Infection control HESI prep

A client with tuberculosis whose status is being monitored in an ambulatory care clinic asks the nurse when it is permissible to return to work. What factor should the nurse include when responding to the client? a) Five blood cultures are negative. b) Three sputum cultures are negative. c) A blood culture and a chest x-ray are negative. d) A sputum culture and a Mantoux test are negative.

b) Three sputum cultures are negative. Rationale: The client with tuberculosis must have sputum cultures performed every 2 to 4 weeks after initiation of antituberculosis drug therapy. The client may return to work when the results of three sputum cultures are negative because the client is considered noninfectious at that point.

An adolescent is diagnosed with conjunctivitis, and the nurse provides information to the adolescent about the use of contact lenses. Which statement by the client would indicate the need for further information? a) "I should not wear my contact lenses." b) "New contact lenses should be obtained." c) "My old contact lenses should be discarded." d) "My contact lenses can be worn if they are cleaned as directed."

d) "My contact lenses can be worn if they are cleaned as directed." Rationale: If the adolescent wears contact lenses, he or she should be instructed to discontinue wearing them until the infection has cleared completely. Securing new contact lenses will eliminate the chance of reinfection from contaminated contact lenses and will also lessen the risk of a corneal ulceration.

The nurse prepares the client for irrigation of an abdominal wound. After preparation, the nurse would appropriately don which item to perform the procedure? a) Gloves b) Gloves and a gown c) Gloves and goggles d) Gloves, gown, and goggles

d) Gloves, gown, and goggles

The nursing student is following standard precautions to prevent a hospital-acquired infection in a client. The student understands that which applies to the use of standard precautions? Select all that apply. 1. Used when working with all clients 2. Used only when specifically indicated 3. Does not apply to those who do not have any open wounds 4. Applies to blood, all body fluids, secretions, and excretions 5. Is designed to prevent the risk of spreading microorganisms

1. Used when working with all clients 4. Applies to blood, all body fluids, secretions, and excretions 5. Is designed to prevent the risk of spreading microorganisms

The community health nurse is providing a teaching session about terrorism to members of the community and is discussing information regarding anthrax. The nurse tells those attending that anthrax can be transmitted by which route(s)? Select all that apply. 1. Bites from ticks or deer flies 2. Inhalation of bacterial spores 3. Through a cut or abrasion in the skin 4. Direct contact with an infected individual 5. Sexual contact with an infected individual 6. Ingestion of contaminated undercooked meat

2. Inhalation of bacterial spores 3. Through a cut or abrasion in the skin 6. Ingestion of contaminated undercooked meat Rationale: Anthrax is caused by Bacillus anthracis and can be contracted through the digestive system or abrasions in the skin, or inhaled through the lungs. It cannot be spread from person to person or from animal to person, and it is not contracted via bites from ticks or deer flies.

The nurse is working in an illness prevention clinic. An important component of the nurse's practice is to advise high-risk clients to receive an influenza vaccination. Which clients are at high risk for influenza and would benefit from vaccination? Select all that apply. 1. A 47-year-old mother of a child with cystic fibrosis 2. A 54-year-old man scheduled for a routine diabetes check 3. A 43-year-old factory worker with symptoms of influenza 4. A 35-year-old registered nurse scheduled for an annual pelvic exam 5. An 87-year-old woman from a nursing home scheduled for a surgical follow-up

1. A 47-year-old mother of a child with cystic fibrosis 2. A 54-year-old man scheduled for a routine diabetes check 4. A 35-year-old registered nurse scheduled for an annual pelvic exam 5. An 87-year-old woman from a nursing home scheduled for a surgical follow-up Rationale:Influenza vaccinations are recommended yearly and developed according to predicted strain for clients at high risk. Influenza immunization is recommended for high-risk clients. Anyone in close contact with clients with a chronic respiratory or other chronic disorder should receive the vaccine. Adults with chronic metabolic disease such as diabetes mellitus are in the high-risk population. Residents of chronic care facilities are at risk for influenza. Health care workers are in the high-risk population. The influenza vaccine does not treat an active infection with the virus.

The nurse in the health care clinic is preparing to obtain a throat swab for culture in a client suspected of having a beta-hemolytic streptococcal infection. Which actions are appropriate in collecting this specimen? Select all that apply. 1. Instruct the client to tilt the head back. 2. Swab the tonsillar pillars and the posterior pharynx wall. 3. Tell the client that the test will help identify microorganisms. 4. Ask the client to open the mouth; then swab the back of the tongue. 5. Place a tongue depressor on the client's tongue before swabbing the throat.

1. Instruct the client to tilt the head back. 2. Swab the tonsillar pillars and the posterior pharynx wall. 3. Tell the client that the test will help identify microorganisms. 5. Place a tongue depressor on the client's tongue before swabbing the throat. Rationale: When collecting a throat culture, the client is told that the test is performed to help identify microorganisms causing the symptoms. The client is instructed to tilt the head back, and both the tonsillar pillars and the posterior pharynx wall are swabbed. A tongue depressor is used in the collection so that the swab is less likely to contact the normal flora of the mouth. The swab is immediately placed in a labeled culture tube and transported to the laboratory.

The nurse has instructed a client diagnosed with tuberculosis about how to prevent the spread of infection after discharge from the hospital. The nurse determines that the client needs further reinforcement of information if the client makes which statement? a) "I should use disposable plates, forks, and knives." b) "I should cough into tissues and throw them away carefully." c) "It's important to cover my mouth if I laugh, sneeze, or cough." d) "It's very important to wash my hands after I touch my mask, tissues, or body fluids."

a) "I should use disposable plates, forks, and knives." Rationale: Because tuberculosis is transmitted by droplet, it cannot be carried on clothing, eating utensils, or other possessions. It is not necessary to discard any of these. The client should cover the mouth with a tissue when laughing, coughing, or sneezing and should dispose of tissues carefully. The client also may need to wear a mask as advised by the health care provider. It is important to perform proper hand washing after contact with body substances, tissues, or face masks.

A registered nurse (RN) is providing instructions to an unlicensed assistive personnel (UAP) assigned to give a bed bath to a client who is on contact precautions. The RN instructs the UAP to use which protective item when giving the bed bath? a) A gown and gloves b) Gloves and goggles c) A gown and goggles d) Gloves and shoe protectors

a) A gown and gloves Rationale: Contact precautions require the use of gloves and a gown if direct client contact is anticipated. Goggles are not necessary unless it is anticipated that splashes of blood, bodily fluids, secretions, or excretions may occur. Shoe protectors are not necessary.

The ambulatory care nurse is working with a 22-year-old female client who has been diagnosed with pelvic inflammatory disease (PID). The nurse incorporates which item in a teaching plan for this client? a) Avoid frequent douching. b) Undergarments made of nylon are best. c) Intrauterine devices are a good birth control method. d) It is necessary to change sanitary pads only every 8 hours.

a) Avoid frequent douching. Rationale: The client who has been diagnosed with PID should avoid frequent douching because it decreases the natural flora that controls the growth of infectious organisms. Intrauterine devices increase the client's susceptibility to infection. The client should wear cotton undergarments, and clothes should not fit tightly. Sanitary pads should be changed at least every 4 hours. Tampons should not be used during the acute infection, and some health care providers may recommend avoiding them indefinitely. The client also should avoid strong soaps, sprays, powders, and similar products that will irritate the perineum.

The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse prepares to attach the distal end of the IV tubing to a needleless device, the tubing drops and hits the top of the medication cart. Which is the appropriate action by the nurse? a) Change the IV tubing. b) Attach a new needleless device. c) Wipe the tubing port with Betadine. d) Scrub the needleless device with an alcohol swab.

a) Change the IV tubing. Rationale: The nurse should change the IV tubing because it has become contaminated and could cause systemic infection to the client. Wiping the port with Betadine is insufficient and would be contraindicated in any case, because the tubing will be attached directly to an angiocatheter in the client's vein. The needleless device has not been contaminated and does not need replacement or cleansing.

The nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertion site appears reddened. The nurse should next assess which item? a) Client's temperature b) Expiration date on the bag c) Time of last dressing change d) Tightness of tubing connections

a) Client's temperature Rationale: Redness at the catheter insertion site is a possible indication of infection. The nurse would next assess for other signs of infection. Of the options given, the temperature is the next item to assess. The tightness of tubing connections should be assessed each time the PN is checked; loose connections would result in leakage, not skin redness. The expiration date on the bag is a viable option, but this also should be checked at the time the solution is hung and with each shift change. The time of the last dressing change should be checked with each shift change.

A client with active tuberculosis demonstrates less-than-expected interest in learning about the prescribed medication therapy. The nurse assesses that this client may ultimately need which intervention as a last resort? a) Directly observed therapy b) More medication instructions c) Involvement of the family in teaching d) Reinforcement by the health care provider

a) Directly observed therapy Rationale: Tuberculosis is a highly communicable disease that is reportable to the local public health department. This agency has regulations that may be enforced to ensure compliance with tuberculosis therapy. Ultimately the client may be required to have directly observed therapy to reduce the risk to the public. This involves having a responsible person actually observe the client taking the medication each day.

A nurse is preparing an intravenous (IV) set before starting the infusion. After removing the cap from the IV tubing port on the IV bag, the nurse removes the cover from the tubing insertion spike, but then touches the spike with a finger. What should the nurse do next? a) Discard the IV tubing and use a new set for the infusion. b) Continue on with the procedure and then flush the tubing thoroughly. c) Clean the spike with an alcohol swab for 15 seconds and then continue. d) Clean the spike and the IV bag tubing port with alcohol and then continue.

a) Discard the IV tubing and use a new set for the infusion. Rationale: The IV tubing's insertion spike must remain sterile. If it is touched during the preparation of the infusion, the tubing must be discarded and replaced with a sterile set. Otherwise the infusion set is contaminated, which could cause infection in the client. Therefore, the remaining actions are incorrect.

The nurse employed on a medical unit in a hospital receives a telephone call from the admission office and is told that a client with a diagnosis of mycoplasmal pneumonia will be admitted to the unit. The nurse prepares for the admission and obtains the necessary supplies to place the client on which type of transmission-based precautions? a) Droplet precautions b) Enteric precautions c) Contact precautions d) Protective precautions

a) Droplet precautions

A female client seen in the ambulatory care clinic has a history of syphilis infection. The nurse assessing the client for reinfection would expect to observe a lesion on the labia that has which characteristic? a) Is painless and indurated b) Has a cauliflower-like appearance c) Is erythematous and papular in appearance d) Appears as one or more vesicles that then rupture

a) Is painless and indurated Rationale: The characteristic lesion of syphilis is painless and indurated. The lesion is referred to as a chancre. Genital warts are characterized by cauliflower-like growths or growths that are soft and fleshy. Scabies is characterized by erythematous, papular eruptions. Genital herpes is accompanied by the presence of one or more vesicles that then rupture and heal.

The nurse is caring for a client with meningococcal pneumonia and implements which transmission-based precautions for this client? a) Private room or cohort client b) Personal respiratory protection device c) Private room with negative airflow pressure d) Mask worn by staff when the client needs to leave the room

a) Private room or cohort client Rationale: Meningococcal pneumonia is transmitted by droplet infection. Precautions for this disease include a private room or cohort client and use of a standard precaution mask. Private negative airflow pressure rooms and personal respiratory protection devices are required for clients with airborne disease such as tuberculosis. When appropriate, a mask must be worn by the client and not the staff when the client leaves the room.

The nurse is teaching a client with acquired immunodeficiency syndrome (AIDS) how to avoid food-borne illnesses. The nurse should instruct the client that which food can cause a food-borne illness? a) Raw oysters b) Bottled water c) Pasteurized milk d) Products with sorbitol

a) Raw oysters Rationale: The client is taught to avoid raw or undercooked seafood, meat, poultry, and eggs. The client also should avoid unpasteurized milk and dairy products. Fruits that the client peels are safe, as are bottled beverages. The client may be taught to avoid sorbitol, but this is to diminish diarrhea and has nothing to do with food-borne infections.

A client with tuberculosis (TB) asks the nurse about precautions to take after discharge to prevent infection of others. The nurse develops a response to the client's question based on which correct understanding of TB transmission? a) The disease is transmitted by droplet nuclei. b) Deep pile carpet should be removed from the home. c) The client should maintain enteric precautions only. d) Clothing and sheets should be bleached after each use.

a) The disease is transmitted by droplet nuclei. Rationale: TB is spread by droplet nuclei or via the airborne route. The disease is not carried on objects such as clothing, eating utensils, linens, or furniture. It is unnecessary to remove carpeting from the home. Bleaching of clothing and linens is unnecessary, although the client and family members should use good hand washing technique.

A client is seen in the health care clinic, and a diagnosis of acute sinusitis is made. The nurse provides home care instructions to the client regarding measures that will promote sinus drainage and comfort. Which statement by the client indicates a need for further instruction? a) "I should drink large amounts of fluids." b) "I should use a hot mist vaporizer to liquefy secretions." c) "I should try to sleep with the head of the bed elevated." d) "I should apply heat, such as a wet pack, over the sinuses."

b) "I should use a hot mist vaporizer to liquefy secretions." Rationale: The nurse provides instructions to the client regarding measures to promote sinus drainage, comfort, and resolution of the infection. The client should be instructed to use a humidifier to help liquefy secretions and promote drainage. Consumption of large amounts of fluids is important to help liquefy secretions. Sleeping with the head of the bed elevated to a 45-degree angle will assist in promoting drainage. The nurse instructs the client to apply heat in the form of wet packs over the affected sinuses to promote comfort and help resolve the infection.

The nurse provides home care instructions to a client with hepatitis B. Which statement made by the client indicates the best understanding of how to prevent transmission of the disease? a) "It is all right to kiss my wife." b) "My wife should get the vaccine." c) "I should be vaccinated as soon as possible." d) "I never will share towels with anyone else."

b) "My wife should get the vaccine." Rationale: The vaccine is used as a preventive measure and is recommended for both sexual and household contacts of the person with hepatitis B. Hepatitis B can be transmitted through intimate contact, such as kissing. The vaccine is used for prevention. This disease is not transmitted through the use of towels.

An unlicensed assistive personnel (UAP) is caring for a client who has an indwelling urinary catheter. Which action by the UAP would indicate the need for instruction in the care of the client? a) Used soap and water to cleanse the perineal area b) Allowed the drainage tubing to rest under the leg c) Kept the drainage bag below the level of the bladder d) Used the drainage tubing port to obtain urine samples

b) Allowed the drainage tubing to rest under the leg Rationale: Proper care of an indwelling urinary catheter is especially important to prevent infection in the client. The drainage tubing is not placed under the client's leg; for the same reason, the drainage bag is kept below the level of the bladder to prevent urine from being trapped in the bladder. The tubing must drain freely at all times. The perineal area is cleansed thoroughly, using mild soap and water at least twice a day and following a bowel movement. The nurse and all caregivers must use strict aseptic technique when emptying the drainage bag or obtaining urine specimens.

The nurse is caring for a client with acute viral hepatitis A who resides in a group home. Which outcome indicates that the most important goal has been achieved for this client? a) Resumes normal bowel elimination patterns b) Avoids transmitting the virus to others in the group home c) Progressively increases activity with planned rest periods d) Gains at least ½ to 1 pound per week until at ideal weight

b) Avoids transmitting the virus to others in the group home Rationale: All the options are expected outcomes of care for this client. However, because the disease can be communicable to others, one of the most important goals in management of acute viral hepatitis is preventing the spread of infection.

The client seen in the health care clinic has tested positive for gonorrhea. The nurse anticipates that which medication will be prescribed based on this finding? a) Acyclovir (Zovirax) b) Ceftriaxone (Rocephin) c) Azithromycin (Zithromax) d) Penicillin G benzathine (Bicillin LA)

b) Ceftriaxone (Rocephin) Rationale: Treatment for gonorrhea consists of antibiotic therapy, usually with ceftriaxone and doxycycline (Vibramycin). Acyclovir is the treatment for genital herpes simplex virus; azithromycin is the treatment for Chlamydia infection and penicillin G benzathine is the treatment for syphilis.

The nurse is preparing to nasotracheally suction a client with acquired immunodeficiency syndrome who has had blood-tinged sputum with previous suctioning. The nurse plans to use which item as part of standard precautions for this client? a) Gloves, gown, and mask b) Gloves, mask, and protective eyewear c) Gown, mask, and protective eyewear d) Gloves, gown, and protective eyewear

b) Gloves, mask, and protective eyewear Rationale: Standard precautions include the use of gloves whenever there is actual or potential contact with blood or body fluids. During procedures that aerosolize blood, the nurse wears a mask and protective eyewear or a face shield. Impervious gowns are worn in those instances when it is anticipated that there will be contact with splashes of secretions or blood. No data in the question is indicative that splashes are a concern.

The ambulatory care nurse is seeing a client for a follow-up visit after treatment for toxic shock syndrome (TSS). To assess the client's recovery from TSS, the nurse should ask whether which signs and symptoms have resolved? a) Low-grade fever, nausea, and vaginal bleeding b) High fever, abdominal pain, vomiting, and diarrhea c) Low-grade fever, vomiting, and greenish vaginal discharge d) High fever, purulent vaginal discharge, and abdominal pain

b) High fever, abdominal pain, vomiting, and diarrhea Rationale: The classic symptoms of TSS are high fever (temperature of 101º F or higher), vomiting, and severe diarrhea. Other typical symptoms include headache, myalgia, chills, abdominal pain, dizziness, lethargy, possible confusion, and agitation. Vaginal bleeding or discharge is not part of the clinical picture. TSS typically is caused by Staphylococcus aureus infection associated with tampon use during menses.

The nurse is caring for a client with a wound infected with methicillin-resistant Staphylococcus aureus (MRSA). The most appropriate infection control precautions for MRSA include which intervention? a) A room with positive-pressure airflow b) Private room, gown, gloves, and face shield c) Private room with negative-pressure airflow d) Mask or respiratory protection device and gown

b) Private room, gown, gloves, and face shield Rationale: Isolation guidelines from the Centers for Disease Control and Prevention (CDC) place MRSA at the tier 2 transmission category. Contact precautions are required and include a private room, gloves, gowns, and face shields in case a splash from the wound drainage occurs, such as with wound irrigation. A room with negative-pressure airflow is required for airborne precautions from small droplet infections such as measles, chickenpox, or tuberculosis. A respiratory protection device is recommended for larger droplet infections such as pneumonia. A room with positive-pressure airflow is recommended for protective environments such as required for clients with stem cell transplants.

Two nurses are leaving the room of a client whose care required them to wear a gown, mask, and gloves. Which action by these nurses could lead to the spread of infection? a) Taking off the gloves first before removing the gown b) Removing the gown without rolling it from inside out c) Washing the hands after the entire procedure has been completed d) Removing the gloves and then removing the gown using the neck ties

b) Removing the gown without rolling it from inside out Rationale: The gown must be rolled from inside out to prevent the organisms on the outside of the gown from contaminating other areas. Gloves are considered the dirtiest piece of equipment and therefore must be removed first. Hands must be washed after removal of the protective garb to remove any unwanted germs still present. Ungloved hands should be used to remove the gown to prevent contaminating the back of the gown with germs from the gloves.

The nurse is conducting a community surveillance study for the purpose of communicable disease control. The nurse knows that performing an active surveillance method of assessment is best for what reason? a) Always results in clear indicators for interventions b) Results in detection of a more accurate number of cases c) Reflects an upward swing if a certain disease is current news d) Relies solely on the initiative of health care providers (HCP) to report cases

b) Results in detection of a more accurate number of cases

A nurse is assigned to care for an infant following a cleft lip repair. The nurse is asked to observe the parent in the procedure for cleaning the lip repair site. The nurse determines that the parent is performing the procedure correctly if the parent uses which solution to clean the site? a) Ice water b) Sterile water c) Half-strength alcohol d) Full strength hydrogen peroxide

b) Sterile water Rationale: The lip repair site is cleansed with sterile water using a cotton swab; it is cleansed after feeding and as prescribed. The mother should be instructed to use a rolling motion from the suture line out.

A nursing instructor asks a nursing student to describe the route of transmission of tuberculosis (TB). The instructor concludes that the student understands this information if the student states that which is the route of transmission for TB? a) Hand to mouth b) The airborne route c) The fecal-oral route d) Blood and body fluids

b) The airborne route

The nursing instructor is observing a student nurse donning a pair of sterile gloves and preparing a sterile field. Which observations, if made by the instructor, indicate the need for further teaching? a) The student puts on the right glove and then the left glove. b) The student dons the sterile gloves without washing the hands. c) The student uses the inner wrapper of the gloves as a sterile field. d) The student touches a glove on the overbed table, removes both gloves, and dons another sterile pair.

b) The student dons the sterile gloves without washing the hands. Rationale: Hands must always be washed (even though sterile gloves are used) to keep germs from spreading. The order of placing gloves on is up to the user, so long as sterile technique is not broken. The inside wrapper provides an excellent area for use because it is sterile. If the gloves touch anything unsterile, they must be considered contaminated, and a new package of gloves must be obtained and used.

A client with tuberculosis (TB), whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. The nurse replies that the client may resume employment when which occurs? a) Five sputum cultures are negative. b) Three sputum cultures are negative. c) A sputum culture and a chest x-ray are negative. d) A sputum culture and a tuberculin skin test are negative

b) Three sputum cultures are negative. Rationale: The client must have sputum cultures performed every 2 to 4 weeks after initiation of antituberculosis drug therapy. The client may return to work when the results of three sputum cultures are negative because the client is considered noninfectious at that point. Therefore the remaining options are incorrect. A negative chest x-ray does not mean that the client is noninfectious. A positive tuberculin skin test never reverts to negative.

The nurse prepares to give a bath and change the bed linens of a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which would the nurse incorporate into the plan during the bathing of this client? a) Wearing gloves b) Wearing a gown and gloves c) Wearing a gown, gloves, and a mask d) Wear a gown and gloves to change the bed linens and gloves only for the bath

b) Wearing a gown and gloves Rationale: Gowns and gloves are required if the nurse anticipates contact with soiled items such as those with wound drainage, or is caring for a client who is incontinent with diarrhea or a client who has an ileostomy or colostomy. Masks are not required unless droplet or airborne precautions are necessary. Regardless of the amount of wound drainage, a gown and gloves must be worn.

A nurse is providing orientation to a newly graduated nurse. During a discussion of isolation procedures, which statement by the graduate nurse indicates a need for further review of isolation guidelines? a) "A client with tuberculosis will be placed on airborne precautions." b) "I will wear a mask when working with an isolated client who has a tracheostomy." c) "I can reuse a gown if it's not dirty, as long as I hang it up inside the client's room." d) "I will remove the gown and gloves and wash my hands before leaving the client's room."

c) "I can reuse a gown if it's not dirty, as long as I hang it up inside the client's room."

The nurse is preparing a group of Cub Scouts for an overnight camping trip and instructs the scouts about the methods to prevent Lyme disease. Which statement by one of the Cub Scouts indicates a need for further instructions? a) "I need to bring a hat to wear during the trip." b) "I should wear long-sleeved tops and long pants." c) "I should not use insect repellents because it will attract the ticks." d) "I need to wear closed shoes and socks that can be pulled up over my pants."

c) "I should not use insect repellents because it will attract the ticks." Rationale: In the prevention of Lyme disease, individuals need to be instructed to use an insect repellent on the skin and clothes when in an area where ticks are likely to be found. Long-sleeved tops and long pants, closed shoes, and a hat or cap should be worn. If possible, heavily wooded areas or areas with thick underbrush should be avoided. Socks can be pulled up and over the pant legs to prevent ticks from entering under clothing.

The nurse teaches the mother of a child diagnosed with bacterial conjunctivitis about measures to prevent transmission of the infection. Which statement by the mother indicates a need for further teaching? a) "Hands need to be washed frequently." b) "A clean washcloth can be used to wipe my child's eyes." c) "It is all right to share towels and washcloths as long as they are bleached after use." d) "The eye drops must be given as prescribed, and hands need to be washed before and after instillation."

c) "It is all right to share towels and washcloths as long as they are bleached after use." Rationale: Bacterial conjunctivitis is highly contagious, and infection-control measures should be taught. These measures include frequent hand washing and not sharing towels and washcloths, regardless of the bleaching process.

A 7-year-old child is diagnosed with viral conjunctivitis. Antibiotic eye drops are prescribed for the child. When the mother asks the nurse when the child can return to school, what should the appropriate response be? a) "The child can return to school immediately." b) "The child cannot return to school until seen by the health care provider in 1 week." c) "The child should be kept home until the antibiotic eye drops have been administered for 24 hours." d) "The child should be kept home until the antibiotic eye drops have been administered for 72 hours."

c) "The child should be kept home until the antibiotic eye drops have been administered for 24 hours." Rationale: Viral conjunctivitis is extremely contagious. The child should be kept home from school or day care until antibiotic eye drops have been administered for 24 hours.

The home care nurse visits a child recently discharged from the hospital with a diagnosis of hepatitis A virus (HAV) infection. The mother asks the nurse when the child can return to school. The nurse should make which response to the mother? a) "In about 2 months." b) "When the jaundice disappears." c) "Within 1 week after the onset of jaundice." d) "At the beginning of the next academic year."

c) "Within 1 week after the onset of jaundice." Rationale: Because HAV is not infectious 1 week after the onset of jaundice, return to school at that time is permitted if the child feels well enough.

The nurse is planning to teach a group of adolescents about the use of condoms as part of a risk-reduction program for sexually transmitted infections (STIs). The nurse should plan to include which recommendation in the teaching plan? a) Condoms should not be lubricated. b) Use condoms whenever the partner seems "risky." c) Always apply the condom before inserting the penis into the vagina. d) Natural membrane condoms can be used because they are just as effective as latex.

c) Always apply the condom before inserting the penis into the vagina.

The nurse is observing a second nurse perform hemodialysis on a client. The second nurse is drinking coffee and eating a doughnut next to the hemodialysis machine, while talking with the client about the events of his week. What is the nurse's most appropriate action regarding this observation? a) Offer the client a cup of coffee. b) Get a cup of coffee and join in on the conversation. c) Ask the nurse to refrain from eating and drinking in that area. d) Appreciate what a wonderful therapeutic relationship this nurse and client have.

c) Ask the nurse to refrain from eating and drinking in that area. Rationale: A potential complication with hemodialysis is the acquisition of dialysis-associated hepatitis B. This is a concern for clients (who may carry the virus), their families (at risk from contact with the client and with environmental surfaces), and staff (who may acquire the virus from contact with the client's blood). This risk is minimized by the use of standard precautions; appropriate handwashing and sterilization procedures; and the prohibition of eating, drinking, or other hand-to-mouth activity in the hemodialysis unit. The first nurse should ask the second nurse to stop eating and drinking in the work area.

A nurse is instructing a postpartum client with endometritis about preventing the spread of infection to the newborn infant. Which statement should the nurse make to the client? a) Visitors are not allowed to hold the baby. b) There is no danger of the newborn contracting the disease. c) Hands should be washed thoroughly before holding the infant. d) The newborn infant will not be allowed in the mother's room at all.

c) Hands should be washed thoroughly before holding the infant. Rationale: Transmission of infectious diseases can occur through contaminated items such as hands and bed linens of clients with endometritis. An important method of preventing infection is to break the chain of infection. Handwashing is one of the most effective methods of preventing the transmission of infectious diseases. The newborn infant is allowed in the mother's room and visitors are allowed to hold the newborn infant as long as handwashing and other protective measures are instituted.

A client with acute prostatitis has difficulty voiding, which is accompanied by pain. The client asks the nurse, "Can't you just put a catheter in so I won't be in this misery when I try to go?" The nurse's response should be based on what understanding about catheterization? a) Will prolong the course of the inflammation b) Could result in puncture of the prostate gland because it is so inflamed c) Is avoided whenever possible to avoid pushing organisms up into the bladder d) Could result in obstruction from rebound edema once the catheter is removed

c) Is avoided whenever possible to avoid pushing organisms up into the bladder Rationale: Occasionally the client with acute prostatitis needs urinary catheterization if he cannot void at all. Otherwise catheterization is avoided to prevent introducing bacteria into the bladder by pushing them up the urethra. Catheterization does not prolong the course of the inflammation, nor does it cause rebound edema when it is removed. Prostate gland puncture from this procedure is not likely, although the procedure may be painful.

The nurse is assisting a female client to collect a midstream urine specimen. How should the nurse implement aseptic technique? a) Cleansing the meatus with antiseptic pads using upward strokes b) Letting go of the labia once this tissue is cleansed, to allow the client to urinate c) Making sure that the fingers avoid touching the inside of the collection container d) Instructing the client to urinate in the container after the labia have been cleansed

c) Making sure that the fingers avoid touching the inside of the collection container Rationale: The inside of the container is sterile, and sterility must be maintained. Fingers touching the inside of the container would cause the container to become unsterile. The meatus should be cleansed from front to back (toward the anus). Upward strokes would bring bacteria from the anal region toward the urinary meatus. The labia should remain open during the procedure. If they are allowed to close, this tissue will have to be cleansed again with the antiseptic pads. The client should void a small amount into the toilet before urinating into the specimen container to allow some of the organisms near the meatus to leave the area.

The nurse is caring for a client who is on airborne precautions. The nurse notes that the client is scheduled for magnetic resonance imaging (MRI). Which nursing action is most appropriate in preparing the client for the test? a) Place the client in gown, gloves, and mask. b) Request that the MRI technicians wear masks. c) Place a surgical mask on the client for transport. d) Call the radiology department to reschedule the test.

c) Place a surgical mask on the client for transport. Rationale: If the client is on airborne precautions, client movement and transport should be limited if possible. If transport or movement is necessary, client dispersal of droplet nuclei can be minimized by placing a surgical mask on the client. Options 1 and 2 are not necessary. Option 4 is not appropriate. This leaves option 3, which is to provide protection for the staff.

A nurse is preparing a plan of care for a client with a diagnosis of agranulocytosis who is being admitted to the hospital. The nurse determines that which is the priority when formulating the client's plan of care? a) Fatigue b) Constipation c) Potential for infection d) Insufficient knowledge

c) Potential for infection Rationale: Agranulocytosis is characterized by a reduced number of leukocytes (leukopenia) and neutrophils (neutropenia) in the blood. The client is at high risk for infection because of the decreased body defenses against microorganisms. Insufficient knowledge related to the nature of the disorder and the prevention of complications may be appropriate, but it is not the priority. Similarly, fatigue and constipation may be a concern for the client with agranulocytosis, but the priority problem relates specifically to infection.

A client receiving parenteral nutrition (PN) suddenly develops a fever. The nurse notifies the health care provider (HCP), and the HCP initially prescribes that the solution and tubing be changed. What should the nurse do with the discontinued materials? a) Discard them in the unit trash. b) Return them to the hospital pharmacy. c) Send them to the laboratory for culture. d) Save them for return to the manufacturer.

c) Send them to the laboratory for culture. Rationale: When the client who is receiving PN develops a fever, a catheter-related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for infectious organisms. The other options are incorrect. Because culture for infectious organisms is necessary, the discontinued materials are not discarded or returned to the pharmacy or manufacturer.

A man is admitted to the hospital with the diagnosis of urethritis secondary to chlamydial infection. What precaution should the nurse implement for this client? a) Enteric b) Contact c) Standard d) Reverse isolation

c) Standard Rationale: Chlamydial infection is a sexually transmitted infection and frequently is called nongonococcal urethritis in the male client. It requires no special precautions other than standard precautions. Caregivers cannot acquire the disease during administration of care, and using standard precautions is the only necessary measure.

The nurse is providing home care instructions to the mother of a child who has bacterial conjunctivitis. The nurse should provide the mother with which information? a) The child may attend school if antibiotics have been started. b) Any unused eye medication should be saved in case a sibling gets the eye infection. c) The child's towels and washcloths should not be used by other members of the household. d) Any crusted material should be wiped from the eye with a cotton ball soaked in warm water, starting at the outer aspect of the eye and moving toward the inner aspect.

c) The child's towels and washcloths should not be used by other members of the household. Rationale: Bacterial conjunctivitis is highly contagious, and infection control measures should be taught. These include good handwashing and not sharing towels or washcloths with others. The child should be kept home from school until 24 hours after antibiotics are started. Bottles of eye medication should never be shared with others. Crusted material may be wiped from the eye with a cotton ball soaked in warm water, starting at the inner aspect of the eye and moving toward the outer aspect.

The nurse is preparing to insert an intravenous (IV) angiocatheter into a client's inner forearm. Before cannulating the vein, what motion will the nurse implement to cleanse the site? a) Scrubbing from the wrist toward the elbow b) Scrubbing from the elbow toward the wrist c) Using a circular motion from the center outward d) Using a circular motion inward toward the center

c) Using a circular motion from the center outward Rationale: The nurse cleans the skin by using a circular motion from inward to outward. This is the standard accepted aseptic technique to carry microorganisms away from the insertion site. The same technique is used to cleanse any area requiring surgical asepsis

A nurse places a hospitalized client with active tuberculosis in a private, well-ventilated isolation room. In addition, which action should the nurse take before entering the client's room? a) Wash hands and don a surgical mask. b) Wash hands and wear a gown and gloves. c) Wash hands and place a high-efficiency particulate air (HEPA) respirator mask over the nose and mouth. d) The nurse needs no precautions. The client is instructed to cover his or her mouth and nose when coughing.

c) Wash hands and place a high-efficiency particulate air (HEPA) respirator mask over the nose and mouth.

The home health nurse visits a client with suspected scabies. Which precaution should the nurse institute during the assessment of the client? a) Wear gloves only. b) Wear a mask and gloves. c) Wear a gown and gloves. d) Avoid touching the client's home furnishings.

c) Wear a gown and gloves.

The nurse is preparing to care for a client with acquired immunodeficiency syndrome (AIDS). In planning infection control for this client, the nurse should implement which form of isolation to prevent the spread of the AIDS virus to others? a) Strict isolation b) Enteric precautions c) Contact precautions d) Blood and body fluid precautions

d) Blood and body fluid precautions

Contact precautions are initiated for a client with a health care-associated (nosocomial) infection caused by methicillin-resistant Staphylococcus aureus. The nurse prepares to provide colostomy care and should obtain which protective items to perform this procedure? a) Gloves and gown b) Gloves and goggles c) Gloves, gown, and shoe protectors d) Gloves, gown, goggles, and face shield

d) Gloves, gown, goggles, and face shield Rationale: Splashes of body secretions can occur when providing colostomy care. Goggles and a face shield are worn to protect the face and mucous membranes of the eyes during interventions that may produce splashes of blood, body fluids, secretions, or excretions. In addition, contact precautions require the use of gloves, and a gown should be worn if direct client contact is anticipated. Shoe protectors are not necessary.

Which infection control method would most effectively prevent hepatitis B? a) Immune globulin b) Hand washing daily c) Proper personal hygiene d) Hepatitis B (HBV) vaccine

d) Hepatitis B (HBV) vaccine Rationale: Immunization with HBV is the most effective method of preventing the spread of hepatitis B infection. Hand washing is another effective preventive measure, but it must be done more frequently than daily. Immune globulin is used to prevent hepatitis A and is indicated within 1 to 2 weeks after exposure or for prophylaxis in persons traveling to endemic areas. Attention to personal hygiene such as hand washing helps prevent the transmission of hepatitis A virus and other forms of hepatitis.

A client with pulmonary tuberculosis (TB) is on airborne isolation precautions. Which item(s) is essential for the nurse to wear? a) Gloves only b) Fluid shield mask c) Gown, mask, and gloves d) High-efficiency particulate air (HEPA) filter mask

d) High-efficiency particulate air (HEPA) filter mask

A hospitalized client who has been placed on contact precautions has been prescribed to have a chest radiograph in the radiology department. The nurse should plan to take which action on receipt of this prescription? a) Transport the client through empty corridors only. b) Place a mask on the client in preparation for transport. c) Place a sterile gown on the client in preparation for transport. d) Question the health care provider about whether a portable chest radiograph may be obtained.

d) Question the health care provider about whether a portable chest radiograph may be obtained. Rationale: The client who is placed on contact precautions has a high microorganism count in some type of body secretion (such as feces or wound drainage). This client is placed in a private room whenever possible and is removed from the room only when absolutely necessary. Client transport should be done only for essential purposes. Notification of departmental personnel and disinfection of any environmental surfaces with which the client has contact are imperative.

A man has been admitted to the surgical unit after a hernia repair surgery. The medical record reports that the client is human immunodeficiency virus (HIV) positive. The nurse should implement which precautions for this client? a) Contact precautions b) Droplet precautions c) Airborne precautions d) Standard precautions

d) Standard precautions Rationale: Having an HIV-positive status does not warrant a special type of precaution; instead, the nurse will implement standard precautions. Contact, droplet, and airborne precautions are implemented with specific types of infections or diseases but are not necessary for HIV-positive clients unless some additional specific infection is present.

A male client who is admitted for an unrelated medical problem is diagnosed with urethritis caused by chlamydial infection. The unlicensed assistive personnel (UAP) assigned to the client asks the nurse what measures are necessary to prevent contraction of the infection during care. What should the nurse tell the UAP? a) Enteric precautions should be instituted for the client. b) Gloves and mask should be used by caregivers in the client's room. c) Contact isolation should be initiated because the disease is highly contagious. d) Standard precautions are quite sufficient because the disease is transmitted sexually.

d) Standard precautions are quite sufficient because the disease is transmitted sexually.

A hospitalized client has a diagnosis of pelvic inflammatory disease (PID). The nurse should encourage the client to assume which therapeutic position when in bed? a) Left side-lying b) Right side-lying c) Prone with the head flat d) Supine in semi-Fowler's

d) Supine in semi-Fowler's Rationale: Placing the client in semi-Fowler's position allows gravity to aid in drainage of the abdominal cavity. This helps prevent the formation of abscesses high in the abdomen. Abscesses in this location could rupture, potentially causing peritonitis. The color, odor, and amount of vaginal secretions also are noted and recorded

Which action by the parent of an infant with respiratory syncytial virus infection who is receiving ribavirin (Virazole) would indicate a need for further instruction regarding the management of the disease process? a) Wearing protective garb when visiting the infant b) Washing the hands before leaving the infant's room c) Telling a family member who has asthma that he should not visit the infant d) Telling the infant's aunt who is pregnant that it is acceptable to visit the infant

d) Telling the infant's aunt who is pregnant that it is acceptable to visit the infant Rationale: When an infant is receiving ribavirin, exposure precautions need to be observed. Anyone entering the infant's room should wear a gown, mask, gloves, and hair covering. Anyone who is pregnant or considering pregnancy and anyone with a history of respiratory problems or airway disease should not care for or visit the infant who is receiving ribavirin. Hand washing is absolutely necessary before leaving the room to prevent the spread of germs.

The home health nurse is watching the caregiver change the sternotomy dressing on the postoperative client. Which action by the caregiver identifies correct principles of infection control? a) The caregiver selects a previously opened gauze to cover the sternal wound. b) The caregiver dons gloves before removal of the old dressing and then applies the new dressing. c) The caregiver covers her mouth with her hand when she sneezes and then continues with the dressing change. d) The caregiver washes hands before removal of the soiled dressing and again before applying the clean dressing.

d) The caregiver washes hands before removal of the soiled dressing and again before applying the clean dressing. Rationale: The single most effective technique to prevent the spread of germs and bacteria is hand washing. The initial step with all aseptic procedures is hand washing. Using previously opened gauze, not washing hands after sneezing, and not applying new gloves after removing the old dressing increase the risk of wound contamination as a result of poor aseptic technique.

A client is being discharged to home after 2 weeks with a diagnosis of tuberculosis and is worried about the possibility of infecting family members and others. How should the nurse respond to provide reassurance? a) The family does not need therapy, and the client will not be contagious after 1 month of drug therapy. b)The family does not need therapy, and the client will not be contagious after 6 consecutive weeks of drug therapy. c) The family will be treated prophylactically, and the client will not be contagious after 1 continuous week of drug therapy. d) The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of drug therapy.

d) The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of drug therapy. Rationale: Family members or others who have been in close contact with a client diagnosed with tuberculosis are placed on prophylactic therapy with isoniazid for 6 to 12 months. The client usually is not contagious after taking the medication for 2 to 3 consecutive weeks. However, the client must take the full course of therapy (for 6 months or longer) to prevent reinfection or drug-resistant tuberculosis.

The nurse participating in a health fair is setting up a booth on prevention of human immunodeficiency virus (HIV) transmission. A poster is planned that will list sexual behaviors in one of two columns, "safe" and "not safe." Which behavior should the nurse place in the "not safe" column? a) Abstinence b) Mutual monogamy c) Use of latex condoms d) Use of natural skin condoms

d) Use of natural skin condoms Rationale: Abstinence is the safest way to avoid HIV infection. Another reliable method is participation in a mutually monogamous relationship. The use of latex condoms is considered safe because the latex prevents the transmission of the HIV so long as the condom is used properly and remains in place. The use of natural skin condoms is not considered safe because the pores in the condom are large enough for the virus to pass through.

The school nurse prepares a list of home care instructions for the parents of schoolchildren diagnosed with pediculosis capitis. Which instruction should the nurse include in the list? a) Soak combs and brushes in warm water. b) Use anti-lice sprays on all bedding and furniture. c) Take all bedding and linens to the cleaners to be dry cleaned. d) Vacuum floors, play areas, and furniture to remove any hairs that might carry live nits.

d) Vacuum floors, play areas, and furniture to remove any hairs that might carry live nits. Rationale: Pediculosis capitis is an infestation of the hair and scalp with lice. Thorough home cleaning is necessary to remove any lice or nits that may fall from the host. Combs and brushes should be soaked in hot water for 10 minutes or a pediculicide for 1 hour. Anti-lice sprays are unnecessary and may be harmful. In addition, they should never be used on a child or on bedding or linens. Bedding and linens should be washed with hot water and dried on a hot setting. Items that cannot be washed should be dry cleaned or sealed in plastic bags in a warm place for 2 weeks.

A nurse is admitting a client to the nursing unit who is suspected of having tuberculosis (TB). The nurse should plan to admit the client to a room that has which properties? a) Venting to the outside and ultraviolet light b) Ultraviolet light and three air exchanges per hour c) Ten air exchanges per hour and venting to the outside d) Venting to the outside, six air exchanges per hour, and ultraviolet light

d) Venting to the outside, six air exchanges per hour, and ultraviolet light Rationale: A client suspected of having tuberculosis (TB) is admitted to a private room that has at least six air exchanges per hour and negative pressure in relation to surrounding areas. The room should be vented to the outside and should have ultraviolet lights installed.

The nurse is giving a bed bath to a client and discovers that an additional washcloth and towel are needed. Which is the most appropriate action to take to obtain the needed items? a) Ask the unit secretary to get the needed items. b) Ask a family member to obtain the needed items. c) Borrow the client's roommate's washcloth and towel. d) Wash hands, leave the client's room, and obtain the needed items.

d) Wash hands, leave the client's room, and obtain the needed items.

A client has been receiving a series of medications as part of intravenous antineoplastic therapy. The nurse should implement neutropenic precautions after noting which laboratory result for this client? a) Clotting time of 10 minutes b) Ammonia level of 20 mcg/dL c) Platelet count of 100,000 cells/mm3 d) White blood cell (WBC) count of 2000 cells/mm3

d) White blood cell (WBC) count of 2000 cells/mm3 Rationale: The normal WBC is 5000 to 10,000 cells/mm3. When the WBC count drops, neutropenic precautions should be implemented to protect the client from infection. Bleeding precautions should be initiated when the platelet count drops; bleeding precautions include avoiding trauma such as from rectal temperatures or injections. The normal platelet count is 150,000 to 450,000 cells/mm3. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 10 to 80 mcg/dL.