Chapter 24 PrepU: Asepsis and Infection Control

A nurse follows surgical asepsis techniques for inserting an indwelling urinary catheter in a client. What is an accurate guideline for using this technique? A. Hold sterile objects above waist level to prevent inadvertent contamination. B. Consider the outside of the sterile package to be sterile. C. Consider the outer 3-in. (8-cm) edge of a sterile field to be contaminated. D. Open sterile packages so that the first edge of the wrapper is directed toward the nurse.

A

An acute medicine unit of a hospital currently has a number of clients who have tested positive for methicillin-resistant Staphylococcus aureus (MRSA). Which measures should the nursing staff prioritize in preventing the spread of MRSA to clients who are currently MRSA-negative? A. diligent handwashing practices B. reduced length of stay for MRSA-positive clients C. constant use of gloves when on the unit D. prophylactic antibiotic therapy for MRSA-negative clients

A

An infection-control nurse is discussing needlestick injuries with a group of newly hired nurses. The infection control nurse informs the group that most needlestick injuries result from: A. recapping a needle. B. needles left in the client's linen. C. full needle boxes. D. faulty needles and syringes.

A

The most common infection in children is: A. respiratory. B. gastrointestinal. C. neurologic. D. urinary.

A

The mother of a newborn asks the nurse about her newborn's risk for infection. Which statement by the nurse would be most appropriate? A. "Your baby's resistance comes from the antibodies you passed on to him before birth and now with breast feeding." B. "It usually takes about a month or two until the baby's immune system to become completely functional." C. "Infections in newborns are rare because they have little difficulty localizing infections" D. "If you notice that the newborn has a fever, then you need to have him seen by the doctor fairly quickly."

A

The nurse observes an unlicensed assistive personnel (UAP) collecting a urine specimen from a client with Staphylococcus aureus infection. Which action by the UAP would require the nurse to intervene? A. removes gloves and walks out of the room B. asks the client to state name and date of birth C. applies a mask with face shield D. performs hand hygiene before donning gloves

A

Upon review of a client's microbiology culture results, the nurse recognizes which organism as indicative of normal flora? A. Escherichia coli in the intestinal tract B. Escherichia coli in the urinary tract C. Shigella in the intestinal tract D. Shigella in the urinary tract

A

Which client should the nurse determine is at greatest risk for vancomycin-resistant enterococci (VRE) infection? A. Client receiving chemotherapy B. Client with a history of eczema C. Client on a short course of vancomycin D. Client in the ICU for one day

A

The nurse is providing an in-service educational program for the interprofessional health care team about infection control precautions. What teaching will the nurse include? Select all that apply. A. Wear personal protective equipment (PPE). B. Practice hand hygiene. C. Use standard precautions only for clients with infection. D. Use equipment repeatedly on clients with similar conditions. E. Keep client's environment clean.

A, B, E

A new perioperative nurse is being educated regarding surgical asepsis. What observations by the preceptor would indicate that there is a need for reinforcement of the principles of asepsis? Select all that apply. A. The nurse's back is facing the sterile field. B. The nurse keeps hands above waist level while donning sterile gloves. C. The nurse touches an unsterile object to the instrument tray. D. The nurse is talking with the scrub nurse over the sterile field. E. The nurse disposes of an opened container of sterile saline after 24 hours.

A, C, D

A nurse is preparing a sterile field for the health care provider to perform a biopsy on a client. Which actions follow recommended guidelines for maintaining the sterile field for this procedure? Select all that apply. A. The nurse considers the outer 1-inch (2.5-cm) edge of the sterile field to be contaminated. B. The nurse places the cap of an opened solution on the table with edges down. C. The nurse discards a sterile field when a portion of it becomes contaminated. D. The nurse calls for help when realizing a supply is missing. E. The nurse drops a sterile item on a sterile field from the height of 12 inches (30 cm). F. The nurse holds an agency-wrapped item with the top flap opening toward the body.

A, C, D

A client has a diagnosis of HIV and has been admitted to the hospital with an opportunistic infection that originated with the client's normal flora. Why did this client most likely become ill from his resident microorganisms? A. The resident microorganisms mutated and became virulent B. The client's immune system became further weakened C. The client's normal flora proliferated because of a nutritional deficit D. The client's normal flora began producing spores

B

A client who comes to the clinic asks the nurse, "Somebody told me that stress increases my risk for infection. How does this happen?" Which response by the nurse would be most appropriate? A. "Stress causes body fluids to accumulate, which leads to bacterial growth." B. "Stress leads to increased secretion of cortisol, which suppresses your immune response." C. "Stress causes the body's normal immune response to turn on itself." D. "Stress leads to a deterioration in the skin's barrier line of defense."

B

A client with cancer has been receiving chemotherapy for the past few weeks. The nurse is concerned about infection and is reviewing the white blood cell count (WBC) in the chart. Which result supports this concern? A. WBC of 7,500 mcL B. WBC of 25,000 mcL C. WBC of 5,500 mcL D. WBC of 10,500 mcL

B

After assessing a client's temperature, the nurse documents that the client has a fever that is categorized as being high-grade. Which reading would the nurse most likely have obtained in this client? A. 37.8 degrees C B. 39.2 degrees C C. 40.8 degrees C D. 36.8 degrees C

B

An older adult client tells the nurse, "I do not understand why I have had so many episodes of infection lately." How should the nurse respond? A. "It is possible that you are not washing your hands well enough." B. "As we age, our immune system does not function as well." C. "You will have to limit who comes to visit since they may be exposing you." D. "There are a lot of infectious processes around and there is nothing that can be done."

B

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? A. Clostridium difficile and diabetic ketoacidosis B. Reactive airway disease and exacerbation of chronic obstructive pulmonary disorder (COPD) C. Tuberculosis and pneumonia D. Appendectomy and a draining leg ulcer positive for methicillin-resistant Staphylococcus aureus

B

The nurse removes personal protective equipment after caring for a client on transmission-based precautions. Which action by the nurse is correct? A. Remove the goggles before removing other equipment. B. Touch the inside of the gown and pull it away from the torso. C. Remove respirator at the doorway of the client's room. D. Slide one gloved hand under the other glove for removal.

B

The nurses on a busy surgical ward use hand hygiene when caring for postsurgical patients. Which action represents an appropriate use of hand hygiene? A. The nurse uses gloves in place of hand hygiene. B. The nurse keeps fingernails less than 1/4 in (0.63 cm) long. C. The nurse uses hand hygiene instead of gloves when in contact with blood. D.The nurse refrains from using hand moisturizer following hand hygiene.

B

The school nurse is educating a group of teenagers about ways in which human immunodeficiency virus (HIV) can be transmitted. Which methods of infection transmission will the nurse educate the group about? Select all that apply. A. contact with sweat B. contact with blood C. via sexual contact D. contact with wound openings E. via mucous membranes F. via syringes shared between the client and others

B, C, D, E, F

Nurses wear personal protective equipment (PPE) to protect themselves and clients from infectious materials. Which examples accurately represent the proper use of personal protective equipment in a health care agency? Select all that apply. A. Nurses need only apply clean gloves when performing or assisting with invasive client procedures. B. During some care activities for an individual client, nurses may need to change gloves more than once. C. Nurses may use a waterproof gown more than one time. D. Nurses should remove PPE at the doorway or in an anteroom, except for the respirator. E. To remove a gown, nurses should unfasten ties, if at the neck and back, and allow the gown to fall away from shoulders. F.Nurses may lower a mask around the neck when not being worn and bring it back over the mouth and nose for reuse.

B, D, E

A nurse in an oncology care unit is reviewing the laboratory test results of several clients. The nurse identifies that the client with which leukocyte count most likely has an infection? A. 8,000 cells/mm B. 5,000 cells/mm C. 18,000 cells/mm D. 10,000 cells/mm

C

Every 2 hours, the nurse turns and repositions the client who is experiencing frequent diarrhea. This action supports, among other things, infection prevention. Which assessment indicates that there is a positive outcome from this nursing care? A. redness size over sacral area is with minimal increase B. blanching over elbow area noted C. skin is dry and intact D. slight bleeding noted while old dressing is removed

C

For which client would the use of standard precautions alone be appropriate? A. a client with diphtheria who needs p.m. care B. a client with TB who needs medications administered C. an incontinent client in a nursing home who has diarrhea D. a child with chickenpox who is treated in the emergency room

C

The nurse is caring for a 27-year-old client who presents with possible signs of an infected abdominal wound. Which action should the nurse prioritize and initiate after receiving the results of the laboratory test indicating the client has methicillin-resistant Staphylococcus aureus (MRSA) infection? A. airborne B. droplet C. contact D. reverse isolation

C

The nurse is setting up a sterile field to perform a catheterization when the client touches the end of the sterile field. What would be the nurse's next appropriate action? A. Change the sterile field, but reuse the sterile equipment. B. Proceed with the procedure since it was only touched by the client. C. Discard the sterile field and the supplies and start over. D. Call for help and ask for new supplies.

C

The nurse notes that the client's temperature is 101.2°F (38.4°C) at 8 a.m. Elevated temperature may be due to several factors. What could be the reason for this? A. very hot coffee B. recent bed bath C. respiratory infection D. loose stool

C

The patient has asked the nurse to explain her WBC level of 8,000 cells/mm3. The nurse would identify the level of WBCs as: A. decreased B. elevated C. within normal limits D. stable

C

When an 86-year-old client reports an inability to concentrate, uneasiness, lightheadedness, weakness, muscle and joint discomfort, and demonstrates normal temperature, the clinic nurse recalls that: A. without an elevated temperature, infection is not present. B. the client's symptoms are typical of an older adult client. C. an older adult can have an infection without a fever. D. an infection was present and has dissipated.

C

The nurse is preparing a client who is in droplet isolation for transport to radiology. What is the appropriate nursing intervention(s)? Select all that apply. A. facilitating interdepartmental coordination about the transport B. removing the client's mask for transport C. placing a clean sheet on the stretcher that the client will be transported upon D. ensuring that the client has a mask on E. reminding transporter to utilize droplet precautions

C, D, E

A lead nurse is removing personal protective equipment after dressing the infected wounds of a client. Which is the priority nursing action? A. remove the garments that are most contaminated B. make contact between two contaminated surfaces C. make contact between two clean surfaces D. handwashing before leaving the client's room

D

The nurse works at an agency that requires its employees to wear a face mask as long as the employee is in the building. The nurse performs the following activities while working. Which action is an error by the nurse? A. positions the mask so that it covers both the nurse's nose and the mouth B. does not touch the mask with the hands while the nurse is wearing the mask C. touching the strings of the mask when applying or removing the mask D. omitting hand hygiene following removal of the nurse's mask

D