TEST 3: Chapter 29 Mastering (Fundamentals of Nursing)

To which patients do standard precautions apply?

*A. All patients receiving care B. Patients with blood-borne infections C. Patients with infected, draining wounds D. Patients believed to have an infectious disease RATIONALE: Standard precautions were implemented to provide safety for caregivers and patients regardless of infectious status. The answer choices concerning the use of standard precautions only for patients with blood-borne infections; those patients with infected, draining wounds; or patients believed to have infectious diseases are incorrect because they limit the scope of standard precautions that are used with certain populations.

A patient who had a hysterectomy 10 days ago has come for a follow-up visit. The patient is experiencing pain and itching at the incision site. The nurse suspects a wound infection and performs an assessment for confirmation. When assessing this patient, what actions should the nurse perform to reduce the spread of infection? Select all that apply.

A. Call for a senior nurse. B. Wait for the laboratory results. *C. Perform hand-hygiene practices. *D. Use gloves when assessing the wound. *E. Use appropriate, personal protective equipment. RATIONALE: Proper hand-hygiene practices are important to control the spread of infection to other sites or other patients. 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.

Which disease can be transmitted when a nurse is drawing blood from a patient with an infection?

A. Chickenpox B. Scarlet fever C. Tuberculosis *D. Hepatitis B virus RATIONALE: Vehicles such as blood may transmit the hepatitis B virus. Chickenpox, scarlet fever, and tuberculosis can be transmitted through the air or droplet nuclei.

Which action made by the nurse may contaminate the surface of the sterile item?

A. Disposing of the outer wrapper *B. Holding the arm over the sterile field C. Peeling the wrapper onto the nondominant hand D. Allowing the drape to unfold on a surface above waist level RATIONALE: While adding sterile items, the nurse should not hold the arm over the sterile field because it may contaminate the surface of the sterile item. Disposing of the outer wrapper prevents accidental contamination of the sterile field. The nurse should carefully peel the wrapper onto the nondominant hand. The nurse should allow the drape to unfold on a surface above the waist and work surface to prevent contamination.

Which is a mode of transmission for the human immunodeficiency virus (HIV) infection?

A. Vectors B. Droplet *C. Vehicles D. Airborne RATIONALE: Human immunodeficiency virus (HIV) infections are transmitted through vehicles such as blood and body fluids. Vectors such as mosquitoes transmit malaria. Infections such as Ebola and tuberculosis are transmitted by droplet nuclei. Infections such as influenza, Ebola, and tuberculosis are airborne.

The nurse is caring for a patient 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. An infectious agent B. A vaccine schedule *C. The source of pathogen growth D. A clean surrounding *E. A susceptible host RATIONALE: An infectious agent is the main pathogen or infection-causing organism that spreads through the chain of infection . The source for pathogen growth is the reservoir where the pathogens 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 their 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.

Which environment would limit the growth of bacteria?

*A. Bacteria growing in a pH of 3.0 B. Bacteria growing under dressings C. Bacteria growing in a moist surgical wound D. Bacteria growing in at a temperature of 38° C RATIONALE: Most bacteria prefer an environment within a pH range of 5.0 to 7.0. Therefore, bacterial growth may be prevented in a pH of 3.0. Bacteria grow vigorously in dark environments such as under dressings and within body cavities. Most bacteria require water or moisture for survival. Therefore, bacteria can grow in a moist surgical wound. Bacteria can grow vigorously if the temperature is 38° C because most bacteria grow in an ideal temperature that ranges from 20° to 43° C.

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.

*A. Cover the nose and mouth with a tissue when coughing. *B. Dispose of any contaminated tissue promptly. C. Maintain a distance of at least 2 feet from persons with respiratory infections. *D. Maintain a distance of greater than 3 feet from persons with respiratory infections. *E. Place a surgical mask on a patient if it does not compromise respiratory function. RATIONALE: 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 the infection through droplets. Placing a surgical mask on a patient if it does not compromise respiratory function helps to prevent infection in the patient. A distance of 2 feet is too close and promotes the spread of infection through droplets.

Which vaccinations are recommended to reduce the risk of infectious diseases in older adults? Select all that apply.

*A. Flu vaccination B. DTaP vaccination C. Rubella vaccination D. Varicella vaccination *E. Pneumonia vaccination RATIONALE: Flu and pneumonia vaccinations are recommended for older adults to reduce the risk of infectious diseases. DTaP vaccinations are effective for preventing whooping cough in children. Children are vaccinated for rubella infections. Varicella vaccination is used to prevent chicken pox in children.

Which 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 RATIONALE: Hands become contaminated through contact with the patient's environment. Clean hands interrupt the transmission of microorganisms. Wearing gloves, placing patients in isolation and providing private rooms also can help break the chain of infection, but hand hygiene is the most effective method.

A registered nurse evaluates the nursing assistive personnel who is wearing a mask. Which action made by the nursing assistive personnel indicates a need for correction?

*A. Having a casual conversation while wearing a mask B. Changing an unused mask due to a moist feeling C. Tying the two top ties at the back of the head and above the ears D. Wearing the mask such that the top of the mask fits below the glasses RATIONALE: While wearing a mask, talking should be kept to a minimum to reduce respiratory airflow. A mask that has become moist does not provide a barrier to microorganisms and should be discarded. While wearing a mask, the two top ties should be tied at the back of the head and above the ears. The top of the mask should fit below the glasses.

A nursing student performs surgical hand asepsis after assisting a registered nurse in a surgical procedure. Which action made by the nursing student needs correction?

*A. Keeping the hands below the waist level B. Turning off the faucet using the knees C. Using a continuous motion to rinse from the fingertips to the elbows D. Using a rotary motion to move the towel from the fingers to the elbows RATIONALE: Because the area below the waist level is considered unsterile, the nurse should keep his or her hands above the waist. The faucet should be closed by using the knees to prevent contamination of the hands. The nurse should use a continuous motion to rinse from the fingertips to the elbows, allowing water to run off at the elbows. The nurse should use a rotary motion to move the towel from the fingers to the elbows during drying to dry the skin from the hands to the elbows.

The nurse provides care to four patients with different medical conditions in four units. In which medical unit should the nurse use an N95 respirator? Patient A (medical unit I): Laryngeal Tuberculosis Patient B (medical unit II): Shigella Infection Patient C (medical unit III): Scabies Patient D (medical unit IV):Disseminated Varicella Zoster

*A. Medical unit I B. Medical unit II C. Medical unit III D. Medical unit IV RATIONALE: Laryngeal tuberculosis is an airborne infection that spreads through small droplets. Therefore, the nurse should use an N95 respirator to prevent infection in medical unit I. Shigella infection spreads through contact; contact precautions should be followed in medical unit II. Scabies spreads through contact; contact precautions should be followed in medical unit III. Disseminated varicella zoster spreads through contact; contact precautions should be followed in medical unit IV. TEST-TAKING TIP: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the patient in formats such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and assistant/patient interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking.

A patient who had undergone a hysterectomy 10 days ago came for a follow-up visit. The patient notices purulent drainage at the incision site. The nurse suspects wound infection and performs assessment for confirmation. Which clinical findings would the nurse evaluate? Select all that apply.

*A. Pain *B. Redness C. Paleness *D. Tenderness E. Cold sensation RATIONALE: Pain is an important finding in wound infection because it is due to inflammation. Redness is commonly seen in wounds that are infected. Tenderness is observed in a wound infection due to localized swelling and inflammation. The infected wound appears red; it does not appear pale. The skin around the infected wound is warm to the touch. STUDY TIP: Sometimes learning a fun fact can help you memorize information, such as the signs of inflammation. The cardinal signs of inflammation as established by early Greek and Roman physicians are the four ors: rubor (redness), calor (heat [think calorie]), dolor (pain), and tumor (swelling).

What is the most effective technique in preventing and controlling the transmission of an infection?

*A. Performing hand hygiene B. Using isolation precautions C. Performing sterilization procedures D. Wearing personal protective equipment (PPE) RATIONALE: Performing hand hygiene is the most effective and basic technique in preventing and controlling the transmission of infection. Isolation precautions cannot control the transmission of microorganisms that cause infections unless the nurses and other health care workers follow proper control measures to prevent infections. Performing sterilization procedures help to control the transmission of infections through surgical instruments or other medical materials. Wearing personal protective equipment (PPE) is used to perform procedures that carry the risk of direct contact with contaminated material. This intervention is a more complicated step, however.

Which disease requires contact precautions?

*A. Scabies B. Measles C. Diphtheria D. Pharyngitis RATIONALE: Scabies spreads through skin contact and the nurse should take contact precautions. Measles require airborne precautions. Diphtheria and pharyngitis require droplet precautions.

A licensed practical nurse is preparing to assist in a sterile procedure. Which nursing action is appropriate in surgical hand asepsis?

*A. Scrubbing the hands for 5 minutes B. Washing over the rings and watch C. Keeping the hands and arms below the elbows D. Allowing the water to flow from the elbows to the hands RATIONALE: While performing surgical hand asepsis, the nurse should scrub the hands for 5 minutes to eliminate transient microorganisms and reduce resident hand flora. During a sterilizing procedure, the nurse should remove all jewelry and accessories, such watches and rings. The hands should be above the elbows while performing a surgical scrub.

Which statement regarding health care-associated infections requires correction?

*A. The costs of health care-associated infections are reimbursed. B. Health care-associated infections can significantly increase the cost of health care. C. The length of hospitalization influences the risk of health care-associated infections. D. Health care-associated infections result from the delivery of health services in a healthcare facility. RATIONALE: The costs of health care-associated infections (HAIs) are not reimbursed; therefore, the prevention of HAIs plays an important role in the managed care of health care systems. HAIs can increase the cost of health care because they increase infections in patients. The invasive procedure involved, the therapies received, and the length of hospitalization can influence the risk of HAIs in patients. HAIs can be caused by invasive procedures performed during the delivery of health services in a health care facility. TEST-TAKING TIP: Sometimes reading a question in the middle or toward the end of an exam may trigger your memory with the answer or provide an important clue to an earlier question.

While reviewing the laboratory blood reports of a male patient, the nurse finds that his iron level is 60 mcg/mL. What does the nurse suspect from this finding?

*A. The patient has a chronic infection. B. The patient has a parasitic infection. C. The patient has a suppurative infection. D. The patient has a tuberculosis infection RATIONALE: The normal range of iron level is from 80 to 180 mcg/mL for men and 60 to 160 mcg/mL for women. Iron levels decrease due to infections. Therefore, a male patient with a 60 mcg/mL iron level indicates a chronic infection. Increased levels of eosinophils (levels higher than 4%) indicate a parasitic infection. The normal range of neutrophils is from 55% to 70%. Increased levels of neutrophils indicate a suppurative infection. The normal range of monocytes is from 2% to 8%. Increased levels of monocytes indicate a tuberculosis infection. TEST-TAKING TIP: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

Which risk factor causes secondary infections?

*A. Trauma B. Heredity C. Nutrition D. Chronic disease RATIONALE: Physical trauma may cause fractures and internal bleeding, which may lead to secondary infections. Heredity causes diseases, such as sickle cell disease, diabetes resulting in anemia, and delayed healing. Poor nutrition causes obesity and anorexia, resulting in an impaired immune response. Chronic disease causes chronic obstructive pulmonary disease, heart failure, diabetes resulting in pneumonia, skin breakdown, and venous stasis ulcers.

A patient is suspected of having malaria. Which mode of transmission spreads malaria?

*A. Vector B. Vehicle C. Airborne D. Direct contact RATIONALE: Vector transmission, such as infection by a mosquito, is responsible for malaria. Vehicles such as water, solution, and blood do not transmit malaria. Respiratory infections are possible through the airborne transmission of microorganisms. Malaria is not transmitted by direct contact with infected persons.

Your ungloved hands come into 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. RATIONALE: Physically removing wound drainage is most effectively accomplished by washing with soap and water. According to the Centers for Disease Control and Prevention (CDC), when hands are visibly soiled due to contact with bodily fluids, only cleaning with soap and water and using friction to clean the hands helps prevent contamination.

A provider writes postoperative orders that include cleaning a patient's surgical wound twice daily with sterile normal saline. Which techniques are appropriate when following these orders? Select all that apply.

*A. Wipe around the edge of the wound first. B. Wipe the center of the wound first. *C. Clean outward away from the wound. D. Clean inward toward the wound. E. Clean the wound using strokes in any direction RATIONALE: The surgical wound is considered sterile and the edges of the wound are considered contaminated. To reduce the risk of infecting the wound, the outermost edge of the wound should be wiped first. Then the wound itself should be cleaned, beginning at the center and moving outward away from the wound. This prevents the entry of microorganisms into the wound. Wiping the center of the wound before wiping the outermost edge, cleaning inward toward the wound, and cleaning the wound in any direction all are techniques that would increase risk of wound contamination.

A patient is admitted to a hospital for surgery to correct urinary incontinence. About what should the nurse instruct the patient in order to avoid infections while cleaning the perineal region?

*A. Wipe from the urinary meatus toward the rectum. B. Wipe from the rectum toward the urinary meatus. C. Clean the perineal region once a day. D. Cleaning the perineal area is more important for young women then for older women past menopause RATIONALE: The nurse should instruct the patient about cleaning the perineal region correctly to reduce the incidence of genitourinary infections. The rectum is a highly contaminated area compared to the urinary meatus. It is necessary to wipe the perineal area from the urinary meatus toward the rectum, as cleaning should be done from least to most contaminated regions to reduce infections. Wiping from the rectum to the urinary meatus would increase the risk for contracting infection. Cleaning the perineal area only once a day increases the risk for contracting infection; the perineal region should be cleaned after every voiding and bowel movement. Keeping the perineal region meticulously clean is particularly important for older women who may wear incontinence pads.

The nurse is caring for a patient who is suffering from a gastrointestinal infection. The nurse understands that any infection occurs in four stages. Arrange the stages of infection in the correct order.

1. Incubation period 2. Prodromal stage 3. Illness stage 4. Convalescence RATIONALE: The incubation period is the interval between the entrance of the pathogen to the body and the appearance of the first symptoms. It may vary from one day to several days. The prodromal phase is the interval between the onset of nonspecific symptoms and the appearance of specific symptoms of the infection. At this time, the pathogen multiplies inside the body, and the host is capable of spreading the infection. The illness stage is characterized by symptoms specific to the particular infection. The convalescence stage is the period of recovery from infection. The duration depends on many factors including the severity of infection and the immunity of the host.

In which order does the chain of infection cycle occur chronologically?

1. Infectious agent 2. Reservoir 3. Portal to exit 4. Mode of transmission 5. Portal to entry 6. Host RATIONALE: Infection occurs in a cycle that depends on the presence infectious agents, reservoirs, portal to exit, mode of transmission, portal to entry, and host. First, infectious agents choose a reservoir to multiply. After multiplying, they exit through sites such as the skin, urinary tract, and reproductive tract. These agents find different modes of transmission to enter the host.

A patient is suspected of having mumps. In which order do the stages of infection occur?

1. Invasion of the pathogen into the body 2. Occurrence of pain and a headache 3. Occurrence of symptoms such as malaise and fatigue 4. Occurrence of a high fever and parotid swelling 5. Identification of rubella virus 6. Disappearance of a high fever and parotid swellings RATIONALE: The incubation period is the first stage of the infection process. This period is marked by pain and a headache. This is followed by the prodromal stage, the interval from the onset of nonspecific signs and symptoms such as malaise and fatigue to more specific symptoms. The interval when a patient manifests signs and symptoms specific to type of infection, such as a high fever and parotid swelling is the illness stage. The causative agent may be identified. Convalescence is the interval when acute symptoms of infection disappear. TEST-TAKING TIP: In this question type, you are asked to prioritize (put in order) the options presented. For example, you might be asked the steps of performing an action or skill such as those involved in medication administration.

The nurse is instructed to clean artery forceps contaminated with blood. Arrange the steps of cleaning in the appropriate order.

1. Rinse the artery forceps with cold water. 2. Wash the artery forceps with soap and water. 3. Rinse the artery forceps with warm water. 4. Dry the artery forceps. RATIONALE: Any object contaminated with organic material like blood should be rinsed with cold running water. If hot water is used in the beginning, the protein in the organic material would coagulate and stick to the object. This may make cleaning difficult. After rinsing with cold water, the object should be washed with soap and water. Next, the object should be rinsed in warm water, and finally dried for reuse. TEST-TAKING TIP: For sequencing questions, first look for the first and last steps. Drying the forceps is definitely the last step, so now you are looking for the first step. You know you have to rinse the artery forceps before washing them, so that makes washing the forceps the second step. Now you decide whether to first rinse with cold water and after washing rinse with warm water, or vice versa. To help you remember to not rinse objects contaminated with blood with hot water first, think of frying an egg without any oil or coating on a hot, cast-iron skillet. The egg would be difficult to remove from the pan. Eggs contain protein just like blood contains protein. The coagulation of protein makes it stickier. Therefore, you have your answer: Rinse with cold water, then wash with soap and water, then rinse with warm water, and dry.

A registered nurse teaches a patient about measures to control the exit and entry of microorganisms. Which statement made by the patient needs correction?

A. "I will brush my teeth regularly." B. "I will apply lotion to my skin appropriately." *C. "I will apply water-insoluble ointment to my lips." D. "I will clean my perineal area by wiping from the urinary meatus toward the rectum." RATIONALE: The patient should maintain the integrity of his or her skin and mucous membranes to reduce the risk of microorganism infections. The patient should apply water-soluble ointment to the lips to keep them lubricated and maintain skin integrity. The patient should brush his or her teeth regularly to prevent the drying of mucous membranes. The patient should apply lotion to the skin appropriately to keep the skin lubricated. The patient should clean the perineal area from the urinary meatus toward the rectum to prevent the entry of infectious microorganisms into the urinary tract.

After reviewing the laboratory reports of a patient, the nurse suspects that the patient has an acute suppurative infection. What would be the patient's neutrophil count?

A. 60% B. 65% C. 70% *D. 75% RATIONALE: The normal range of neutrophils in a healthy adult ranges from 55% to 70%. A high neutrophil count (such as 75%) would indicate an acute suppurative infection.

Which patients are at a low risk of disease transmission? Select all that apply.

A. A patient with Ebola B. A patient with influenza *C. A patient with pneumonia D. A patient with chickenpox *E. A patient with viral meningitis RATIONALE: A patient with pneumonia and a patient with viral meningitis are at a low risk of disease transmission. A patient with Ebola, a patient with influenza, and a patient with chickenpox are at a high risk of disease transmission because these conditions can spread through direct contact.

What is an infective disease that can be transmitted directly from one person to another considered?

A. A susceptible host *B. A communicable disease C. A port of entry to a host D. A port of exit from the reservoir RATIONALE: 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. A susceptible host is someone who is more prone to develop an infectious disease process. The port of entry is where microorganisms enter the body and the portal of exit is where microorganisms exit a host such as blood or the skin.

When the nurse is performing surgical hand asepsis, where should the nurse keep his or her hands?

A. Below the elbows *B. Above the elbows C. At a 45-degree angle D. In a comfortable position RATIONALE: Keeping the hands above the elbows when performing a surgical scrub prevents contaminated water from coming into contact with the hands.

What is the portal of exit of the influenza virus?

A. Blood *B. Respiratory tract C. Reproductive tract D. Skin and mucous membrane RATIONALE: The influenza virus is released from the body via the respiratory tract when an infected person sneezes or coughs. Organisms that cause communicable disease such as Hepatitis B and HIV exit from wounds and bloody stool. Organisms such as Neisseria gonorrheae and HIV exit through the reproductive tract during sexual contact. Any break in the skin and mucous membranes allows pathogens to exit the body; the influenza virus does not exit through the skin.

A nursing student uses a surgical mask to assist in a sterile surgical procedure. Which action made by the nursing student indicates a need for correction?

A. Dropping the used mask in a trash receptacle B. Removing the mask when leaving the surgical room *C. Removing the mask by touching the outer surface of the mask D. Tying the two lower ties snugly around the neck RATIONALE: After using a surgical mask, the mask should be removed by untying the bottom mask strings, followed by the top strings. The outer surface of the mask should never be touched while removing it. Used masks should be dropped in a trash receptacle. Surgical masks should be removed before leaving the surgical room to prevent infection. While using a surgical mask, the two lower ties of the mask should be tied around the neck.

Which type of medical equipment is cleaned outside the health care facilities?

A. Endoscopes *B. Drainage collection devices C. Respiratory therapy equipment D. Heat-tolerant surgical instruments RATIONALE: Boiling is done outside health care facilities for items such as drainage collection devices. Endoscopes and respiratory therapy equipment are cleaned by chemical disinfectants in health care settings. Heat-tolerant surgical instruments are cleaned by autoclaves in the health care facilities.

Which microorganism causes gas gangrene?

A. Escherichia coli B. Neisseria gonorrheae C. Staphylococcus aureus *D. Clostridium perfringens RATIONALE: Clostridium perfringens causes gas gangrene. Escherichia coli causes gastroenteritis and urinary tract infection. Neisseria gonorrhoeae causes gonorrhea and pelvic inflammatory disease. Staphylococcus aureus causes wound infection and pneumonia.

The nurse is assessing a group of patients in a health screening program. A patient complains of itching and irritation under the right arm and the nurse suspects a localized infection. What assessments should be done on this patient? Select all that apply.

A. Examine for paleness of skin. *B. Palpate the area for tenderness. *C. Inquire about pain and tightness. *D. Inspect the area for redness and swelling. E. Inquire about gastrointestinal disturbances. RATIONALE: Gentle palpation of the infected area may reveal some degree of local tenderness due to inflammation. Inquiring about pain and tightness is important, because 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 a localized infection, and voila! You are left with the correct answers.

In the hospital setting, what 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 healthcare worker's hands RATIONALE: Hands become contaminated through contact with the patient and the environment and serve as an effective vector of transmission. Exposure to another patient's cough and the sharing of equipment between patients can also lead to cross infection between patients, but proper hand hygiene by all healthcare workers is the most effective way to break the chain of infection. TEST-TAKING TIP: The importance of hand hygiene, hand hygiene, and hand hygiene cannot be overstated.

What major infections are caused by Escherichia coli? Select all that apply.

A. Hepatitis A B. Pneumonia *C. Gastroenteritis D. Food poisoning *E. Urinary tract infections RATIONALE: Gastroenteritis and urinary tract infections are major infections caused by Escherichia coli. The hepatitis A virus causes Hepatitis A. Pneumonia and food poisoning are major infections caused by Staphylococcus aureus.

The nurse pours a sterile liquid into a container. Which action made by the nurse is appropriate?

A. Holding the bottle with its label pointed outside the palm of the hand B. Placing the cap with the inner surface facing down on the table C. Keeping the edge of the bottle close to the edge of the container *D. Pouring a small amount in a disposable cap before pouring in the container RATIONALE: While pouring a sterile liquid into a container, a small amount of liquid should be poured in a disposable cap before it is poured into the container because the discarded solution cleans the lip of the bottle. The cap should be placed with its inner surface facing upwards on the table because the inner surface should not be contaminated. The nurse should hold the bottle with its label in the palm of the hand to prevent the possibility of the solution wetting and fading the label. The edge of the bottle should be kept away from the container.

The nurse is going to perform a procedure on a patient who is positive for the human immunodeficiency virus (HIV) infection. The nurse needs to put on personal protective equipment (PPE). Arrange the steps in the appropriate order.

A. Perform hand hygiene. B. Put on a gown. C. Put on a mask and eyewear. D. Put on gloves. RATIONALE: When complete personal protective equipment is necessary, hand hygiene should be done first. The next step should be to put on the gown, followed by the face mask and eyewear. The last step in this process is to put on the gloves.

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. RATIONALE: Patients on isolation precautions [1] [2] [3] may interpret the needed restrictions as a sign of rejection by the healthcare worker. Explaining the reasons for isolation and providing meaningful stimulation can help the patient accept and adapt to the isolation precautions. Keeping a patient in a dark, quiet room can increase the patient's perception of social isolation and decrease sensory stimulation. Reducing the level of precautions can lead to cross contamination and hospital-acquired infections. Family and caregiver visits do not need to be limited unless the family members or caregivers are immunocompromised.

A patient who had a hysterectomy 10 days ago has come for a follow-up visit. The patient is experiencing pain and itching at the incision site. After assessment, the health care provider suspects the incision site is infected. Which interventions would help control infection? Select all that apply.

A. Reduce water intake. *B. Administer antibiotics. C. Administer anxiolytics. *D. Provide adequate nutrition. *E. Monitor response to drug therapy. RATIONALE: Antibiotics should be administered to control the wound infection. Adequate nutrition is a supportive therapy, which helps in wound healing and recovery from infection. The response to drug therapy should be monitored to plan further management. Reducing water intake is not advisable; instead adequate water intake should be encouraged. Administration of anxiolytics is only considered for anxious patients and not for wound infection.

A registered nurse (RN) teaches a nursing student about applying a sterile gown. The registered nurse instructs the student to lift the folded gown directly upward and step back from the table. What is the reason behind this instruction?

A. To provide proper positioning B. To ensure dexterity *C. To provide a wide margin of safety D. To ensure that the hair is protected from contamination RATIONALE: Lifting the folded gown and stepping back from the table provides a wide margin of safety and avoids contamination of the gown. This action does not provide proper positioning. The nurse's dexterity Is ensured while wearing gloves. Wearing a clean cap protects the hair from contamination.

Which is the most effective way to control the transmission of infection in health care facilities?

A. Vaccinations B. Isolation precautions *C. Hand hygiene practices D. Use of clean equipment RATIONALE: Hand hygiene practices are the most effective way to break the chain of infection and control the transmission of infection. Vaccinations are effective measures to prevent the occurrence of infection in an individual. Even if a patient is isolated, the nurse caring for the patient has a risk of infection. Therefore, the nurse should perform hand hygiene before and after providing patient care. The use of clean equipment without hand hygiene may spread infection.

What is the major reservoir of the microbe that causes gas gangrene?

A. Water B. Oxygen *C. Organic matter D. Undigested food in the bowel RATIONALE: Clostridium perfringens causes gas gangrene; it thrives mostly on organic matter. Some bacterial forms, such as spores, live on a water surface for long periods of time. Aerobic organisms such as Staphylococcus aureus require oxygen for survival and multiplication sufficient to cause disease. Escherichia coli consumes undigested food in the bowel.