. Different scopes of practice allow modification of procedures.

ANS: A The nurse is responsible for providing a safe environment for the patient.

The nurse is dressed and is preparing to care for a patient in the perioperative area. The nurse has scrubbed her hands and has donned a sterile gown and gloves. Which action would indicate a break in sterile technique? a. Touching protective eyewear b. Standing with hands folded on chest c. Accepting sterile supplies from the surgeon d. Staying with the sterile table once it is open

ANS: A Touching nonsterile protective eyewear once gowned and gloved with sterile gown and gloves would indicate a break in sterile technique. Sterile objects remain sterile only when touched by another sterile object.

The nurse has received a report from the emergency department that a patient with tuberculosis will be coming to the unit. What items will the nurse need to care for this patient? (Select all that apply.) a. Private room b. Negative-pressure airflow in room c. Communication signs for Droplet Precautions d. Communication signs for Airborne Precautions e. Surgical mask, gown, gloves, eyewear f. N95 respirator, gown, gloves, eyewear

ANS: A, B, D, F

The nurse is preparing to insert a urinary catheter. The nurse is using open gloving to don the sterile gloves. Which steps are included in this process? (Select all that apply.) a. Lay glove package on clean flat surface above waistline. b. Remove outer glove package by tearing the package open. c. Glove the dominant hand of the nurse first. d. While putting on the first glove, touch only the outside surface of the glove. e. With gloved dominant hand, slip fingers underneath second glove cuff. f. After second glove is on, interlock hands.

ANS: A, C, E, F

The nurse is caring for a patient with an incision. Which of the following actions would best indicate an understanding of medical and surgical asepsis? a. Donning sterile gown and gloves to remove the wound dressing b. Utilizing clean gloves to remove the dressing and sterile supplies for the new dressing c. Donning clean goggles, gown, and gloves to dress the wound d. Utilizing clean gloves to remove the dressing and clean supplies for the new dressing

ANS: B

Which of the following nursing actions would most increase a patient's risk for developing a health care-associated infection? a. Use of surgical aseptic technique to suction an airway b. Urinary catheter drainage bag placed below the level of the bladder c. Clean technique for inserting a urinary catheter d. Use of a sterile bottled solution more than once within a 24-hour period

ANS: C Using clean technique (medical asepsis) to insert a urinary catheter would place the patient at risk for a health care-associated infection.

The nurse is caring for a patient who has a bloodborne pathogen. The nurse splashes blood above the glove to intact skin while discontinuing an intravenous infusion. The nurse's best next step is to a. Obtain an alcohol swab, remove the blood with an alcohol swab, and continue care. b. Immediately wash the site with soap and running water, and seek guidance from the manager. c. Delay washing of the site until the nurse is finished providing care to the patient. d. Do nothing; accidentally getting splashed with blood happens frequently and is part of the job.

ANS: B Immediately wash the site with soap and running water, and seek guidance from the manager.

The nurse is caring for a patient on Contact Precautions. Which of the following actions would be appropriate to prevent the spread of disease? a. Wear a gown, gloves, face mask, and goggles for interactions with the patient. b. Use a dedicated blood pressure cuff that stays in the room and is used for that patient only. c. Place the patient in a room with negative airflow. d. Transport the patient quickly when going to the radiology department.

ANS: B Use a dedicated blood pressure cuff that stays in the room and is used for that patient only

The nurse is providing an education session to an adult community group about the effects of smoking. Which of the following is the most important point to be included in the educational session? a. Smoke from tobacco products clings to your clothing and hair. b. Smoking affects the cilia lining the upper airways in the lungs. c. Smoking tobacco products can be very expensive. d. Smoking can affect the color of the patient's fingernails.

ANS: B A normal defense mechanism against infection in the respiratory tract is the cilia lining the upper airways of the lungs and normal mucus. When a patient inhales a microbe, the cilia and mucus trap the microbe and sweep them up and out to be expectorated or swallowed.

The infection control nurse is reviewing data for the medical-surgical unit. The nurse notices a spike in postoperative infections on this unit and categorizes this type of health care-associated infection as _____ infections. a. Iatrogenic b. Exogenous c. Endogenous d. Nosocomial

ANS: B An exogenous organism is one that is present outside the patient. A postoperative infection is an exogenous infection because the organism that has caused the infection presents from outside the body. An example is Staphylococcus aureus. An endogenous organism is part of the normal flora of residing virulent organisms that could cause infection.

The nurse is observing a family member changing a dressing for a patient in the home health environment. Which of these observations would indicate that the family member has a correct understanding of how to manage contaminated dressings? a. The family member removes gloves and gathers items for disposal. b. The family member places the used dressings in a plastic bag. c. The family member saves part of the dressing because it is clean. d. The family member wraps the used dressing in toilet tissue before placing in the trash.

ANS: B Contaminated dressings and other infectious items should be placed in impervious plastic or brown paper bags and then disposed of properly in garbage containers. Gloves should be worn during this process. Parts of the dressing should not be saved, even though they may seem clean, because microbes may be present.

The home health nurse is teaching a patient and family about hand hygiene in the home. The nurse is sure to emphasize washing hands before a. And after shaking hands. b. And after treatments. c. Opening the refrigerator. d. And after using a computer.

ANS: B Patients should perform hand hygiene before and after treatments and when coming in contact with body fluids. Depending on the type of patient, holding hands does not require washing of hands before but is advisable before touching eyes, nose, or mouth—washing hands afterward would be a good practice. Washing hands before and after opening the refrigerator and using the computer is not required but during cold and flu season might be advisable.

The nurse is caring for a patient with leukemia and is preparing to provide fluids through a vascular access device. Which nursing intervention is priority in this procedure? a. Position the patient comfortably. b. Maintain aseptic technique. c. Gather available supplies. d. Review the procedure with the patient.

ANS: B Patients with disease processes of the immune system are at particular risk for infection. These diseases include leukemia, AIDS, lymphoma, and aplastic anemia. These disease processes weaken the defenses against an infectious organism. It is priority that anytime an intravenous device is accessed, aseptic technique must be maintained with wearing of appropriate personal protective equipment, preparation of the skin, and use of sterile gloves, sterile supplies, appropriate flushing, and appropriate discontinuation.

The nurse is caring for a patient with a nursing diagnosis of risk for infection. Aware of the need for Standard Precautions, the nurse is careful to a. Teach the patient about good nutrition. b. Wear eyewear when emptying a urinary drainage bag. c. Avoid contact with intact skin without wearing gloves. d. Don gloves when wearing artificial nails.

ANS: B Standard Precautions include the wearing of eyewear whenever there is a possibility of a splash or splatter. Teaching the patient about good nutrition is positive but does not apply to Standard Precautions. The term Standard Precautions applies to all blood and body fluids except sweat, even if blood is not present. It also applies to nonintact skin and mucous membranes.

The nurse is caring for a patient who becomes nauseated and vomits without warning. The nurse has contaminated hands. The nurse's best next step is to a. Clean hands with wipes from the bedside table. b. Wash hands with an antimicrobial soap and water. c. Use an alcohol-based waterless hand gel. d. Instruct the patient to wash his face and hands.

ANS: B The Centers for Disease Control recommends that when hands are visibly soiled, one should wash with a non-antimicrobial soap or with antimicrobial soap.

The nurse is caring for a group of medical-surgical patients. The patient most at risk for developing an infection is the patient who a. Is in observation for chest pain. b. Is recovering from a right total hip arthroplasty. c. Has been admitted with dehydration. d. Has been admitted for stabilization of atrial fibrillation.

ANS: B The patient who is recovering from a right total hip arthroplasty has had a surgical procedure wherein bone was removed from the body and an implant was placed within the patient. The patient has a large incision from surgery.

The nurse is caring for a patient who is susceptible to infection. Which of the following nursing interventions will assist in decreasing the risk of infection? a. Teaching the patient about fall prevention b. Teaching the patient to select nutritious foods c. Teaching the patient to take a temperature d. Teaching the patient about the effects of alcohol

ANS: B When protein intake is inadequate as a result of poor diet, the rate of protein breakdown exceeds that of tissue synthesis. A reduction in the intake of protein and other nutrients such as carbohydrates and fats reduces the body's defenses against infection and impairs wound healing. Teaching the patient about fall prevention, how to take a temperature, or about the effects of alcohol does not decrease the risk of infection.

The nurse and the student nurse are caring for two different patients on the medical-surgical unit. One patient is in Airborne Precautions, and one is in Contact Precautions. The nurse explains to the student different interventions for care. What should the nurse include in her teaching? (Select all that apply). a. Be consistent in nursing interventions; there is only one difference in the precautions. b. Wash hands before entering and leaving both of the patients' rooms. c. Dispose of supplies to prevent the spread of microorganisms. d. Apply the knowledge the nurse has of the disease process to prevent the spread of microorganisms. e. Patients in Airborne Precautions wear a mask during transportation to departments. f. Checking the working order of the negative-pressure room is done on admission and at the time of discharge.

ANS: B, C, D, E

The nurse is caring for a patient in Contact Precautions. The nurse includes hand hygiene as part of the plan of care to (Select all that apply). a. Provide an uninterrupted chain of infection. b. Decrease the incidence of health care-associated infection. c. Protect the nurse from transmission of the microbes. d. Decrease the transmission of microbes to other patients. e. Prevent contamination of clean supplies. f. Decrease the drying effects of soap.

ANS: B, C, D, E

The nurse has been caring for a patient in the perioperative area for several hours. The surgical mask the nurse is wearing has become moist. The nurse's best next step is to a. Change the mask when relieved. b. Air-dry the mask while at lunch, and reapply. c. Ask for relief, step out of the surgical area, and apply a new mask. d. Not change the mask, if the nurse is comfortable.

ANS: C A mask should fit snugly around the face and nose. After the mask is worn for several hours, it can become moist. The mask should be changed as soon as possible because moisture encourages the growth of microorganisms. Waiting to change the mask, air-drying it, or wearing it because it is comfortable does not support the principles of infection control.

The patient has contracted a urinary tract infection while in the hospital. Which of these actions would most likely increase the risk of a patient contracting a urinary tract infection (UTI)? a. Emptying the urinary drainage bag once a shift b. Reusing the patient's graduated receptacle to empty the drainage bag c. Allowing the drainage bag port to touch the graduated receptacle d. Providing perineal hygiene at least once a shift

ANS: C Allowing the urinary drainage bag port to touch contaminated items may introduce bacteria into the system and contribute to a urinary tract infection. The urinary drainage bag should be emptied at least once every 8 hours. Each patient should have his own receptacle for measurement to prevent cross-contamination. Perineal hygiene should be provided every 8 hours and after bowel movements to assist in preventing a UTI.

The patient and the nurse are discussing Rickettsia rickettsii—Rocky Mountain spotted fever. Which patient statement to the nurse indicates understanding regarding the mode of transmission of this disease? a. "When I go camping, I will be sure to wear sunscreen." b. "When I go camping, I will drink bottled water." c. "When I go camping, I will be sure to wear insect repellent." d. "When I go camping, I will be sure to use hand gel on my hands."

ANS: C Each infectious disease has a specific mode of transmission—a component of the chain of infection. Rocky Mountain spotted fever is caused by bacteria transmitted by the bite of ticks. Wearing a repellent that is designed for repelling ticks, mosquitoes, and other insects can help in preventing transmission of this disease.

The nurse is caring for a home health patient. After completing an assessment, the nurse has diagnosed the patient as being at risk for infection. Which of the following orders would the nurse question? a. Urinary catheter to bedside drainage bag. May change to leg bag during the day. b. May reuse nebulizer equipment. Clean with mild soap and warm water, and allow to dry. c. Prepare enough enteral feedings for 12 hours. Rinse feeding bag and tubing daily. d. Call for temperature greater than 100.5, heart rate greater than 100, and respiratory rate greater than 24.

ANS: C For patients who receive tube feedings in the home, to decrease the risk of bacterial contamination it is important to prepare enough commercially prepared formula for only 8 hours and home-prepared formula for 4 hours. Sometimes the urinary drainage system is disrupted in the home to place the patient on a leg bag system when up and about. Nebulizer equipment is cleaned and reused in the home health environment. Notifying the physician about potential signs and symptoms of infection would be common practice in the home health environment.

A diabetic patient presents to the clinic for a dressing change. The wound is located on the right foot and has purulent yellow drainage. Which of these interventions would be most appropriate for the nurse to provide? a. Position the patient comfortably on the stretcher. b. Explain the procedure for dressing change to the patient. c. Don gloves and other appropriate personal protective equipment. d. Review the medication list that the patient brought from home.

ANS: C Localized infections are most common in the skin or with mucous membrane breakdown. Wear gloves and other personal protective equipment as appropriate when examining or providing treatment to localized infected areas. Positioning the patient, explaining the procedure, and reviewing the medication list are all tasks that need to be completed, but preventing the spread of infection takes precedence.

The nurse is caring for a patient in labor and delivery. When near completing an assessment of the patient for dilatation and effacement, the electronic infusion device being used on the intravenous infusion alarms. Which of these actions is most appropriate for the nurse to take? a. Complete the assessment, remove gloves, and silence the alarm. b. Discontinue the assessment, and assess the intravenous infusion. c. Complete the assessment, remove gloves, wash hands, and assess the intravenous infusion. d. Discontinue the assessment, remove gloves, use hand gel, and assess the intravenous infusion.

ANS: C Medical asepsis or clean technique includes procedures to decrease the number of organisms present and to prevent the transfer of organisms. Wearing gloves while assessing the dilatation and effacement of a labor and delivery patient, removing gloves, washing hands after contact with body fluids, and then assessing the intravenous infusion will assist in the prevention and transfer of any potential organisms to this intravenous line. Completing the assessment, removing gloves, and silencing the alarm leaves out the crucial step of decontaminating and washing the hands.

The nurse is caring for a patient in the endoscopy area. The nurse observes the technician performing these tasks. Which of these observations would require the nurse to intervene? a. Washing hands after removing gloves b. Placing the endoscope in a container for transfer c. Removing gloves to transfer the endoscope d. Disinfecting endoscopes in the workroom

ANS: C Standard Precautions are used to prevent and control the spread of infection. Transferring contaminated equipment without the protection of gloves can assist in the spread of microbes to inanimate objects and to the person doing the transfer.

What would be required after exposure of a nurse to blood by a cut from a scalpel in the perioperative area? a. Removing sterile gloves and disposing of in kick bucket b. Placing the scalpel in a needle safe container c. Testing the patient and offering treatment to the nurse d. Providing a medical evaluation of the nurse to the manager

ANS: C Testing the patient and offering treatment to the nurse

The nurse is caring for an adult patient in the clinic who has been evacuated and is a victim of flooding. The patient presents with signs and symptoms of a urinary tract infection. Along with needed education surrounding this diagnosis, the nurse teaches the patient about rest, exercise, eating properly, and how to utilize deep breathing and visualization. Which of these explanations would best support these nursing interventions? a. Urinary tract infections are painful, and these techniques would help with managing the pain. b. Interventions listed are standard topics taught during health care visits. c. Stress for long periods of time can lead to exhaustion and decreased resistance to infection. d. The patient requested this information to teach to extended family at home.

ANS: C The body responds to emotional or physical stress by the general adaptation syndrome. If stress extends for long periods of time, this can lead to exhaustion, whereby energy stores are depleted and the body has no defenses against invading organisms. Techniques of deep breathing and visualization may be helpful with pain, but the interventions listed are not all standard interventions taught at every health care visit.

The nurse is performing hand hygiene before assisting a physician with insertion of a chest tube. While washing hands, the nurse touches the sink. What is the next action the nurse should take? a. Inform the physician and recruit another nurse to assist. b. Rinse and dry hands, and begin assisting the physician. c. Repeat handwashing using antiseptic soap, d. Extend the handwashing procedure to 5 minutes.

ANS: C The inside of the sink and the counter at the edges of the sink, faucet, and handles are considered contaminated areas. If the hands touch any of these areas during handwashing, repeat the handwashing procedure utilizing antiseptic soap.

The circulating nurse in the perioperative area is observing the surgical technologist while applying a sterile gown and gloves to care for a patient having an appendectomy. Which of the following behaviors indicate to the nurse that the procedure has been done correctly? (Select all that apply.) a. Surgical cap and face mask are in place. b. Surgical technologist ties the back of the gown. c. Surgical technologist touches only inside of gown. d. Surgical technologist slips arms into arm holes simultaneously. e. Surgical technologist uses hands covered by sleeves to open gloves. f. Fingers are extended fully into both gloves. .

ANS: C, D, E, F

The nurse is caring for a school-aged child who has injured his leg after a bicycle accident. To determine whether the child is experiencing a localized inflammatory response, the nurse should assess for which of these signs and symptoms? a. Fever, malaise, anorexia, and nausea and vomiting b. Chest pain, shortness of breath, and nausea and vomiting c. Dizziness and disorientation to time, date, and place d. Edema, redness, tenderness, and loss of function

ANS: D

The patient experienced a surgical procedure, and Betadine was utilized as the surgical prep. Two days postoperatively, the nurse's assessment indicates that the incision is red and has a small amount of purulent drainage. The patient reports tenderness at the incision site. The patient's temperature is 100.5° F and the WBC is 10,500/mm3. Which nursing action should the nurse take? a. Plan to change the surgical dressing during the shift. b. Check to see what solution was used for skin preparation in surgery. c. Collect supplies to culture the surgical incision. d. Utilize SBAR to call and communicate the patient's needs to the physician.

ANS: D Organisms enter the body in several different ways. Proper skin preparation for surgery is essential to decrease the chance of infection. The nursing assessment indicates signs and symptoms of infection. The physician needs to be called and notified of the patient's needs. SBAR—Situation, Background, Assessment, and Recommendation—can be utilized to organize thoughts and data and to provide a through explanation of the patient's current status. .

The nurse is caring for a patient who has just delivered a neonate. The nurse is checking the patient for excessive vaginal drainage. It is important for the nurse to utilize _____ Precautions. a. Contact b. Protective c. Droplet d. Standard

ANS: D Standard Precautions apply to contact with blood, body fluid, nonintact skin, and mucous membranes of all patients. Contact Precautions apply to individuals with colonization of infection such as MRSA. Protective Precautions apply to individuals who have undergone transplantations. Droplet Precautions focus on diseases that are transmitted by large droplets.

The nurse is providing an educational session for a group of preschool workers. The nurse reminds the group that the most important thing to do to prevent the spread of infection is to a. Encourage preschool children to eat a nutritious diet. b. Encourage parents to provide a multivitamin to the children. c. Clean the toys every afternoon before putting them away. d. Wash their hands between each interaction with children.

ANS: D The single most important thing that individuals can do to prevent the spread of infection is to wash their hands