infection control

Which of the following patients presents the most significant risk factors for the development of Clostridium difficile infection? a) An 81-year-old patient who has been receiving multiple antibiotics for the treatment of sepsis b) A 44-year-old patient who is paralyzed and whose coccyx ulcer has required a skin graft c) A patient with renal failure who receives hemodialysis three times weekly d) A 30-year-old patient who has recently contracted human immunodeficiency virus after engaging in high-risk sexual behavior

a) An 81-year-old patient who has been receiving multiple antibiotics for the treatment of sepsis --Old age and recent, long-term antibiotic therapy are significant risk factors for C. difficile infection. These supersede the risks posed by recent HIV infection, skin grafts, and hemodialysis

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation? a) Empathy b) Indifference c) Pity d) Sympathy

a) Empathy --The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition. If the nurse becomes indifferent to the family's condition, the nurse may not be able to assess their needs. The nurse should not pity, or provide sympathy to, the family for their loss, as it would involve the nurse emotionally.

Which of the following nursing actions carries the greatest likelihood of contributing to the spread of vancomycin-resistant enterococci (VRE)? a) Emptying the Foley catheter bag of a patient with VRE and then helping the patient in the next bed transfer to a chair b) Sending a VRE-positive patient to the radiology department for a chest X-ray without a face mask c) Delivering a meal tray to a VRE-positive patient without first donning gloves and a gown d) Removing the staples from a VRE-positive, postsurgical patient's incision without prior handwashing

a) Emptying the Foley catheter bag of a patient with VRE and then helping the patient in the next bed transfer to a chair --Direct patient contact between a VRE-positive patient and another patient without handwashing carries a significant risk of infection, especially when contact includes body fluids. Handwashing is necessary before a procedure such as staple removal, but foregoing this infection control measure is less likely to spread VRE unless the nurse failed to handwash after the procedure. VRE does not normally require droplet or airborne precautions and delivering an item to a patient without gloves or a gown is less of a risk than failing to handwash after such contact.

The nurse working with the hospital's infection control team is attempting to decrease the transmission of health care-associated pathogens. Which of the following will be most effective? a) Incentivizing health care workers to utilize hand hygiene b) Limiting visitors to family members over the age of 18 c) Revising the facility's infection control protocols d) Encouraging visitors to adhere to isolation precautions

a) Incentivizing health care workers to utilize hand hygiene --Most health care-associated pathogens are transmitted via the contaminated hands of health care workers. Therefore, the most effective strategies for decreasing transmission are those that educate or encourage health care workers to utilize effective hand hygiene.

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? a) Open a new sterile dressing kit b) Continue changing the dressing c) Wash the client's hands d) Restrain the client's hands

a) Open a new sterile dressing kit

When caring for a psychiatric patient, a formal contract is made with the patient during which phase of the nurse-patient relationship? a) Orientation phase b) Intimate phase c) Termination phase d) Working phase

a) Orientation phase --In the psychiatric setting, the orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are used as a therapeutic tool to help a patient develop more insight and control over his or her own behavior.

In which of the following situations would the SBAR technique of communication be most appropriate? a) A nurse is explaining the process of bone marrow biopsy to a client who is scheduled for the procedure. b) A nurse is calling a physician to report a client's new onset of chest pain. c) A nurse is facilitating a family meeting in order to coordinate a client's discharge planning. d) A nurse is teaching a client about the benefits of smoking cessation and the risks of continuing to smoke.

b) A nurse is calling a physician to report a client's new onset of chest pain. --There are numerous applications of the SBAR technique of communication, including nurse-physician communication surrounding acute client developments. The technique is not normally applied in client education or in communication between the health care team and patients' families.

Which of the following patients is most likely to require neutropenic precautions? a) A patient recovering from orthopedic surgery b) A patient recovering from a bone marrow transplant c) A patient diagnosed with tuberculosis d) A patient awaiting a liver transplant

b) A patient recovering from a bone marrow transplant

What are the general nursing care guidelines that the nurse should follow when caring for clients in a health care facility? a) Avoid physical contact with the infected client. b) Avoid jewelry with prongs or protruding stones. c) Shake linens properly when changing the beds. d) Isolate the client and keep the room door closed.

b) Avoid jewelry with prongs or protruding stones.

When a nurse picks up a client's contaminated tissue without gloves and fails to wash his hands sufficiently, the nurse provides for the client's organisms to be spread by which type of transmission? a) Airborne b) Contact c) Vector d) Vehicle

b) Contact --Direct contact involves body surface-to-body surface contact, causing the physical transfer of organisms between an infected or colonized host and a susceptible host.

A student nurse is attempting to improve her communication skills. Which of the following is an appropriate therapeutic communication skill? a) Avoid the use of periods of silence. b) Control the tone of the voice to avoid hidden messages. c) Be precise and inflexible regarding the intent of the conversation. d) Use cliches to enhance a client's understanding of information.

b) Control the tone of the voice to avoid hidden messages. --Conversation skills involve controlling the tone of one's voice so that exactly what is intended is conveyed, and there is no hidden message. Periods of silence have an important role in conversations because they allow for periods of reflection. Cliches should be avoided, and the conversation should be flexible.

Which of the following agents has the potential to affect the integrity of latex gloves? a) Soap and water b) Oil-based lotions c) Betadine scrub d) Alcohol-based handrubs

b) Oil-based lotions

A group of nursing students is working together on a presentation for their clinical instructor. One student in the group participates by arguing and attempting to block each step of the process of this presentation. The student's behavior is causing frustration for the others and slowing their progress. Which of the following best describes the role this individual student is playing in relationship to the group dynamics? a) Maintenance b) Self-serving c) Group-building d) Task-oriented

b) Self-serving --The student's behavior is best described as self-serving. Self-serving roles advance the needs of individual members at the group's expense.

The nurse has entered a client's room after receiving a morning report. The nurse rapidly assessed the client's airway, breathing, and circulation and greeted the client by saying "Good morning." The client has made no reciprocal response to the nurse. How should the nurse best respond to the client's silence? a) The nurse should apologize for bothering the client, perform necessary assessments efficiently and leave the room. b) The nurse should ask appropriate questions to understand the reasons for the client's silence. c) The nurse should document the client's withdrawal and diminished mood in the nurse's notes. d) The nurse should ask the client if he feels afraid or angry.

b) The nurse should ask appropriate questions to understand the reasons for the client's silence. --Silence can have many meanings, and the nurse should attempt to identify the meaning of the client's silence in a tactful manner. Directly asking if the client is angry or fearful is likely presumptuous and may harm rapport. The nurse should not make assumptions around the client's mood nor should the nurse cease to engage with the client.

A nurse is caring for a client with rubella. Which nursing action is an important precaution to be taken when caring for this client? a) Changing gloves after contact with the client's infective material b) Wearing a mask when working within 3 feet of the client c) Washing hands with an antimicrobial agent or waterless antiseptic agent d) Using a special high-filtration particulate respirator

b) Wearing a mask when working within 3 feet of the client --Rubella spreads through droplet transmission; thus, the nurse should wear a mask when working within 3 feet of the rubella client as a precaution against droplet transmission. Changing gloves after contact with the client's infective material and washing hands with an antimicrobial agent or waterless antiseptic agent are contact precautions used in case of clients with diseases that spread through contact transmission. Also, using a special high-filtration particulate respirator is an airborne precaution followed in case of clients with active tuberculosis.

For which of the following clients would the use of Standard Precautions alone be appropriate? a) A client with TB who needs medications administered b) A client with diphtheria who needs pm care c) An incontinent client in a nursing home who has diarrhea d) A child with chickenpox who is treated in the ER

c) An incontinent client in a nursing home who has diarrhea --Standard Precautions apply to blood and all body fluids, secretions, and excretions, except sweat. Transmission-Based Precautions are used in addition to Standard Precautions for clients hospitalized with suspected infection by pathogens that can be transmitted by airborne, droplet, or contact routes, such as is the case in answers A, B, and D.

A nurse needs to visit the intensive care unit to administer an enema to a client. Which of the following steps should the nurse take when using the sterile solution located at the entrance to the intensive care unit? a) Hold the container from the top. b) Clean the nozzle area with a damp cloth. c) Pour and discard a small amount of the solution. d) Loosen the cap or the seal on the bottle.

c) Pour and discard a small amount of the solution. --Before each use of a sterile solution, the nurse should pour and discard a small amount to wash away airborne contaminants from the mouth of the container. To avoid contamination, the nurse should place the cap upside down on a flat surface or hold it during pouring. The nurse should control the height of the container to avoid splashing the sterile field, causing a wet area of contamination. The nurse should not loosen the cap or hold the container from the top. The nurse also should not clean the nozzle area with a damp cloth, as this would lead to contamination of the solution.

A nurse is caring for a client who is admitted to the infection control room of a health care facility with AIDS and acute diarrhea. Which of the following isolation measures is taken in the infection control room? a) Door to the room is kept open for cross-ventilation b) Sink is located outside the room for handwashing c) Private bathroom is provided for flushing contaminated liquids d) Housekeeping personnel clean the infection control room first

c) Private bathroom is provided for flushing contaminated liquids

A nurse finds that a client has infiltration around the IV line that needs to be removed. What explanation should the nurse give to reduce the client's anxiety? a) "The infiltration is causing you pain and you will be relieved when I remove the IV line." b) "It will be a painless procedure and there is nothing to worry about; many clients experience this." c) "You should relax and take deep breaths; the procedure is very minimal and will be over soon." d) "I know that you are anxious, but removal will be painless and the IV location needs to be changed."

d) "I know that you are anxious, but removal will be painless and the IV location needs to be changed." --The nurse uses therapeutic communication by both acknowledging the client's anxiety and giving honest information that another IV line needs to be started. Telling the client that infiltration is causing pain that would be relieved when the IV line is removed does not address the client's anxiety and does not inform the client about restarting another IV line. Also, the nurse telling the client to take deep breaths, or saying that the procedure is very minimal and will be over soon, does not consider the client's anxiety. Finally, telling the client that many clients experience this is generalizing the client and is not appropriate.

Which of the following practices is a correct application of infection control practices? a) A nurse dons a pair of gloves prior to any patient contact. b) A nurse ensures that she rinses her hands thoroughly after the application of an alcohol-based handrub. c) A nurse uses an alcohol-based handrub each time that his hands are visibly soiled. d) A nurse performs handwashing each time she removes a pair of gloves.

d) A nurse performs handwashing each time she removes a pair of gloves. --Handwashing should be performed after the removal of a pair of gloves. Gloves are not required for each and every patient contact and visibly soiled hands require a wash with soap and water. Alcohol-based handrubs are not followed by a rinse.

Which of the following pieces of personal protective equipment should be removed first? a) Respirator b) Gown c) Goggles d) Gloves

d) Gloves --The order for removal of PPE is gloves, goggles, gown, and respirator.

A nurse changing the linens of a patient bed is exposed to urine and performs hand hygiene. Which of the following is a guideline for performing this skill properly following this patient encounter? a) Remove all jewelry, including wedding bands before handwashing. b) Pat dry with a paper towel, beginning with the forearms and moving down to fingertips. c) Use an alcohol-based hand rub to decontaminate hands. d) Keep hands lower than elbows to allow water to flow toward fingertips.

d) Keep hands lower than elbows to allow water to flow toward fingertips.

A client develops a high fever and has a urinary tract infection. The client has malaise and is confused. The client is a) Lethargic b) Apneic c) Anorexic d) Septic

d) Septic

The nurse planning to insert an indwelling urinary catheter into a client should utilize which of the following techniques? a) Medical asepsis b) Contact precautions c) Universal precautions d) Surgical asepsis

d) Surgical asepsis --Surgical asepsis, also known as sterile technique, is utilized to keep objects and areas free from microorganisms when performing surgery and procedures such as inserting an indwelling urinary catheter or IV catheter. Medical asepsis reduces the number and transfer of pathogens. Universal precautions and contact precautions help to decrease the risk of transmitting infection.

A client with TB has been discharged from the health care facility. What care should be taken with regard to cleaning the bed linens used by the client during his stay at the facility? a) Expose them to steam. b) Wash them in a sterile solution. c) Wash them using a disinfectant. d) Wash them with boiling water.

d) Wash them with boiling water. --Boiling water can kill bacteria, especially the organism that causes TB. Boiling water is a convenient way to sterilize items and to clean the bed linens used. To be effective, contaminated items should be boiled for 15 minutes at 212°F (100°C). Washing them with a sterile solution or disinfectant or exposing them to steam will not free the bed and mattresses from infections

T/F The use of alcohol-based hand rubs for hand hygiene in healthcare facilities is approved by the Centers for Disease Control (CDC), but The Joint Commission (TJC) discourages its use.

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