Taylor Review Questions - Asepsis and Infection Control

The client presents to the Emergency Department reporting fever, chills and a productive cough. The chest x-ray shows an area of infiltrate, and the primary care provider prescribes a broad spectrum antibiotic. Which client teaching statement from the nurse is most appropriate regarding the prescribed drug?

"This antibiotic is the best choice since the causative organism is not known." RATIONALE: Broad spectrum antibiotics are appropriate when the client is symptomatic and the causative bacteria is not yet known. These agents produce the best change of effectiveness. The side effects of all antibiotics are similar. The antibiotic can cause resistance when used excessively in the absence of infection. Pneumonia may or may not be caused by multiple organisms; however this is not the best answer regarding the medication.

The nurse is preparing to enter the client's room who is on airborne precautions. Which technique should the nurse use when wearing a non particulate respirator (N-95) mask? SATA

- The mask covers the nose and mouth - replace the mask after 20-30 minutes - tie the upper strings of the mask snuggly against back of the head RATIONALE: The nonparticulate respirator (N-95) mask should be worn by covering the mouth and nose with the strings tied snugly against the back of the head and lower strings against the back of the neck. The mask should be replaced every 20-30 minutes or when visibly damp or soiled. The mask should be removed by the strings, never touching the front of the mask. The mask should be discarded in a waterproof container.

The nurse is removing soiled gloves after assisting with a sterile procedure. Which actions follow recommended guidelines for this procedure? SATA

- Use the dominant hand to grasp the opposite glove near cuff end on the outside exposed area. - Remove the glove by pulling it off, inverting it as it is pulled, and keeping the contaminated area on the inside. - Slide the fingers of the ungloved hand between the remaining glove and the wrist. - Discard the gloves in appropriate container, removing additional PPE, if used, and performing hand hygiene. RATIONALE: The recommended actions for removing soiled gloves are numerous. The nurse would use the dominant hand to grasp the opposite glove near the cuff end on the outside exposed area. Next, the nurse would remove the glove by pulling it off, inverting it as it is pulled, and keeping the contaminated area on the inside. The nurse would then slide the fingers of the ungloved hand between the remaining glove and the wrist. The nurse would discard the gloves in an appropriate container, removing additional PPE if used, and performing hand hygiene. The nurse would also remove the second glove by pulling the cuff up, inverting it as it is pulled, and keeping the contaminated area on the inside, not the outside. Next, the nurse would secure the second glove inside the first glove while keeping the contaminated area on the inside.

Personal protective equipment for use with standard precautions includes which items? SATA

- face mask - disposable gloves - eye protection - fluid-repellent gown RATIONALE: For standard precautions, wear personal protective equipment, such as mask, eye protection, face shield, or fluid-repellent gown during procedures and care activities that are likely to generate splashes or sprays of blood or body fluids. Use gown to protect skin and prevent soiling of clothing. Disposable shoe and head covers are not required under standard precautions.

After providing are to a client, the nurse is disposing of waste materials. Which waste would the nurse identify as injurious waste? SATA

- used syringe with attached needle - used fingerstick lancet RATIONALE: Injurious wastes include needles, scalpel places, lancets, broken glass, pipettes and aerosol cans. Blood-soiled dressing or contaminated cotton-tipped applicators are considered infectious waste. Chemotherapy solution containers would be considered hazardous waste.

The school nurse is educating a group of teenagers about ways in which HIV can be transmitted. Which methods of infection transmission will the nurse educate the group about? SATA

- via syringes shared between the client and others - via sexual contact - contact with wound openings - contact with blood - via mucous membranes

Which client would the nurse consider the most infectious?

A client who is in the prodromal stage RATIONALE: The client is most infectious during the prodromal stage of the illness. Early signs and symptoms of disease are present, but these are often vague and nonspecific, ranging from fatigue and malaise to a low-grade fever. This period lasts from several hours to several days. During this phase, the client often is unaware of being contagious. As a result, the infection spreads. The incubation period is the interval between the pathogen's invasion of the body and the appearance of symptoms of infection. During this stage, the organisms are growing and multiplying. The length of incubation may vary. The presence of specific signs and symptoms indicated the full stage of illness. The type of infection determines the length of the illness and the severity of the manifestations. The convalescent period is the recovery period from the infection. Convalescence may vary according to the severity of the infection and the client's general condition. The signs and symptoms disappear, and the person returns to a healthy state.

A nurse is preparing an operating room theatre for a surgical procedure. Which point regarding the principles of surgical asepsis should the nurse keep in mind when preparing sterilized surgical instruments?

A commercially packaged surgical item is not considered sterile if past expiration date. RATIONALE: When preparing the operation theater for a surgical procedure, the nurse should remember that a commercially packaged surgical item is not considered sterile if it has passed its recommended expiration date. When a sterile item touches an item that is not sterile, then the sterile item is contaminated. If a sterile item touches another sterile item, it is not considered contaminated. A partially uncovered sterile package is considered contaminated.

The nurse is caring for a 7-year-old client with varicella. Which precautions will the nurse initiate?

Airborne RATIONALE: Varicella is transmitted via airborne mechanisms; therefore, airborne precautions are appropriate

What national organization determined that unintentional injuries were the fifth-leading cause of all deaths in the United States?

Centers for Disease Control and Prevention

The nurse is caring for a client with a surgical wound. Which action by the nurse best reduces the reservoir of infection?

Changing the soiled dressing RATIONALE: A reservoir is a place where microbes grow and reproduce. A soiled dressing can be a reservoir for microbes to breed. Changing the soiled dressing reduces the microbes at the wound. Wearing gloves, isolating client's belongings, and applying a face mask decrease the transmission of infection.

Which client should the nurse determine is at greatest risk for vancomycin-resistant enterococci (VRE)?

Client receiving chemotherapy RATIONALE: The nurse should determine that the client receiving chemotherapy is the client at greatest risk for VRE infection due to having a compromised immune system from the chemotherapy. Other risk factors for VRE include recent abdominal or chest surgery, presence of urinary or central IV catheter, prolonged antibiotic use (especially vancomycin), and lengthy hospital stays (especially in an ICU).

A client is admitted to the hospital with pneumonia. The nurse is preparing to enter the client's room. Which action would the nurse perform first?

Complete hand hygiene and don gloves RATIONALE: The nurse will always perform hand hygiene and don gloves (in the case of contact precautions) before performing any other interventions. This action must precede client interactions, including education or assessment.

The nurse is caring for a client who required frequent airway suctioning. Which precautions will the nurse select for the client?

Droplet

The nurse is caring for a college student with meningococcal meningitis. Which precautions will the nurse begin?

Droplet RATIONALE: Meningococcal meningitis is transmitted through droplets; therefore droplet precautions are appropriate.

A nurse is explaining the different procedures used to break the chain of infection to a nursing student. In which link in the chain of infection should a nurse provide special attention to the respiratory and gastrointestinal tracts?

Exit route RATIONALE: The nurse should provide special attention to the respiratory and gastrointestinal tracts as potential exit routes.

An older adult client has been receiving care in a two-bed room that he has shared with another older, male client for the past several days. Two days ago, the client's roommate developed diarrhea that was characteristic of Clostridium difficle. This morning, the client himself was awakened early by similar diarrhea. The client may have developed which type of infection?

Exogenous healthcare-associated RATIONALE: The client's suspected infection originated with another person (exogenous) and was contracted in the hospital (healthcare-associated). It was not the result of his treatment (iatrogenic) and C. Difficle is not an antibiotic-resistant microorganism. Endogenous infections originate from within the organism and are not attributed to an external or environmental factor.

When discontinuing use of a gown in the care of a client in droplet precautions, which method does the nurse use to dispose of this personal protective equipment (PPE)?

Fold soiled side to the inside and roll with inner surface exposed RATIONALE: To dispose of the gown, the nurse will fold the soiled side to the inside and roll with the inner surface exposed. The other answers are incorrect.

A lead nurse is removing personal protective equipment after dressing the infected wounds of a client. Which is the priority nursing action?

Handwashing before leaving the client's room RATIONALE: The most important nursing action is to perform thorough handwashing before leaving the client's room and before touching any other client, personnel, environmental surface, or client care items. Regardless of which garments they wear, nurses follow an orderly sequence for removing them. The procedure involves making contact between two contaminated surfaces or two clean surfaces. Nurses remove the garments that are most contaminated first, preserving the clean uniform underneath.

The nurse is teaching a client the correct procedure for pouring a sterile solution. Which client action indicates need for further education from the nurse?

Holding the container off to the side RATIONALE: The client should hold the bottle in front of them for the most control and to see what they are pouring. Pouring out a small amount of the solution is appropriate; this is called lipping. Holding the lid or placing it upside down prevents contamination when the lip is reapplied to the sterile solution. Splashing can contaminate the area around the client. Pouring slowly will avoid splashing.

The nurse is caring for a client who requires droplet precautions. Which statement made by the client would indicate further teaching is required?

I can leave my room any time I want as long as I wear a mask RATIONALE: The client on droplet precautions should only leave the room when necessary and wear a mask. The nurse should limit the client's movement outside the room. Visitors should remain 3 feet (1 meter) from the client. Anything that enters the isolation room should remain until discharge. Any staff who enters the room will wear PPE

A nurse is inserting a male client's indwelling urinary catheter. After preparing the sterile field and cleansing the client's meatus, the nurse realizes that he has brought the wrong-sized catheter to the bedside. What is the nurse's best action?

Illuminate the client's call light and have a colleague bring the correct catheter to the bedside. RATIONALE: If you realize a supply is missing after setting up the sterile field, you should call for help. Leaving the sterile field unattended renders it contaminated.

A nurse has been exposed to urine while changing the linens of a client's bed. Which guideline is followed for performing hand hygiene after this client encounter?

Keep hands lower than elbows to allow water to flow toward fingertips RATIONALE: Handwashing, as opposed to hand hygiene with an alcohol-based rub, is required when hands are exposed to body fluids. Jewelry should be removed, if possible, and secured in a safe place, but a plain wedding band may remain in place. Wet the hands and wrist area, and keep hands lower than elbows to allow water to flow toward fingertips and pat hands dry with a paper towel, beginning with the fingers and moving upward toward forearms.

The nurse is caring for a client who has been hospitalized and placed in airborne precautions for a week. Which nursing intervention is appropriate to provide sensory stimulation?

Move the bed and furnishings to a different place in the room RATIONALE: To promote sensory stimulation, move the bed and furnishings around in the room. The client cannot be transported outside without risking infecting others. Family and friends may not be able to visit more without exposing themselves to infection or bringing further infection to the client. Communicating only through the intercom is not appropriate, as the client will still need hands-on care as well.

A nurse is caring for four clients. Which client has the highest risk of infection?

Older male with an enlarged prostate RATIONALE: An older male with an enlarged prostate can have urine trapped in the bladder leading to urinary tract infections. A toddler with a benign heart murmur is developmental in nature and does not place them at an increased risk of infection. Pregnancy can alter immunity, however this is not the highest risk. Scoliosis has no impact on infection.

The nurse is adding a sterile solution onto a prepared sterile field. What is the best technique performed by the nurse?

Pouring the sterile solution from a height of 5 inches RATIONALE: Sterile solutions can be poured onto a sterile field from a height of 4-6 inches. The top of the bottle should not touch the sterile container on the field. The cap should always be placed with edges up to maintain sterility. Unused solution can be labeled with date and time and stored for up to 24 hours.

Nurses working in bed management are assigning clients from the emergency room to semiprivate rooms. Clients with which two diagnoses are appropriate to room together, based on safety and infection control standards?

Reactive airway disease and exacerbation of chronic obstructive pulmonary disorder (COPD) RATIONALE: Reactive airway disease and exacerbation of COPD are both medical diagnoses and not communicable conditions. Clients with these conditions can room together. C. difficile requires contact isolation and is contagious. Diabetic ketoacidosis is considered a medical diagnosis and requires standard precautions. A surgical incision from and appendectomy is considered clean. A draining leg ulcer can transmit an infection to a client with a clean surgical incision. In both of these cases, rooming these clients together violates infection control standards. Tuberculosis requires airborne precautions and pneumonia requires standard precautions. Based on the mode of transmission of tuberculosis, these clients cannot room together.

The nurse is caring for a client who has been placed in strict isolation. Which nursing action is appropriate?

Remove fresh fruit from the room. RATIONALE: Fresh fruit and flowers can carry pathogens and chemicals to which the client should not be exposed. The number of visitors should be controlled to prevent exposure to multiple infection opportunities

Which action is the best example of a nurse donning/removing protective equipment properly?

Removing respirator after leaving the client's room RATIONALE: The best example of proper utilization of protective equipment is the removal of a respirator after leaving the client's room, as doing so prevents contact with airborne microorganisms. Gowns should be removed before leaving the client's room. Gowns and respirators should be donned prior to entering the client's room.

the nurse is observing a sterile field that was prepared by another staff member. Which, if present, would indicate that the sterile field is contaminated?

Sterile drape positioned with the moisture-proof side facing up RATIONALE: If the sterile drape is placed with the moisture-proof side up, it will become contaminated if it gets wet. It is acceptable to place gloves away from the field and to place gauze on the field. The edges commonly overhang the end of the table slightly, and this is acceptable.

The nurse is caring for a client that is suspected of having a latex allergy. What item of personal protective equipment should the nurse use with caution?

Surgical masks RATIONALE: Surgical masks may contain latex. Pillows, googles and gowns likely do not contain latex. The nurse can order latex-free medical supplies, although most items in the acute care setting are latex-free including googles, pillows and gowns.

An operating room nurse is putting on sterile gloves to assist with client surgery. Which actions are performed correctly in this procedure? SATA

The nurse opens the outside wrapper by carefully peeling the top layer back. The nurse carefully opens the inner package by folding open the top flap, then then the bottom and sides The nurse lifts and holds the glove up and off the inner package with gingers down and carefully inserts hand palm up into glove

A nurse is applying the principles of Standard and Contact Precautions in the care of a hospital client. Which action violates these principles?

The nurse removes her gown and then removes her gloves RATIONALE: Gloves should be removed prior to a gown. Hand hygiene is necessary before applying gloves and after touching a client's surroundings. The use of moisturizers is acceptable.

The nurse performs hand hygiene using soap and water before and after providing client care. Which nursing action is performed correctly according to the procedure?

The nurse washes at least 1 in above the area of contamination if present RATIONALE: The nurse must wash at least 1 in above the area of contamination to properly perform hand hygiene. The nurse should use warm to hot water to wash hands. The amount of liquid soap varies depending on the concentration of the soap. The nurse rinses with water flowing toward the fingertips.

The nurse is caring for a client who is hospitalized and has an indwelling urethral catheter. Which finding would most likely indicate the client has developed an infection?

Urine culture positive for vancomycin-resistant enterococci (VRE) RATIONALE: Infections result from pathogens that produce illness after invading body tissues and organs. The client with the indwelling urethral catheter is at risk for developing infection. The finding that would most likely indicate an infection would be a positive result. Nausea and vomiting, a fever, and dark yellow urine with sediment are possible signs of an infection, but each of these findings alone does not confirm an infection.

A team of nurses is caring for a client with tuberculosis. They have not been fitted an N95 respirator. How will the team proceed with care?

Utilize a powered air, purifying respirator (PAPR). RATIONALE: A PAPR is an alternative that can be used if a caregiver has not yet been fitted with an N95 respirator. All the other options are inappropriate.

A nurse is caring for a child who is hospitalized for diphtheria. Which guideline would be appropriate when caring for this client?

Wear personal protective equipment (PPE) when entering the room for all interactions that may involve contact with the client. RATIONALE: The nurse should wear PPE upon entry into the room for all interactions that may involve contact with the client. The nurse should use a private room, if available, and the door may remain open. Placing a client in a private room that has monitored negative air pressure is appropriate for airborne infections. Frequent disinfecting is not indicated.

The nurse educator is reminding a group of new nurses about precautions. Which statement by a new nurse requires further teaching by the nurse educator?

Wearing an N95 respirator is critical when I care for clients with droplet precautions RATIONALE: N95 Respirators are used when caring for clients in airborne precautions; therefore, this statement requires further teaching. The other statements reflect that teaching has been effective.

For which client would the use of standard precautions alone be appropriate?

an incontinent client in a nursing home who has diarrhea RATIONALE: 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 client hospitalized with suspected infection by pathogens that can be transmitted by airborne, droplet and contact routes, such as is the case in answers A, B, and D.

For which client would the use of standard precautions alone be appropriate?

an incontinent client in a nursing home who has diarrhea RATIONALE: 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, D.

Which piece of personal protective equipment (PPE) should be removed first?

gloves RATIONALE: The order for removal of PPE is gloves, goggles, gown, and respirator. If removal of PPE is not in that order, contamination of the nurse can occur.

The nurse is preparing discharge instructions for a family member who will be caring for a client with an abdominal incision. Which concept should be the priority in the teaching plan?

hand washing RATIONALE: Hand washing technique is the single most important procedure in reducing the spread of microorganisms from either the client to the surroundings or surroundings to the client. A client does not need to learn a sterile technique for the abdominal incision. Most client procedures are related to clean handing and do not need gloves to be added to a dressing change. The nurse should review signs of infection and healing of the abdominal incision.

A client on a surgical unit has developed an infection at the site of a diagnostic laparoscopy. This type of infection is best termed as which of the following?

iatrogenic RATIONALE: An infection is referred to as iatrogenic when it results from a treatment or diagnostic procedure. There is not enough information to determine if the infection was exogenous (causative organism is acquired from other people) or endogenous (causative organism come from microbial life harbored in the person). An antibiotic-resistant organism is an organism against which more common antibiotics are ineffective.

When the client who has been diagnosed with hepatitis B has been hospitalized, the type of isolation the nursing staff should observe is

standard precautions RATIONALE: Standard universal precautions relate to blood and certain body fluids to protect health care workers from clients possibly carrying HIV, hepatitis B virus, or other blood borne pathogens.

The nurse observes a member of the care team removing a gown after assisting a client with hygiene, as seen in the image above. What is the nurse's most appropriate action?

teach the colleague to let the gown fall away rather than pulling on the sleeves RATIONALE: The individual should allow the gown to fall away from the shoulders, touching only the inside of the gown. Gloves are removed first; this should be performed inside the client's room, unassisted.

A nurse is providing care to a client who has Salmonella food poisoning. The nurse understands that this pathogen was transmitted by which mechanism?

vehicle RATIONALE: Vehicle transmission involves the transfer of microorganisms by way of vehicles or contaminated items that transmit pathogens; for example. Food can carry Salmonella. Direct contact transmission involves body surface-to-body surface contact causing the physical transfer of organisms between an infected or colonized person and an infected host. Droplet transmission occurs when mucous membranes of the nose, mouth or conjunctiva are exposed to secretions of an infected person who is coughing, sneezing or talking. Airborne transmission occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens.