Test 2 - Infection 10/12/2022

What is Medical Asepsis?

"clean technique" - procedures that REDUCE pathogens & help break chain of infection

What is Surgical Asepsis?

"sterile technique" - procedures that ELIMINATE pathogens

What are some common Means of Transmission? (chain of infection)

** how infection being transmitted from the exit portal ** - airborne - droplet - contact

What are some common Susceptible Hosts? (chain of infection)

** someone with decreased immune system already ** - burn pt - pt receiving chemotherapy - pt with immune deficiencies - pt with kidney transplant - pt who has taken a lot of steroids recently - neonate (1st month of life) - elderly

What are some common Reservoirs/Hosts? (chain of infection)

** where infectious agent lives ** - humans - animals - soil - food - water - milk - inanimate objects

What kind of symptoms can you expect with a pt who is febrile? (fever)

- shivering - loss of appetite - headache - hot, dry skin - flushed face - thirst - muscle aches & fatigue - respirations & heart rate increase

What is Neutropenia?

- unable to fight infection - WBC count under 1,000

What kind of procedures are Surgical Asepsis used for?

- wound dressing care (changing or cleaning) - inserting an indwelling urinary/IV catheter - any invasive surgical procedures

What is the Chain of Infection (in order)?

1. Infectious Agent 2. Reservoir/Host 3. Portal of Exit 4. Mode of Transmission 5. Portal of Entry 6. Susceptible Host

What is the correct order to remove PPE? * doffing = d-OFF-ing *

1. gloves off 2. goggles off 3. gown off 4. mask off 5. hand hygiene

What is the correct order to put PPE on? * donning = d-ON-ning *

1. hand hygiene 2. gown 3. mask 4. goggles 5. gloves

How many WBC in Normal count?

5,000 - 10,000

The nurse is providing care for a client with varicella. What action should the nurse perform? A - Ensure the client is housed in a negative pressure room. B - Teach visitors to maintain a distance of 3 feet (1 meter) from the client. C - Wear a surgical mask at all times when in the client's room. D - Perform hand hygiene with soap and water rather than alcohol handrub.

A - Ensure the client is housed in a negative pressure room.

What isolation precaution used for TB?

Airborne Isolation

What isolation precaution used for Varicella?

Airborne Isolation

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

C - within normal limits

What isolation precaution used for C-Diff (Clostridium Difficile Bacteria)?

Contact Isolation

What isolation precaution used for MRSA?

Contact Isolation

What isolation precautions used for MDRO (multidrug-resistant organism)?

Contact Isolation

What isolation precaution used for Pertussis?

Droplet Isolation

What is active-acquired immunity?

Gained either from - immunizations - exposure to infection

What is passive-acquired immunity?

Gained from another person, as in from mother to infant thru breastfeeding .. only last few wks to few months

What is an Exaggerated Immune Response?

Immune system is unable to tell difference between "self" & "non-self", it begins to start attacking its own host - allergic reactions - autoimmune disease - cytotoxic reactions

What is acquired immunity?

Immunity gained after birth .. either actively or passively

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

Surgical Asepsis

How many WBC in Suppressed Immunity count?

less than 5,000

If a patient is Neutropenic, what isolation precautions should be taken?

protective isolation .. which includes: - positive pressure room - no flowers in room - normally full PPE

What are some common Portals of Exit? (chain of infection)

** point of escape for the infection, from the reservoir ** - respiratory - gastrointestinal (mouth, esophagus, stomach, intestines) - genitourinary tracts (coming out thru urine or feces) - breaks in skin - blood & tissue

What do Standard Precautions apply to?

- ALL care in hospital, regardless of diagnosis or possible infection - blood - all bodily fluids - secretions - excretions (except sweat) - nonintact skin - mucous membrane

In relation to Chain of Infection, what are some examples Modes of Transmission?

- Droplets - Airborne - Physical Contact

What are the common Infectious Agents? (chain of infection)

- bacteria - fungi - viruses - parasites

The nurse is completing a sterile dressing change on a confused client. During the procedure, the client reaches down and touches the contents of the open dressing kit. What is the nurse's next action? A - Continue changing the dressing B - Restrain the client's hands C - Open a new sterile dressing kit D - Wash the client's hands

C - Open a new sterile dressing kit

What are some common Portals of Entry? (chain of infection)

** point of entry for the infection to the new host ** - respiratory - gastrointestinal (mouth, esophagus, stomach, intestines) - genitourinary tracts (coming out thru urine or feces) - breaks in skin

What is included for Airborne Isolation Precautions?

- n95 mask/respirator - negative pressure room w/ door closed

What are the 5 specific white blood cells to remember?

- neutrophils - basophils - monocytes - eosinophils - t lymphocytes

What is included in Contact Isolation Precautions?

- nonsterile gloves - surgical mask - gown - goggles ** no hand sanitizer for C-Diff, only soap & water **

What is included in Droplet Isolation Precautions?

- nonsterile gloves - surgical mask (regular) - gown - goggles

A client has tested positive for colonization with a multidrug-resistant organism (MDRO) and has been placed on contact precautions. Which actions should be included in this client's care? Select all that apply. A - Arrange for the client to be housed in a single room. B - Ensure that all care providers have current immunizations against the microorganism. C - Appoint one specific nurse to provide all of the client's care for the duration of a shift. D - Use appropriate PPE. E - Change the client's linens and gown at least twice daily.

A - Arrange for the client to be housed in a single room. D - Use appropriate PPE.

A nurse has put on personal protective equipment (PPE) to perform the dressing change of a client's surgical wound. While the nurse is cleansing the incision, the client begins bleeding & blood hits the nurse's wrist, running down under the cuff of her glove. What is the nurse's best action? A - Interrupt the dressing change to perform thorough handwashing, & document the exposure according to protocol. B - Rinse the infected hand with hydrogen peroxide after applying a sterile bandage to the client's wound. C - Perform thorough hand hygiene immediately after completing the dressing change. D - Remove the contaminated gloves & apply a clean pair of gloves.

A - Interrupt the dressing change to perform thorough handwashing, & document the exposure according to protocol.

A nurse has been exposed to feces while changing the linens of a client's bed. Which guideline is followed for performing handwashing after this client encounter? A - Keep hands lower than elbows to allow water to flow toward fingertips. B - Remove all jewelry, including wedding bands, before hand washing. C - Pat dry with a paper towel, beginning with the forearms and moving down to fingertips. D - Use an alcohol-based hand rub to decontaminate the hands.

A - Keep hands lower than elbows to allow water to flow toward fingertips.

Standard precautions apply to which items? Select all that apply. A - Mucous membranes B - Sweat C - Body fluid secretions D - Nonintact skin E - Intact skin F - Blood

A - Mucous membranes C - Body fluid secretions D - Nonintact skin F - Blood

When is it necessary for the nurse to implement the observable personal protective equipment (PPE) intervention? PHOTO OF NURSE IN GOWN, MASK & FACE SHIELD A - Suctioning a Tracheostomy B - Providing care to a patient in isolation C - Removing double bagged medical waste D - Feeding a patient who has the habit of spitting

A - Suctioning a Tracheostomy

The student nurse observes another nurse wash her hands in the client's bathroom before exiting the room. This client's stool came back positive (+) for Clostridium Difficile (C diff). Why is this behavior incorrect? A - The bathroom is highly contaminated with the Clostridium difficile bacteria. B - Clostridium difficile bacteria is eradicated by the use of hand sanitizer only. C - The behavior is not a problem as long as the nurse uses gloves in the room. D - The nurse must make sure that the bathroom has been cleaned recently before washing her hands.

A - The bathroom is highly contaminated with the Clostridium difficile bacteria.

The nurse is caring for a postoperative client in contact isolation. Which actions should the nurse employ to reduce the spread of disease? Select all that apply. A - Wash hands after removing gloves before leaving the client's room. B - Place used syringes and uncapped needles in a puncture-resistant container after use. C - Use sealed items from the client's room when caring for other clients. D - Wear clean gloves when performing a sterile dressing change. Instruct the client to ambulate in the hall several times a day.

A - Wash hands after removing gloves before leaving the client's room. B - Place used syringes and uncapped needles in a puncture-resistant container after use.

The nurse is evaluating risk factors for a developmentally diverse group of clients. Which client(s) is at risk for safety? Select all that apply. A - older adult client with a shuffling gait B - machinist working in an environment with exposure to loud noises C - sales executive worried about making the yearly sales quota D - 42-year-old client with left-side paralysis following a stroke E - toddler allowed to crawl in a house that has not been childproofed

A - older adult client with a shuffling gait E - toddler allowed to crawl in a house that has not been childproofed

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? A - The nurse keeps visitors 3 feet away from the infected person. B - The nurse places the client in a private room with monitored negative air pressure. C - The nurse places the client in a private room with the door open. D - The nurse uses droplet precautions when providing care for the client.

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

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

C - During some care activities for an individual client, nurses may need to change gloves more than once. E - To remove a gown, nurses should unfasten ties, if at the neck & back than allow the gown to fall away from shoulders. F - Nurses should remove PPE at the doorway or in an anteroom, except for the respirator.

Which should be documented by the nurse? A - The specific items that the nurse transferred into a sterile field B - The fact that the nurse donned gloves two different times during a procedure C - The fact that sterile technique was used for a given procedure D - The fact that the nurse washed her hands before a procedure

C - The fact that sterile technique was used for a given procedure

A nurse prefers to use an alcohol-based hand rub when providing care for clients. In which case is this practice contraindicated? A - The nurse performs routine care and is moving to another client. B - The nurse finishes cleaning a client's table. C - The nurse is caring for a client with a C. difficile infection. D - The nurse finishes client care and hands are not visibly soiled.

C - The nurse is caring for a client with a C. difficile infection.

A nurse is explaining the different procedures used to break the chain of infection to a nursing student. In which link in the chain of infection should a nurse provide special attention to the respiratory and gastrointestinal tracts? A - susceptible host B - infectious microorganism C - exit route D - vehicle of transmission

C - exit route

Which client presents the most significant risk factors for the development of Clostridium difficile infection? A - 44 yr old client who is paralyzed & whose coccyx ulcer has required a skin graft B - 30 yr old client who has recently contracted human HIV after engaging in high-risk sexual behavior C - client w/ renal failure who receives hemodialysis three times weekly D - 81 yr old client who has been receiving multiple antibiotics for the treatment of sepsis

D - 81 yr old client who has been receiving multiple antibiotics for the treatment of sepsis

The nurse is caring for a client with a latex sensitivity. Which resource would be most appropriate for the nurse to access when developing the client's plan of care? A - The infectious disease nurse B - Human resources department C - The emergency room charge nurse D - Policy for clients with latex sensitivity

D - Policy for clients with latex sensitivity

The nurse uses a small amount of sterile solution from a large, multiuse bottle to moisten gauze in a sterile field. What technique does the nurse use? A - Pour the liquid onto gauze on the sterile field until the gauze is moist. B - Pour the liquid into the palm of a sterile gloved hand for use. C - Pour the liquid into the cap of the bottle and dip the gauze as needed. D - Pour the liquid into a sterile container within the sterile field.

D - Pour the liquid into a sterile container within the sterile field.

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

D - an older adult can have an infection without a fever.

A client develops a fever. When assessing the client, the nurse determines that the client is in the crisis phase based on assessment of: A - increased shivering B - decreased sweating C - gooseflesh D - flushed skin

D - flushed skin

A nurse is caring for four clients. Which client has the highest risk of infection? A - young woman with a history of scoliosis B - toddler with a benign heart murmur C - woman in second trimester of pregnancy D - older male with an enlarged prostate

D - older male with an enlarged prostate

What isolation precaution used for influenza?

Droplet Isolation

A nurse is working with a 55-year-old woman diagnosed with human immunodeficiency virus (HIV). This nurse has another client that day who has an upper respiratory infection. What is the most important thing the nurse can do to prevent the client with HIV from acquiring the upper respiratory infection?

perform hand hygiene before & after entering the client's room