Chapter 22 Surgical Asepsis

A patient was discharged after treatment for a staph infection. The blood pressure cuff and electronic thermometer were kept in the patient's room to prevent transmission of the infection. The nurse bags and sends the equipment to be sterilized. Which method does the nurse recognize as being used for the process?

Gaseous disinfection is used to kill pathogens that are heat sensitive and must remain dry. This is the method used for the blood pressure cuff and electronic thermometer.

The nurse works in an oncology unit. Which action by the nurse violates the principles of sterility maintained in this restricted area?

Goes to the cafeteria with shoes uncovered *When the nurse wears uncovered shoes to the cafeteria, pathogens can be brought back to the unit. Shoes should be left at the hospital and covered when the unit is left

The nurse oversees a sterilization department. Instruments that are going to be sterilized are first prepared for the process. Which preparation step is correct?

Hinged instruments are left unhinged to prevent damage during sterilization preparation.

The registered nurse (RN) is observing the licensed practical nurse/licensed vocational nurse (LPN/LVN) apply a sterile dressing. The LPN/LVN drops part of the dressing on the patient's abdomen and exhibits an intention to use it on the wound. The RN stops the action and opens a new sterile dressing for the LPN/LVN. Which explanation should the RN provide later to the LPN/LVN?

If a sterile dressing touches an unsterile object of any kind, the dressing is contaminated

The licensed practical nurse/licensed vocational nurse (LPN/LVN) works in an extended care facility and assigns patient care to an unlicensed assistive personnel (UAP). The UAP tells the nurse that during a bath it was noted that an old intravenous (IV) site had slight bleeding. Which action should the LPN/LVN take regarding the UAP's report?

Inform the UAP that the nurse will investigate

the nurse in an acute care facility is aware that supplies and equipment need to be sterilized for certain procedures. Which method of sterilization does the nurse recognize as being correct? Select all that apply.

Ionizing radiation is used to sterilize sutures made from biological sources.

The nurse has the position as scrub nurse in the operating room. Which task is delegated to the circulating nurse instead of the scrub nurse?

Leave the operating suite to get needed items.This is a task performed by the circulating nurse who is not scrubbed in.

The nurse works in a hospital setting. The nurse is aware that certain areas are restricted to prevent contamination. Which unit can the nurse be transferred to without needing to follow restriction guidelines?

Medical care units are not restricted. The patients are most likely affected by chronic conditions or short-term infectious diseases, such as chronic obstructive pulmonary disease (COPD) or influenza.

The nurse is part of a committee that meets to discuss how to perform sterile procedures in a timelier manner. One suggestion is to have sterile packs available that will be procedure specific. Which sterile packs does the nurse recognize as fitting this description? Select all that apply.

Neonate circumcision packs Indwelling bladder catheter packs Vaginal examination packs Laceration suturing pack Suture removal packs (consistent and predictable type of supplies and equipment)

The nurse works in an acute care setting. The nurse knows the importance of preventing patients from contracting an illness or infection during hospitalization. Which processes are effective in disease and infection control in this setting? Select all that apply.

-Autoclaving all metal instruments that need to be sterile -Cleaning patient rooms with a chlorine bleach between admissions -.Maintaining sterile principles when performing invasive patient procedures -Practicing the guidelines set for restricted areas of the facility.

The nurse is setting up a sterile field. The nurse needs to add sterile dressings to the sterile field. Which actions will the nurse perform if the additional dressings are in peel-apart packages? Select all that apply

-Avoid touching sterile items or the drape with bare hands.(In order to keep the drape sterile, the nurse will avoid touching the area and the items with bare hands.) -Expose the two open surfaces of the package toward the sterile field.(When peel-apart packages are opened, the opening should face the drape to avoid contaminating the contents with the edges of the package.) -Open the pack and drop the contents on the drape.(The package is peeled back until the sterile contents fall freely without touching the unsterile edges of the package.)

The nurse is preparing to perform a surgical hand scrub. Which assessments will the nurse make prior to starting the scrub? Select all that apply.

-Check that all hair is confined under a cover. -Make sure that hospital-laundered scrubs are on. -Validate that the surgery mask is on correctly. -Be sure to have on the right shoes or shoe covers.

The nurse is working in a hospital setting with patients admitted for multiple diagnoses. Which patient does the nurse recognize as requiring a sterile procedure?

A patient who is prescribed to have an indwelling urinary catheter *The placement of an indwelling urinary catheter is a sterile procedure to avoid introducing pathogens into the patient's body.

The nurse works on an acute care unit. The nurse is aware of the importance of using sterile technique to prevent contamination and infection. Which patient would the nurse recognize as being least likely to require sterile technique?

A patient who needs assistance with changing a colostomy appliance *assisting a patient with the changing of a colostomy appliance does not require sterile technique unless there is a recent surgical wound.

The nurse works in an extended care facility. Which patient does the nurse recognize as needing care involving sterile technique?

A patient with a skin rash with open, weeping blisters.

The nurse works in a long-term care facility. Which reason is the least important for using sterile procedures in this setting?

As in the hospital, pathogens are a concern.

The nurse is preparing to remove sutures as ordered by the health-care provider. The nurse notes that the suture removable pack has a peel-away covering with a plastic tray to hold the instruments. Which action by the nurse increases the possibility of contamination?

Carefully dropping the instruments from the package onto a sterile field Dropping the instruments from the sterile package onto a sterile field is unnecessary and may increase the possibility of contamination. The plastic tray can be used as a mini-sterile field.

The nurse is setting up a sterile field using instruments and supplies sterilized within the facility. Each item is double-wrapped. Which fact about the double-wrapping is correct?

Of the outer wrap, only the inside surface is sterile.

The nurse is opening a sterile pack prepared and sterilized in the hospital. Which procedure for opening the pack is correct?

Open the first flap in the direction away from the nurse *The pack should be positioned so that the first flap opens away from the nurse. This keeps the nurse from reaching across the open pack.

The home care nurse is visiting a patient who performs self-catheterization several times daily for urinary retention. Which patient practice indicates a need for teaching clarification?

Rubber catheters are sterilized by boiling for 10 minutes after use.Catheters used in self-catheterization are either sterile or clean. Rubber-based catheters will deteriorate with boiling. Most insurance companies will pay for a sterile catheter with every use. Cleaning at home is also possible.

The nurse manager is concerned about the number of infections that have occurred on a medical unit. Which guidelines presented by the nurse manager will be effective in helping the nursing staff prevent patient infections? Select all that apply.

That nurses check the expiration date on all products used for patient care (The nurses should check the expiration dates on all products; sterility is only assured up to the expiration date.) That nurses carefully inspect sterile packaging before use of supplies and equipment (The nurse should be reminded to carefully inspect sterile packaging before using supplies and equipment.)

The nurse is preparing to set up a sterile field in a patient's room. Which consideration by the nurse is the least important?

The cleanliness of the surface of the over-the-bed table for locating the sterile field *The cleanliness of the over-the-bed table surface is the least important consideration because the surface will be cleaned with alcohol before the field is set up.

The nurse is working in minor surgery and is setting up a surgical instrument tray. Which item will the nurse send back as a possible source of contamination?

The instrument with a hole in the outer wrapper *hen an instrument has a hole in the outer wrapper, it is considered contaminated and must be sent back

The nurse is pouring a sterile solution into a small cup on the sterile field. Which action by the nurse is considered incorrect?

The label of the solution bottle is opposite the nurse's palm. -The label of the solution bottle is placed into the nurse's hand to prevent solution from running onto the label and obscuring printed information.

The nurse is preparing to perform a straight catheterization on a patient with urine retention. When the nurse gathers the sterile equipment needed for the procedure, the nurse notes a discolored line on the packaging. Which action should the nurse take next?

The nurse should either discard the package or send the package back for sterilization. Another package should be obtained to maintain sterility.

The nurse needs to perform a sterile procedure on a patient. When the nurse arrives in the patient's room, the patient is showering. Which action by the nurse is correct?

The nurse should give the patient sufficient time to finish showering and then return to the patient's room with the sterile supplies.

The nurse is performing a sterile dressing change for a patient when the nurse determines that a sterile gauze wrap is needed. The nurse has the patient turn on the call light and asks another nurse to bring the gauze. Which action by the second nurse will contaminate the existing sterile field?

The second nurse reaches across the sterile field to hand the nurse the unopened package.

The nurse is aware of the principles of surgical asepsis and the conditions that define contamination. Which condition does the nurse recognize as remaining uncontaminated when liquid is spilled on a sterile field

The sterile drape covering the table is backed with a waterproof material *When the sterile drape is backed with a waterproof material, the drape is not considered contaminated if liquid is spilled on the sterile field

The nurse works as a scrub nurse and is preparing to perform hand hygiene for a surgical procedure. Which action is avoided during this preparation?

Use a soft-bristle brush to thoroughly clean hands, arms, and nails. *Brushes are not used during a surgical hand scrub because of the possibility of creating microscopic abrasions on the skin.

The nurse is planning to don sterile gloves for surgery using the closed method. Which steps apply to this method of gloving? Select all that apply.

When donning the gown, the nurse's hands are left inside the cuffs of the gown he sterile glove wrapper is opened by the nurse's hands still while inside the cuffs. This technique needs the assistance of the circulating nurse.

The nurse has applied sterile gloves to assist in surgery. Which activity by the nurse mandates that the nurse's sterile gloves be changed?

When the nurse bends to place an item in the trash can, the nurse's hands have left the safety zone. Items must be dropped from the height of the nurse's waist. The gloves must be changed

The nurse is preparing to change a sterile dressing. At which time during the procedure is it unnecessary for the nurse to wear sterile gloves?

When the old dressing is being removed. *Clean gloves are worn when the old dressing is being removed.

The nurse is preparing to perform a sterile procedure on a patient. The nurse is aware of the principles of maintaining surgical asepsis. Which situation will the nurse recognize as a break in sterile procedure?

When the sterile dressing falls on the edge of the sterile field, it is considered contaminated. One inch inward from the edge is not considered sterile.