Infection, Exposure Control, and Safety
A. The patient should wear a gown, gloves, and mask to maintain contact-droplet isolation. In a healthcare setting, the staff wears Personal Protective Equipment (PPE), not the patients. The purpose of following contact-droplet isolation precautions are to contain the patient's environment and prevent the spread of infection. Since they have contact with multiple patients, medical professionals must wear proper PPE and perform proper hand hygiene when caring for every patient. Antimicrobial wipes can be utilized to clean exam rooms between patients. In order to limit potential for accidental exposure/puncture, Sharps containers should be replaced when 2/3 full.
1. Which of the following statements by the medical assistant indicates the need for a better understanding of standard precautions? A. The patient should wear a gown, gloves, and mask to maintain contact-droplet isolation. B. I will perform hand hygiene after removing gloves. C. Sharps containers should be replaced when 2/3 full. D. Antimicrobial wipes may be used for cleaning an exam room between patients.
A. airborne Tuberculosis (TB) is a worldwide health problem caused by Mycobacterium Tuberculosis, a type of bacteria. Patients with Pulmonary or Laryngeal TB may transmit the disease through airborne particles call "droplet nuclei" when they cough or sneeze (as examples) so airborne precautions are important. The particles are so small that normal air currents can keep them airborne making it easy to spread. Contact, Standard, and Universal Precautions alone are not sufficient as a mask is needed to keep from inhaling the organism through the respiratory tract.
10. Which precautions would be used for a patient with Pulmonary TB? A. airborne B. droplet C. contact D. percutaneous
B. N95 respirator Airborne precautions are advised for patients with tuberculosis, measles, chickenpox and herpes zoster (until lesions are crusted over) and use of an N95 respirator is recommended as an additional precaution to standard precautions.
11. If a patient has measles, which of the following is a required additional precaution? A. hand hygiene B. N95 respirator C. gloves D. eye protection
B. patient who has rubeola Airborne precautions must be followed for patients with Rubeola (measles) virus exhibiting maculopapular rash with cough, nasal mucosa secretions, and fever. A patient with a fever of unknown origin, rheumatic fever, or pneumonia requires standard precautions.
12. A phlebotomist must follow transmission based precaution for which of the following patients? A. patient with fever of unknown origin B. patient who has rubeola C. patient who has rheumatic fever D. patient with pneumonia
B. N95 respirator The N95 respirator is the most common of the seven types of particulate filtering respirators, as it filters 95% or more of all airborne particles. It would be the best choice for airborne precautions. A surgical mask would prevent droplet transmission, but is not the best choice. A mask with a face shield could still allow air borne transmission. A full face and head mask would not be as effective as the N95 respirator if one is available.
13. In addition to usual PPE what would you add or replace before entering a patient's room with air borne precautions. A. Surgical mask B. N95 respirator C. Mask with face shield D. Full face/head mask
B. Tuberculosis and Varicella A person transporting a patient would have the patient use a mask if the patient had an airborne illness such as Tuberculosis or Varicella. Hepatitis, HIV and Staphylococcal infections are blood borne pathogens, so a mask would be of little protection.
14. Which of the following disease states would require the use of a mask by the patient during transportation? A. HIV and Varicella B. Tuberculosis and Varicella C. Hepatitis and Tuberculosis D. Staphylococcal Infection and Hepatitis
C. standard, airborne, droplet and contact precautions. Diphtheria is an acute, toxin-mediated disease caused by Corynebacterium diphtheriae. Transmission is most often person-to-person from the respiratory tract, but transmission may occur from skin lesions or fomites in touch with discharges from the skin. Thus, both standard and contact precautions are indicated, in addition to airborne and droplet.
15. A phlebotomist has received a requisition to collect a blood specimen on a patient infected with diphtheria. The phlebotomist must be sure to follow what precautions? A. standard precautions and airborne precautions B. droplet precautions and contact precautions. C. standard, airborne, droplet and contact precautions. D. droplet precautions and airborne precautions.
A. contact precautions There are 3 transmission-based precautions: droplet, airborne, and contact. Contact precautions should be followed in addition to standard precautions when a patient could transmit their pathogen by direct contact or skin-to-skin. RSV is a virus that can be transmitted by contact. Airborne precautions are necessary when transmission could occur through small droplets on the air (i.e. TB). Droplet precautions should be taken when large droplets (like from a cough or sneeze) could infect the care giver by way of contact with mucous membranes or the eye (i.e. influenza). In instances where a patient has a highly infectious or transmittable pathogen, complete isolation precautions must be implemented (i.e. if infected with the Ebola virus).
16. A phlebotomist has been asked to collect a specimen from a patient with respiratory syncytial virus (RSV). Which of the following transmission-based precautions should be used? A. contact precautions B. complete isolation precautions C. airborne precautions D. droplet precautions
D. Apply PPE and N95, and proceed with procedure Rationale No procedure is so time sensitive that a phlebotomist cannot adhere to established protocols of infection control. Use of PPE is a requirement at all times. Airborne precautions are necessary when Contact, Standard, and Universal Precautions alone are not sufficient to prevent the transmission of infectious agents that might be carried in the air. Sterile cloth or other surgical masks are not designed for use as particulate respirators and do not provide as much respiratory protection as an N95 respirator. Surgical masks provide barrier protection against droplets with large respiratory particles; they do not effectively filter small particles from the air or prevent leakage around the edge of the mask when the user inhales. The N95 Respirators and Surgical Masks provide the best protection.
17. When arriving at a patient's room for a timed blood draw, a phlebotomist observes an airborne precautions sign on the patient's door. How should the phlebotomist proceed? A. Enter patient's room, and proceed with procedure, as it is time sensitive B. Apply PPE, sterile cloth mask, and proceed with procedure C. Apply N95, and proceed with procedure D. Apply PPE and N95, and proceed with procedure
D. Airborne Precautions Rationale Tuberculosis (TB) is a worldwide health problem caused by Mycobacterium tuberculosis, a type of bacteria. Patients with pulmonary or laryngeal TB may transmit the disease through airborne particles call "droplet nuclei" when they cough or sneeze (as examples) so airborne precautions are important. The particles are so small that normal air currents can keep them airborne making it easy to spread. Contact, Standard, and Universal Precautions alone are not sufficient as a mask is needed to keep from inhaling the organism through the respiratory tract.
18. Which of the following measures is applicable when treating patients diagnosed with tuberculosis? A. Contact Precautions B. Standard Precautions C. Universal Precautions D. Airborne Precautions
Hepatitis B Rationale There is no cure (beyond supportive care) for a person who contracts acute Hepatitis B (HBV), which often leads to chronic infection, liver failure, and/or liver cancer. A safe and effective vaccine exists for the prevention of HBV.
19. An immunization is currently available for prevention of which of the following blood borne diseases? A. Hepatitis C B. HIV C. Herpes simplex D. Hepatitis B
alopecia Alopecia is a noncontagious skin disorder that leads to hair loss or baldness. The cause is largely unknown, but may be hereditary or a side effect of medication. Impetigo, scabies, and poison ivy are all highly contagious skin conditions. Impetigo causes red sores on the body, while individuals with scabies develop a skin rash from mites. Poison ivy is well known for causing an itchy and sometimes painful rash.
2. Which of the following skin disorders are noncommunicable? A. alopecia B. impetigo C. scabies D. poison ivy
B. hepatitis C Rationale Bloodborne pathogens are infectious agents transmitted via the blood that can cause diseases. Tuberculosis and influenza are considered airborne pathogens transmitted when an infected individual coughs, sneezes, laughs or via close contact. The Varicella virus can be transmitted through a cough or sneeze, but these viral particles are also passed along via the puss from blisters and sores caused by the disease.
20. Which of the following diseases is a bloodborne pathogen? A. tuberculosis B. hepatitis C C. varicella D. influenza
D. OSHA Rationale The Occupational Safety and Health Administration (OSHA) is a federal agency of the United States that regulates workplace safety and health. The DEA is a United States federal law enforcement agency under the U.S. Department of Justice. DEA registrations are valid for three years and must be renewed. Clinical Laboratory Improvement Amendments (CLIA) of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research. The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, the nations food supply, cosmetics, and products that emit radiation. The FDA is tasked with providing accurate, science-based health information to the public.
21. Which federal agency is responsible for regulating safe workplace environments, including compliance with blood borne pathogen standards? A. DEA B. CLIA C. FDA D. OSHA
D. Provide a confidential medical evaluation. Rationale Counseling, education, and follow-up should be provided by an employer for up to one year after exposure. Every hospital employee or any healthcare personnel at risk from accidental exposure to blood should be vaccinated against HBV. There are no preventive vaccines available yet for HCV and HIV. It is good to note that the risk of a HIV infection following exposure to blood is very small (0.1-0.5%). The actual risk depends on type of contact and on the amount of virus in the contaminated material.
22. Which of the following interventions is required by an employer, at no cost to the employee, following a needle stick exposure? A. Offer Hepatitis B vaccine if the needle was contaminated. B. Place exposed personnel on antiviral medications. C. Offer HIV testing to the employee's spouse or significant other. D. Provide a confidential medical evaluation.
C. documentation of annual blood borne pathogen training Rationale It is important to document and make sure that all employees have annual training to be in compliance with OSHA regulations. According to the OSHA Blood borne Pathogens Standard, an Exposure Control Plan must meet certain criteria: It must be written specifically for each facility, it must be reviewed and updated at least yearly (to reflect changes), list positions or technology used to reduce exposures to blood or body fluids and it must be readily available to all workers.
23. Which of the following is included in an exposure control plan? A. dates of each employee's last tetanus booster B. maintenance of incident report logs C. documentation of annual bloodborne pathogen training D. emergency exit markings in compliance with OSHA standards
D. Use a broom and dust pan to sweep up the glass and fragments and place in a sharps container. Rationale To prevent exposure to potentially infectious materials, a broom and dust pan should be used to sweep up the glass and fragments and then they should be placed in the sharps container. This ensures that no one will touch the glass or any of the materials that were in the ampule. If a paper towel, piece of paper, or wet towel are used, the risk of coming into direct contact with the glass is increased.
24. Which of the following best describes the proper way to clean up a broken glass ampule? A. Use a paper towel to pick up the pieces of glass and place them in a trash can. B. Place the pieces of glass on a piece of paper and carry the paper to the dumpster. C. Use a wet towel and wipe over the area so that minute fragments of glass may be picked up. D. Use a broom and dust pan to sweep up the glass and fragments and place in a sharps container.
C. Wash the site with soap and water for a minimum of 30 seconds. Rationale Once an exposure incident occurs, it is important to provide immediate attention to the needle stick site. The immediate course of action for this employee would be to wash the site with soap and water for a minimum of 30 seconds. Then, following the institution's exposure control protocol, the employee should report the incident to an immediate supervisor and seek direct care from a licensed healthcare provider. Swift post exposure treatment is necessary and should be started as soon as possible to support the most promising outcome in a case like this.
25. While collecting a sample for HIV, HBV and HCV antibody tests, the phlebotomist accidentally sticks his finger when disconnecting the venipuncture. Which of the following should be the phlebotomist's immediate course of action? A. Report the incident to the immediate supervisor. B. Wash the site with a disinfectant for a minimum of 30 seconds. C. Wash the site with soap and water for a minimum of 30 seconds. D. Report directly to a licensed healthcare provider for treatment.
C. wash the site with soap and water for a minimum of 30 seconds. Rationale Once an exposure incident occurs, it is important to provide immediate attention to the needle stick site. The immediate course of action for this employee would be to wash the site with soap and water for a minimum of 30 seconds. Then, following the institution's exposure control protocol, the employee should report the incident to an immediate supervisor and seek direct care from a licensed healthcare provider. Swift post exposure treatment is necessary and should be started as soon as possible to support the most promising outcome in a case like this
26. The first course of action a phlebotomist should follow immediately after a needle stick is A. report the incident to the immediate supervisor. B. wash the site with a disinfectant for a minimum of 30 seconds. C. wash the site with soap and water for a minimum of 30 seconds. D. report directly to a licensed healthcare provider for treatment.
B. OSHA Rationale Proper hand washing violations are associated with OSHA standards. The Occupational Safety and Health Administration (OSHA) is the federal agency charged with the enforcement of safety and health legislation in the United States. The Clinical Laboratory Improvement Amendments (CLIA) is how the Centers for Medicare and Medicaid Services (CMA) regulates laboratory testing of human samples within the United States. The Joint Commission (JC- formerly JCAHO) sets performance and quality standards of health care organizations. The National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) is associated with education program accreditation in the clinical laboratory.
27. You are an employee in a healthcare setting and you have noticed a couple phlebotomist are not using proper hand washing technique. What standards are being violated? A. CLIA B. OSHA C. JC D. NAACLS
A. OSHA. Rationale In the United States, the treatment, storage and disposal of hazardous waste is regulated by the Hazardous Waste Operations and Emergency Response (HAZWOPER) standards set forth by the Occupational Safety and Health Administration (OSHA). The Clinical Laboratory Improvement Amendment (CLIA) regulates laboratories by providing a classification system based upon method complexity. The Federal Drug Administration regulates pharmaceuticals. Laboratory Managers merely enforce regulations as defined by the government and other regulatory agencies.
28. When disposing of hazardous materials, the phlebotomist must adhere to the guidelines and standards set forth by A. OSHA. B. CLIA. C. FDA. D. the Lab Manager.
C. written, reviewed, and updated annually. Rationale According to the OSHA Bloodborne Pathogens Standard, an Exposure Control Plan must meet certain criteria. It must be written specifically for each facility, reviewed and updated at least annually, and readily available to all workers.
29. An exposure control plan must be A. ordered through OSHA annually. B. signed by all employees of the facility, regardless of their duties. C. written, reviewed, and updated annually. D. kept with the personal protective equipment for quick reference.
Active TB With Active TB, transmission occurs through inhaling bacteria in microscopic droplets - airborne precautions should be initiated per protocol. COPD refers to a group of lung diseases that block airflow and make breathing difficult. Emphysema and chronic bronchitis are the two most common conditions that make up COPD. Asthma is a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing. It usually results from an allergic reaction or other forms of hypersensitivity. Croup refers to an infection of the upper airway, generally in children, which obstructs breathing and causes a characteristic barking cough.
3. A patient suspected of having which of the following respiratory disorders should be placed in isolation in the medical office? A. COPD B. Active TB C. Asthma D. Croup
D. replacing sterile items that may have become contaminated Rationale Replacing sterile items that may have come into contact with a contaminant will prevent contamination from possible non-sterile sources. The general rule of thumb is: "When in doubt, throw it out."
30. Which of the following actions by the medical assistant demonstrates the correct use of surgical asepsis? A. closing the door to an exam room if a sterile field must be left unattended B. opening sterile items with scrubbed hands C. pouring liquids onto the sterile field from at least 20 inches above the field D. replacing sterile items that may have become contaminated
A. to clamp off blood vessels until they can be closed with sutures Rationale Hemostats are used to control bleeding or hold skin or tissue back during minor surgery or medical office procedures. Hemostats can clamp off blood vessels until they can be closed with sutures.
31. Hemostatic forceps are primarily used for which of the following functions during minor surgery? A. to clamp off blood vessels until they can be closed with sutures B. to remove foreign objects C. to destroy tissue by cutting and sealing blood flow using heat D. to cut through tissues
D. in a temperature controlled environment to prevent moisture accumulation. Rationale Storage in an environment that controls the temperature maintains the integrity of packaging sterility and prevents the possible infiltration of microorganisms. The date of sterilization and the specific sterilizer used should be clearly indicated on the outside of the packaging material. Storing items within a set time frame used does not insure that the instruments have remained sterile. NOTE: CDC guidelines recommend ensuring consistency of sterilization practices requires a comprehensive program that ensures operator competence and proper methods of cleaning and wrapping instruments, loading the sterilizer, operating the sterilizer, and monitoring of the entire process.
32. Sterilized instruments should be stored A. for a maximum of 90 days. B. with the tape side down to avoid susceptibility to contamination. C. for a maximum of 10 days. D. in a temperature controlled environment to prevent moisture accumulation.
D. transfer forceps Rationale Transfer forceps are made of surgical stainless steel which are autoclave safe. Cautery pens, nylon sutures and synthetic sutures should not be processed via autoclave.
33. Which of the following items requires autoclave processing? A. cautery pen B. nylon sutures C. synthetic sutures D. transfer forceps
C. monthly Rationale An autoclave is a strong, heated container used for chemical reactions and other processes using high pressures and temperatures, e.g., steam sterilization. Checking the safety valve on an autoclave monthly, is an important part of quality control program to ensure attainment of adequate sterilization, protecting health and safety of all patients.
34. When performing routine quality control for an autoclave, how frequently should the safety valve be checked to ensure it is functioning properly? A. after each use B. daily C. monthly D. weekly
A. transfer forceps Rationale Surgical asepsis requires that all tools be completely sterile, free of microorganisms and spores. Transfer forceps are used to maintain surgical asepsis in instances when something needs to be transferred into the sterile field or onto a sterile tray. They are unwrapped, used one time, and then require sterilization before the next use. Rochester forceps, mosquito hemostats, and sponge forceps also require surgical asepsis if they are to be used during a procedure.
35. During a minor surgical procedure, which of the following equipment is required to maintain surgical asepsis if something needs to be added to a sterile surgical tray? A. transfer forceps B. Rochester forceps C. mosquito hemostat D. sponge forceps
A. medical asepsis Rationale Medical asepsis is the prevention of direct effect of cross contamination from ourselves to another patient. Medical asepsis is the destruction of disease causing pathogens. Surgical asepsis is the destruction of all microorganisms. Sanitization is the cleaning process that reduces the number of organisms. Disinfection is the process of killing pathogenic organisms making them inactive, not effective for all spores
36. Keeping contaminated equipment and supplies away from the medical assistant's clothing to prevent pathogen transmission to the next patient is an example of which of the following? A. medical asepsis B. surgical asepsis C. sanitization D. disinfection
B. direct Rationale Direct transmission occurs when an infectious agent is transmitted directly to an individual. In this case the exudate would be the infectious agent being directly passed from person to person. Indirect transmission occurs when a host or reservoir houses the infectious agent and someone comes in contact with the reservoir or host. The infectious agent is then passed on. Airborne transmission occurs when the infectious agent enters a person through the respiratory tract. A vector is the carrier that takes the infectious agent from one host to another.
37. Handling exudate from a patient is an example of which of the following modes of disease transmission? A. indirect B. direct C. airborne D. vector
A. a biohazard waste container Rationale Biohazard waste includes disposable items with visibly contaminated blood and/or body fluids, therefore the medical assistant should dispose of her gloves in a biohazard container instead of the regular trash (could be an infection risk). A sharps container is for sharp objects (not soft gloves). A specimen transport bag would not be acceptable, because noticeably soiled gloves need to be properly disposed of in a biohazard waste container.
38. The medical assistant is preparing to remove her gloves after a venipuncture and notices blood on the gloves. Where should the medical assistant dispose of her gloves? A. a biohazard waste container B. a red sharps container C. a regular trash container D. a specimen transport bag
D. sodium hypochlorite Rationale A 10% solution of household bleach (i.e., sodium hypochlorite) is the most commonly used disinfectant for solid surfaces in medical laboratories. Hypochlorites have a broad spectrum of antimicrobial activity, and are inexpensive and fast acting. Benzalkonium chloride is a major non-alcohol-based active ingredient used for clinical, food line, and domestic household use. It can be applied topically on living tissue as an antiseptic or on inanimate objects as a disinfectant. Chlorhexidine gluconate is a germicidal mouthwash that reduces bacteria in the mouth. Isopropanol alcohol is a readily available alcohol used as a solvent and cleaning fluid; it is relatively non-toxic and evaporates quickly. It is commonly used to clean the skin of patients prior to injection or phlebotomy.
39. Which of the following chemicals is most commonly used to disinfect work surfaces? A. benzalkonium chloride B. chlorhexidine gluconate C. isopropanol D. sodium hypochlorite
B. measuring a patient's apical pulse In addition to when visibly soiled, hands should always be washed with an antimicrobial soap and water before eating and after using a restroom to reduce the incidence of health care environment related infections.
4. It is appropriate for the medical assistant to use an alcohol-based hand rub as the only method of hand hygiene after which of the following activities? A. applying non-sterile gloves for a dressing change B. measuring a patient's apical pulse C. using the restroom D. assisting the physician with a laceration repair
A. is a health hazard. Rationale This label represents the National Fire Protection Agency (NFPA) hazardous material identification system. It classifies the severity of the hazard based on; health (blue), flammability (red), reactivity (yellow), and special precautions (white). The rating system ranges from zero (no hazard) to four (extremely hazardous).
40. The medical assistant is preparing to use a new chemical in the office with the label pictured here. The medical assistant should know that the chemical A. is a health hazard. B. may be stored next to an oxidizer. C. is a corrosive. D. is not flammable.
B. gloves only Rationale To prevent viral exposure and transmission, gloves are required when drawing lab work on a patient with suspected HIV. HIV can be spread through blood, so it is important that gloves be worn at all times when drawing lab work. Gowns and masks do not need to be worn when drawing lab work, because HIV cannot be spread through ordinary contact.
41. Which of the following is the minimum PPE requirement when drawing ordered lab work on a patient with suspected HIV? A. gown, gloves, and mask B. gloves only C. mask only D. gloves and mask only
42. Sterile Gloves Rationale Suture placement is a relatively low risk procedure. The main personal protective equipment required for all medical personnel are sterile gloves. Face masks, body gowns and shoe covers are not indicated for this procedure. Face masks, gowns and shoe covers would be necessary if the procedure was a higher risk (i.e. extensive blood or body fluid loss).
42. As the medical assistant, you are assisting the primary provider with suture placement. What is the most important personal protective equipment you are going to gather for yourself and the provider? A. Sterile Gloves B. Face Mask C. Body Gown D. Shoe covers
A. Remove her gloves, then the gown, then the mask. Rationale To reduce the risk of contaminating oneself with infectious agents, the order of personal protective equipment is important. The correct order of PPE removal is always gloves, gown, and mask.
43. The medical assistant has received a requisition to collect a blood specimen on a patient infected with multidrug-resistant TB. When leaving the patient's room the medical assistant should be sure to A. Remove her gloves, then the gown, then the mask. B. Remove her gown, then the mask, then the gloves. C. Remove her mask, then the gloves, then the gown. D. Remove her mask, then the gown, then the gloves.
A. direct contact with the skin of infected persons Rationale Because SA can be on the surface of the skin, the most common way MRSA spreads from person to person is by direct contact. A much less common way it can spread is by touching surfaces such as railings, faucets, or handles that may be contaminated with MRSA. Prevention by keeping wounds covered, washing hands regularly, and not sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with a contaminated wound or bandage.
44. Which of the following is the most common means of transmission of Methicillin-Resistant Staphylococcus Aureus (MRSA)? A. direct contact with the skin of infected persons B. direct contact with contaminated blood C. inhaling contaminated respiratory droplets of infected persons D. direct contact with contaminated feces
D. A patient reporting a high fever, stiff neck, blurry vision, and petechial rash. Rationale If bacterial meningitis is suspected, the patient requires immediate isolation to prevent exposure and spread of infection. MRSA is spread by contact. MRSA is carried by about 2% of the population (or 2 in 100 people), although most of them aren't infected. Vancomycin-resistant enterococci (VRE) are a type of bacteria called enterococci that have developed resistance to many antibiotics. Enterococci bacteria live in our intestines and on our skin, usually without causing problems. Chickenpox is caused by the herpes varicella-zoster virus. The disease is most contagious a day or two before the rash appears.
45. The medical assistant should place which of the following patients arriving to the medical office screening area in immediate isolation? A. A patient with a known history of Methicillin-Resistant Staph Aureus (MRSA) presenting with a new wound. B. A patient with a known history of Vancomycin-Resistant Enterococcus (VRE) of the GI tract. C. A patient being seen for a fever and a rash who has never had chicken pox. D. A patient reporting a high fever, stiff neck, blurry vision, and petechial rash.
A. surgical mask Rationale Pertussis is spread when an infectious patient coughs or sneezes, producing air droplet spread. The spread of infection typically requires very close contact for an extended period of time; close contact in this case is defined as being within 3 feet for at least 10 hours per week. An N95 respirator is not required as Pertussis is not airborne like tuberculosis. Droplet spread would not typically penetrate a regular gown, so a fluid resistant gown is not necessary. Sterile gloves are also not needed, as no sterile field must be maintained.
46. Which of the following personal protective equipment must be used when working with a patient suspected of having pertussis? A. surgical mask B. fluid resistant gown C. N95 respirator D. sterile gloves
A. gloves, N95 respirator Rationale Appropriate PPE for airborne isolation is gloves and an N95 respirator. The gloves are a standard precautionary measure and the respirator would keep the health care professional from breathing in any particles that are airborne.
47. When a phlebotomist enters an airborne isolation room, the appropriate PPE would be A. gloves, N95 respirator B. gown, gloves, N95 respirator C. gown, gloves, mask D. gown, mask
D. Clostridium difficile, escherichia coli, and pediculosis Rationale Clostridium difficile (a.k.a. C. diff), escherichia coli (a.k.a. E. coli), and pediculosis (a.k.a. Lice) all can be contracted from a patient through contact. Therefore, contact precautions must be followed to keep staff and visitors from spreading these by touching the patient or objects the patient has touched. The other responses in this scenario vary among contact, droplet and airborne transmission.
48. Which of the diseases listed below require contact precautions? A. Rubella, mumps, and pertussis B. Parovirus B19, streptococcal, and mycoplasma C. Neisseria meningitis, sepsis, and epiglottitis D. Clostridium difficile, escherichia coli, and pediculosis
D. urticaria Rationale A common allergic reaction to a latex product is urticaria, also known as hives. Patients can develop itchy, red welts on the skin as the result of an allergy to a latex product. Vertigo, the medical term for dizziness, and syncope, the medical term for fainting, can both be associated with a latex allergy, but are not as common as urticaria. Hemorrhage (bleeding) isn't associated with a latex allergy.
49. Which of the following is a common allergic reaction to a latex product? A. vertigo B. hemorrhage C. syncope D. urticaria
B. intact skin Having intact skin is the best defensive mechanism, because the skin acts as a protective barrier and prevents bacteria from entering. If there is a cut in the skin, bacteria can enter the blood stream and cause an infection. The oral mucous membranes are in the mouth and are also a protective barrier, but aren't as important at protecting against pathogens as the skin. The acidic environment of the digestive tract is needed to break down the foods to make them easier to digest, and the ability to cough and sneeze doesn't protect the body against pathogens.
5. Which of the following is the most important defensive mechanism against pathogens? A. oropharyngeal mucous membranes B. intact skin C. acidic environment of the digestive tract D. the ability to cough and sneeze
B. perform regular hand hygiene Rationale Performing regular hand hygiene is the first of preventative measure against disease transmission in caring for patients. According to the CDC, the simple act of hand washing is the single most important means of preventing the spread of viral and bacterial infections.
50. Which of the following actions by the medical assistant is the first line of defense in preventing the spread of microorganisms? A. wear non-sterile gloves when performing venipuncture B. perform regular hand hygiene C. wear sterile gloves when changing a dressing D. use aseptic technique when drawing up a medication
C. organism that causes tetanus Rationale Infection generally occurs through wound contamination and often involves a cut or puncture wound. As the infection progresses, muscle spasms develop in the jaw (thus the name lockjaw) and elsewhere in the body. Tetanus bacteria are resistant to many standard disinfection processes. Only oxidizing (bleach) disinfectants dependably kill tetanus spores. Influenza (RNA virus), giardiasis (a parasite) and the rotavirus (causes severe diarrhea) all require cleaning and disinfection processes to prevent the spread of the disease.
51. Which of the following requires the highest level of disinfection in order to be destroyed? A. organism that causes influenza B. organism that causes giardiasis C. organism that causes tetanus D. organism that causes rotavirus
D. prepared plasma specimens Rationale Any biologic material (plasma specimens) that contains an infectious disease transmission risk must be stored separately, in a biohazard labeled refrigerator, to prevent cross-contamination. Glucometer control solution is used to check that the glucosemeter and the test strips are working properly. Glucometer control solution, unused viral media tubes and xylocaine 2% jelly are not considered biohazards.
52. Which of the following should be stored in a refrigerator labeled with a biohazard sticker? A. glucometer control solution B. unused viral media tubes C. xylocaine (Lidocaine HCl) 2% Jelly D. prepared plasma specimens
D. a hamburger from a local fast food restaurant Rationale Hepatitis is generally caused by a viral infection of the liver and can be contracted by the fecal-oral route, blood, or unprotected sex. Hepatitis A can be contracted via fecal-oral means (food or water contamination) and infected sexual partners. Hepatitis A infection is primarily transmitted by the fecal-oral route, by either person-to-person contact or consumption of contaminated food (like a hamburger in this case) or water. Although viremia occurs early in infection and can persist for several weeks after onset of symptoms, bloodborne transmission of Hep A is uncommon. Hepatitis B, C, D & G are contracted by blood or blood products, including infected needles, razors, etc. (thus these infections are common among IV drug users). Hepatitis E virus is usually spread by the fecal-oral route. While rare in the United States, Hepatitis E is common in many parts of the world. The most common source of infection of Hep E is fecally contaminated drinking water. Dental surgery should not put a patient at risk for Hepatitis since gloves should be worn and sterile technique followed.
53. A patient is diagnosed with Hepatitis A. Which of the following is the most likely source of the infection? A. exposure from sharing a roommate's razor B. recent dental implant surgery C. improper use of a hypodermic needle D. a hamburger from a local fast food restaurant
D. disinfect all equipment. Rationale While all apply when in contact precaution the ECG tech should disinfect all equipment with disinfected wipes or spray which is available to them so not to transfer of contamination with the next patient or health worker.
54. The final step the ECG technician should take with a patient on contact precautions is to A. wash hands. B. remove gloves. C. avoid contaminated surfaces. D. disinfect all equipment.
D. use universal precautions. Rationale In the case of a patient presenting with MRSA sores, the technician does not need a mask but will need to use universal precautions, which would include gloves and gown. The EKG machine must be cleaned after the EKG is performed. The patient would not need to be rescheduled as long as universal precautions were used.
55. After hand washing, the ECG technician notices the patient has MRSA sores. The next step to take in order to prevent infection is to A. reschedule the patient when the MRSA sores have healed. B. implement reverse isolation. C. don a protective mask. D. use universal precautions.
C. a female patient who develops a UTI after having a urinary catheter Rationale A nosocomial infection is a "hospital-acquired" infection acquired by a patient who enters the hospital without any symptoms of it and appears to have acquired the infection during the hospital stay. A female patient who develops a urinary tract infection after having a urinary catheter inserted is a perfect example. The other patients were exposed prior to admission or were never admitted, in the case of the healthcare worker.
56. Which of the following would be considered a nosocomial infection? A. an elderly man in the ER with flu-like symptoms B. an 8-year old boy that develops chicken pox 2 days after admission C. a female patient who develops a UTI after having a urinary catheter D. a healthcare worker that develops Hepatitis C
A. strong side of the patient is closest to the medical assistant. Rationale Patients in wheelchairs have varying levels of physical weakness. Transferring from the wheelchair to an examination table can sometimes be difficult. If a patient is able to bear weight, it is important to position the wheelchair with the patient's weak side next to the table and the strong side closest to the person assisting the patient. If the patient's strong side gives out, their weak side will be closest to the table to "catch" the fall. The medical assistant should stand in front of the wheelchair, between the patient's knees, which would be between the patient's feet.
57. When transferring a patient from a wheelchair to the examination table, the wheelchair should be positioned so that the A. strong side of the patient is closest to the medical assistant. B. weak side of the patient is closest to the medical assistant. C. patient's feet are positioned in front of the medical assistant. D. back of the wheelchair is positioned in front of the medical assistant.
D. The medical assistant activated the needle safety device appropriately, but the needle and tube holder/adapter should not have been separated. Rationale There are two actions to evaluate, the timing of activation of the safety device and the disposal of the needle and adapter (i.e., plastic tube holder). The safety device is designed to be activated immediately following collection, as the time following collection is the point at which most needle injuries occur. Once activated, the entire needle/adapter/safety device must be disposed of in a sharps container to eliminate injury that could occur with needle handling in any type of separation.
58. A medical assistant completes a blood collection using the evacuated system with a safety needle. The needle safety device is activated immediately following the collection. The needle is removed from the tube holder/adapter and discarded in a sharps container. Which of the following best describes the medical assistant's actions? A. The medical assistant activated the needle safety device too soon, but removing the needle was acceptable. B. The medical assistant activated the needle safety device too soon and the needle and tube holder/adapter should not have been separated. C. The medical assistant activated the needle safety device appropriately and removing the needle was acceptable. D. The medical assistant activated the needle safety device appropriately, but the needle and tube holder/adapter should not have been separated.
C. Dispose of the sharps in puncture-proof biohazard sharps container, then dispose of the contaminated gloves in a biohazard bag. Rationale Needle disposal is always first, as it carries the most invasive risk. Both the contaminated needle and contaminated gloves are biohazards, so both must be placed in biohazard waste receptacles. Needles must be placed in puncture-proof biohazard waste receptacles so as to avoid risk of puncture after disposal as well, but gloves pose no risk of puncture and may be placed in biohazard bags.
59. During a phlebotomy collection, the needle came out of the patient's arm and the phlebotomist's gloves became grossly bloody. Which of the following statements correctly describes the disposal of the waste? A. Dispose of the contaminated gloves in a biohazard bag; then dispose of the sharps in puncture-proof biohazard sharps container. B. Dispose of the contaminated gloves in the trashcan; then dispose of the sharps in puncture-proof biohazard sharps container. C. Dispose of the sharps in puncture-proof biohazard sharps container, then dispose of the contaminated gloves in a biohazard bag. D. Dispose of the sharps in puncture-proof biohazard sharps container, then dispose of the contaminated gloves in the trashcan.
Wear gloves, gown, and facial protection. , Remove glass without contact with hands., Absorb the spill and remove all visible material., Dispose of all materials in bio-hazard container., Decontaminate the area with a dilution of sodium hypochlorite and allow to air dry. Rationale It is presumed the health care professional is wearing the appropriate PPE (gloves, gown, facial protection) when dealing with a large volume of fluid. To avoid injury to self or others, glass removal (without touching) would be the first step after spill. Any residual liquid would be absorbed with the appropriate material, as it might otherwise be a splash hazard and would be more difficult to contain. Everything should be disposed in the biohazard container and body fluid with blood definitely qualifies as a biohazard. Afterward, the area would be decontaminated with a 10% hypochlorite solution and allowed to air dry. Air drying ensures sufficient contact time to destroy spores and viruses, as well as bacteria.
60. While processing a large volume of bloody body fluid, a medical assistant is startled and knocks the sample off the counter. The glass container breaks on the floor. What steps should the phlebotomist take to disinfect the spill area? (Put choices in order.) Decontaminate the area with a dilution of sodium hypochlorite and allow to air dry. Remove glass without contact with hands. Wear gloves, gown, and facial protection. Absorb the spill and remove all visible material. Dispose of all materials in biohazard container.
D. Report the incident to a supervisor. If a healthcare worker is accidently stuck with a needle, there are specific OSHA guidelines to follow. The worker should immediately flush with water, then tell a supervisor of the incident. The worker would then be directed to confidentially seek a physicians care. Documents must be filed recording the incident date/time, patient if known, type of stick. The source individual should be tested for infectious diseases (HBV,HCV,HIV). OSHA requires that the employee be notified of the results. The exposed worker then needs to be tested for HBV, HCV, and HIV. The exposed employee must have a physicians written list of treatment options within 15 days.
7. While giving a patient an injection, the patient jumped, causing the medical assistant to get stuck on the hand with a contaminated needle. After performing thorough hand washing, which of the following should the medical assistant do first? A. Begin infectious disease prophylaxis. B. Complete an exposure incident report. C. Obtain patient consent for infectious disease testing. D. Report the incident to a supervisor.
D. contact Clostridium difficile (C. diff) is a toxin-producing, spore-forming bacterium found in feces. Clinical symptoms of infection include both nausea and watery diarrhea and can result in colitis, perforation, or sepsis. Clostridium difficile spores can live for a very long time outside the patient and can reside on bed linens, bed rails, bathroom fixtures, and medical equipment. In addition, it can be spread from person to person from the hands of physicians or other health care workers and visitors. For this reason, standard precautions are not enough; contact precautions are added. The spores do not reside in the respiratory system so airborne/droplet precautions are not necessary.
8. Which of the following specific precautions should a patient be placed on to prevent the transmission of Clostridium difficile? A. standard B. airborne C. droplet D. contact
A. take the precautions for a contact pathogen. The medical professional needs to take the appropriate precautions for a contact pathogen, since MRSA is spread by contact. These precautions would include gloves, hand hygiene, mouth, nose, and eye protection, and a gown. Since MRSA is not an airborne pathogen, it does not require a special mask to be used, and the patient would not need to be in isolation. The medical professional should use gloves and a mask at all times when in contact with the patient, not just when the patient is being treated.
9. When working with a patient with methicillin-resistant Staphylococcus aureus (MRSA), the ECG technician should A. take the precautions for a contact pathogen. B. use a special mask as it is an airborne pathogen. C. use the procedures for reverse isolation. D. use gloves and a mask if the patient is being treated.
B. disinfection The Spaulding Scheme of classification divides medical devices into critical, semi-critical, and non-critical categories based on the infection risk to the patient. An endoscope is categorized as a semi-critical instrument within the Spaulding Scheme. The absolute minimum level of asepsis required for an endoscope is high level disinfection. Critical devices should undergo sterilization (destroys all microbial life; accomplished either chemically or by utilizing an autoclave). Semi-critical devices should at least undergo disinfection (rids the device of most all pathogenic microorganisms, but not necessarily all forms). Non-critical devices require low level disinfection. Sanitization is a general term often associated with cleansing with a soap or detergent.
The medical assistant is reprocessing a contaminated endoscope. Which of the following is the minimum level of asepsis required for this instrument? A. chemical sterilization B. disinfection C. autoclave D. sanitization
