Chapter 5 - Safety and Infection Control

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A client has been diagnosed with disseminated herpes zoster. Which person protective equipment will you need to put on when preparing to assess the client? (Select all that apply) 1. surgical face mask 2. N95 respiratory 3. gown 4. gloves 5. goggles 6. shoe covers

3

A client who has recently traveled to China comes to the ED with increasing SOB and is strongly suspected of having severe acute respiratory syndrome (SARS). Which of these prescribed actions will you take first? 1. infuse NS at 75 ml/hr 2. obtain blood, urine, sputum cultures 3. place the client on airborne and contact precautions 4. give methylprednisolone (Solu-Medrol) 1 g IV

4

A healthy 65 yr old woman who cares for a newborn grandchild has a clinic appointment in May. The client needs several immunizations but tells you, "I hate shots! I will only take one today." Which immunization is most appropriate to give? 1. influenza 2. herpes zoster 3. pneumococcal 4. tetanus, diphtheria, pertussis

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The LPN/LVN whom you are supervising comes to you and says, "I gave the client with myasthenia gravis 90 mg neostigmine (Prostigmin) instead of the ordered 45 mg!" In which order should you perform the following actions? 1. assess the client's HR 2. complete a medication error report 3. ask the LPN/LVN to explain how the error occurred 4. notify the physician of the incorrect medication dose

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Which information about a client who has meningococcal meningitis is the best indicator that you can discontinue droplet precautions? 1. pupils are equal and reactive to light 2. appropriate antibiotics have been given for 24 hours 3. cough is productive or clear, nonpurulent mucous 4. temperature is lower than 100 F (37.8 C)

2

You are administering vancomycin (Vancocin) 500 mg IV to a client with a MRSA wound infection when you notice that the client's neck and face are becoming flushed. What action should you take next? 1. Discontinue the infusion 2. Slow the rate of infusion 3. Obtain an order for an antihistamine 4. Check the client's temperature

3

You are caring for 4 clients who are receiving IV infusions of NS. Which client is at highest risk for bloodstream infection? 1. client with implanted port in the right subclavian vein 2. client who has a midline IV catheter in the left antecubital fossa 3. client who has a nontunneled central line in the left internal jugular vein 4. client with a PICC line in the right upper arm

2

You are caring for a confused and agitated client who has wrist restraints in place on both arms. Which action included in the client plan of care can you delegate to an LPN/LVN? 1. determining whether the client's mental status justifies the continued use of restraints 2. undoing and retying the restraints in order to improve client comfort 3. reporting the client's status and continued need for restraints to the HCP 4. explaining the purpose of the restraints to the client's family members

1

You are caring for a newly admitted client with increasing dyspnea, hypoxia, and dehydration who has possible avian influenza ("bird flu"). Which of these prescribed actions will you implement first? 1. start O2 using a nonrebreather mask 2. infused D5W at 100 ml/hr 3. administer first dose of oseltamivir (Tamiflu) 4. obtain blood and sputum specimens for testing

4

You are the charge nurse on the medical unit. Which infection control activity should you delegate to an experience UAP? 1. screening clients for upper respiratory tract symptoms 2. asking clients about the use of immunosuppressant medications 3. demonstrating correct handwashing to the clients' visitors 4. disinfecting BP cuffs after clients are discharged

2

You are working as the triage nurse in the ED when the following four clients arrive. Which client requires the most rapid action to protect other clients in the ED from infection? 1. 3 yr old who has paroxysmal coughing and whose sibling has pertussis 2. 5 yr old who has a new pruritic rash and a possible chickenpox infection 3. 62 yr old who has a history of MRSA abdominal wound infection 4. 74 yr old who needs TB testing after being exposed to TB during a recent international airplane flight

3

A 23 yr old client comes to the outpatient clinic reporting increasing SOB, diarrhea, abdominal pain, epistaxis. Which action should you take first? 1. assist the client to pinch the anterior nares firmly for 5 minutes 2. call an ambulance to take the client immediately to the hospital 3. ask the client about any recent travel to Asia or the Middle East 4. determine whether the client has had recommended immunizations

3

A client who has frequent watery stools an a possible C. diff infection is hospitalized with dehydration. Which nursing action should the charge nurse delegate to an LPN/LVN? 1. performing ongoing assessments to determine the client's hydration status 2. explaining the purpose of ordered stool cultures to the client and family 3. administering the ordered metronidazole (Flagyl) 500 mg PO to the client 4. reviewing the client's medical history for any risk factors for diarrhea

2

A client who states that he may have been contaminated by anthrax arrives at the ED. Which action included in the ED protocol for possible anthrax exposure will you take first? 1. notify hospital security personnel about the client 2. escort the client to a decontaminated room 3. give ciprofloxacin (Cipro) 500 mg by mouth 4. assess the client for signs of infection

1

A client with atrial fibrillation is ambulating in the hallway on the coronary step-down unit and suddenly tells you, "I feel really dizzy." What action should you take first? 1. help the client to sit down 2. check the client's apical pulse 3. take the client's BP 4. have the client breathe deeply

3

A client with vancomycin-resistant enterococcus (VRE) infection is admitted to the medical unti. Which action can be delegated to the UAP who is assisting with the client's care? 1. teaching the client and family members about means to prevent transmission of VRE 2. communicating with other departments when the client is transported for ordered tests 3. implementing contact precautions when providing care for the client 4. monitoring the results of ordered laboratory culture and sensitivity tests

4

A hospitalized 88 yr old client who has been receiving antibiotics for 10 days tells you that he is having frequent watery stools. Which action will you take first? 1. notify the HCP about the loose stools 2. obtain stool specimens for culture 3. instruct the client about correct handwashing 4. place the client on contact precautions

2

As the infection control nurse in an acute care hospital, which action will you take to most effectively reduce the incidence of health care-associated infections? 1. require nursing staff to don gowns to change wound dressings for all clients 2. ensure that dispensers for alcohol-based hand rubs are readily available in all client care areas of the hospital 3. screen all newly admitted clients for colonization or infection with MRSA 4. develop policies that automatically start antibiotic therapy for clients colonized by multidrug-resistant organisms

1

In your role as the hospital infection control nurse, which policy will you implement to most effectively reduce the incidence of catheter-associated urinary tract infections (CAUTIs)? 1. limit the use of indwelling urinary catheters in all hospitalized clients 2. ensure that clients with catheters have at least 1500 mL fluid intake daily 3. use urine dipstick testing to screen catheterized clients for asymptomatic bacteriuria 4. require the use of antimicrobial/antiseptic impregnated catheters for catheterization

1

Which medication order for a client with a pulmonary embolism is most important to clarify with the prescribing physician before administering? 1. warfarin (Coumadin) 1.0 mg pO 2. morphine sulfate 2-4 mg IV 3. cephalexin (Keflex) 250 mg PO 4. heparin infusion at 900 units/hr

3

You are admitting 4 clients with infections to the medical unit, but only one private room is available. Which client is it most appropriate to assign to the private room? 1. Client with diarrhea caused by C. diff 2. Client with a wound infected by VRE 3. Client with a cough who may have TB 4. Client with toxic shock syndrome and fever

3

You are caring for a client who has been admitted to the hospital for a leg ulcer that is infected with vancomycin-resistant S. aureus (VRSA). Which nursing action can you delegate to the LPN/LVN? 1. planning ways to improve the client's oral protein intake 2. teaching the client about home care of the leg ulcer 3. obtaining wound cultures during dressing changes 4. assessing the risk for further skin breakdown

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You are caring for a client who is intubated and receiving mechanical ventilation. Which nursing actions are most essential in reducing the client's risk for VAP? (select all) 1. keep the HOB at least 30 degrees 2. assess the client's readiness for extubation at least daily 3. ensure that the pneumococcal vaccine is administered 4. use a kinetic bed to continuously change the client's position 5. provide oral care with chlorhexidine solution at least daily

1

You are checking medication orders that were received by telephone for a client with RA who was admitted with methotrexate toxicity. Which order is most important to clarify with the HCP? 1. administer chlorambucil (Leukeran) 4 mg PO daily 2. infuse NS at 250 mL/hr for 4 hours 3. administer folic acid (Folacin) 2000 mcg PO daily 4. give cyanocobalamin (vitamin B12) 10,000 mcg PO

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You are preparing to change the linens on the bed of a client who has a draining sacral wound infected with MRSA. Which PPE items will you plan to use? (Select all that apply) 1. gown 2. gloves 3. goggles 4. surgical mask 5. N95 respirator

3

You are preparing to insert a PICC line in a client's left forearm. Which solution will be best for cleaning the skin prior to PICC insertion? 1. 70% isopropyl alcohol 2. povidone-iodine (Betadine) 3. 0.5% chlorhexidine in alcohol (Hibistat) 4. betadine followed by 70% isopropyl alcohol

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You are preparing to leave the room after performing oral suctioning on a client who is on contact and airborne precautions. In which order will you perform the following actions? 1. remove N95 respirator 2. take off goggles 3. remove gloves 4. take off gown 5. perform hand hygiene

3

You have received a needlestick injury after giving a client an IM injection, but you have no information about the client's HIV status. What is the most appropriate method of obtaining this information about the client? 1. you should personally ask the client to authorize HIV testing as soon as possible 2. the charge nurse should tell the client about the need for HIV testing 3. the occupational health nurse should discuss HIV status with the client 4. HIV testing should be performed the next time blood is drawn for other tests