Purple NCLEX Fundi: Infection Control

The nurse is caring for a client with meningococcal pneumonia and implements which transmission-based precautions for this client? 1. Private room or cohort client 2. Personal respiratory protection device 3. Private room with negative airflow pressure 4. Mask worn by staff when the client needs to leave the room

1. Private room or cohort client Meningococcal pneumonia is transmitted by droplet infection. Precautions for this disease include a private room or cohort client and use of a standard precaution mask. Private negative airflow pressure rooms and personal respiratory protection devices are required for clients with airborne disease such as tuberculosis. When appropriate, a mask must be worn by the client and not the staff when the client leaves the room.

A man is admitted to the hospital with the diagnosis of urethritis secondary to chlamydial infection. What precaution should the nurse implement for this client? 1. Enteric 2. Contact 3. Standard 4. Reverse isolation

3. Standard Chlamydial infection is a sexually transmitted infection and frequently is called nongonococcal urethritis in the male client. It requires no special precautions other than standard precautions. Caregivers cannot acquire the disease during administration of care, and using standard precautions is the only necessary measure.

A female client seen in the ambulatory care clinic has a history of syphilis infection. The nurse assessing the client for reinfection would expect to observe a lesion on the labia that has which characteristic? 1. Is painless and indurated 2. Has a cauliflower-like appearance 3. Is erythematous and papular in appearance 4. Appears as one or more vesicles that then rupture

1. Is painless and indurated The characteristic lesion of syphilis is painless and indurated. The lesion is referred to as a chancre. Genital warts are characterized by cauliflower-like growths or growths that are soft and fleshy. Scabies is characterized by erythematous, papular eruptions. Genital herpes is accompanied by the presence of one or more vesicles that then rupture and heal.

The nurse is teaching a client with acquired immunodeficiency syndrome (AIDS) how to avoid food-borne illnesses. The nurse should instruct the client that which food can cause a food-borne illness? 1. Raw oysters 2. Bottled water 3. Pasteurized milk 4. Products with sorbitol

1. Raw oysters The client is taught to avoid raw or undercooked seafood, meat, poultry, and eggs. The client also should avoid unpasteurized milk and dairy products. Fruits that the client peels are safe, as are bottled beverages. The client may be taught to avoid sorbitol, but this is to diminish diarrhea and has nothing to do with food-borne infections.

The nurse has instructed a client diagnosed with tuberculosis about how to prevent the spread of infection after discharge from the hospital. The nurse determines that the client needs further reinforcement of information if the client makes which statement? 1. "I should use disposable plates, forks, and knives." 2. "I should cough into tissues and throw them away carefully." 3. "It's important to cover my mouth if I laugh, sneeze, or cough." 4. "It's very important to wash my hands after I touch my mask, tissues, or body fluids."

1. "I should use disposable plates, forks, and knives." Because tuberculosis is transmitted by droplet, it cannot be carried on clothing, eating utensils, or other possessions. It is not necessary to discard any of these. The client should cover the mouth with a tissue when laughing, coughing, or sneezing and should dispose of tissues carefully. The client also may need to wear a mask as advised by the health care provider. It is important to perform proper hand washing after contact with body substances, tissues, or face masks.

A registered nurse (RN) is providing instructions to an unlicensed assistive personnel (UAP) assigned to give a bed bath to a client who is on contact precautions. The RN instructs the UAP to use which protective item when giving the bed bath? 1. A gown and gloves 2. Gloves and goggles 3. A gown and goggles 4. Gloves and shoe protectors

1. A gown and gloves Contact precautions require the use of gloves and a gown if direct client contact is anticipated. Goggles are not necessary unless it is anticipated that splashes of blood, bodily fluids, secretions, or excretions may occur. Shoe protectors are not necessary.

The nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that the catheter insertion site appears reddened. The nurse should next assess which item? 1. Client's temperature 2. Expiration date on the bag 3. Time of last dressing change 4. Tightness of tubing connections

1. Client's temperature Redness at the catheter insertion site is a possible indication of infection. The nurse would next assess for other signs of infection. Of the options given, the temperature is the next item to assess. The tightness of tubing connections should be assessed each time the PN is checked; loose connections would result in leakage, not skin redness. The expiration date on the bag is a viable option, but this also should be checked at the time the solution is hung and with each shift change. The time of the last dressing change should be checked with each shift change.

The nurse in the health care clinic is preparing to obtain a throat swab for culture in a client suspected of having a beta-hemolytic streptococcal infection. Which actions are appropriate in collecting this specimen? Select all that apply. 1. Instruct the client to tilt the head back. 2. Swab the tonsillar pillars and the posterior pharynx wall. 3. Tell the client that the test will help identify microorganisms. 4. Ask the client to open the mouth; then swab the back of the tongue. 5. Place a tongue depressor on the client's tongue before swabbing the throat.

1. Instruct the client to tilt the head back. 2. Swab the tonsillar pillars and the posterior pharynx wall. 3. Tell the client that the test will help identify microorganisms. 5. Place a tongue depressor on the client's tongue before swabbing the throat. When collecting a throat culture, the client is told that the test is performed to help identify microorganisms causing the symptoms. The client is instructed to tilt the head back, and both the tonsillar pillars and the posterior pharynx wall are swabbed. A tongue depressor is used in the collection so that the swab is less likely to contact the normal flora of the mouth. The swab is immediately placed in a labeled culture tube and transported to the laboratory.

A client with tuberculosis (TB) asks the nurse about precautions to take after discharge to prevent infection of others. The nurse develops a response to the client's question based on which correct understanding of TB transmission? 1. The disease is transmitted by droplet nuclei. 2. Deep pile carpet should be removed from the home. 3. The client should maintain enteric precautions only. 4. Clothing and sheets should be bleached after each use.

1. The disease is transmitted by droplet nuclei. TB is spread by droplet nuclei or via the airborne route. The disease is not carried on objects such as clothing, eating utensils, linens, or furniture. It is unnecessary to remove carpeting from the home. Bleaching of clothing and linens is unnecessary, although the client and family members should use good hand washing

The nursing student is following standard precautions to prevent a hospital-acquired infection in a client. The student understands that which applies to the use of standard precautions? Select all that apply. 1. Used when working with all clients 2. Used only when specifically indicated 3. Does not apply to those who do not have any open wounds 4. Applies to blood, all body fluids, secretions, and excretions 5. Is designed to prevent the risk of spreading microorganisms

1. Used when working with all clients 4. Applies to blood, all body fluids, secretions, and excretions 5. Is designed to prevent the risk of spreading microorganisms Standard precautions are to be used on all clients and are designed to prevent the risk of spreading microorganisms. It applies to contact with blood, body fluids, secretions, and excretions.

The client seen in the health care clinic has tested positive for gonorrhea. The nurse anticipates that which medication will be prescribed based on this finding? 1. Acyclovir (Zovirax) 2. Ceftriaxone (Rocephin) 3. Azithromycin (Zithromax) 4. Penicillin G benzathine (Bicillin LA)

2. Ceftriaxone (Rocephin) Treatment for gonorrhea consists of antibiotic therapy, usually with ceftriaxone and doxycycline (Vibramycin). Acyclovir is the treatment for genital herpes simplex virus; azithromycin is the treatment for Chlamydia infection and penicillin G benzathine is the treatment for syphilis.

The nurse is preparing to nasotracheally suction a client with acquired immunodeficiency syndrome who has had blood-tinged sputum with previous suctioning. The nurse plans to use which item as part of standard precautions for this client? 1. Gloves, gown, and mask 2. Gloves, mask, and protective eyewear 3. Gown, mask, and protective eyewear 4. Gloves, gown, and protective eyewear

2. Gloves, mask, and protective eyewear Standard precautions include the use of gloves whenever there is actual or potential contact with blood or body fluids. During procedures that aerosolize blood, the nurse wears a mask and protective eyewear or a face shield. Impervious gowns are worn in those instances when it is anticipated that there will be contact with splashes of secretions or blood. No data in the question is indicative that splashes are a concern.

The community health nurse is providing a teaching session about terrorism to members of the community and is discussing information regarding anthrax. The nurse tells those attending that anthrax can be transmitted by which route(s)? 1. Bites from ticks or deer flies 2. Inhalation of bacterial spores 3. Through a cut or abrasion in the skin 4. Direct contact with an infected individual 5. Sexual contact with an infected individual 6. Ingestion of contaminated undercooked meat

2. Inhalation of bacterial spores 3. Through a cut or abrasion in the skin 6. Ingestion of contaminated undercooked meat Anthrax is caused by Bacillus anthracis and can be contracted through the digestive system or abrasions in the skin, or inhaled through the lungs. It cannot be spread from person to person or from animal to person, and it is not contracted via bites from ticks or deer flies.

The nurse is conducting a community surveillance study for the purpose of communicable disease control. The nurse knows that performing an active surveillance method of assessment is best for what reason? 1. Always results in clear indicators for interventions 2. Results in detection of a more accurate number of cases 3. Reflects an upward swing if a certain disease is current news 4. Relies solely on the initiative of health care providers (HCP) to report cases

2. Results in detection of a more accurate number of cases The best outcome of any type of surveillance is accuracy. Active surveillance method focuses on assessment rather than interventions. An active surveillance method of assessment is best because it results in detection of a more accurate number of cases. Relying on the initiative of HCPs to report cases is a passive method that results in an upward swing of cases reported based on the latest disease trend.

A nurse is providing orientation to a newly graduated nurse. During a discussion of isolation procedures, which statement by the graduate nurse indicates a need for further review of isolation guidelines? 1. "A client with tuberculosis will be placed on airborne precautions." 2. "I will wear a mask when working with an isolated client who has a tracheostomy." 3. "I can reuse a gown if it's not dirty, as long as I hang it up inside the client's room." 4. "I will remove the gown and gloves and wash my hands before leaving the client's room."

3. "I can reuse a gown if it's not dirty, as long as I hang it up inside the client's room." Centers for Disease Control and Prevention (CDC) guidelines require that gowns used in isolation rooms be discarded after each use and not reused, even for the same client. The other options reflect correct isolation guidelines.

A client receiving parenteral nutrition (PN) suddenly develops a fever. The nurse notifies the health care provider (HCP), and the HCP initially prescribes that the solution and tubing be changed. What should the nurse do with the discontinued materials? 1. Discard them in the unit trash. 2. Return them to the hospital pharmacy. 3. Send them to the laboratory for culture. 4. Save them for return to the manufacturer.

3. Send them to the laboratory for culture. When the client who is receiving PN develops a fever, a catheter-related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for infectious organisms. The other options are incorrect. Because culture for infectious organisms is necessary, the discontinued materials are not discarded or returned to the pharmacy or manufacturer.

A nurse places a hospitalized client with active tuberculosis in a private, well-ventilated isolation room. In addition, which action should the nurse take before entering the client's room? 1. Wash hands and don a surgical mask. 2. Wash hands and wear a gown and gloves. 3. Wash hands and place a high-efficiency particulate air (HEPA) respirator mask over the nose and mouth. 4. The nurse needs no precautions. The client is instructed to cover his or her mouth and nose when coughing.

3. Wash hands and place a high-efficiency particulate air (HEPA) respirator mask over the nose and mouth. The nurse wears a HEPA respirator mask when caring for a client with active tuberculosis. Hands are always thoroughly washed before and after caring for the client. Options 1, 2, and 4 offer inadequate protection. Option 1, a surgical mask, will not protect against Mycobacterium tuberculosis.

The home health nurse visits a client with suspected scabies. Which precaution should the nurse institute during the assessment of the client? 1. Wear gloves only. 2. Wear a mask and gloves. 3. Wear a gown and gloves. 4. Avoid touching the client's home furnishings.

3. Wear a gown and gloves. The Centers for Disease Control and Prevention recommends wearing gowns and gloves for close contact with a client infested with scabies. Masks are not necessary. Transmission via clothing and other inanimate objects is uncommon. Scabies usually is transmitted from client to client by direct skin contact. All contacts that the client has had should be treated at the same time.

The nurse participating in a health fair is setting up a booth on prevention of human immunodeficiency virus (HIV) transmission. A poster is planned that will list sexual behaviors in one of two columns, "safe" and "not safe." Which behavior should the nurse place in the "not safe" column? 1. Abstinence 2. Mutual monogamy 3. Use of latex condoms 4. Use of natural skin condoms

4. Use of natural skin condoms Abstinence is the safest way to avoid HIV infection. Another reliable method is participation in a mutually monogamous relationship. The use of latex condoms is considered safe because the latex prevents the transmission of the HIV so long as the condom is used properly and remains in place. The use of natural skin condoms is not considered safe because the pores in the condom are large enough for the virus to pass through.

The nurse is caring for a client with acute viral hepatitis A who resides in a group home. Which outcome indicates that the most important goal has been achieved for this client? 1. Resumes normal bowel elimination patterns 2. Avoids transmitting the virus to others in the group home 3. Progressively increases activity with planned rest periods 4. Gains at least ½ to 1 pound per week until at ideal weight

2. Avoids transmitting the virus to others in the group home All the options are expected outcomes of care for this client. However, because the disease can be communicable to others, one of the most important goals in management of acute viral hepatitis is preventing the spread of infection.

An unlicensed assistive personnel (UAP) is caring for a client who has an indwelling urinary catheter. Which action by the UAP would indicate the need for instruction in the care of the client? 1. Used soap and water to cleanse the perineal area 2. Allowed the drainage tubing to rest under the leg 3. Kept the drainage bag below the level of the bladder 4. Used the drainage tubing port to obtain urine samples

2. Allowed the drainage tubing to rest under the leg Proper care of an indwelling urinary catheter is especially important to prevent infection in the client. The drainage tubing is not placed under the client's leg; for the same reason, the drainage bag is kept below the level of the bladder to prevent urine from being trapped in the bladder. The tubing must drain freely at all times. The perineal area is cleansed thoroughly, using mild soap and water at least twice a day and following a bowel movement. The nurse and all caregivers must use strict aseptic technique when emptying the drainage bag or obtaining urine specimens.

A 7-year-old child is diagnosed with viral conjunctivitis. Antibiotic eye drops are prescribed for the child. When the mother asks the nurse when the child can return to school, what should the appropriate response be? 1. "The child can return to school immediately." 2. "The child cannot return to school until seen by the health care provider in 1 week." 3. "The child should be kept home until the antibiotic eye drops have been administered for 24 hours." 4. "The child should be kept home until the antibiotic eye drops have been administered for 72 hours."

3. "The child should be kept home until the antibiotic eye drops have been administered for 24 hours." Viral conjunctivitis is extremely contagious. The child should be kept home from school or day care until antibiotic eye drops have been administered for 24 hours.

The home care nurse visits a child recently discharged from the hospital with a diagnosis of hepatitis A virus (HAV) infection. The mother asks the nurse when the child can return to school. The nurse should make which response to the mother? 1. "In about 2 months." 2. "When the jaundice disappears." 3. "Within 1 week after the onset of jaundice." 4. "At the beginning of the next academic year."

3. "Within 1 week after the onset of jaundice." Because HAV is not infectious 1 week after the onset of jaundice, return to school at that time is permitted if the child feels well enough. Options 1, 2, and 4 are incorrect.

A nurse is preparing a plan of care for a client with a diagnosis of agranulocytosis who is being admitted to the hospital. The nurse determines that which is the priority when formulating the client's plan of care? 1. Fatigue 2. Constipation 3. Potential for infection 4. Insufficient knowledge

3. Potential for infection Agranulocytosis is characterized by a reduced number of leukocytes (leukopenia) and neutrophils (neutropenia) in the blood. The client is at high risk for infection because of the decreased body defenses against microorganisms. Insufficient knowledge related to the nature of the disorder and the prevention of complications may be appropriate, but it is not the priority. Similarly, fatigue and constipation may be a concern for the client with agranulocytosis, but the priority problem relates specifically to infection.

The nurse is caring for a restless client who is beginning nutritional therapy with parenteral nutrition (PN). The nurse should plan to ensure that which action is taken to prevent the client from sustaining injury? 1. Calculate daily intake and output. 2. Monitor the temperature once daily. 3. Secure all connections in the PN system. 4. Monitor blood glucose levels every 12 hours.

3. Secure all connections in the PN system. The nurse should plan to secure all connections in the tubing (tape is used per agency protocol). This helps prevent the restless client from pulling the connections apart accidentally. The nurse should also monitor intake and output, but this does not relate specifically to a risk for injury as presented in the question. Also, monitoring the temperature and blood glucose levels does not relate to a risk for injury as presented in the question. In addition, the client's temperature and blood glucose levels are monitored more frequently than the time frames identified in the options to detect signs of infection and hyperglycemia, respectively.

A client with active tuberculosis demonstrates less-than-expected interest in learning about the prescribed medication therapy. The nurse assesses that this client may ultimately need which intervention as a last resort? 1. Directly observed therapy 2. More medication instructions 3. Involvement of the family in teaching 4. Reinforcement by the health care provider

1. Directly observed therapy Tuberculosis is a highly communicable disease that is reportable to the local public health department. This agency has regulations that may be enforced to ensure compliance with tuberculosis therapy. Ultimately the client may be required to have directly observed therapy to reduce the risk to the public. This involves having a responsible person actually observe the client taking the medication each day.

The nurse is planning to teach a group of adolescents about the use of condoms as part of a risk-reduction program for sexually transmitted infections (STIs). The nurse should plan to include which recommendation in the teaching plan? 1. Condoms should not be lubricated. 2. Use condoms whenever the partner seems "risky." 3. Always apply the condom before inserting the penis into the vagina. 4. Natural membrane condoms can be used because they are just as effective as latex.

3. Always apply the condom before inserting the penis into the vagina. To be effective, condoms must be applied before any vaginal penetration occurs. A condom must be used with every sexual encounter if it is to be safe. A lubricated condom may be used to increase sensitivity of the glans. Natural membrane condoms are less effective than latex in preventing the spread of some STIs

A nurse is instructing a postpartum client with endometritis about preventing the spread of infection to the newborn infant. Which statement should the nurse make to the client? 1. Visitors are not allowed to hold the baby. 2. There is no danger of the newborn contracting the disease. 3. Hands should be washed thoroughly before holding the infant. 4. The newborn infant will not be allowed in the mother's room at all.

3. Hands should be washed thoroughly before holding the infant. Transmission of infectious diseases can occur through contaminated items such as hands and bed linens of clients with endometritis. An important method of preventing infection is to break the chain of infection. Handwashing is one of the most effective methods of preventing the transmission of infectious diseases. The newborn infant is allowed in the mother's room and visitors are allowed to hold the newborn infant as long as handwashing and other protective measures are instituted.

The nurse is assisting a female client to collect a midstream urine specimen. How should the nurse implement aseptic technique? 1. Cleansing the meatus with antiseptic pads using upward strokes 2. Letting go of the labia once this tissue is cleansed, to allow the client to urinate 3. Making sure that the fingers avoid touching the inside of the collection container 4. Instructing the client to urinate in the container after the labia have been cleansed

3. Making sure that the fingers avoid touching the inside of the collection container The inside of the container is sterile, and sterility must be maintained. Fingers touching the inside of the container would cause the container to become unsterile. The meatus should be cleansed from front to back (toward the anus). Upward strokes would bring bacteria from the anal region toward the urinary meatus. The labia should remain open during the procedure. If they are allowed to close, this tissue will have to be cleansed again with the antiseptic pads. The client should void a small amount into the toilet before urinating into the specimen container to allow some of the organisms near the meatus to leave the area.

The nurse is caring for a client who is on airborne precautions. The nurse notes that the client is scheduled for magnetic resonance imaging (MRI). Which nursing action is most appropriate in preparing the client for the test? 1. Place the client in gown, gloves, and mask. 2. Request that the MRI technicians wear masks. 3. Place a surgical mask on the client for transport. 4. Call the radiology department to reschedule the test.

3. Place a surgical mask on the client for transport. If the client is on airborne precautions, client movement and transport should be limited if possible. If transport or movement is necessary, client dispersal of droplet nuclei can be minimized by placing a surgical mask on the client. Options 1 and 2 are not necessary. Option 4 is not appropriate. This leaves option 3, which is to provide protection for the staff.

Contact precautions are initiated for a client with a health care-associated (nosocomial) infection caused by methicillin-resistant Staphylococcus aureus. The nurse prepares to provide colostomy care and should obtain which protective items to perform this procedure? 1. Gloves and gown 2. Gloves and goggles 3. Gloves, gown, and shoe protectors 4. Gloves, gown, goggles, and face shield

4. Gloves, gown, goggles, and face shield Splashes of body secretions can occur when providing colostomy care. Goggles and a face shield are worn to protect the face and mucous membranes of the eyes during interventions that may produce splashes of blood, body fluids, secretions, or excretions. In addition, contact precautions require the use of gloves, and a gown should be worn if direct client contact is anticipated. Shoe protectors are not necessary.

A client with pulmonary tuberculosis (TB) is on airborne isolation precautions. Which item(s) is essential for the nurse to wear? 1. Gloves only 2. Fluid shield mask 3. Gown, mask, and gloves 4. High-efficiency particulate air (HEPA) filter mask

4. High-efficiency particulate air (HEPA) filter mask The hospitalized client with TB is placed on airborne isolation. A HEPA filter mask must be worn whenever the nurse enters the client's room, because these masks can remove almost 100% of the small TB particles. This mask must fit snugly around the nose and mouth. Option 1 is an incorrect option; although gloves may be needed, the nurse must wear a HEPA mask. Option 2 is incorrect. The mask must be a HEPA mask. Option 3 is an incorrect choice. The mask must be a HEPA mask, and there is no need for gown and gloves unless a wound, body fluid, or blood is involved.

A hospitalized client who has been placed on contact precautions has been prescribed to have a chest radiograph in the radiology department. The nurse should plan to take which action on receipt of this prescription? 1. Transport the client through empty corridors only. 2. Place a mask on the client in preparation for transport. 3. Place a sterile gown on the client in preparation for transport. 4. Question the health care provider about whether a portable chest radiograph may be obtained.

4. Question the health care provider about whether a portable chest radiograph may be obtained. The client who is placed on contact precautions has a high microorganism count in some type of body secretion (such as feces or wound drainage). This client is placed in a private room whenever possible and is removed from the room only when absolutely necessary. Client transport should be done only for essential purposes. Notification of departmental personnel and disinfection of any environmental surfaces with which the client has contact are imperative.

A man has been admitted to the surgical unit after a hernia repair surgery. The medical record reports that the client is human immunodeficiency virus (HIV) positive. The nurse should implement which precautions for this client? 1. Contact precautions 2. Droplet precautions 3. Airborne precautions 4. Standard precautions

4. Standard precautions Having an HIV-positive status does not warrant a special type of precaution; instead, the nurse will implement standard precautions. Contact, droplet, and airborne precautions are implemented with specific types of infections or diseases but are not necessary for HIV-positive clients unless some additional specific infection is present.

A male client who is admitted for an unrelated medical problem is diagnosed with urethritis caused by chlamydial infection. The unlicensed assistive personnel (UAP) assigned to the client asks the nurse what measures are necessary to prevent contraction of the infection during care. What should the nurse tell the UAP? 1. Enteric precautions should be instituted for the client. 2. Gloves and mask should be used by caregivers in the client's room. 3. Contact isolation should be initiated because the disease is highly contagious. 4. Standard precautions are quite sufficient because the disease is transmitted sexually.

4. Standard precautions are quite sufficient because the disease is transmitted sexually. Chlamydial infection is a sexually transmitted infection and frequently is called nongonococcal urethritis in the male client. It requires no special precautions in delivery of nursing care. Caregivers cannot acquire the disease during administration of care, and use of standard precautions is the only necessary measure.

A hospitalized client has a diagnosis of pelvic inflammatory disease (PID). The nurse should encourage the client to assume which therapeutic position when in bed? 1. Left side-lying 2. Right side-lying 3. Prone with the head flat 4. Supine in semi-Fowler's

4. Supine in semi-Fowler's Placing the client in semi-Fowler's position allows gravity to aid in drainage of the abdominal cavity. This helps prevent the formation of abscesses high in the abdomen. Abscesses in this location could rupture, potentially causing peritonitis. The color, odor, and amount of vaginal secretions also are noted and recorded. Options 1, 2, and 3 will not aid in gravity drainage.

Which action by the parent of an infant with respiratory syncytial virus infection who is receiving ribavirin (Virazole) would indicate a need for further instruction regarding the management of the disease process? 1. Wearing protective garb when visiting the infant 2. Washing the hands before leaving the infant's room 3. Telling a family member who has asthma that he should not visit the infant 4. Telling the infant's aunt who is pregnant that it is acceptable to visit the infant

4. Telling the infant's aunt who is pregnant that it is acceptable to visit the infant When an infant is receiving ribavirin, exposure precautions need to be observed. Anyone entering the infant's room should wear a gown, mask, gloves, and hair covering. Anyone who is pregnant or considering pregnancy and anyone with a history of respiratory problems or airway disease should not care for or visit the infant who is receiving ribavirin. Hand washing is absolutely necessary before leaving the room to prevent the spread of germs.

The home health nurse is watching the caregiver change the sternotomy dressing on the postoperative client. Which action by the caregiver identifies correct principles of infection control? 1. The caregiver selects a previously opened gauze to cover the sternal wound. 2. The caregiver dons gloves before removal of the old dressing and then applies the new dressing. 3. The caregiver covers her mouth with her hand when she sneezes and then continues with the dressing change. 4. The caregiver washes hands before removal of the soiled dressing and again before applying the clean dressing.

4. The caregiver washes hands before removal of the soiled dressing and again before applying the clean dressing. The single most effective technique to prevent the spread of germs and bacteria is hand washing. The initial step with all aseptic procedures is hand washing. Using previously opened gauze, not washing hands after sneezing, and not applying new gloves after removing the old dressing increase the risk of wound contamination as a result of poor aseptic technique.

The school nurse prepares a list of home care instructions for the parents of schoolchildren diagnosed with pediculosis capitis. Which instruction should the nurse include in the list? 1. Soak combs and brushes in warm water. 2. Use anti-lice sprays on all bedding and furniture. 3. Take all bedding and linens to the cleaners to be dry cleaned. 4. Vacuum floors, play areas, and furniture to remove any hairs that might carry live nits.

4. Vacuum floors, play areas, and furniture to remove any hairs that might carry live nits. Pediculosis capitis is an infestation of the hair and scalp with lice. Thorough home cleaning is necessary to remove any lice or nits that may fall from the host. Combs and brushes should be soaked in hot water for 10 minutes or a pediculicide for 1 hour. Anti-lice sprays are unnecessary and may be harmful. In addition, they should never be used on a child or on bedding or linens. Bedding and linens should be washed with hot water and dried on a hot setting. Items that cannot be washed should be dry cleaned or sealed in plastic bags in a warm place for 2 weeks.

A client has been receiving a series of medications as part of intravenous antineoplastic therapy. The nurse should implement neutropenic precautions after noting which laboratory result for this client? 1. Clotting time of 10 minutes 2. Ammonia level of 20 mcg/dL 3. Platelet count of 100,000 cells/mm3 4. White blood cell (WBC) count of 2000 cells/mm3

4. White blood cell (WBC) count of 2000 cells/mm3 The normal WBC is 5000 to 10,000 cells/mm3. When the WBC count drops, neutropenic precautions should be implemented to protect the client from infection. Bleeding precautions should be initiated when the platelet count drops; bleeding precautions include avoiding trauma such as from rectal temperatures or injections. The normal platelet count is 150,000 to 450,000 cells/mm3. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 10 to 80 mcg/dL.