Chapter 17: Infection Prevention and Control in the Hospital and Home

31. A patient had abdominal surgery 3 days ago and now has a temperature of 101.2° F and reports feelings of malaise. The nurse assesses the abdominal incision and observes edema around the incision and some purulent drainage. This patient is in the ____________ stage of infection.

ANS: illness The illness period of infection is defined by the presence of systemic signs and symptoms such as fever, headache, malaise, rash, swelling, leukocytosis, purulent wound exudate, diarrhea, and vomiting.

32. The most contagious stage of infection is the ___________ period.

ANS: prodromal Although the prodromal period is short, it is the most contagious. People often do not realize they are ill, and precautions may not be taken, which increases the risk of transmission.

17. A patient with primary tuberculosis is on Airborne Precautions, and he spends much of the day sleeping and is confused and awake at night. An appropriate nursing intervention for this patient is to: a. provide diversionary activities or visitors during the day to decrease his sense of isolation and sensory deprivation. b. arrange for the patient to be transported to the lounge while wearing a surgical mask to provide more stimulation. c. consult with the physician for an order for an antidepressant and sleeping medication to treat the depression. d. encourage staff to "visit" with him from the doorway so that they do not have to wear a mask and they can increase his wakeful times during the day.

ANS: A A patient on Airborne Precautions (or any isolation) may become confused and have difficulty sleeping related to sensory deprivation, and the daytime sleeping may reflect boredom and further contribute to sleeplessness at night. Providing diversionary activities addresses these problems.

8. A patient has a nursing diagnosis of Infection, related to inadequate primary defenses, as evidenced by surgical incision and intravenous (IV) line access. An appropriate nursing intervention for this patient is to: a. assess and document skin condition around the incision and IV site at each shift. b. limit visitors to immediate family to decrease exposure to infection. c. require the use of a face mask by nursing staff when they are providing care. d. maintain "clean" technique in the change of wound dressing and IV site.

ANS: A Early identification of infection leads to prompt treatment and decreased transmission to others. Effective documentation provides a comparison from shift to shift about appearance of incision and IV site.

14. The nursing intervention most likely to decrease the chance of health care-associated infections (HAIs) for a 76-year-old patient following bowel resection surgery would be to have the patient: a. turn, cough, and deep-breathe every 2 hours. b. limit ambulation. c. get blood pressure, pulse, and respirations assessed every 4 hours. d. keep the room door closed.

ANS: A Having the patient turn, cough, and deep-breathe every 2 hours can help prevent the complication of pneumonia in the postoperative patient. Turning, coughing, and deep-breathing can enhance the prevention of pneumonia in the surgical patient.

7. The nurse performing a surgical scrub is aware that the average time for the scrub is _____ minutes. a. 3 b. 5 c. 6 d. 7

ANS: A The average length of time required for a surgical scrub will differ with the antimicrobial solution used and the agency policy, but the average is 2 to 4 minutes.

When the patient complains of vague symptoms of malaise and fatigue and has a low grade fever, but has no other specific signs of illness, the nurse suspects that this patient is in the prodromal phase of infection (the time immediately before the illness is diagnosed). The nurse should include in the plan of care to: a. increase assessment for specific signs of illness. b. increase fluid intake. c. place the patient in isolation. d. report findings to the Infection Preventionist Officer.

ANS: A The nurse should increase observation and assessments for specific signs of illness during the prodromal phase of infection.

26. In caring for a patient with active tuberculosis, the nurse should anticipate: a. wearing an N95 mask. b. wearing two masks to better filter microorganisms. c. donning a mask only in the case of close contact. d. placing a mask on the patient while care is being performed.

ANS: A When the patient has known or suspected pulmonary tuberculosis, a special particulate filter mask called an N95 mask must be worn.

34. A nurse is caring for a patient in protective isolation for extreme immunosuppression. Before entering the room, which of the following actions should the nurse take? (Select all that apply.) a. Don a gown. b. Don a mask. c. Put on gloves. d. Apply a head covering. e. Apply shoe coverings. f. Bring in the blood pressure cuff and stethoscope.

ANS: A, B, C A gown, mask, and gloves are all that is required; however, the CDC or hospital policies may require full PPE protection.

35. The nurse clarifies that the duties of the facility's Infection Preventionist include: (Select all that apply.) a. viewing every culture that is performed in the facility that is positive for pathogens. b. investigating possible causes for the occurrence of health care-associated infections (HAIs). c. sanitizing isolation rooms after patients have been discharged. d. counseling persons who have been found to be careless about infection control protocols. e. providing education to health care staff relative to infection control.

ANS: A, B, E The Infection Preventionist (IP) follows up on all positive cultures, investigates possible causes of HAIs, and provides ongoing education to staff. Counseling and sanitizing are not directly the responsibility of the IP, although he or she might suggest counseling and supervise sanitizing procedures.

21. A nurse is instructing one of the facility's unlicensed assistive personnel (UAP) in ways to prevent health care-associated infections. The nurse recognizes that further instruction is warranted when the UAP states, "I will: a. wash my hands before and after caring for patients." b. cleanse patients from the rectum to the urinary meatus." c. clean residual urine off the catheter bag when emptying it." d. put all the soiled linen in the hamper in the room."

ANS: B A person should never cleanse from the rectal area to the urinary meatus because of the risk of introducing infection into the urinary tract.

13. The nurse recognizes a break in aseptic technique when: a. the hand towel is kept above the waist level. b. the hands are kept lower than the elbows during the surgical scrub. c. faucets are turned off with a paper towel elbow or foot control in a scrub for a surgical operation. d. the sterile glove is donned by sliding the ungloved hand under the cuff of the sterile glove.

ANS: B Allowing the hands to become lower than the elbow is a break in aseptic technique.

6. A patient who has active primary tuberculosis is placed on Airborne Precautions. In addition to observing Standard Precautions for this patient, the nurse expects that: a. the patient can be in a room with a roommate, if both persons wear masks. b. a special particulate filter mask (respirator) will be worn by anyone entering the room. c. the patient may leave the room freely as long as the patient wears a mask at all times. d. no mask is needed unless performing close-contact nursing care.

ANS: B An N95 particulate filter respirator is worn by anyone entering the room of a patient with primary tuberculosis. A private room is preferred. The patient should leave the room only for essential activities (with a mask).

4. The nurse cautions that a person in the incubation period of an infection: a. has identifiable signs of a specific illness. b. can transmit the disease although he or she does not feel ill. c. will seek medical attention for the relief of symptoms. d. will always exhibit symptoms within 48 hours.

ANS: B During the incubation period, patients can transmit the disease, although they don't have identifiable symptoms. The incubation period varies depending on the microorganisms.

5. The nurse clarifies that the difference between the use of earlier types of isolation procedures and the use of current Standard Procedures plus Transmission-Based Precautions as outlined by the CDC is: a. that new diseases have continued to appear for which the older isolation techniques were ineffective. b. based on the premise in the new procedures that all body substances except sweat may be infectious, even when the person is not known to have a specific disease. c. complicated and hard to follow. d. based on newer knowledge of how HIV is spread, to better protect health care workers from blood-borne pathogens.

ANS: B Earlier Universal Precautions and Isolation Precautions focused on preventing the spread of blood-borne pathogens and secretions or excretions of a person specifically known to be infected. They have been replaced with Standard Precautions for all patients, and Transmission-Based Precautions for those specifically infected, because of the understanding that infection may be present in body secretions or excretions even when the person is apparently healthy.

18. An 84-year-old patient is hospitalized for an infected stasis ulcer on his ankle. The nurse is aware that this patient is at risk for a hospital-acquired infection (HAI) because the: a. patient already has a blood-borne infection. b. patient's defenses are already engaged with the initial infection. c. ulcer will make this patient bedfast. d. stasis ulcers predispose the elderly to pneumonia and urinary infections.

ANS: B The elderly have an impaired immune system. This patient's immune system is already engaged with the stasis ulcer, which may put him at risk for an HAI.

9. The correct way to handle soiled linens in the room of a patient who is on Contact Precautions is for the nurse to: a. shake out the linens before placing them in a designated laundry bag to ensure that there are no plastics or valuables caught in the sheets. b. wear a gown to protect the uniform and wear barrier gloves to roll the soiled sheets together and place them in the designated container. c. remove the soiled sheets using barrier gloves and to keep the linens away from the uniform and then place them in a laundry bag held by another nurse outside the room. d. carry the soiled sheets directly to the unit laundry area before removing the personal protective equipment (PPE).

ANS: B The nurse should wear a gown to protect the uniform and should wear barrier gloves to roll the soiled sheets together and place them in the designated container inside the room.

22. A patient is hospitalized with suspected disseminated zoster (varicella). The nurse should anticipate that this patient will be placed on _____ Precautions. a. Standard b. Droplet c. Airborne d. Contact

ANS: C Airborne Precautions are used in addition to Standard Precautions for patients with known or suspected serious illnesses transmitted by airborne droplet nuclei. Examples of such diseases are measles, varicella (including disseminated zoster), and pulmonary tuberculosis.

19. The nurse collecting a sputum specimen for a patient with staphylococcal pneumonia will: a. wipe the specimen container with antimicrobial solution and hand carry it to the lab. b. double bag the specimen container and send the specimen to the lab. c. send the specimen to the lab in a Biohazard bag. d. notify the lab to collect the contaminated specimen.

ANS: C Contaminated specimens are collected using appropriate PPEs and sent to the lab in a clearly marked Biohazard bag as required by OSHA.

23. A patient is hospitalized with pertussis. The nurse should place the patient on what type of precautions? a. Contact Precautions b. Airborne Precautions c. Droplet Precautions d. Standard Precautions

ANS: C Droplet Precautions are used in addition to Standard Precautions for patients with known or suspected serious illnesses transmitted by large-particle droplets. An example of such an illness is pertussis.

28. A nurse is caring for a patient who is in isolation. The nurse would correctly do which of the following? a. Freely take items in and out of the isolation room. b. Shake linen when removing it from the bed. c. Turn faucets on and off using a paper towel. d. Consider items dropped on the floor useable.

ANS: C General principles regarding isolation include that anything that is brought into the isolation area must not be removed except in proper containers, which are then placed in an outside container labeled "Hazardous Material—Biohazard." They also include never shaking linen when removing it or placing it on the bed, turning faucets on and off using a paper towel to protect the hands, and that floors are considered contaminated; anything dropped on the floor is contaminated and must be discarded or cleaned carefully before reuse.

11. A patient is discharged home with a draining wound that was infected and for which he was on Contact Precautions while in the hospital. He lives at home with his 48-year-old wife and their 17-year-old daughter. It is most important to emphasize to this patient that: a. he should maintain a safe distance from his family. b. he should use paper plates and disposable utensils. c. soiled dressings should be disposed of in plastic bags that are tied securely. d. his family members should wear gloves when handling his plate and eating utensils.

ANS: C In the home, Contact Precautions require the use of barrier gloves to prevent contact with wound secretions during dressing changes (or if linens were soiled) and during the handling of soiled dressings. Soiled dressings should be disposed of in a securely tied plastic bag. Good hand hygiene and attention to medical asepsis principles are sufficient.

20. The nurse is helping the physician perform a sterile procedure at the bedside. Halfway through the procedure, the nurse believes the physician has contaminated the sterile field. The nurse should: a. report the physician for violating surgical asepsis and endangering the patient. b. ask the physician whether she contaminated her glove and the sterile field. c. point out the possible break in surgical asepsis and provide another set of sterile gloves and a fresh sterile field. d. not say anything, because it is near the end of the procedure.

ANS: C It is the responsibility of the nurse to point out any possible break in surgical asepsis. Saying nothing does not protect the patient and is negligence on the part of the nurse. A fresh sterile field should be provided.

27. The nurse is instructing one of the facility's unlicensed assistive personnel (UAP) about how to correctly use a sharps container. The nurse recognizes that further instruction is warranted when the UAP states, "I will: a. drop sharp items, including needles, into a sharps container." b. shake the sharps container gently to settle the contents." c. put my fingers inside the opening to push the item well inside the container." d. replace the sharps container when it is two thirds full."

ANS: C No one should ever put fingers inside the opening of the sharps container. The container may be shaken gently to settle the contents and make more room if necessary. Sharps containers should be replaced when they are two thirds full.

16. The nurse adding sterile liquids to a sterile field should: a. hold the liquid container high over the sterile field. b. remove the cap and place the container with the inside facing down. c. prepare a new sterile field if it becomes wet during the procedure. d. carefully reach over the sterile field to pour the liquid.

ANS: C Once a sterile field is wet, it is contaminated and a new field needs to be prepared.

The nurse is aware that the patient most at risk for a health care-associated infection (HAI) would be the: a. 45-year-old in traction for a fractured femur. b. 56-year-old with pneumonia who is receiving oxygen by mask. c. 65-year-old with a Foley catheter. d. 70-year-old with congestive heart failure attached to a monitor.

ANS: C Patients with incisions, IV lines, urinary catheters, and other invasive procedures are more likely to develop a health care-associated infection (HAI).

30. A nurse is instructing a nursing student about principles of aseptic technique. The nurse would recognize the need for further instruction if the nursing student states, "I must: a. avoid coughing, sneezing, or unnecessary talking near or over a sterile field." b. avoid reaching across or above a sterile field with my bare hands or arms." c. open the wrapper of a sterile pack toward my body, the proximal flap first." d. keep my sterile gloved hands in sight, away from all unsterile objects."

ANS: C Principles of aseptic technique include avoiding coughing, sneezing, or unnecessary talking near or over a sterile field. They also include avoiding reaching across or above a sterile field with bare hands or arms or with other non-sterile items. The wrapper of a sterile pack must be opened away from the body, the distal flap first, the lateral flaps next, and the proximal flap toward the body last, thus making it unnecessary to reach over the sterile field. When wearing sterile gloves, hands must be kept in sight away from all unsterile objects, and above the waist level.

10. A patient on Airborne Precautions says to the nurse, "I feel like I'm going crazy cooped up in here. I feel like just sneaking out and finding someone to talk to." The best response by the nurse is: a. "You would be jeopardizing everyone you come into contact with. You could give a lot of innocent people your disease." b. "It won't be long before you can safely get out of here without being a danger to others." c. "You must be feeling bored being shut up in here. Have you been following the wonderful season our football team has been having?" d. "I know just how you feel. Sometimes I can't get outdoors because of the rain, and it's so hard being cooped up."

ANS: C Talking about a shared interest will divert the patient.

29. When picking up the first sterile glove, the nurse will: a. grasp the cuff with the thumb and fingers. b. insert fingers into the opening and pull the glove on while holding the cuff. c. slip a thumb in the opening and grasp the glove between the thumb and fingers. d. leave the glove on a flat surface and work the fingers into the opening.

ANS: C The first glove is grasped by slipping the thumb in the opening and grasping the cuff with the fingers.

25. When the nurse is explaining Tier 2 as developed by the Hospital Infection Control Practices Advisory Committees (HICPAC), the nurse will emphasize that the purpose of Tier 2 is to: a. interrupt the mode of transmission. b. monitor the efficiency of the treatment. c. be put in place of Standard Precautions. d. update all information relative to infections.

ANS: C Tier 2, or Transmission-Based Precautions, is focused on interrupting the mode of transmission and is always used in combination with Standard Precautions.

33. Differences between Airborne and Droplet Precautions include which of the following? (Select all that apply.) a. A surgical mask must be worn with Airborne Precautions. b. Patients on Droplet Precautions do not need to wear a surgical mask when outside their rooms. c. A surgical mask must be worn if working within 3 feet of a patient on Droplet Precautions. d. Airborne Precautions include placing the patient in a negative-pressure room. e. A specialized respirator mask must be worn with patients on Droplet Precautions. f. Standard Precautions need to be used only with patients on Airborne Precautions.

ANS: C, D, E The Centers for Disease Control and Prevention (CDC) recommends the use of specialized respirator masks when working with patients on Airborne Precautions and a surgical mask when working within 3 feet of a patient on Droplet Precautions. Both Airborne and Droplet Precautions include the use of a private room; however, a negative-pressure room is required for Airborne Precautions. Standard Precautions are to be used with all patients.

24. The patient for whom the nurse should observe Contact Precautions in addition to Standard Precautions would be diagnosed with: a. pulmonary tuberculosis. b. Haemophilus influenzae meningitis. c. pertussis. d. respiratory syncytial virus.

ANS: D Contact Precautions are used in addition to Standard Precautions for patients with known or suspected serious illnesses easily transmitted by direct patient contact or by contact with items in the patient's environment. An example of such an illness is respiratory syncytial virus.

3. The most effective part of infection control to reduce the incidence of health care-associated infections (HAIs) is to: a. use surgical asepsis for care of patients outside the operating room who are most at risk for a HAI. b. put all patients with wounds or invasive procedures on transmission-based precautions before they become infected. c. place an alcohol-based hand sanitizer solution in every patient room. d. use proper hand hygiene before and after caring for any patient, before donning gloves and after their removal.

ANS: D Proper hand hygiene is the single most important aspect of medical asepsis and infection control.

12. A family member has been instructed in the administration of subcutaneous medication at home. The nurse instructs her to: a. break the needle off from the syringe so that it can't be reused and wrap the broken needle and syringe in newspaper and throw them in the garbage. b. recap the needle and dispose of it in the garbage, because it can't accidentally stick anyone with the cap replaced. c. save the used needles and syringes for the visiting nurse, who can collect them and arrange for proper disposal. d. place the used syringe and needle, without recapping it, in a large plastic bottle with a secure lid.

ANS: D The use of a heavy plastic container with a secure lid, such as a bleach or detergent bottle, is a safe way to dispose of the uncapped syringe.

15. When caring for a patient on Droplet Precautions, it is most important for the nurse to: a. wear the appropriate respiratory device for any entry into the room. b. cover the patient with a clean sheet when transporting the patient to x-ray. c. wear a gown and gloves for any contact with the patient. d. wear a mask if working within 3 feet of the patient.

ANS: D The wearing of a mask when working within 3 feet is all that is necessary for a patient on Droplet Precautions.