PrepU: Ch. 24 Asepsis and Infection Control

A client is admitted to the hospital with tuberculosis. Which statement by the nurse explains how to reduce the risk of transmission to others?

"All visitors who enter the room must wear special masks."

The nurse is caring for a client who is to have a sterile dressing change to a wound. A student nurse enters the client's room and notices the nurse preparing the sterile field. After reviewing the image, which response by the student nurse to the nurse is the most accurate understanding of this procedure?

"The way you are doing it helps to minimize contamination of the non-waterproof side."

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

"This antibiotic is the best choice since the causative organism is not known."

A pregnant woman with a history of genital herpes infection who is near term asks the nurse why she must have a cesarean section when she has not had an outbreak in a "long time". The nurse responds:

"You may have infection in your birth canal that you are unaware of."

A nurse at health care facility uses a mask to prevent spread of microorganisms by droplet or airborne transmission. What action(s) is appropriate by the nurse when using masks? Select all that apply.

-Position the mask so that it covers the nose and mouth. -Avoid touching the mask once it is in place. -Change the mask every 20 to 30 minutes. -Touch only the strings of the mask during removal.

The nurse is preparing to perform handwashing. Place the following steps in the correct order. Use all options.

-Turn on the faucet and adjust force and temperature of the water. -Wet the hand and wrists. -Apply soap. -Wash the palms and backs of the hands for at least 20 seconds. -Pat the hands dry with a paper towel. -Turn the faucet off with a paper towel.

The nurse is preparing to provide wound care for a client who is on droplet precautions. Place the following steps in the correct order that the nurse should take. All options must be used.

1. Perform hand hygiene. 2. Put on gown, with the opening in the back and tie gown securely at neck and waist. 3. Apply mask with face shield, secure ties at the middle of the head and neck. 4. Put on clean disposable gloves.

A nurse is caring for a client, age 4 years, who is being treated for osteomyelitis in his left femur. He is on a 28-day course of IV vancomycin to be administered daily at 1300. Today is day 3 of treatment, and the pharmacist asks the nurse to draw a peak vancomycin level. What would be the most appropriate time to draw this blood?

1500

The nurse determines that which client is at greatest risk for a wound infection?

A two-day postoperative client The client at greatest risk for a wound infection is the two-day postoperative client, as the surgery disrupted the integrity of the skin, thereby increasing the risk for wound infection.

About which public health principle should the nurse educate clients to prevent the spread of West Nile virus?

Avoid contact with mosquitoes

The nurse has finished caring for a client on contact precautions. Which nursing action regarding the stethoscope used to auscultate this client's lungs and bowel sounds is appropriate?

Disinfect it with alcohol swabs.

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

Gloves

A nurse follows surgical asepsis techniques for inserting an indwelling urinary catheter in a client. What is an accurate guideline for using this technique?

Hold sterile objects above waist level to prevent inadvertent contamination.

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

Remove fresh fruit from the room.

A client is to have an indwelling urinary catheter inserted. Which precaution is followed during this procedure?

Surgical asepsis technique

The nurses on a busy surgical ward use hand hygiene when caring for postsurgical patients. Which action represents an appropriate use of hand hygiene?

The nurse keeps fingernails less than 1/4 in (0.63 cm) long.

A nurse is caring for a client who is diagnosed with tuberculosis. Which nursing intervention promotes infection control based on nursing practice standards for safety?

The nurse places the client in a private room with monitored negative air pressure.

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

The nurse removes her gown and then removes her gloves.

The nurse is preparing to apply a prescription ointment to the client's wound. After reviewing the image, what is the most important step for the nurse to take?

Use a sterile cotton-tipped applicator to apply the prescription to the site

Surgical asepsis is defined as:

absence of all microorganisms.

The nurse is caring for a client with tuberculosis. Which precautions will the nurse select for this client?

airborne

Which are the names of the transmission-based precautions defined by the Centers for Disease Control and Prevention (CDC)? Select all that apply.

airborne precautions droplet precautions contact precautions

The nurse is reviewing the plan of care for assigned clients. Which client has the highest risk for developing an infection?

an older adult client with a history of heart failure

The nurse will assess a client who has a draining abscess. The nurse should perform what action to safely enter the room?

contact precautions: gown and gloves

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

handwashing before leaving the client's room

The nurse is caring for a client who became very ill after ingesting seafood. How will the nurse document this condition?

noncommunicable disease

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

older male with an enlarged prostate

Any microorganism capable of disrupting normal physiologic body processes is a:

pathogen.

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

pouring the sterile solution from a height of 5 in. (13 cm)

Which care intervention should the nurse anticipate when providing care to a client admitted with a possible diagnosis of tuberculosis (TB)?

wearing a particulate respirator for all client care and interaction