N5451 Skills Lab > Video Quizzes > Module 1. Asepsis

The charge nurse confronts a new nurse about not wearing gloves into a client's room. The client is not on transmission-based precautions. How does the new nurse best respond?

"Can you show me the hospital policy for when to wear gloves?" Explanation: When there is any doubt, the facility resources should be consulted for verification of existing policies regarding transmission-based and standard precautions. This question prevents the nurse from arguing with the charge nurse, too. Gloves are not required for every client interaction.

The nurse is performing hand washing using soap and water after providing client care. The nurse has performed hand hygiene using soap and water. What action would the nurse take next?

Dry the hands with a paper towel. Explanation: After rinsing the hands, the nurse would dry the hands using paper towels, wiping from the fingertips toward the forearms. Once dry, the nurse would then use another clean paper towel to turn off the water at the faucet to prevent clean hands from coming in contact with the soiled surface. The fingernails are cleaned before the hands are rinsed. The hands are dried using clean paper towel. An alcohol‑based sanitizer or hospital‑provided lotion can be used after handwashing and drying, if desired.

While removing gloves after performing client care, what action does the nurse take?

Ensure the skin of the hands does not touch the outside surface of the glove. Explanation: The glove surface is contaminated, and one of the goals of wearing gloves is decreasing contamination between client and nurse. The nurse does not touch the outer surface of the glove with bare skin. Using hand sanitizer on the glove is a needless and unhelpful step. The gloves and sterile field remnants can be disposed of separately. Optimally, the gloves need to be folded into each other for disposal to decrease contamination risk.

Which item would the nurse remove first when removing personal protective equipment?

Gloves. Explanation: When removing personal protective equipment (PPE), the first item to be removed is the gloves. If the gown is tied in the front, the nurse unties the gown first and then removes the gloves. The face shield is removed next, followed by the gown, and lastly the mask.

The nurse is required to wear a gown, gloves, goggles, and mask as personal protective equipment (PPE) when caring for an assigned client. What should the nurse put on first?

Gown. Explanation: When using personal protective equipment (PPE), the nurse would put on the gown first. Then the nurse would then put on the mask and goggles, and lastly the gloves

When removing soiled gloves, which should the nurse do first?

Grasp the outside of one glove with the opposite gloved hand. Explanation: When removing soiled gloves, the nurse would grasp the outside of one glove with the opposite gloved hand and peel it off, turning the glove inside out as it is pulled. The removed glove is held in the remaining gloved hand. The nurse would then slide the fingers of the ungloved hand under the remaining glove at the wrist and peel off the glove over the first glove, containing one glove inside the other.

What action does the nurse perform to remove gloves after performing a sterile procedure?

Invert the glove as it is removed. Explanation: Inverting the glove as it is removed is correct. This action decreases contamination risk during removal. Pulling the gloves off from the fingertips is a less clean manner in which to dispose of the gloves and can lead to contamination to the nurse. Gloves are not laid into the sterile field, but directly disposed of. The nurse disposes of the gloves together, not one at a time.

When washing the hands with soap and water what is an appropriate action for the nurse to perform?

Keep the hands below the elbow. Explanation: The nurse keeps the hands lower than the elbows to allow water to flow toward fingertips. Explanation: When hand washing, the nurse washes jewelry, usually restricted to only a wedding band, before starting; jewelry can harbor microorganisms and contaminants. Next, the nurse would turn on the water, apply soap to the hands, and rub it in using a circular motion. After thoroughly cleaning the hands, the nurse would then clean under the nails. The nurse does not lean on the sink as this can lead to contamination.

The client asks the nurse why the nurse wears a disposable gown every time she enters the client's room. What is the nurse's best response?

"I am required to wear a gown for certain infections that are easily passed to others." Explanation: The client needs a matter‑of‑fact response that does not make him or her feel dirty, guilty, or confused. The nurse teaches the client in a direct way that

When adding sterile items to a sterile field, the nurse would drop the sterile items from which height?

6 in (15 cm). Explanation: When adding sterile items to a sterile field, the item is dropped from a height of 6 in (15 cm).

The nurse has prepared a sterile field with the necessary sterile supplies. The nurse begins to perform the care and realizes that an item is missing. What action would be appropriate?

Call someone to bring in the necessary item to the client's room. Explanation: So as not to disrupt the prepared sterile field, when the nurse notices that an item is missing, the most appropriate action would be to call someone to bring the necessary item to the client's room. If the nurse leaves the room at any time to obtain an item, the sterile field is no longer considered sterile and an entirely new sterile field would need to be set up. Skipping the part of care that requires the missing item would be inappropriate.

The nurse prepares the sterile tray for indwelling catheter insertion while wearing sterile gloves. The nurse then pulls the client's blankets away from the pelvis to begin catheter insertion. What action should the nurse take next?

Change into a new pair of sterile gloves. Explanation: The client must be prepared prior to preparing the catheter kit. The nurse must wear sterile gloves while preparing the sterile tray, because it involves opening sterile supplies. If the nurse then touches a non‑sterile surface, like the client's blankets, the sterile gloves must be changed prior to continuing the procedure. The nurse does not need to reposition the kit at this time. The nurse is no longer sterile and cannot proceed with cleaning the client with sterile solution. Only the nurse's gloves are contaminated; the nurse does not need to dispose of the kit.

When preparing a sterile field, which action would be appropriate for the nurse to take first?

Check the packages for expiration date. Explanation: When setting up a sterile field, it is essential that the nurse check the packages for their expiration dates to ensure that the items are sterile. This must be done before opening any sterile items. The work surface should be placed at waist level before checking the expiration dates and opening any sterile packages. Sterile gloves are put on once the sterile field is set up.

What is the best source for the nurse to determine the type of transmission precaustions a client needs?

Client's medical record. Explanation: The client's medical record includes the type of precautions to observe and the laboratory reports to verify the organism. The sign on the client's room may be incorrect. Nurses typically ensure the client is on the correct precautions. The assigned nurse updates the charge nurse's report regarding transmission precautions.

The nurse is preparing a sterile field using a prepackaged kit. After performing hand hygiene, which action would the nurse take next?

Confirm the client's identity Explanation: After performing hand hygiene, the nurse would confirm the client's identity. The nurse would then ensure that the work surface is at waist height and place the package in the center of the surface. Lastly, the nurse would open the outside cover of the package and remove the kit.

While donning sterile gloves for a client's dressing change, the nurse rips the cuff while pulling it over a wristwatch. What is the appropriate nursing action?

Obtain a new pair of sterile gloves. Explanation: The nurse must change gloves. The ripped glove is not sterile, nor is the wrist which should be covered by the cuff. The intact glove may also be contaminated because the fingers were in the cuff as it ripped.

The nurse opens the package of sterile gloves using the interior side folds, and the package will not open fully for the nurse to reach the gloves. What action does the nurse take?

Open the top and bottom folds completely. Explanation: When the inside folds of the glove package will not open correctly, the nurse might not have fully opened the top and bottom folds of the package. When this occurs, the package keeps closing back in on itself, making it difficult to put the sterile gloves on correctly. Therefore, opening the bottom and top fold completely allows the interior side folds to open as needed. Sliding the gloves out of the package leads to the gloves contacting the edge of the sterile package, which is not considered sterile—just like any sterile field edge. Reaching under the package is not a useful action, and there is no reason to obtain new gloves yet.

When putting on the second sterile glove, the nurse places the gloved thumb at which location?

Outward away from the gloved hand Explanation: When putting on the second sterile glove, the nurse holds the gloved thumb outward away from the rest of the gloved hand. The remaining gloved four fingers are placed inside the cuff of the second glove to apply it to the ungloved hand. The other grasping positions are awkward and not attempted

The nurse prepares to wear personal protective equipment (PPE) when entering a client's room. What action does the nurse take first?

Perform hand hygiene. Explanation: The nurse must perform hand hygiene before putting on gloves, just like any other time. The nurse does not want to introduce additional infectious organisms to this client. The client's door, for most isolation types, can be opened after PPE is on. Though often done incorrectly, when gowning it is important to ensure the gown covers the back and front of the nurse. As the nurse is dressing in PPE is it wise to double check that the correct transmission precautions are being observed and that each pieve of equipment needed is being worn by the nurse. The nurse would not be wrong if wearing more than is required but would not want to wear less than is needed.

The nurse notes that a healthcare provider failed to observe transmission precautions in a client's room and is entering another client's room. What is the nurse's next action?

Remind the healthcare provider about the transmission precautions. Is it best to directly and immediately address the issue with the healthcare provider. The nurse may suggest that additional precautions are taken prior to entering the client's room, but really can't insist, and hand hygiene is expected for every client. The charge nuse or supervisor can intervene, following the chain of command, if the healthcare provider does not take corrective action.

While performing a sterile dressing change, the nurse inadvertently contaminates the right hand glove. Which action by the nurse would be most appropriate?

Replace the current gloves with a new set of sterile gloves. Explanation: If gloves become contaminated at any time, the nurse should remove the gloves and put on a new pair of sterile gloves. Using only the left hand, applying a new pair of gloves over the current pair, or covering the contaminated glove with a nonsterile one would be inappropriate.

The nurse has created a sterile field with sterile dressings in preparation for a client's wound care. While getting ready to apply a dressing, the client moves his arm and touches the sterile field. Which action by the nurse would be most appropriate?

Set up an entirely new sterile field. Explanation: The client came in contact with the sterile field. As a result, the sterile field is contaminated, and an entirely new sterile field must be created. Adding new sterile dressings to the sterile field would contaminate the new dressings because the sterile field is now contaminated. All the items need to be replaced. Asking the client if he touched anything would be inappropriate because the client's contact with the sterile field rendered it unsterile and it should not be used.

The nurse has put on one sterile glove and is preparing to put on the other. What is the next step in donning the second glove?

Slide the gloved fingers under the cuff of the second glove. Explanation: After putting on the first glove, the nurse would slide the fingers of the gloved hand under the cuff of the second glove, thereby maintaining sterility, and insert the hand into the glove. When putting on the first glove, the nurse would use the thumb and index finger to grasp its cuff. Holding the second glove in the palm of the gloved hand would be inappropriate. Using the fingers to grasp the edges of the cuff of the second hand could cause contamination of the first gloved hand.

The nurse prepares for a sterile dressing change on one end of the table by opening a sterile field and dropping the supplies onto it. The nurse needs to gather additional supplies remaining on the other side of the table. What action does the nurse take?

Take a few steps around the table to pick up the additional supplies. Explanation: The nurse can step around the edge of the table, without turning his or her back on the sterile field, to gather the remaining supplies. Reaching across the current sterile field would be a reason to discard all the supplies and the field due to contamination. The table does not need to be completely covered with sterile drapes.

The nurse performs hand hygiene using an alcohol-based hand rub after exiting a client's room. The nurse does not touch another surface or client until what has occurred?

The antiseptic has evaporated from the skin. Explanation: Although products may vary, typically the nurse would apply the antiseptic to the palm of the hand, covering all surfaces of the hands and fingers. The nurse would continue to rub until it evaporates from the hand. Hand hygiene is not documented. Thirty seconds may not be enough time for the solution to dry. Hands are not dried with a paper towel after using the alcohol-based hand rub.

The nurse has prepared a sterile field using a prepackaged kit. Which would be important for the nurse to keep in mind?

The field is contaminated if it is out of the nurse's site. Explanation: When a pre‑packaged kit is used to create a sterile field, it and everything it contains are considered sterile. The kit would become unsterile if the field is out of the nurse's site or if it was below waist level. Other sterile items can be added to the sterile field, and the nurse would need to wear sterile gloves to obtain any items from the field.

The nurse is wearing a gown as part of using personal protective equipment and is preparing to put on clean disposable gloves. Which placement indicates that the nurse has put on the gloves properly?

The glove ends extend to cover the gown's cuffs. Explanation: When properly applied, the edges of the gloves should extend to cover the cuffs of the gown so that there is no visible skin exposed.

The nurse is putting on sterile gloves. Which principle would be important to keep in mind?

The hands should remain above waist level at all times. Explanation: When putting on sterile gloves, the nurse must ensure that the hands remain above waist level at all times. The inner package should be placed on the surface with the cuff side toward the body. The inner aspect of the cuff is used to put on the glove for the dominant hand, while the gloved fingers are slid under the cuff of the second glove to apply it. The cuffs are adjusted once both gloves are on.

When opening a pre‑packaged kit to prepare a sterile field, which would be important to keep in mind?

The inner surface of the outer wrapper is considered sterile. Explanation: The outer wrapper of a pre‑packaged kit is used to create the sterile field, such that the inner surface of the wrapper, which is sterile, becomes the sterile field once it is opened. The outside surface of the outer wrapper is considered contaminated. A 1‑in (2.5‑cm) border of the wrapper is considered contaminated. The wrapper is positioned on the work surface so that when it is flat, the edges are on the work surface and do not hang over the sides of the surface.

The nurse is opening a package containing a sterile drape to establish a sterile field. Which occurrence would indicate that the nurse had contaminated the sterile drape?

The nurse allows the drape to touch his or her body. Explanation: The drape becomes contaminated when it touches anything that is not sterile, such as the nurse's body clothing, or a non‑sterile surface. Touching the drape by the corners and allowing it to unfold gently maintains sterility. The shiny or blue side is the moisture‑proof side that prevents contamination of the field if it becomes wet.

The nurse is performing a sterile dressing change. What action would require the nurse to put on a new pair of gloves?

The nurse touches the client's skin with one hand. Explanation: The nurse would need to put on a new pair of gloves if the ones being worn became contaminated, such as by touching the client's skin with one of the gloves. Picking up a sterile dressing from the field, keeping both hands above waist level, or touching one glove to the other glove would not cause contamination and thus not necessitate putting on a new pair of gloves.

The nurse determines that the sterile field has been contaminated when which action occurs?

The nurse turns his or her back to the field. Explanation: A sterile field becomes compromised if the nurse turns away from it, if it drops below waist level, if an object falls onto or outside of the 1‑in (2.5‑cm) border of the field, or if the nurse reaches over the sterile field.

The nurse is planning to use a pre‑packaged kit to prepare a sterile field. Which would be of least importance in ensuring the sterility of the kit?

The outer wrapper is disposed in an appropriate receptacle. Explanation: When using a pre‑packaged kit to set up a sterile field, it is important that the nurse check the expiration date to make sure that it is still valid. It is also important to ensure that the kit is dry and unopened, indicating that the kit is still sterile. Although the outer wrapper is discarded in an appropriate receptacle, this step does not ensure that the contents of the kit are sterile.

The nursing instructor observes the nursing student removing sterile gloves. Which action indicates the need for further teaching?

The student pulls the gloves off starting with the fingertips prior to removal. Explanation: Grabbing the outside surface of the non‑dominant glove with the glove on the dominant hand ensures the gloves are removed smoothly without contaminating the room, surfaces, or the nurse's hands. The nurse ensures that the dirty side of the glove does not touch the skin and that any contaminants are contained to the glove's outer surface. The other actions are correct. The student does use one gloved hand to grab the outside surface of the other reaches under the glove on one hand to peel the glove off the other hand, and rolls gloves into each other during removal for disposal in the waste can.

The nurse is wearing a gown and gloves as part of using personal protective equipment. The gown is tied in the front at the waist and at the neck. Which action would the nurse take first?

Unfasten the gown at the waist. Explanation: When removing PPE, a gown that is tied in the front at the waist is unfastened first because the front the gown, including the waist ties, are considered contaminated. The nurse would then remove the gloves, one at a time, so that one glove is contained within the other. After discarding the gloves, the nurse would then untie the gown at the neck and back.

The nurse is removing a gown after providing care to a client. Which action would the nurse take first?

Unfasten the ties at the neck and back. Explanation: When removing a gown, the nurse first unfastens the ties at the neck and back, and then allows the gown to fall away from the shoulders. Touching only the inside of the gown, the nurse pulls the gown away from the torso. Keeping the hands on the inner surface of the gown, the nurse pulls the gown from the arms., turns it inside out, and folds or rolls it into a bundle to be discarded.

When setting up a sterile field, the nurse opens a sterile package prepared by the facility. Which action would the nurse take first?

Unfold the top flap away from the body. Explanation: When opening a sterile package prepared by a facility, the nurse would hold the package in the dominant hand with the top flap facing away from the body. The nurse would first unfold the top flap away from the body, then the side flaps (reaching under the package to open the opposite side flap), and lastly the flap closest to the body. The nurse would then pull the corners of the wrapper back toward the wrist.

The nurse uses soap and water for hand hygiene. Which action demonstrates proper handwashing?

Using a rubbing, circular motion. Explanation: When washing the hands with soap and water, the nurse would use a rubbing circular motion to wash the palms and back of the hands, each finger, the areas between the fingers and knuckles, and the wrists and forearms. Throughout the process, the nurse would keep the hands lower than the elbows to allow water to flow toward the fingertips. The nurse would wash to at least 1 in (2.5 cm) above the level of contamination or to 1 in (2.5 cm) above the wrists. When drying the hands, the fingers are dried first and the nurse then moves upward toward the forearms.

When removing soiled gloves, which action should the nurse take?

Using the gloved dominant hand, grasp the glove of the non‑dominant hand near the cuff on the outside. Explanation: When removing soiled gloves, the nurse would use the gloved dominant hand to grasp the opposite (non‑dominant) glove near the cuff end on the outside and remove it by pulling it off while inverting it so that the contaminated area remains on the inside The nurse would then slide the fingers of the now ungloved hand between the remaining glove and the wrist, pulling it off while inverting it, to keep the contaminated area on the inside and secure the first glove inside the second.

The nurse prepares to enter a client's room where goggles are required but not available. Which action by the nurse is best?

Wear a face shield as part of the protective equipment. Explanation: The nurse would not delay care due to a lack of goggles. The acceptable alternate is a face shield, which is a mask with a clear plastic covering for the eyes. If goggles are needed, the nurse would not enter the room without eye covering unless there was an emergent reason to do so. However, it is not correct to delay care until goggles can be obtained. This can take quite a long time. Even if the goggles can be supplied soon, the nurse can easily locate and use a face shield.