Advanced Patho/Pharm: Saunders Infection Control ?'s

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

Correct answer: 4 Rationale: Placing the client in a semi Fowler's position allows gravity to aid in drainage of the abdominal cavity. This helps to 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.

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."

Correct answer: 1 Rationale: 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

Correct answer: 1 Rationale: 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 employed on a medical unit in a hospital receives a telephone call from the admission office and is told that a client with a diagnosis of mycoplasmal pneumonia will be admitted to the unit. The nurse prepares for the admission and obtains the necessary supplies to place the client on which type of transmission-based precautions? 1. Droplet precautions 2. Enteric precautions 3. Contact precautions 4. Protective isolation

Correct answer: 1 Rationale: Droplet precautions are required for a client with mycoplasmal pneumonia because this type of pneumonia is transmitted by droplet nuclei larger than 5 mm. The nurse wears a mask while in the client's room. Enteric precautions are necessary when exposure from feces is likely; gloves are necessary and possibly a gown and face shield if splashes are expected to occur. Contact precautions are implemented when exposure to contaminated material, such as wound drainage, can occur and requires the use of gloves and possibly a gown. Protective isolation is instituted when it is necessary to protect the client from others.

The nurse is caring for a client with meningitis 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

Correct answer: 1 Rationale: Meningitis 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 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. Clothing and sheets should be bleached after each use to kill the TB nuclei. 3. Deep pile carpet collects TB bacteria and should be removed from the home. 4. The client should specifically maintain enteric precautions to prevent transmission.

Correct answer: 1 Rationale: 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 technique.

The nurse is preparing an intravenous (IV) set before starting the infusion. After removing the cap from the IV tubing port on the IV bag, the nurse removes the cover from the tubing insertion spike but then touches the spike with a finger. What should the nurse do next? 1. Discard the IV tubing and use a new set for the infusion. 2. Continue with the procedure and then flush the tubing thoroughly. 3. Clean the spike with an alcohol swab for 15 seconds and then continue. 4. Clean the spike and the IV bag tubing port with alcohol and then continue.

Correct answer: 1 Rationale: The IV tubing's insertion spike must remain sterile. If it is touched during the preparation of the infusion, the tubing must be discarded and replaced with a sterile set. Otherwise, the infusion set is contaminated, which could cause infection in the client. Therefore, the remaining actions are incorrect.

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 1 or more vesicles that then rupture

Correct answer: 1 Rationale: 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 1 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

Correct answer: 1 Rationale: 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 ambulatory care nurse is working with a 22-year-old female client who has been diagnosed with pelvic inflammatory disease (PID). The nurse incorporates which item in a teaching plan for this client? 1. Avoid frequent douching. 2. Undergarments made of nylon are best. 3. Intrauterine devices are a good birth control method. 4. It is necessary to change sanitary pads only every 8 hours.

Correct answer: 1 Rationale: The client who has been diagnosed with PID should avoid frequent douching because it decreases the natural flora that controls the growth of infectious organisms. The client should wear cotton undergarments, and clothes should not fit tightly. Intrauterine devices increase the client's susceptibility to infection. Sanitary pads should be changed at least every 4 hours. Tampons should not be used during the acute infection, and some health care providers may recommend avoiding them indefinitely. The client also should avoid strong soaps, sprays, powders, and similar products that will irritate the perineum.

The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse prepares to attach the distal end of the IV tubing to a needleless device, the tubing drops and hits the top of the medication cart. Which is the appropriate action by the nurse? 1. Change the IV tubing. 2. Attach a new needleless device. 3. Wipe the tubing port with Betadine. 4. Scrub the needleless device with an alcohol swab.

Correct answer: 1 Rationale: The nurse should change the IV tubing because it has become contaminated and could cause systemic infection to the client. Wiping the port with Betadine is insufficient and would be contraindicated in any case, because the tubing will be attached directly to an angiocatheter in the client's vein. The needleless device has not been contaminated and does not need replacement or cleansing.

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

Correct answer: 1 Rationale: 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 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 to 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.

Correct answer: 1, 2, 3, 5 Rationale: 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.

The nursing instructor determines that the nursing student understands the purposes of standard and transmission-based precautions if which statements are made? Select all that apply. 1."They prevent transmission of organisms from client to client." 2."They prevent transmission of organisms from health care providers to clients." 3."They prevent transmission of organisms from clients to health care providers." 4."They prevent transmission of organisms from hospital visitors to in-hospital clients." 5."They prevent transmission of organisms from hospital visitors to health care providers." 6."They prevent transmission of organisms from health care providers and clients to people outside of the hospital."

Correct answer: 1, 2, 3, 6 Rationale: The purpose of these precautions is to prevent the transmission of organisms from clients to health care providers (HCPs), from HCPs to clients, from client to client, and from HCPs and clients to people outside of the hospital. Hospital visitors are not included in these infection-based precautions.

The nurse is working in an illness prevention clinic. An important component of the nurse's practice is to advise high-risk clients to receive an influenza vaccination. Which clients are at high risk for influenza and would benefit from vaccination? Select all that apply. 1. A 47-year-old mother of a child with cystic fibrosis 2. A 54-year-old man scheduled for a routine diabetes check 3. A 43-year-old factory worker with symptoms of influenza 4. A 35-year-old registered nurse scheduled for an annual pelvic exam 5. An 87-year-old woman from a nursing home scheduled for a surgical follow-up

Correct answer: 1, 2, 4, 5 Rationale: Influenza vaccinations are recommended yearly and developed according to predicted strain for clients at high risk. Influenza immunization is recommended for high-risk clients. Anyone in close contact with clients with a chronic respiratory or other chronic disorder should receive the vaccine. Adults with chronic metabolic disease such as diabetes mellitus are in the high-risk population. Residents of chronic care facilities are at risk for influenza. Health care workers are in the high-risk population. The influenza vaccine does not treat an active infection with the virus.

The nurse is caring for a client with newly diagnosed human immunodeficiency virus (HIV). Besides preventing the transmission of the disease, what are the goals of medication therapy? Select all that apply. 1. Decreasing the viral load 2. Delaying disease progression 3. Administering the HIV vaccine 4. Eliminating the use of illegal drugs 5. Maintaining or increasing CD4+ T cell counts 6. Preventing HIV-related symptoms and opportunistic diseases

Correct answer: 1, 2, 5, 6 Rationale: Besides preventing HIV transmission, the goals of medication therapy include decreasing the viral load, delaying disease progression, maintaining or increasing CD4+ T cell counts, and preventing HIV-related symptoms and opportunistic diseases. Administering the HIV vaccine and eliminating the use of illegal drugs are not included in the goals of medication therapy. Antiretroviral therapy (ART) can delay disease progression, and when taken consistently and correctly, ART can reduce viral loads by 90% to 99%. This makes adherence to treatment regimens extremely important. Although it is usually not possible to eradicate opportunistic diseases once they occur, prophylactic medications can significantly decrease morbidity and mortality rates.

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? 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 (0.2 to 0.5 kg) per week until at ideal weight

Correct answer: 2 Rationale: All of the options are expected outcomes of care for this client. However, because the disease is communicable to others, one of the most important goals in management of acute viral hepatitis is preventing the spread of infection.

The nurse prepares to give a bath and change the bed linens of a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which would the nurse incorporate into the plan during the bathing of this client? 1. Wearing gloves 2. Wearing a gown and gloves 3. Wearing a gown, gloves, and a mask 4. Wearing a gown and gloves to change the bed linens, and gloves only for the bath

Correct answer: 2 Rationale: Gowns and gloves are required if the nurse anticipates contact with soiled items such as those with wound drainage, or is caring for a client who is incontinent with diarrhea or a client who has an ileostomy or colostomy. Masks are not required unless droplet or airborne precautions are necessary. Regardless of the amount of wound drainage, a gown and gloves must be worn.

The nursing instructor is observing a student nurse donning a pair of sterile gloves and preparing a sterile field. Which observation made by the instructor indicates the need for further teaching? 1.The student puts on the right glove and then the left glove. 2.The student dons the sterile gloves without washing the hands. 3.The student uses the inner wrapper of the gloves as a sterile field. 4.The student touches a glove on the overbed table, removes both gloves, and dons another sterile pair.

Correct answer: 2 Rationale: Hands must always be washed (even though sterile gloves are used) to keep germs from spreading. The order of placing gloves on is up to the user, as long as sterile technique is not broken. The inside wrapper provides an excellent area for use because it is sterile. If the gloves touch anything unsterile, they must be considered contaminated, and a new package of gloves must be obtained and used.

The nurse is caring for a client with a wound infected with methicillin-resistant Staphylococcus aureus (MRSA). The most appropriate infection control precautions for MRSA include which intervention? 1. Room with positive-pressure airflow 2. Private room, gown, gloves, and face shield 3. Private room with negative-pressure airflow 4. Mask or respiratory protection device and gown

Correct answer: 2 Rationale: Isolation guidelines from the Centers for Disease Control and Prevention (CDC) place MRSA at the tier 2 transmission category. Contact precautions are required and include a private room, gloves, gowns, and face shields in case a splash from the wound drainage occurs, such as with wound irrigation. A room with negative-pressure airflow is required for airborne precautions from small droplet infections such as measles, chickenpox, or tuberculosis. A respiratory protection device is recommended for larger droplet infections such as pneumonia. A room with positive-pressure airflow is recommended for protective environments such as those required for clients with stem cell transplants.

A nursing instructor asks a nursing student about a client admitted with tuberculosis (TB). What comment by the student indicates that there is a need for further teaching? 1."It is transmitted by the airborne route." 2."It is a fast-growing infectious disease." 3."People who have been in constant close contact with the infected person will need to be tested and treated if necessary." 4."The risk for transmission is reduced after the infectious person has received proper medication therapy for 2 to 3 weeks and clinical improvement occurs."

Correct answer: 2 Rationale: Mycobacterium tuberculosis is a nonmoving, slow-growing (not fast-growing), acid-fast rod transmitted via the airborne route. The other options are accurate statements.

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 further 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

Correct answer: 2 Rationale: 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.

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 (HCPs) to report cases

Correct answer: 2 Rationale: The best outcome of any type of surveillance is accuracy. An active surveillance method focuses on assessment rather than interventions and 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.

The ambulatory care nurse is seeing a client for a follow-up visit after treatment for toxic shock syndrome (TSS). To assess the client's recovery from TSS, the nurse should ask whether which signs and symptoms have resolved? 1. Low-grade fever, nausea, and vaginal bleeding 2. High fever, abdominal pain, vomiting, and diarrhea 3. Low-grade fever, vomiting, and greenish vaginal discharge 4. High fever, purulent vaginal discharge, and abdominal pain

Correct answer: 2 Rationale: The classic symptoms of TSS are high fever (temperature of 101°F [38.3°C] or higher), vomiting, and severe diarrhea. Other typical symptoms include headache, myalgia, chills, abdominal pain, dizziness, lethargy, possible confusion, and agitation. Vaginal bleeding or discharge is not part of the clinical picture. TSS typically is caused by Staphylococcus aureus infection associated with tampon use during menses.

A client with tuberculosis (TB), whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. The nurse replies that the client may resume employment when which occurs? 1. Five sputum cultures are negative. 2. Three sputum cultures are negative. 3. A sputum culture and a chest x-ray are negative. 4. A sputum culture and a tuberculin skin test are negative.

Correct answer: 2 Rationale: The client must have sputum cultures performed every 2 to 4 weeks after initiation of antituberculosis medication therapy. The client may return to work when the results of 3 sputum cultures are negative because the client is considered noninfectious at that point. Therefore, the remaining options are incorrect. A negative chest x-ray does not mean that the client is noninfectious. A positive tuberculin skin test never reverts to negative.

A client with tuberculosis whose status is being monitored in an ambulatory care clinic asks the nurse when it is permissible to return to work. What factor should the nurse include when responding to the client? 1. Five blood cultures are negative. 2. Three sputum cultures are negative. 3. A blood culture and a chest x-ray are negative. 4. A sputum culture and a tuberculin skin test are negative.

Correct answer: 2 Rationale: The client with tuberculosis must have sputum cultures performed every 2 to 4 weeks after initiation of antituberculosis medication therapy. The client may return to work when the results of three sputum cultures are negative because the client is considered noninfectious at that point. Options 1, 3, and 4 are not reliable determinants of a noninfectious status.

Two nurses are leaving the room of a client whose care required them to wear a gown, mask, and gloves. Which action by these nurses could lead to the spread of infection? 1. Taking off the gloves first before removing the gown 2. Removing the gown without rolling it from inside out 3. Washing the hands after the entire procedure has been completed 4. Removing the gloves and then removing the gown using the neck ties

Correct answer: 2 Rationale: The gown must be rolled from inside out to prevent the organisms on the outside of the gown from contaminating other areas. Gloves are considered the dirtiest piece of equipment and therefore must be removed first. Hands must be washed after removal of the protective garb to remove any unwanted germs still present. Ungloved hands should be used to remove the gown to prevent contaminating the back of the gown with germs from the gloves.

The nurse is assigned to care for an infant following a cleft lip repair. The nurse is asked to observe the parent in the procedure for cleaning the lip repair site. The nurse determines that the parent is performing the procedure correctly if the parent uses which solution to clean the site? 1. Ice water 2. Sterile water 3. Half-strength alcohol 4. Full-strength hydrogen peroxide

Correct answer: 2 Rationale: The lip repair site is cleansed with sterile water using a cotton swab; it is cleansed after feeding and as prescribed. The mother should be instructed to use a rolling motion from the suture line outward. Options 1, 3, and 4 are incorrect solutions and can affect tissue integrity.

A client is seen in the health care clinic, and a diagnosis of acute sinusitis is made. The nurse provides home care instructions to the client regarding measures that will promote sinus drainage and comfort. Which statement by the client indicates a need for further instruction? 1. "I should drink large amounts of fluids." 2. "I should use a hot mist vaporizer to liquefy secretions." 3. "I should try to sleep with the head of the bed elevated." 4. "I should apply heat, such as a wet pack, over the sinuses."

Correct answer: 2 Rationale: The nurse provides instructions to the client regarding measures to promote sinus drainage, comfort, and resolution of the infection. The client should be instructed to use a humidifier to help liquefy secretions and promote drainage. Consumption of large amounts of fluids is important to help liquefy secretions. Sleeping with the head of the bed elevated to a 45-degree angle will assist in promoting drainage. The nurse instructs the client to apply heat in the form of wet packs over the affected sinuses to promote comfort and help resolve the infection.

The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which items when performing this care? 1. Surgical mask and gloves 2. Particulate respirator, gown, and gloves 3. Particulate respirator and protective eyewear 4. Surgical mask, gown, and protective eyewear

Correct answer: 2 Rationale: The nurse who is in contact with a client with tuberculosis should wear an individually fitted particulate respirator. The nurse also would wear gloves as per standard precautions. The nurse wears a gown when the possibility exists that the clothing could become contaminated, such as when giving a bed bath.

The nurse provides home care instructions to a client with hepatitis B. Which statement made by the client indicates the best understanding of how to prevent transmission of the disease? 1. "It is all right to kiss my wife." 2. "My wife should get the vaccine." 3. "I should be vaccinated as soon as possible." 4. "I never will share towels with anyone else."

Correct answer: 2 Rationale: The vaccine is used as a preventive measure and is recommended for both sexual and household contacts of the person with hepatitis B. Hepatitis B can be transmitted through intimate contact, such as kissing. The vaccine is used for prevention. This disease is not transmitted through the use of towels.

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 2. Ceftriaxone 3. Azithromycin 4. Penicillin G benzathine

Correct answer: 2 Rationale: Treatment for gonorrhea consists of antibiotic therapy, usually with ceftriaxone and doxycycline. 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 community health nurse is providing a teaching session about anthrax to members of the community and asks the participants about the methods of transmission. Which answers by the participants would indicate that teaching was effective? Select all that apply. 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

Correct answer: 2, 3, 6 Rationale: 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, and it is not contracted via bites from ticks or deer flies.

The nurse is observing a second nurse perform hemodialysis on a client. The second nurse is drinking coffee and eating a doughnut next to the hemodialysis machine, while talking with the client about the events of his week. What is the nurse's most appropriate action regarding this observation? 1. Offer the client a cup of coffee. 2. Get a cup of coffee and join the conversation. 3. Ask the nurse to refrain from eating and drinking in that area. 4.Appreciate what a wonderful therapeutic relationship this nurse and client have.

Correct answer: 3 Rationale: A potential complication with hemodialysis is the acquisition of dialysis-associated hepatitis B. This is a concern for clients (who may carry the virus), their families (at risk from contact with the client and with environmental surfaces), and staff (who may acquire the virus from contact with the client's blood). This risk is minimized by the use of standard precautions; appropriate hand washing and sterilization procedures; and the prohibition of eating, drinking, or other hand-to-mouth activity in the hemodialysis unit. The nurse should ask the second nurse to stop eating and drinking in the work area.

The 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

Correct answer: 3 Rationale: 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 providing home care instructions to the mother of a child who has bacterial conjunctivitis. The nurse should provide the mother with which information? 1.The child may attend school if antibiotics have been started. 2.Any unused eye medication should be saved in case a sibling gets the eye infection. 3.The child's towels and washcloths should not be used by other members of the household. 4.Any crusted material should be wiped from the eye with a cotton ball soaked in warm water, starting at the outer aspect of the eye and moving toward the inner aspect.

Correct answer: 3 Rationale: Bacterial conjunctivitis is highly contagious, and infection control measures should be taught. These include good hand washing and not sharing towels or washcloths with others. The child should be kept home from school until 24 hours after antibiotics are started. Bottles of eye medication should never be shared with others. Crusted material may be wiped from the eye with a cotton ball soaked in warm water, starting at the inner aspect of the eye and moving toward the outer aspect.

The nurse teaches the mother of a child diagnosed with bacterial conjunctivitis about measures to prevent transmission of the infection. Which statement by the mother indicates a need for further teaching? 1."Hands need to be washed frequently." 2."A clean washcloth can be used to wipe my child's eyes." 3."It is all right to share towels and washcloths as long as they are bleached after use." 4."The eye drops must be given as prescribed, and hands need to be washed before and after instillation."

Correct answer: 3 Rationale: Bacterial conjunctivitis is highly contagious, and infection control measures should be taught. These measures include frequent hand washing and not sharing towels and washcloths, regardless of the bleaching process. Options 2 and 4 are also correct treatment measures.

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. "One week after the onset of jaundice." 4. "At the beginning of the next academic year."

Correct answer: 3 Rationale: 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.

The 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."

Correct answer: 3 Rationale: 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 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

Correct answer: 3 Rationale: 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.

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.

Correct answer: 3 Rationale: 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 done to provide protection for the staff.

The nurse is preparing a group of Cub Scouts for an overnight camping trip and instructs the Scouts about the methods to prevent Lyme disease. Which statement by one of the Scouts indicates a need for further instruction? 1. "I need to bring a hat to wear during the trip." 2. "I should wear long-sleeved tops and long pants." 3. "I should not use insect repellents because it will attract the ticks." 4. "I need to wear closed shoes and socks that can be pulled up over my pants."

Correct answer: 3 Rationale: In the prevention of Lyme disease, individuals need to be instructed to use an insect repellent on the skin and clothes when in an area where ticks are likely to be found. Long-sleeved tops and long pants, closed shoes, and a hat or cap should be worn. If possible, heavily wooded areas or areas with thick underbrush should be avoided. Socks can be pulled up and over the pant legs to prevent ticks from entering under clothing.

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.

Correct answer: 3 Rationale: 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 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

Correct answer: 3 Rationale: 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 preparing to insert an intravenous (IV) angiocatheter into a client's inner forearm. Before cannulating the vein, what motion will the nurse implement to cleanse the site? 1. Scrubbing from the wrist toward the elbow 2. Scrubbing from the elbow toward the wrist 3. Using a circular motion from the center outward 4. Using a circular motion inward toward the center

Correct answer: 3 Rationale: The nurse cleans the skin by using a circular motion from inward to outward. This is the standard, accepted aseptic technique to carry microorganisms away from the insertion site. The same technique is used to cleanse any area requiring surgical asepsis. Options 1, 2, and 4 are incorrect procedures and do not represent aseptic technique.

The 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 the mouth and nose when coughing.

Correct answer: 3 Rationale: The nurse wears an 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. In addition, a surgical mask will not protect against Mycobacterium tuberculosis.

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.

Correct answer: 3 Rationale: 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.

The 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.

Correct answer: 3 Rationale: Transmission of infectious diseases can occur through contaminated items such as the hands and bed linens of clients with endometritis. An important method of preventing infection is to break the chain of infection. Hand washing 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 hand washing and other protective measures are instituted.

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."

Correct answer: 3 Rationale: 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 nurse is admitting a client who is suspected of having tuberculosis (TB) to the nursing unit. The nurse should plan to admit the client to a room that has which properties? 1. Venting to the outside and ultraviolet light 2. Ultraviolet light and 3 air exchanges per hour 3. Ten air exchanges per hour and venting to the outside 4. Venting to the outside, 6 air exchanges per hour, and ultraviolet light

Correct answer: 4 Rationale: A client suspected of having TB is admitted to a private room that has at least 6 air exchanges per hour and negative pressure in relation to surrounding areas. The room should be vented to the outside and should have ultraviolet lights installed.

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 1 of 2 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

Correct answer: 4 Rationale: 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 HIV as 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.

A 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 sufficient because the disease is transmitted sexually.

Correct answer: 4 Rationale: 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.

The nurse prepares the client for irrigation of an abdominal wound. After preparation, the nurse would appropriately don which item to perform the procedure? 1. Gloves 2. Gloves and gown 3. Gloves and goggles 4. Gloves, gown, and goggles

Correct answer: 4 Rationale: Click on the Rationale Video button. Irrigation of a wound can cause splashing of the irrigation solution and wound exudates. Contact precautions are required, and the nurse needs to protect herself or himself in the event that splashing occurs; therefore, option 4 is correct.

A client is being discharged to home after 2 weeks with a diagnosis of tuberculosis and is worried about the possibility of infecting family members and others. How should the nurse respond to provide reassurance? 1.The family does not need therapy, and the client will not be contagious after 1 month of medication therapy. 2.The family does not need therapy, and the client will not be contagious after 6 consecutive weeks of medication therapy. 3.The family will be treated prophylactically, and the client will not be contagious after 1 continuous week of medication therapy. 4.The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy.

Correct answer: 4 Rationale: Family members or others who have been in close contact with a client diagnosed with tuberculosis are placed on prophylactic therapy with isoniazid for 6 to 12 months. The client usually is not contagious after taking the medication for 2 to 3 consecutive weeks. However, the client must take the full course of therapy (for 6 months or longer) to prevent reinfection or medication-resistant tuberculosis.

A man has been admitted to the surgical unit after 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

Correct answer: 4 Rationale: 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 clients who are HIV positive unless some additional specific infection is present.

An adolescent is diagnosed with conjunctivitis, and the nurse provides information to the adolescent about the use of contact lenses. Which statement by the client would indicate the need for further information? 1. "I should not wear my contact lenses." 2. "New contact lenses should be obtained." 3. "My old contact lenses should be discarded." 4. "My contact lenses can be worn if they are cleaned properly."

Correct answer: 4 Rationale: If the adolescent wears contact lenses, he should be instructed to discontinue wearing them until the infection has cleared completely. Securing new contact lenses will eliminate the chance of reinfection from contaminated contact lenses and will also lessen the risk of a corneal ulceration.

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.

Correct answer: 4 Rationale: 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.

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 a mask or face shield

Correct answer: 4 Rationale: Splashes of body secretions can occur when providing colostomy care. Goggles and a mask or 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.

The nurse is preparing to nasotracheally suction a client with acquired immunodeficiency syndrome (AIDS) 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. Gown, mask, and protective eyewear 3. Gloves, gown, and protective eyewear 4. Gloves, gown, mask, and protective eyewear

Correct answer: 4 Rationale: 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.

The nurse is preparing to care for a client with acquired immunodeficiency syndrome (AIDS). In planning infection control for this client, the nurse should implement which form of isolation to prevent the spread of the AIDS virus to others? 1. Strict isolation 2. Enteric precautions 3. Contact precautions 4. Blood and body fluid precautions

Correct answer: 4 Rationale: The AIDS virus is transmitted through contact with oral secretions, sexual contact with infected semen or vaginal secretions, through contact with infected blood or blood products, from mother to fetus during childbirth, or during breast-feeding. Blood and body fluid precautions will prevent contact with infectious matter from the AIDS virus. Strict isolation is not needed and may contribute to feelings of isolation in the client. Enteric or contact precautions alone are insufficient to prevent transmission of the AIDS virus.

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.

Correct answer: 4 Rationale: 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 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

Correct answer: 4 Rationale: The hospitalized client with TB is placed on airborne isolation. An 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 an HEPA mask. Option 2 is incorrect. The mask must be an HEPA mask. Option 3 is an incorrect choice. The mask must be an HEPA mask, and there is no need for gown and gloves unless a wound, body fluid, or blood is involved.

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. Ammonia level of 20 mcg/dL (33.3 mcmol/L) 2. Platelet count of 100,000 mm3 (100 × 109/L) 3. International normalized ratio (INR) of 1.2 seconds 4. White blood cell (WBC) count of 2000 mm3 (2 × 109/L)

Correct answer: 4 Rationale: The normal WBC count is 5000 to 10,000 mm3 (5 to 10 × 109/L). 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 ammonia value is 10 to 80 mcg/dL (6 to 47 mcmol/L). The normal platelet count is 150,000 to 400,000 mm3 (150 to 400 × 109/L). The normal INR is 0.81 to 1.2 for someone who is not on anticoagulant therapy.

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 her hands before removal of the soiled dressing and again before applying the clean dressing.

Correct answer: 4 Rationale: 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 the 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 nurse is giving a bed bath to a client and discovers that an additional washcloth and towel are needed. Which is the most appropriate action to take to obtain the needed items? 1. Ask the unit secretary to get the needed items. 2. Ask a family member to obtain the needed items. 3. Borrow the client's roommate's washcloth and towel. 4. Wash hands, leave the client's room, and obtain the needed items.

Correct answer: 4 Rationale: To avoid spreading the client's germs, the nurse's hands must be washed before leaving. By going to the linen room without washing the hands first, the nurse will spread those germs into the clean linen. It is not appropriate to ask the unit secretary or a family member to obtain the supplies. It is never appropriate to borrow other clients' supplies because this action may spread germs.

Which action by the parent of an infant with respiratory syncytial virus infection who is receiving ribavirin 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

Correct answer: 4 Rationale: 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.