Elsevier Chapter 28 Infection Prevention & Control Mastery Quiz
A nurse is planning discharge instructions for a client diagnosed with human immunodeficiency virus (HIV). Which statement made by the client would indicate effective teaching? "The virus cannot spread through sexual contact." "The virus can spread through feces only when I have symptoms of the disease." "The virus can be spread to another person by contact with body fluids." "The virus can cause Rocky Mountain spotted fever."
"The virus can be spread to another person by contact with body fluids." The primary routes of HIV infection are associated with contact of HIV-infected body fluids such as blood or semen, blood transfusions, sharing of infected needles, and needle-stick injuries. The virus spreads through sexual contact, and does not spread through feces. The virus does not cause Rocky Mountain spotty fever, which is caused by Rickettsia rickettsii. TEST-TAKING TIP: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 400
A nurse works in a medical-surgical unit. Which client should the nurse evaluate as the highest risk for health care-associated infections (HAIs)? A 20-year-old client admitted with gastroenteritis A 24-year-old client admitted with a fracture of the leg A 34-year-old client admitted for appendectomy A 53-year-old diabetic client admitted for herniorraphy
A 53-year-old diabetic client admitted for herniorraphy Health care-associated infections (HAIs) are those which are acquired by clients in the hospital during their stay. People whose immunity is compromised are at risk of these infections. Those who are at greater risk include the elderly, the malnourished, or those who have some underlying conditions that compromise their immunity, such as diabetes or malignancies. Therefore, the 53-year-old diabetic client is at increased risk of HAI. Gastroenteritis, fracture, and appendectomy do not increase the risk of HAIs. Test-Taking Tip: Notice how the listings of the three incorrect choices do not include the descriptor of "diabetic" before client. Sometimes the phrasing of the choice can be a clue—in addition to your knowledge of the susceptibility to infection of diabetic clients. Text Reference - p. 403
The nurse works in a hospital. The nurse understands that health care-associated infections (HAI) are difficult to treat. Which client may be at increased risk of developing HAI? Select all that apply. A client who has a fever A client who receives broad-spectrum antibiotics A client who underwent bronchoscopy A client who suffers from diabetes mellitus A client who has an indwelling urinary catheter
A client who receives broad-spectrum antibiotics A client who underwent bronchoscopy A client who suffers from diabetes mellitus A client who has an indwelling urinary catheter Bronchoscopy bypasses the natural defenses of the body and predisposes to HAIs. Broad-spectrum antibiotics suppress the normal flora, and promote growth of resistant strains of microorganisms. An indwelling urinary catheter surpasses the natural defenses and also serves as a port of entry for microorganisms. Diabetes mellitus suppresses the body's immunity, and increases the risk of HAIs. Fever does not affect the natural defense mechanism, and therefore does not increase the risk of HAIs. Text Reference - p. 403
While preparing to do a sterile dressing change, a nurse accidentally sneezes over the sterile field that is on the over-the-bed table. Which of the following principles of surgical asepsis, if any, has the nurse violated? A. When a sterile field comes in contact with a wet surface, the sterile field is contaminated by capillary action. B. Fluid flows in the direction of gravity. C. A sterile field becomes contaminated by prolonged exposure to air. D. None of the principles were violated.
A sterile field becomes contaminated by prolonged exposure to air. Avoid activities that create air currents, such as sneezing. When you sneeze, microorganisms travel through the air by droplets, contaminating the sterile field.
The nurse is caring for a client who has a respiratory infection. The nurse understands that an infection occurs in a cycle, and involves several elements. What are the elements in the chain of infection? Select all that apply. A susceptible host A clean surrounding Source of pathogen growth A vaccine schedule An infectious agent
A susceptible host Source of pathogen growth An infectious agent An infectious agent is the main pathogen or infection-causing organism that spreads through the chain of infection. Source for pathogen growth is the reservoir where the pathogen can multiply, survive, and wait until they are transferred to a susceptible host. A susceptible host is the element in the chain of infection that receives the pathogens and is in a favorable condition for its growth and transmission. A vaccine schedule is the plan of immunization and is not an element in the chain of infection. A clean surrounding is an ideal situation to prevent the spread of pathogens and is not an element in the chain of infection. TEST-TAKING TIP: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass. Text Reference - p. 399
Your ungloved hands come in contact with the drainage from your patient's wound. What is the correct method to clean your hands? A. Wash them with soap and water. B. Use an alcohol-based hand cleaner. C. Rinse them and use the alcohol-based hand cleaner. D. Wipe them with a paper towel.
A. Wash them with soap and water. Physically removing wound drainage is most effectively accomplished by washing with soap and water.
When a nurse is performing surgical hand asepsis, the nurse must keep hands: Below elbows. Above elbows. At a 45-degree angle. In a comfortable position.
Above elbows. Keeping hands above the elbows when performing a surgical scrub prevents contaminated water from contact with hands. Text Reference - p. 421
When a nurse is performing surgical hand asepsis, the nurse must keep hands A. Below elbows. B. Above elbows. C. At a 45-degree angle. D. In a comfortable position.
Above elbows. Keeping hands above the elbows when performing a surgical scrub prevents contaminated water from contact with hands.
To which clients do standard precautions apply? All clients receiving care Clients with blood-borne infections Clients with infected, draining wounds Clients believed to have an infectious disease
All clients receiving care Standard precautions were implemented to provide safety for caregivers and clients regardless of infectious status. Using standard precautions only for clients with blood-borne infections; clients with infected, draining wounds; and clients believed to have infectious diseases is incorrect because this limits the scope of standard precautions that are used to certain populations. Text Reference - p. 410
If an infectious disease can be transmitted directly from one person to another, it is a: Susceptible host. Communicable disease. Port of entry to a host. Port of exit from the reservoir.
Communicable disease. When an infectious disease can be transmitted directly from one person to another, it is termed a communicable disease. No vector is necessary for transmission. Text Reference - p. 399
If an infectious disease can be transmitted directly from one person to another, it is a: A. Susceptible host. B. Communicable disease. C. Port of entry to a host. D. Port of exit from the reservoir.
Communicable disease. When an infectious disease can be transmitted directly from one person to another, it is termed a communicable disease. No vector is necessary for transmission.
The nurse is learning about various modes of infection transmission. What are the vehicles for transmission of infection? Select all that apply. Blood Flies Mosquito Water Food
Blood Water Food Infections can be transmitted through blood, food, and water. These act to help the microorganisms spread from one person to another. Mosquitoes and flies are vectors and can spread infection through external and internal transmission. Text Reference - p. 401
The nurse wears a gown when: The client's hygiene is poor. The nurse is assisting with medication administration. The client has acquired immunodeficiency syndrome (AIDS) or hepatitis. Blood or body fluids may get on the nurse's clothing from a task that he or she plans to perform.
Blood or body fluids may get on the nurse's clothing from a task that he or she plans to perform. The gown serves as a barrier between the client's blood and/or body fluid and potential contact with the caregiver's skin. Text Reference - p. 415
The nurse wears a gown when: A. The patient's hygiene is poor. B. The nurse is assisting with medication administration. C. The patient has acquired immunodeficiency syndrome (AIDS) or hepatitis. D. Blood or body fluids may get on the nurse's clothing from a task that he or she plans to perform.
Blood or body fluids may get on the nurse's clothing from a task that he or she plans to perform. The gown serves as a barrier between the patient's blood and/or body fluid and potential contact with the caregiver's skin.
A nurse who is working in a postoperative unit realizes that there is chipped nail polish on her fingers. Another colleague who has artificial nails tells the nurse that it is not a concern. Which of them poses a greater risk of infection to the clients? There is no risk of infection with either situation. The nurse with artificial nails has a higher risk. The nurse with chipped nail polish has a higher risk. Both nurses have an equal risk of causing infection.
Both nurses have an equal risk of causing infection. Research has shown that health care providers with chipped nail polish or with artificial nails have greater numbers of microorganisms, and therefore pose a greater risk to the clients. The Centers for Disease Control (CDC) hand hygiene guidelines recommend that artificial nails should not be worn by health care providers when working with high-risk clients. Test-Taking Tip: Were you puzzling over whether artificial nails versus chipped nail polish were a higher risk? The best answer included both, because both are a risk. This is an example of why it is necessary to read every choice before finalizing your answer. Text Reference - p. 411
A community nurse is conducting an awareness program for community members with substance abuse problems and sex workers. What should the nurse tell the attendees about prevention of the spread of hepatitis C virus? A symptomatic client cannot transmit hepatitis C. Hepatitis C can be transmitted through the fecal-oral route. Only symptomatic clients can transmit the virus. Both symptomatic and asymptomatic clients can transmit the virus.
Both symptomatic and asymptomatic clients can transmit the virus. Hepatitis C is a communicable disease. A person with or without symptoms can transmit the virus. It is present in blood and body fluids. It can be spread through sexual contact but not through the fecal-oral route. Text Reference - p. 399
Which is the most likely means of transmitting infection between patients? A. Exposure to another patient's cough B. Sharing equipment among patients C. Disposing of soiled linen in a shared linen bag D. Contact with a health care worker's hands
Contact with a health care worker's hands Hands become contaminated through contact with the patient and the environment and serve as an effective vector of transmission.
A nurse is instructed to get a specimen from the feeding tube of a client. What should the nurse do before taking the specimen? Rinse the tube with cold water. Rinse the tube with warm water. Disinfect the tube by scrubbing with alcohol. Remove the tube and take the specimen.
Disinfect the tube by scrubbing with alcohol. It is important for a nurse to know that the feeding tube should be disinfected by scrubbing with alcohol for 15 seconds before taking any specimen. It helps to prevent contamination of the specimen collected. Rinsing the tube with cold or hot water does not prevent contamination. Removing the tube for collecting a specimen is inappropriate. Text Reference - p. 415
The nurse is educating a client on how to prevent the spread of infections. Which client habits should be discouraged to prevent infections? Select all that apply. Covering the mouth or nose when coughing or sneezing Eating thawed meat that is partially cooked Covering food with lids to avoid flies Removing a contaminated wound dressing by self Washing hands after using the toilet
Eating thawed meat that is partially cooked Removing a contaminated wound dressing by self A partially cooked thawed piece of meat is more likely to cause infection since it is stored for a longer duration of time. Also, the wound dressing may have bacteria and removing the dressing by oneself can cause infection. Airborne infection may spread while sneezing; hence sneezes should be covered. Washing hands after using the toilet and covering foods with lids are some of the measures to prevent infection. TEST-TAKING TIP: Careful reading of this question ensures that you see the word "discouraged," and do not automatically read "encouraged" when it is not there. Text Reference - p. 401
A nurse is assessing a group of clients in a health screening program. A client has an abscess under the right arm. The nurse suspects the possibility of a systemic infection. What sign and symptoms may indicate a systemic infection? Select all that apply. Elevated body temperature Increased blood pressure Enlarged lymph nodes Fatigue and malaise Increased appetite
Elevated body temperature Enlarged lymph nodes Fatigue and malaise Fatigue and malaise are the generalized symptoms observed in a systemic infection. A systemic infection leads to enlargement of lymph nodes draining that area and can be palpated. Systemic infections often cause elevated body temperature or fever. Systemic infection leads to a decrease in appetite and blood pressure. TEST-TAKING TIP: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. Text Reference - p. 406
A patient is isolated for pulmonary tuberculosis. The nurse notes that the patient seems to be angry, but he knows that this is a normal response to isolation. Which is the best intervention? A. Provide a dark, quiet room to calm the patient. B. Reduce the level of precautions to keep the patient from becoming angry. C. Explain the reasons for isolation procedures and provide meaningful stimulation. D. Limit family and other caregiver visits to reduce the risk of spreading the infection.
Explain the reasons for isolation procedures and provide meaningful stimulation. Patients on isolation precautions may interpret the needed restrictions as a sign of rejection by the health care worker.
A hospital employee fails to properly dispose of a syringe used on a client, and sustains a needle stick injury. A nurse in the emergency department assesses the hospital employee knowing that the employee is at risk for contracting numerous illnesses from the needle stick injury. Which types of infections could be contracted from the needle stick? Select all that apply. Hepatitis A HIV Hepatitis C Hepatitis B Tuberculosis
HIV Hepatitis C Hepatitis B Hepatitis B, hepatitis C, and HIV can be contracted from a needle stick injury, as they are blood-borne infections. Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV). Hepatitis C is a liver infection caused by hepatitis A virus (HAV). HIV infection is caused by the HIV virus which can result in acquired immunodeficiency syndrome (AIDS). Hepatitis A spreads through the oro-fecal route. Tuberculosis spreads through droplet infection. Text Reference - p. 424
Which of the following is the most effective way to break the chain of infection? A. Hand hygiene B. Wearing gloves C. Placing patients in isolation D. Providing private rooms for patients
Hand hygiene Hands become contaminated through contact with the patient's environment. Clean hands interrupt the transmission of microorganisms.
A patient has an indwelling urinary catheter. Why does an indwelling urinary catheter present a risk for urinary tract infection? A. It keeps an incontinent patient's skin dry. B. It can get caught in the linens or equipment. C. It obstructs the normal flushing action of urine flow. D. It allows the patient to remain hydrated without having to urinate.
It obstructs the normal flushing action of urine flow. The presence of a catheter in the urethra breaches the natural defenses of the body. Reflux of microorganisms up the catheter lumen from the drainage bag or backflow of urine in the tubing increases the risk of infection.
A client's surgical wound has become swollen, red, and tender. You note that the client has a new fever and leukocytosis. What is the best immediate intervention? Notify the health care provider and use surgical technique to change the dressing. Reassure the client and recheck the wound later. Notify the health care provider and support the client's fluid and nutritional needs. Alert the client and caregivers to the presence of an infection to ensure care after discharge.
Notify the health care provider and support the client's fluid and nutritional needs. Early intervention can reduce the risk of sepsis caused by the progression of the infection. Fever depletes body fluid stores, resulting in an increased risk of dehydration, and providing proper nutrition promotes healing. Text Reference - p. 406
A patient's surgical wound has become swollen, red, and tender. You note that the patient has a new fever and leukocytosis. What is the best immediate intervention? A. Notify the health care provider and use surgical technique to change the dressing. B. Reassure the patient and recheck the wound later. C. Notify the health care provider and support the patient's fluid and nutritional needs. D. Alert the patient and caregivers to the presence of an infection to ensure care after discharge.
Notify the health care provider and support the patient's fluid and nutritional needs. Early intervention can reduce the risk of sepsis caused by the progression of the infection. Fever depletes body fluid stores, resulting in an increased risk of dehydration, and providing proper nutrition promotes healing.
A nurse is assessing a group of clients in a health screening program. A client complains of itching and irritation under the right arm and the nurse suspects a localized infection. What assessments should be done on this client? Select all that apply. Palpate the area for tenderness. Inquire about gastrointestinal disturbances. Inspect the area for redness and swelling. Inquire about pain and tightness. Examine for paleness of skin.
Palpate the area for tenderness. Inspect the area for redness and swelling. Inquire about pain and tightness Gentle palpation of the infected area may reveal some degree of local tenderness due to inflammation. Inquiring about pain and tightness is important as they may be caused by edema. Infected areas generally appear red and swollen due to inflammation. Paleness of skin is not a manifestation of infection. Gastrointestinal disturbances are not related to localized infection and may sometimes be found in systemic infections. TEST-TAKING TIP: Narrow the choices first by eliminating answers you know are incorrect. For this question, paleness of skin does not indicate infection and so would be eliminated. Gastrointestinal disturbances are not related to localized infection so that choice would be eliminated. Then reread the others, which are all consistent with localized infection--and voila! You are left with the correct answers. Text Reference - p. 406
A family member is providing care to a loved one who has an infected leg wound. What would you instruct the family member to do after providing care and handling contaminated equipment or organic material? A. Wear gloves before eating or handling food. B. Place any soiled materials into a bag and double bag it. C. Have the family member check with the doctor about need for immunization. D. Perform hand hygiene after care and/or handling contaminated equipment or material.
Perform hand hygiene after care and/or handling contaminated equipment or material. Clean hands interrupt the transmission of microorganisms from family members.
A nurse is changing the dressing of a client admitted to the hospital with cellulitis. Meanwhile, another health care provider in the same unit asks for the nurse's help with the blocked intravenous line of another client. What should the nurse do? Immediately flush the IV line and restore its patency. Inform the other health care provider to leave the IV line as it is. Complete the dressing and then go to the next client. Perform hand hygiene and then ensure the patency of the IV line.
Perform hand hygiene and then ensure the patency of the IV line. Nurses should be aware of the routes through which transmission of infections can occur. During the procedure of changing a dressing, if the nurse handles the IV line of the other client without performing hand hygiene, the infection is likely to spread to the other client. Therefore, the nurse should perform hand hygiene before handling the IV line. Restoring the patency of the IV line requires the nurse to flush the IV line, which may increase the risk of infection if performed immediately. The IV line needs to be unblocked immediately, so the nurse should not delay it. The nurse should not take time to complete the dressing, as it may take time. Text Reference - p. 410
A head nurse is teaching cough etiquette to staff members at the hospital. What should the nurse include in the instructions? Select all that apply. Place a surgical mask on a client if it does not compromise respiratory function. Maintain a distance of greater than 3 feet from persons with respiratory infections. Maintain a distance of at least 2 feet from persons with respiratory infections. Dispose of any contaminated tissue promptly. Cover the nose and mouth with a tissue when coughing.
Place a surgical mask on a client if it does not compromise respiratory function. Maintain a distance of at least 2 feet from persons with respiratory infections. Dispose of any contaminated tissue promptly. Cover the nose and mouth with a tissue when coughing. Cough etiquette involves covering the nose and mouth with a tissue when coughing. It helps to prevent the spread of infections. Disposing of contaminated tissue promptly helps to contain the microbes. Spatial separation of greater than 3 feet from persons with respiratory infections helps to avoid contracting infection through droplets. Placing a surgical mask on a client if it does not compromise respiratory function helps to prevent infection in the client. A distance of 2 feet is too close and promotes spread of infection through droplets. Text Reference - p. 413
Identify the interval when a patient progresses from nonspecific signs to manifesting signs and symptoms specific to a type of infection. A. Illness stage B. Convalescence C. Prodromal stage D. Incubation period
Prodromal stage The prodromal stage is the interval between entrance of a pathogen into the body and appearance of first symptoms.
The nurse has redressed a patient's wound and now plans to administer a medication to the patient. Which is the correct infection control procedure? A. Leave the gloves on to administer the medication. B. Remove gloves and administer the medication. C. Remove gloves and perform hand hygiene before administering the medication. D. Leave the medication on the bedside table to avoid having to remove gloves before leaving the patient's room.
Remove gloves and perform hand hygiene before administering the medication. Gloves need to be changed, and hand hygiene performed to prevent transfer of microorganisms from one source (wound) to another (nurse's hands).
The nurse has redressed a client's wound and now plans to administer a medication to the client. Which is the correct infection control procedure? Leave the gloves on to administer the medication. Remove gloves and administer the medication. Remove gloves and perform hand hygiene before administering the medication. Leave the medication on the bedside table to avoid having to remove gloves before leaving the client's room.
Remove gloves and perform hand hygiene before administering the medication. Gloves need to be changed and hand hygiene performed to prevent transfer of microorganisms from one source (wound) to another (nurse's hands). Text Reference - p. 410
A client is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) infection of the respiratory system and has a productive cough. A nurse auscultates the lungs and finds that the breath sounds are clear. The disposable thermometer used by the nurse indicates fever. The nurse collects a urine specimen of the client as ordered. What interventions should the nurse perform to prevent spread of infection? Select all that apply. Review agency policies and precautions necessary for the specific isolation system. Label the specimen in the bathroom where samples of clients are collected. Place specimen containers on a clean paper towel in the client's bathroom. Clean the bell and diaphragm of the stethoscope with soap and water. Confirm fever using an electronic thermometer.
Review agency policies and precautions necessary for the specific isolation system. Place specimen containers on a clean paper towel in the client's bathroom. Confirm fever using an electronic thermometer. The nurse should be aware of the equipment used in an isolation room and indications for isolation. If the disposable thermometer indicates fever, it is important to confirm it using an electronic thermometer. The nurse also needs to review agency policies and procedures. Methicillin-resistant Staphylococcus aureus (MRSA) can cause a health care-associated infection (HAI). Therefore, the nurse has to take precautions to prevent the spread of infections within the hospital. Specimen containers are to be kept in the client's bathroom appropriately. If a stethoscope is to be reused, the diaphragm or bell should be cleaned with alcohol, rather than soap, and should be set aside on a clean surface to dry completely. After the sample is collected, labeling on the specimen container is to be done in front of the client to avoid errors. Text Reference - p. 417
Which microorganism is associated with an exogenous infection? Staphylococci Enterococci Streptococci Salmonella
Salmonella The microorganisms associated with an exogenous infection are those that do not exist as normal flora in humans such as salmonella. Staphylococci, enterococci, and streptococci are responsible for endogenous infection and exist as normal flora in an individual. TEST-TAKING TIPS: Remember Latin and Greek word parts. For this question "exo-" means out or outside. That is the clue that exogenous means an infection from a microorganism that does not part of normal flora in humans. Text Reference - p. 403
During a health fair a nurse examines a family of four people. The 66-year-old father is healthy with no history of respiratory problems. The 60-year-old mother has a family history of chronic respiratory problems. Their 26-year-old son and 20-year-old daughter have been on medication for asthma since birth. Who should be given the pneumonia vaccine in this case? Select all that apply. None of the family members Son Mother Father Daughter
Son Mother Father Daughter A pneumonia vaccine is available and recommended for all persons with chronic respiratory problems and those over 65 years of age. As the father is over 65 years of age and the mother and both children have chronic respiratory problems, they all need a pneumonia vaccine. Text Reference - p. 406
A 10-year-old client with symptoms of a throat infection develops rheumatic fever. What could be the possible causative organism for the throat infection and rheumatic fever in this client? Staphylococcus aureus Streptococcus (beta-hemolytic group A) Streptococcus (beta-hemolytic group B) Methicillin-resistant Staphylococcus aureus
Streptococcus (beta-hemolytic group A) Streptococcus (beta-hemolytic group A) organisms that cause throat infection can spread to other systems as well. The oropharynx, skin, and perianal areas are the reservoirs of this organism. It causes rheumatic fever in clients who are susceptible. Streptococcus (beta-hemolytic group B), Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus do not cause rheumatic fever. STUDY TIP: The value of a throat culture for Streptococcus (beta-hemolytic group A) goes far beyond a sore throat. To help you remember which beta-hemolytic group is so dangerous, consider that if you knew the answer to this question, you get an "A" in Streptococcus! Text Reference - p. 401
A 47-year-old client has arrived at the clinic after accidentally cutting his forearm with a pair of scissors. Which clinical manifestations would the nurse expect to indicate a local inflammation? Select all that apply. Swelling Vomiting Anorexia Pain Redness
Swelling Pain Redness The local manifestations of inflammation include swelling, redness, and pain. These manifestations are caused by protective vascular reactions that help to combat inflammation. Anorexia and vomiting are systemic manifestations of inflammation. Text Reference - p. 402
A 30-year-old client with a history of irritable bowel syndrome complains of diarrhea. A nurse finds that the client is infected with Clostridium difficile and is on appropriate treatment. What could be the most likely reason for the client's current complaints of diarrhea? The use of antibiotics Secondary viral infection Irritable bowel syndrome Aerobic bacteria
The use of antibiotics The patient currently has diarrhea related to Clostridium Difficile. Clostridium Difficile is an organism that is caused by taking antibiotics (known as antibiotic induced diarrhea). Therefore the most likely reason, for this particular patient's current complaints of diarrhea, is going to be the use of antibiotics. A secondary viral infection could be a reason for diarrhea, but not the most likely in this situation. Since she has a history of irritable bowel syndrome and that can cause diarrhea as well, it could be reason. Given that she is currently infected with Clostridium Difficile that is a more likely cause. Clostridium Difficile is an anaerobic bacteria that thrive where little or no free oxygen is available. An aerobic bacteria requires oxygen to survive and is not the cause of this patient's diarrhea. Text Reference - p. 399
Put the following steps for removal of protective barriers after leaving an isolation room in order: A. Untie top, then bottom mask strings and remove from face. B. Untie waist and neck strings of gown. Allow gown to fall from shoulders and discard. Remove gown, rolling it onto itself without touching the contaminated side. C. Remove gloves. D. Remove eyewear or goggles. E. Perform hand hygiene.
Untie waist and neck strings of gown. Allow gown to fall from shoulders and discard. Remove gown, rolling it onto itself without touching the contaminated side. This sequence ensures that the risk of contamination to other surfaces or health care personnel is minimized.
A nurse is instructed to disinfect urinary catheters, bedpans, endoscopes, and anesthesia equipment. Which of these items is required to be sterile and free of microorganisms, including spores? Bedpans Endoscopes Urinary catheters Anesthesia equipment
Urinary catheters Critical, semicritical, and noncritical are three different categories of sterilization, disinfection, and cleaning, which a nurse needs to know. Items such as urinary catheters are in the critical category and are required to be sterile and free of microorganisms including spores. Endoscopes and anesthesia equipment are semicritical items, whereas, a bedpan is a noncritical item. Text Reference - p. 412
A client who had undergone a hysterectomy 10 days ago came for a follow-up visit. The client experiences pain and itching at the incision site. The nurse suspects wound infection and performs assessment for confirmation. When assessing this client, what actions should the nurse perform to reduce the spread of infection? Select all that apply. Wait for the laboratory results. Call for a senior nurse. Use appropriate personal protective equipment. Use gloves when assessing the wound. Perform hand hygiene practices.
Use appropriate personal protective equipment. Use gloves when assessing the wound. Perform hand hygiene practices Proper hand hygiene practices are important to control the spread of infection to other sites or other clients. The nurse should use gloves when assessing the wound to prevent cross contamination of the wound and her hand. The nurse should use appropriate personal protective equipment (PPE) when assessing the wound to prevent the microorganisms from spreading. Calling a senior nurse may be considered only if there is additional assistance required. Waiting for the laboratory results is not required to perform an assessment. Text Reference - p. 401
The nurse works in a hospital. What precautions are necessary to help prevent health care-associated infections? Select all that apply. Use aseptic technique when suctioning the airway. Change the IV access site if inflamed. Ensure a closed urinary catheter drainage system. Insert drug additives to IV fluids. Frequently irrigate urinary catheters.
Use aseptic technique when suctioning the airway. Change the IV access site if inflamed. Ensure a closed urinary catheter drainage system. A closed urinary catheter drainage system helps to contain microorganisms and prevent spread of infection. An IV access site should be changed as soon as signs of inflammation appear. Inflammation can lead to infection. Microorganisms can be introduced into the airway, if aseptic technique is not followed for suctioning. Repeated catheter irrigation may increase the risk of infection as it bypasses the normal defenses of the body. Adding drug additives to IV fluids also increases the risk of infections. Text Reference - p. 404
What is the best method to sterilize a straight urinary catheter and suction tube in the home setting? A. Use an autoclave. B. Use boiling water. C. Use ethylene oxide gas. D. Use chemicals for disinfection.
Use boiling water. The best sterilizer in a home setting is boiling water.
A nurse is instructed to clean a client's infected surgical wound. How should the nurse apply antiseptic on the wound? Select all that apply. Wipe around the edge of the wound first. Clean the wound using strokes in any direction. Clean inward toward the wound. Clean outward from the wound. Wipe the center of the wound first.
Wipe around the edge of the wound first. Clean outward from the wound. The surgical wound is considered sterile and the edges of the wound are contaminated. To reduce the risk of infecting the wound, the edge of the wound should be wiped first. Then the wound should be cleaned outward from the wound. This prevents the entry of microorganisms into the wound. Wiping the center of the wound first, cleaning inward toward the wound, and cleaning the wound in any direction increases risk of infection. Text Reference - p. 415