NUR-300 Exam 1: Ch. 27-28 EAQ
During an infection control surveillance study, the nurse reviews medical records and identifies that which person is at an increased risk for an airborne infection?
A neonate, a 78-year-old who is hospitalized, a resident of an assisted-living facility
Which patient is at risk for developing a health care-associated infection (HAI)?
A patient who underwent bronchoscopy A patient who receives broad-spectrum antibiotics A patient who has an indwelling urinary catheter A patient who suffers from diabetes mellitus
An 18-year-old patient is brought to the emergency department after a motor vehicle accident. Which factor is a possible cause of motor vehicle accidents in this age group?
Drunk driving Fast driving Carelessness regarding road hazards
When educating a nursing student about the transmission of infection, the nurse would discuss which item that can easily lead to cross-infection by indirect contact?
Eating utensils Urinal Bedpan Bath basin Bedclothes
After receiving education about controlling the exit and entry of microorganisms, which statement made by the patient indicates the need for further learning?
"I will apply water-insoluble ointment to my lips"
The nursing student is teaching a parent about toddler care. Which instruction provided by the nurse indicates effective teaching?
"Immunize with all recommended vaccines"
The nurse expects which neutrophil count in an acute suppurative infection?
75% (healthy range: 55%-70%)
The nurse would determine that which patient is at the highest risk of health care-associated infections (HAIs)?
A 53-year old diabetic patient admitted for herniorrhaphy
When the assessment findings of a patient post-hysterectomy include fever, chills, and pain at the incision site, the nurse anticipates that which treatment will be prescribed?
Administer antibiotics Provide adequate nutrition Monitor response to drug therapy
Which intervention is no longer recommended for routine home treatment of poisoning cases?
Administration of ipecac syrup
Which manifestation is an effect of lead poisoning in a child?
Adverse effects on child's growth Learning and behavioral problems Brain and kidney damage
The nurse expects which assessment finding in a patient with an abscess on the arm and a suspected systemic infection?
Anorexia Malaise Enlarged lymph nodes Elevated body temperature
The nurse would suspect which cause of an older patient's health care-associated exogenous infection?
Aspergillus
Which microorganism can cause an exogenous infection?
Aspergillus Clostridium tetani
The nurse is performing fall prevention measures for a patient. During which step of the nursing process does the nurse perform a "timed up and go" (TUG) test if a patient is able to ambulate?
Assessment
The nurse is reviewing the manufacturer's instructions for the restraint application before entering the patient's room. Which step in the nursing process is the nurse demonstrating?
Assessment
Which cellular component makes up purulent exudate?
Bacteria, neutrophils, monocytes, white blood cells (WBCs)
Which care intervention would reduce the risk of sudden infant death syndrome (SIDS)?
Immunizing the infant
When discussing the chain of infection, which statement made by the nursing student indicates a need for further learning regarding the portal of exit?
In a patient with a urinary tract infection, organisms exit through drainage tubes. The influenza virus is released from the body through the mucous membranes.
Which action by the nurse could be responsible for the development of a urinary tract infection in a patient who is hospitalized?
Repeated irrigations of the urinary catheter Improper urine specimen collection technique
Of which common cause of death in the elderly population would the nurse be aware?
Falls Hypothermia Heatstroke
During a health fair, the 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?
Father Mother Son Daughter
A systematic infection causes which symptoms?
Fatigue, malaise
Which health condition is likely to be observed in people working in cold conditions?
Frostbite Hypothermia
Which skill is implemented by the nurse during the planning phase to prevent falls in patients?
Gathering the equipment and performing hand hygiene
Based on the Centers for Disease Control and Prevention's guidelines, which information would the nurse include in a hand hygiene teaching session for health care workers?
Handwashing is defined as the vigorous, brief rubbing together of all surfaces of lathered hands followed by rinsing under a stream of warm water for 15 seconds
Which nursing measure lowers the risk of death caused by sudden infant death syndrome (SIDS)?
Having the baby sleep on the back
Following a skin puncture from a needle that had been used on a patient, the nurse would be tested for which type of infection?
Hepatitis B virus
Which condition is an example of a communicable disease that can be asymptomatic?
Hepatitis C virus (HCV)
To reduce the risk of infectious diseases, which vaccine is recommended in older adults?
Influenza Pneumonia
Which major reservoir hosts the microbe that causes gas gangrene?
Organic matter
When an older patient's assessment findings include a fever, diarrhea, vomiting, and a neutrophil count of 20%, the nurse suspects which type of infection?
Overwhelming bacterial infection
The nurse identifies that which patient's differential count is indicative of a rickettsial infection?
Patient 2 - Basophils: 0.1% Monocytes: 10% (normal value: 2%-8%) Lymphocytes: 25% Eosinophils: 2%
Which patient has the highest susceptibility to infection?
Patient 4: second-degree burns
Which patient is at highest risk of transmitting an infection to others?
Patient A: Headache 2 days after glands began to swell - Mumps
Which patient's laboratory finding indicates a chronic or existing infection?
Patient A: The total iron level in the blood is 30 mcg/100dL (normal levels 50-175 mcg/dL)
Place the chain of infection in the correct order
Reservoir Port of exit Mode of transmission Port of entry Susceptible host
Which statement is true regarding use of patient restraints?
Restraints are a part of the patient's prescribed medical treatment and plan of care
Which priority postoperative nursing diagnosis does the nurse include in the care plan of a patient who states, "I am a diabetic, and I haven't been allowed to eat or drink anything. Also, I am worried about having anesthesia while my open leg fracture is being repaired"?
Risk for infection
A patient reports difficulty seeing object at a distance after a cerebrovascular accident. Which result would the nurse anticipate?
Risk of falls
Which explanation would the nurse give when a patient with tuberculosis (TB) asks why isolation in a special kind of room is necessary?
To prevent the spread of the disease to other people To provide negative-pressure airflow
Which is an example of The Joint Commissions' 2021 National Patient Safety Goals?
Use correct identifiers for patient identification
Which question would the nurse ask a patient to determine environmental comfort in a patient's home?
"Are you using space heaters?" "Are you using an air conditioning system?" "Are your fire extinguishers routinely serviced?"
The registered nurse is teaching the parent of a toddler about interventions to promote safety. Which statement made by the parent indicates the need for further teaching?
"Avoid installing safety locks on floor-level cabinets"
Which question would be appropriate for the nurse to ask when assessing home maintenance and safety for a patient?
"Do you have someone to call in case of an emergency?"
Which statement by the nurse reflects an intervention directed at eliminating an environmental threat for an inpatient individual?
"I have placed your call light right next to your bed so you can reach it"
The registered nurse is teaching a nursing student about interventions that would be performed in the event of an accidental poisoning. Which statement indicates a need for further teaching?
"Induce vomiting if the victim has ingested furniture polish, grease, or petroleum products"
The registered nurse is instructing a nursing student regarding providing safety tips to the parent of a preschooler. Which statement made by the nursing student requires correction?
"Instruct your child about proper bicycle safety"
The nurse has attended a community neighborhood safety workshop about precautions to minimize the chance of becoming a victim of a crime. When sharing information with others, which statement will the nurse include?
"Keep the doors locked while driving" "Always park the car near a bright light or busy public area" "Pay attention while driving to notice if anyone is following"
The registered nurse is teaching a group of student nurses about precautions to be taken when using oxygen tanks in a hospital. Which statement made by a student nurse indicates a need for further teaching?
"Place the oxygen tanks in an upright position on the floor when not in use"
The nurse is preparing to educate the parents about infant safety. Which statement made by the nurse reflects a developmentally appropriate intervention in the home?
"Place your infant on a firm sleep surface" "Keep your infant up to date on immunizations"
A registered nurse is teaching an older adult about safety measures related to the physiological changes associated with aging. Which statement by the patient indicates the need for further teaching?
"Take diuretics in the late evening" "Perform vision and hearing examinations every 2 years"
Regarding a person's susceptibility to infection throughout the lifespan, which statement made by the nursing student indicates the need for further learning?
"The immune system declines as a child grows" "An infant's immune system produces a large amount of immunoglobulins"
Which statement made by the student nurse indicates the need for additional teaching regarding the stages of infection?
"The incubation period for mumps is 1 to 5 days" (incubation period: 16-18 days)
Which outcome would the nurse include when preparing a plan of care for a patient with a risk of falling?
"The patient remains injury free for 1 month"
Which statement made by the patient would indicate effective teaching regarding the transmission of human immunodeficiency virus (HIV)?
"The virus can be spread to another person by contact with body fluids"
In a health care setting, the restraint order for a patient is renewed every 2 hours. Which is likely the age of the patient?
14 years (applies to 9-17 year olds)
Which infectious disease has a low risk or no risk for transmission to caregivers?
Pneumonia Viral meningitis
The nursing team leader intervenes when a staff nurse delegates which task to assistive personnel (AP)?
Preparation of a sterile field
Which order of steps would be correct for applying a belt restraint?
Ask the patient to sit on the bed Apply the belt over clothing Remove wrinkles in clothing Tie through slots in belt Ask patient to lie down in bed
A 62-year-old woman is being discharged home with her husband after surgery for a hip fracture from a fall at home. Which information would the nurse consider when providing discharge teaching about home safety to this patient and her husband?
A safe environment promotes patient activity
The nurse is calculating the fall risk score of an 85-year-old patient using a standard fall assessment tool. Which factor contributes to the patient's overall fall risk?
Age Fall history Medications
Which action describes a patient safety strategy planned by the nurse in the hospital setting?
Applying standards for infection prevention
The nurse instructs the parent of an infant not to leave the mesh sides of a playpen lowered to prevent which accidental trauma?
Asphyxiation
Which organism is normal flora of the human colon that can cause an infection when it is displaced into the bloodstream?
Bacteroides fragilis
Human immunodeficiency virus (HIV) is transmitted via which major reservoir?
Blood, semen, vaginal secretions
A parent calls the pediatrician's office frantic about a bottle of cleaner that the 2-year-old son drank. Which instruction is most important for the nurse to give to the parent?
Call the poison control center
A patient has ingested poison and is found conscious and alert. What action by the nurse is priority?
Calling the local poison control center or the national toll-free poison control center number
A patient has been locked in a poorly ventilated room containing a furnace. Which condition is likely to be observed in the patient after a period of time?
Carbon monoxide poisoning
Which task related to the use of patient restraints can be delegated to assistive personnel (AP)?
Checking on a restraint
The nurse suspects which type of infection when a male patient's iron level is 60 mcg/mL?
Chronic infection (normal iron range for men: 80-180 mcg/mL)
A child in the hospital starts to have a grand mal seizure while in the playroom. Which nursing intervention is the most important during this situation?
Clear the area around the child to protect the child from injury
Which organism causes antibiotic-induced diarrhea?
Clostridium difficile
Which microorganism causes gas gangrene?
Clostridium perfringens
Which term is used to describe an infection that can be transmitted directly from one person to another?
Communicable disease
The nurse caring for a visually impaired patient has increased the frequency of rounding. Based on this intervention, which extrinsic factor is the nurse addressing to decrease the risk of injury to the patient?
Communication issues
Which patient would need a temporary restraint?
Confused patients Patients who repeatedly fall Patients who try to remove medical devices
Which nursing activity is performed during safety planning for a patient?
Consult with occupational and physical therapists for assistive devices Select interventions that will improve the safety of the patient's home environment
The emergency department nurse learns that a tornado just hit the east side of town. Which action would the nurse take first?
Prepare for an influx of patients
Which education would the nurse provide to parents of a 6-month-old infant based on the environmental assessment findings that include the infant's crib in the parent's room, side rails up, mattress in the middle position, small infant blanket, and pacifier in the crib?
Do not leave loose bedding in the crib when the child is present
The nurse has discussed with a patient and their family member the normal changes of aging, specific effects of their recent stroke, associated risks for injury, and how to reduce those risks. Which statement supports the rationale for this educational intervention?
Education regarding hazards reduces the fear of falling
Which element is included among the passive strategies of health promotion?
Enacting public sanitation legislation
Which precaution is necessary to help prevent heath care-associated infections?
Ensure a closed urinary catheter drainage system Change the IV access site if inflamed Use aseptic technique when suctioning the airway
Which nursing process step is demonstrated when the nurse performs a visual examination on a patient who is in restraints and becomes agitated and violent when approached?
Evaluation
The nurse notes a patient has a diagnosis of risk for fall owing to left-sided weakness, which has impaired their gate. Which intervention will the nurse anticipate implementing to address the nursing diagnosis?
Explain the fall risks associated with the patient's stroke
The nurse reviews a student assignment about infections caused by pathogens and identifies which student's listing as accurate?
Student nurse 1: Escherichia coli, colon, urinary tract infection
For a patient who has wrist and ankle restraints, which position will place the patient at risk of aspiration?
Supine
The use of which restraint has been eliminated by many health care agencies because of the risk of fatal injuries>
Jacket
The nurse is changing the dressing of a patient with cellulitis who has been admitted to the hospital. Meanwhile, another health care provider in the same unit asks for the nurse's help with the blocked intravenous (IV) line of another patient. Which action would the nurse take?
Leave the first patient, perform hand hygiene, and then ensure the patency of the IV line
After reviewing medical records, the nurse identifies that the patients with what condition are more susceptible to infections?
Malnutrition Cancer Diabetes Critical illness
Which laboratory parameter is indicative of an acute suppurative infection?
Neutrophil count: 80% (normal range: 55%-70%)
Which action would the nurse take when a patient's assessment findings include a red and tender surgical wound, a new-onset fever, and leukocytosis?
Notify the health care provider (HCP)
The senior nurse is discussing with student nurses the serious reportable events included on the National Quality Forum (NFQ) list. Which environmental event would be discussed?
Patient death caused by burns from agency equipment Patient death associated with falls Patient death caused by electrocution
Arrange the steps in order when the personal protective equipment (PPE) is being applied before entering a patient's room
Perform hand hygiene Put on a gown Apply mask Apply eyewear Put on clean gloves
Which patient would be suspected to have an electrolyte imbalance?
Person exposed to heat for an extended period
Which reason would justify the use of restraints on a disoriented patient?
Helps reduce the risk of patient injury from falls Prevents the patient from removing intravenous (IV) infusions Helps reduce the risk of injury to others by the patient
Which nursing activity is performed during the assessment of a patient?
Identifying patient perceptions of safety needs and risks
An older adult with diminished eyesight accidentally ingests a toxic substance. Which intervention would the nurse follow when caring for this patient?
Identifying the type and amount of substance ingested Assessing for signs and symptoms of ingestion of harmful substances
Because of the changes in the inflammatory and immune processes due to aging, the nurse would expect an older adult with pneumonia to experience which type of response?
Increased fatigue
A patient has accidentally consumed kerosene. Which nursing intervention would further complicate this patient's condition?
Inducing vomiting
The nurse is assessing a patient with impaired mobility. The nurse observes poor coordination and muscle weakness. Which risk would the nurse anticipate in the patient?
Injury
The registered nurse provides various instructions to the caregiver of an infant before discharge from the hospital. Which instruction promotes safety for the infant?
Install deadbolts on exterior doors above the child's reach
Which source is an example of the vehicle mode of transmission for infection?
Intravenous (IV) fluid Food Water
In which order do the stages of infection for mumps occur?
Invasion of the pathogen into the body Incubation period Occurrence of symptoms such as malaise and fatigue Occurrence of a high fever and parotid swelling Convalescence
Why does an indwelling urinary catheter present a risk of urinary tract infection?
It obstructs the normal flushing action of urine flow
Which statement is true about the skin as a primary defense against infections?
It provides a barrier to microorganisms It helps remove organisms when they adhere to outer layers of the skin It contains fatty acid that has an antibacterial action
The nurse recognizes which stage of infection in a patient with herpes simplex who states, "My skin itches and tingles but there are no lesions on my body"?
Prodromal stage
Which stage of the infection process can be described as the onset of nonspecific symptoms and the patient being capable of spreading a disease because microorganisms are growing and multiplying?
Prodromal stage
Which aspect of nursing care is included in supportive therapy that is provided to a patient with infection?
Provide adequate rest Provide adequate nutrition
In a trauma unit, a patient who was injured in a traffic accident begins having seizures. How would the nurse position this patient to prevent traumatic injury caused by seizures?
Raise the side rails of the bed Clear the surrounding area of all furniture
Arrange the events in the order of their occurrence in an acute inflammation
Rapid vasodilation at the site of injury Redness and localized warmth Accumulation of fluid at the site of injury Formation of exudate at the site of injury Formation if granulation tissue if inflammation is chronic
Which precaution would be taken for the patient with muscle weakness while walking?
Rubber-soled shoes
Which natural defense mechanism of the body helps to prevent infections?
Saliva Blinking Macrophages
Which microorganism is associated with an exogenous infection?
Salmonella
To ensure safe use of oxygen in the home by a patient, which teaching point would the nurse include?
Smoking is prohibited around oxygen Do not use electrical equipment around oxygen Special precautions may be required when traveling with oxygen
The nurse reviews a student assignment about infections caused by pathogens and identifies which student's listing as accurate?
Student nurse 1: Escherichia coli Colon Urinary tract infection
Which information would the nurse provide to a patient about using a fire extinguisher?
The fire extinguisher should be used only when a fire is confined to small areas
Which information about chickenpox would the nurse include in an education module related to infectious processes?
The incubation period is 14 to 16 days after exposure Airborne precautions are implemented It can be spread by direct contact
Which statement is true regarding the illness stage of an infection?
The patient has signs and symptoms specific to the infection type
For which condition would the nurse wear gloves and a gown when in the patient's room?
The patient's infection can be transmitted to the nurse via blood or body fluids
An older patient with a history of frequent falls is being admitted for the treatment of tuberculosis. Which intervention will the nurse include in the plan of care to protect the patient from falls?
Use a gait belt to assist the patient with ambulation
Which risk factor is seen in young and middle-age adults?
Use of firearms Substance abuse Inadequate nutrition
A parasitic condition caused by a tick is an example of which mode of transmission?
Vector
When discussing modes of transmission for pathogens, which example would the nurse include?
Vehicle; eating thawed meat that is partially cooked Droplet; an infected person coughs or sneezes Indirect; personal contact of susceptible host with contaminated inanimate object Vector; internal transmission such as a parasitic condition between vector and mosquito Airborne; germs that are suspended in the dust from a construction zone
Human immunodeficiency virus (HIV) infection is transmitted through which mode of transmission?
Vehicles
The nurse suspects which type of infection in a patient with a white blood cell differential count of neutrophils 90%, lymphocytes 60%, monocytes 5%, eosinophils 2%, and basophils 1%?
Viral infection Chronic bacterial infection Acute suppurative infection
Which test would be performed immediately after the nurse experiences an accidental needlestick injury from a needle that was used on a patient with human immunodeficiency virus (HIV)?
Viral load study
The nurse recalls that purulent exudate from a patient's inflamed incision site contains which substance?
White blood cells (WBCs)
Which laboratory value is an indication of acute infection?
White blood cells (WBCs): 18,000/mm^3 (normal range: 5,000-10,000/mm^3)
Which environment would limit bacteria growth?
pH of 3.0
