305 Chapter 29 Infection Control

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

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. p. 456

After assessing a patient with an infection, the nurse follows contact precautions. Which disease condition does the nurse suspect the patient to have?

Contact precautions are used in conditions that are easily transmitted by direct patient contact or by contact with the patient's belongings. Scabies is an infection that spreads by contact. Pertussis, also called whooping cough, is transmitted by droplets; therefore, the nurse should follow droplet precautions for patients who have pertussis. Chickenpox is an airborne infection; the nurse should follow airborne precautions in this case. Pneumonic plague is a droplet infection; the nurse should follow droplet precautions in this case. p. 459

A registered nurse teaches a nursing student about cleaning instruments before sterilization. Which statement made by the nursing student needs correction?

Contaminated objects should be rinsed with cold water. Hot water should not be used because it causes the protein in organic material to coagulate and stick to objects, which makes removal difficult. The nurse should use a brush to remove dirt or material in grooves or seams. The nurse should wash objects with soap and warm water. Objects should be dried before disinfection or sterilization. p. 455

A nurse cares for a patient who is diagnosed with tuberculosis. Which nursing interventions would be most appropriate to reduce the risk of transmission?

Diseases such as tuberculosis are transmitted by small droplets that remain in the air for longer periods of time. The nurse should wear an N95 respirator whenever entering the patient's room. The nurse should also wear gloves while performing a physical examination to reduce the transmission of infection by direct contact. A specially equipped room with a negative airflow is referred to as an airborne infection isolation room; this room is used to reduce the risk of airborne transmission. Positive airflow is used with patients with allogeneic hematopoietic stem cell transplants as a protective environment precaution. A surgical mask is applied when the patient is 3 feet away or less to reduce the risk of transmission through larger droplet nuclei. The patient, not the nurse, should wear a mask when he or she is outside of his or her room as a protective environment precaution. p. 460

After performing a prescrub wash, a nurse dries his or her hands and forearms with a paper towel. What is the rationale behind this action?

Drying the hands and forearms with a paper towel can promote a reduction in microorganisms on the hands and arms. Repeated drying and dropping the towel into a linen hamper after surgical hand scrub can prevent accidental contamination. Scrubbing the arm by dividing it into thirds can eliminate transient microorganisms and reduce the resident hand flora. Performing hand hygiene twice in a row ensures complete antiseptic coverage on all the surfaces of the hand. p. 478

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?

Gloves need to be changed and hand hygiene performed to prevent transfer of microorganisms from one source (the wound) to another (the nurse's hands). Gloves are not a foolproof method of preventing contamination of the nurse's hands so it is necessary to perform hand hygiene according to approved protocol. Medications should never be left at the bedside. It is the nurse's responsibility to ensure that patients take their medications. pp. 459-460

While performing hand hygiene, the nurse avoids wearing rings. What is the rationale behind this action?

Gram-negative bacilli such as Enterobacter and Staphylococcus aureus are more common under rings; therefore, the nurse should not wear rings to avoid infections. The nurse rubs the hands together by covering all the surfaces of the hands and fingers with antiseptic to ensure complete antimicrobial action. The nurse's fingernails should be less than a quarter-inch long to decrease the number of bacteria residing on hands. The nurse rubs his or her hands together with an antiseptic for several seconds and allows his or her hands to dry before applying gloves to provide enough time for the antimicrobial solution to be effective. p. 471

While caring for a patient with testicular cancer in a health care setting, the nurse observes that the patient develops a urinary tract infection. Which actions of the nurse could be responsible for the development of this health care-associated infection?

Health-care associated infections result from the delivery of health services in a health care facility. Repeated catheter irrigations or improper specimen collection techniques can cause urinary tract infections. The use of contaminated antiseptic solutions may cause surgical or traumatic wounds. The improper care of the intravenous (IV) insertion site may affect the patient's bloodstream. Improper disposal of respiratory exudates may cause respiratory tract infection. p. 448

A patient is diagnosed with a bronchial airway obstruction after performing a bronchoscopy. Which type of infection may the patient contract after performing the test?

Iatrogenic infections are caused by an invasive diagnostic or therapeutic procedure. Patients who underwent a bronchoscopy and are treated with broad-spectrum antibiotics are at a greater risk of developing this type of infection. The use of broad-spectrum antibiotics for the treatment of infection may cause a suprainfection. An exogenous infection is caused by organisms that are found outside of an individual. Endogenous infections occur when a patient receives broad-spectrum antibiotics that alter the normal flora. p. 448

A nurse cares for a patient with diarrhea. The nurse's hands become visibly soiled while cleaning the patient after a diarrheal episode. Which precaution should the nurse follow to disinfect his or her hands?

If the nurse's hands are soiled while cleaning the patient after a diarrheal episode, he or she should wash his or hands with soap and water to disinfect them and avoid transmission of microorganisms. Using only tissues may not disinfect the hands. If the hands are not visibly soiled after cleaning the patient, the nurse should use alcohol-based hand products as a disinfectant. p. 443

A registered nurse evaluates a nursing student after teaching the nursing skills required during sterilization disinfection and cleaning of equipment. Which statements made by the nursing student indicates a need for further teaching?

Implants are considered critical items and must be sterilized. Urinary catheters are considered critical items and must be sterilized. Stethoscopes are considered noncritical items and must be disinfected. Surgical instruments are considered critical items and must be sterilized. Endotracheal tubes are considered semi-critical items and must be sterilized. p. 456

The nurse is reviewing the laboratory reports of four patients. Which lab finding indicates chronic or existing infection?

Iron levels are decreased; in patients with chronic infection as microorganisms utilize iron for DNA synthesis, generation of energy, and carrying oxygen. Normal levels of iron are in the range of 60 to 90 g/100 mL. Normal levels of eosinophils are in the range of 1% to 4%, and increased levels indicate infection in patients. Therefore, an eosinophil percentage of 2% indicates a normal finding. The normal range of a white blood cell count is 5000 to 10,000/mm 3, and it is elevated during infection. A white blood cell level of 6000/mm 3 indicates normal findings. The normal percentage of neutrophils in the blood is 55% to 70%, and elevated levels indicate infection. Therefore, a neutrophil level of 60% indicates a normal finding. p. 451

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?

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.

The nurse is analyzing the laboratory results of a hospitalized patient. The nurse reads the differential count of white blood cells and makes a note that the eosinophils, basophils, and monocytes are within normal limits. The neutrophilic count, which should be between 55% and 70%, is increased to 90%. The lymphocytes, which should be between 20% and 40%, are increased to 60%. What does the increased count indicate?

Lymphocytes are increased when there is chronic viral and bacterial infection. Neutrophils are white blood cells that ingest and destroy microorganisms by a process called phagocytosis. They are increased in cases of acute suppurative infection. Lymphocytes are decreased when there is sepsis, while monocytes increase in tuberculous infection. p. 451

A patient is admitted in the hospital with a diagnosis of meningococcal pneumonia. Which is the priority nursing intervention in this condition?

Meningococcal pneumonia is an infectious droplet infection. Therefore, the patient should be isolated first to prevent the transmission of the disease. The nurse should isolate the patient before performing oral hygiene. The nurse should provide antimicrobial therapy after isolating the patient. The nurse should maintain adequate hydration to promote the patients' health and reduce the risk of infections. p. 459

Which microorganism exits through a man's urethral meatus during sexual contact?

Neisseria gonorrhea exits through a man's urethral meatus or a woman's vaginal canal during sexual contact. Ebolavirus is transmitted through blood or body fluids. Clostridium difficile causes antibiotic-induced diarrhea. Legionella pneumophila grows only at certain temperatures. p. 445

A patient with a urinary tract infection is hospitalized due to severe discomfort. The primary health care provider advises the nurse to provide supportive therapy to the patient. Which actions of the nurse are included when providing supportive therapy?

Patients who require attentive care are provided with supportive therapy, which includes providing adequate rest and nutrition to the patient to improve the patient's defense mechanisms against infections. Maintaining proper hand hygiene, monitoring the patient's response to drug therapy, and the usage of standard precautions while handling patients during therapy are general responsibilities of the nurse while caring for a patient with exogenous or endogenous infections. p. 445

Which factor can alter the defense mechanism of sebum?

Excessive bathing can remove sebum present in the skin, which increases the risk of infections. Abrasions can provide an entrance for microbial infections on the skin. Dehydration can cause infections in the oral cavity. Improper hand washing can cause infections because many microorganisms remain on the skin. p. 447

65 y/o w/ chronic bronchitis developes exogenous HAI; what action by the nurse could have caused this infection?

Exogenous infections are caused by microorganisms found outside the individual such as Aspergillus, Salmonella and Clostridium tetani. Therefore, a patient infected with Aspergillus is considered to have an exogenous infection. Endogenous infections are caused by organisms such as Streptococci or Enterococci. Infections caused by a bronchoscopy or the administration of broad spectrum antibiotics are iatrogenic infections. p. 448

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

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. p. 458

The 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 for contracting an infection to the patients?

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 patients. The Centers for Disease Control and Prevention's (CDC) hand hygiene guidelines recommend that artificial nails should not be worn by health care providers when working with high-risk patients. p. 469

The nurse finds that a patient is a chain smoker and bathes more than five times a day. On assessing medical reports, the nurse finds that the patient is on contraceptive therapy. Based on the nurse's findings, which of the patient's body defense mechanisms may weaken?

Smoking can result in poor oral hygiene and dehydration in the patient. Saliva contains microbial inhibitors, such as lysozyme, which plays an important role in the defense mechanism. However, poor oral hygiene and dehydration may alter this defense mechanism. Excessive bathing may result in the removal of the skin's sebum layer. Sebum is one of the skin's defense mechanisms; it contains fatty acid and kills some bacteria. Oral contraceptives and antibiotics disrupt the normal flora present in the vagina. Smoking affects macrophages and the cilia lining the upper airway, which play a crucial role in defending against microorganisms entering the body through the airway. The shedding of the outer layers of skin cells removes surface microorganisms from the body. Irregular, but not excessive, bathing can result in a failure to shed outer layers of skin cells. Smoking and excessive bathing do not affect any defense mechanisms related to the eyes. p. 447

A 10-year-old patient 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 patient?

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 patients who are susceptible. Streptococcus (beta-hemolytic group B), Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus do not cause rheumatic fever. p. 444

A registered nurse is teaching a student nurse about the various stages of infections. Which statement made by the student nurse indicates a need for additional teaching?

The average incubation period for mumps is 16 to 18 days, but can range from 12-25 days. The recovery of the patient is noticed during the convalescence stage of malaria. Acute infections are noticed during the illness stage. Group A beta-hemolytic Streptococcus causes strep throat manifested by a sore throat, pain, and swelling. Herpetic whitlow is the infection caused by the herpes simplex virus. The nonspecific signs and symptoms, such as itching and tingling, develop during the prodromal stage at the site before the appearance of the lesions. p. 446

Which statement regarding health care-associated infections requires correction?

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. p. 447

What is the name of the interval when a patient manifests signs and symptoms specific to a type of infection?

The illness stage is the interval in which the patient manifests signs and symptoms specific to a type of infection. (For instance, strep throat is manifested by sore throat, pain, and swelling). The incubation period is the interval between the entrance of a pathogen into the body and the appearance of the first symptoms. The prodromal stage is the interval from the onset of nonspecific signs and symptoms (such as a low-grade fever or fatigue) to more specific symptoms. Convalescence is the interval in which acute symptoms of infection disappear. p. 446

A registered nurse teaches a student nurse about how age influences infection prevention and control. Which statements made by the nursing student indicate the need for further learning?

The immune system of the child matures with age. An infant's immune system is incapable of producing immunoglobulins and white blood cells. Cell-mediated immunity decreases with an increase in age because older adults experience alterations in the structure and function of body parts. Young and middle-aged adults have refined defenses and immunity against infections. Breastfed infants receive antibodies through breast milk; these infants have greater immunity than infants who are bottle-fed. p. 449

What is the portal of exit of the influenza virus?

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. p. 444

A patient reporting sore throat and pain while swallowing arrives at the hospital. The laboratory reports revealed the presence of beta-hemolytic group A streptococcus. What would be the patient's stage of infection?

The interval when a patient manifests signs and symptoms (such as a sore throat and pain while swallowing) that are specific to a type of infection is the illness stage. Convalescence is the interval when acute symptoms of infection disappear. The prodromal stage is the interval from the onset of nonspecific signs and symptoms to more specific symptoms. The incubation period is the first stage of the infection process. It is the interval between the entrance of a pathogen into body and the appearance of the first symptoms. p. 446

The nurse cares for a patient with a history of tuberculosis who underwent surgery. Which laboratory parameters would indicate the absence of infection in the patient?

The normal range of monocytes is from 2 to 8%. A monocyte count of 4% indicates the absence of infection. Although the normal range of basophils is 0.5 to 1.5%, a reading of 1% may not indicate the absence of infection. The normal range of neutrophils is between 55 and 70%. This count may increase during acute suppurative infection. The normal range of lymphocytes is between 20 and 40%. This count may decrease in sepsis, which may occur postoperatively. p. 451

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?

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. p. 451

A nurse reviews the laboratory test reports of a postoperative patient. Which finding indicates the presence of infection?

The normal white blood cell (WBC) values range from 5000 to 10,000/mm 3. An increased WBC count of 18,000/mm 3 indicates acute infection. The normal levels of eosinophils range from 1% to 4%. Normal neutrophil levels range from 55% to 70%. The normal erythrocyte sedimentation rate (ESR) is 15 mm/hr for men and 20 mm/hr for women. p. 451

A registered nurse provides guidelines to a nursing student on how to handle sterile instruments. Which statement made by the nursing student indicates effective learning?

The nurse should apply sterile gloves to handle sterile forceps to keep the equipment sterile. Placing a syringe on a clean disposable glove may contaminate the syringe. Hand hygiene indicates cleanliness of hands. Clean hands touching a sterile scissors may still cause contamination. A sterile object should be discarded even if it is untouched when a tear or small break of the covering is observed. p. 467

Which questions posed by a nurse during an assessment indicate that the nurse is assessing existing possible infections?

The nurse should assess the patient's defense mechanisms, susceptibility, and knowledge of how infections are transmitted to provide proper nursing care. The presence of cough and sputum indicates the presence of pulmonary infection. Pain during urination indicates urinary tract infection. Therefore, asking questions about a patient's cough or urination indicate that the nurse is assessing existing possible infections. Questions about a patient's medication show that the nurse is assessing the patient's medication history. Questions about recent diagnostic testing, cuts, or lacerations indicate that the nurse is assessing risk factors that may cause infection. p. 450

A surgeon applies a sterile gown before a procedure. Which actions should the circulating nurse perform?

While a surgeon is applying a sterile gown, the circulating nurse should tie the back of the surgeon's gown securely at the neck and waist. The circulating nurse should prepare the glove package by peeling the outer wrapper. The circulating nurse can open the sterile pack containing the sterile gown. The circulating nurse should not touch the sterile flap, because it may get contaminated. While applying a sterile gown, the surgeon should keep the inside of the gown towards the body. p. 479

Which nursing intervention should a nurse perform while dealing with a patient with a droplet infection?

While caring for a patient with a droplet infection, the nurse should wear a surgical mask when working within 3 feet of the patient to help prevent the spread of infection. Wearing a gown while entering the room is a contact precaution. Wearing a respiratory device and placing the patient in a room with 12 air exchanges per hour should be performed with a patient who has an airborne infection. p. 460

While using an antiseptic hand rub to perform hand hygiene, the nurse feels dryness in his or her hands after rubbing them together for 10 to 15 seconds. What is the reason for this dryness?

While maintaining hand hygiene, if the nurse's hands are dry after rubbing them together for 10 to 15 seconds, an insufficient volume of product was likely applied. Dryness of the hands does not indicate allergic reaction. Ten to 15 seconds is a sufficient amount to time to rub the hands the together. Complete antimicrobial action is not achieved if an insufficient antiseptic solution is applied. p. 471

A nurse performs hand hygiene before providing direct patient care. Which action made by the nurse may cause an infection?

While performing hand hygiene, finger rings should be removed. Wearing rings increases the risk for infection because the skin underneath the rings carries a high bacterial load. The nail tips should be less than a quarter-inch long. Antiseptic should be applied on the palm and both hands should be rubbed together. Any wristwatches and long uniform sleeves should be pushed above the wrist to provide complete access to the fingers, hands, and wrists. p. 471

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

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. p. 477

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

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. p. 469

The registered nurse is evaluating a nursing student who is caring for a patient with an infection. The registered nurse suspects that the nursing student is acting as a transmitter of infection. Which action made by the nursing student would confirm this suspicion?

While providing care for patients who have infections, the nurse should avoid wearing rings because microorganisms may get lodged in the grooves of the ring. Wearing a ring will make the nurse act as a transmitter of infection. Fingernails up to 1/3 inch past the fingertips are safe. The nurse can wear a watch with an expandable band, which can be pushed above the wrist. The nurse can wear long uniform sleeves above the wrists while caring for patient with an infection. p. 471

A patient is diagnosed with a methicillin-resistant Staphylococcus aureus (MRSA) infection of the respiratory system and has a productive cough. The 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 patient as ordered. What interventions should the nurse perform to prevent the spread of infection?

The nurse should be aware of the equipment used in an isolation room and the 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 patient'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 at the bedside of the patient to avoid errors. pp. 461-462

A registered nurse teaches a group of nursing students about home care considerations for patients with infections. Which statement made by the nursing student indicates the need for further learning?

The nurse should check if warm running water faucets at the patient's home. The nurse should determine potential sources of contamination and possible preventive measures. The nurse should evaluate all hand washing facilities in the patient's home. The nurse should anticipate the need for alternative hand washing products for use in emergency and immediate situations. p. 473

A registered nurse teaches a nursing student about preparing a patient for a sterile procedure. Which statements made by the nursing student indicate effective learning?

The nurse should provide guidelines to the patient to avoid contamination while performing the surgery. The patient should avoid touching sterile supplies, drapes, and the nurse's gown and gloves to prevent contamination. If a patient is in pain, the nurse should administer ordered analgesics about half an hour before a sterile procedure begins. The patient should be informed to avoid sudden movements of any body parts that are covered by sterile drapes. The nurse should explain how the surgical procedure is being carried out and what can the patient do to avoid contaminating the sterile objects. The nurse should place a surgical mask on the patient in conditions such as respiratory infections, but this action is not necessary in all cases. p. 467

A registered nurse teaches a group of nursing students about standard precautions to prevent infections. Which statement made by the nursing student needs correction?

The nurse should wash his or her hands with an alcohol-based, waterless antiseptic agent to perform hand hygiene if his or her hands are not visibly soiled. The nurse should follow respiratory hygiene and cough etiquette to prevent droplet infections; therefore, the nurse should remain at least 3 feet away from patients who are coughing. The nurse should dispose of used needles uncapped and in a puncture-resistant container to prevent infections and needlestick injuries. The nurse should perform hand hygiene before, after, and between direct contact with patients to prevent the risk of developing infections. p. 459

Which statement is true regarding donning a sterile gown?

The nurse should wear a sterile gown while caring for a patient with large open wounds and while assisting the healthcare provider during invasive procedures, such as inserting an arterial catheter. A circulatory nurse generally does not wear a sterile gown. Nurses should not apply a sterile gown until after applying a mask and surgical cap. Only certain areas of the gown are considered sterile; the collar and the anterior surface of the sleeves may not be considered sterile. p. 469

What would a nurse use for a high-level disinfection?

The nurse uses chemical sterilants such as hydrogen peroxide, iodophors, phenolics, and quaternary ammonium compounds for high-level disinfection. Moist heat, boiling water, and ethylene oxide gas are used for sterilization. p. 456

A registered nurse is evaluating a student nurse on the skill of open gloving. Which action by the student nurse does the registered nurse correct?

The student nurse should open the inner package of gloves above waist level to prevent contamination of sterile objects. Because the inner surface of the cuff lies against the skin and is not sterile, the nurse should touch the inner side of the cuff to avoid contamination. After wearing a glove on the dominant hand, the nurse should slip the fingers of the gloved dominant hand underneath the cuff of the second glove to avoid contamination. The nurse should avoid touching exposed areas of the skin with a gloved hand to avoid contamination. pp. 447-475

A 56-year-old patient has a severe, productive cough. The patient is diagnosed with tuberculosis (TB) and is placed in an isolation room. What are the possible reasons for this action?

Tuberculosis of the lungs is an airborne infection, so patients with suspected or confirmed active TB are usually treated in an airborne infection isolation room to restrict their movements. This helps to prevent the spread of infection to others. Isolation rooms are not meant for chest x-ray procedures. Isolation of the patient is not required to administer intravenous fluids. Though all patients are prone to secondary contagious infections, the reason for isolation is to prevent the spread of infection from an isolated patient to other patients. Depending on the mode of the spread of infection, there are different isolation precautions, such as an airborne, droplet, contact, and protective environment. p. 448

Which statement regarding vascular and cellular responses is true?

Vasodilation occurs at the site of injury resulting in excessive blood loss at the site. The immediate response to a cellular injury is an acute inflammation. Increased blood flow at the site of inflammation leads to redness and warmth at the site of inflammation. The cellular response involves white blood cells at the site of inflammation. p. 446

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

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. p.445

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

Vehicles such as blood may transmit the hepatitis B virus. Chickenpox, scarlet fever, and tuberculosis can be transmitted through the air or droplet nuclei. p. 445

A patient who is diagnosed with laryngeal tuberculosis requires isolation precautions. The nurse finds that the patient is depressed, angry, and rejected. What is the most appropriate nursing intervention that would provide relief to the patient?

When a patient who has laryngeal tuberculosis is on isolation process, the nurse should follow certain measures to improve the patient's stimulation. The nurse should explain the isolation procedures that are used to maintain infection prevention and control practices and he or she should discuss ways to provide meaningful stimulation to the patient. Darkening the room can increase the patient's sense of isolation. The nurse should allow family members to visit as long as they follow infection precautions. The nurse should explain the patient's risk for depression or anger to the patient's family so they can provide proper emotional support. pp. 460-461

The nurse is assessing a patient who complains of sore throat, fever, and productive cough. The nurse needs to assess for lymph node enlargement. In which area should the nurse palpate?

When a systemic infection occurs, lymph nodes draining the region become enlarged. This patient has an upper respiratory tract infection and cervical lymph nodes will be enlarged. Inguinal lymph nodes are enlarged in cases of infection in the perineal or groin region. Mammary nodes may be enlarged in breast infections, and paraaortic nodes in cases of intraabdominal infections. p. 451

A registered nurse teaches a nursing student about the nursing skills required to care for patients with infections. Which statements made by the nursing student indicate the need for further learning?

When there is a risk of a splash, a nurse should use a gown, mask, and eye protection. The nurses should use clean glove when caring for a patient's mucous membranes. The nurses should use only cleaned equipment. The nurses should instruct and ensure that patients cover their mouths and noses when they cough and sneeze. The nurses should keep bedside table surfaces clutter-free, clean, and dry while performing aseptic techniques. p. 471

The nurse suspects the exit of an infectious organism through a purulent skin discharge. What would be the components of this discharge?

A break in the integrity of the skin and mucous membranes may allow pathogens to exit the body, which may be exhibited by the presence of a purulent drainage. This purulent discharge contains white blood cells and bacteria. Serous exudates may contain serum. Platelets may not be present in any exudates. Sanguineous exudates may contain red blood cells. p. 446

Which equipment is required for surgical hand asepsis?

A paper facemask, protective eyewear, and surgical scrub sponges are required during surgical hand asepsis. Sterile gloves and a counter top surface are required for the preparation of a sterile field. p. 476

Which statement is true regarding the donning and removing of caps, masks, and eyewear?

Eyewear protects the eyes from procedures that have a risk of splashing. Surgical masks and eyewear should be worn in the general nursing units. The hair should be covered with a cap first before putting on the mask and eyewear. If the mask gets moist, the mask should be removed and another mask should be worn even if the procedure takes several hours to complete. p. 468

In the hospital setting, what is the most likely means of transmitting infection between patients?

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. p. 445

The nurse works in a medical-surgical unit. Which patient should the nurse evaluate as the highest risk for health care-associated infections (HAIs)?

Health care-associated infections (HAIs) are those that are acquired by patients in the hospital during their stays. 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 patient is at increased risk of an HAI. Gastroenteritis, fracture, and appendectomy do not increase the risk of HAIs. p. 448

A patient is diagnosed with pulmonary tuberculosis. Which personal protection equipment (PPE) is most important to be worn whenever entering the patient's room?

Patients with pulmonary tuberculosis require airborne precautions because the droplets are smaller than 5 microns and remain for longer periods in the air. Therefore, a respirator is the most appropriate personal protection equipment (PPE) that the nurse should use. Gowns and gloves are most important when a nurse performs a physical examination to avoid a contact infection. A head cap is applied when the nurse is in a surgical room. p. 459

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?

Performing hand hygiene before and after care interrupts the transmission of microorganisms from family members. Hands should be washed before eating or handling food, but gloves are not necessary. In the home care setting, soiled materials should be placed in an impervious plastic or brown paper bag. Immunizations are important, but in this situation, they would not protect against a leg wound infection. pp. 458, 467

Which risk factor causes secondary infections?

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. p. 450

Which nursing intervention requires surgical asepsis?

Surgical asepsis prevents contamination of an open wound and isolates an operative area from the unsterile environment. Thus the nurse would use surgical asepsis at the patient's bedside for suctioning the tracheobronchial airway. Emptying and disposing of drainage suction bottles, keeping drainage tubes and collection bags patent, and placing needleless systems into puncture-proof containers indicates that the nurse is reducing reservoirs of infection. p. 467

Which part of a sterile gown is actually considered sterile?

The anterior surface of the sleeves is considered sterile. The collar of the gown, the area below the waist, and the underside of the sleeves are not considered as sterile. p. 469

When does the nurse wear a gown?

The gown serves as a barrier between the patient's blood and/or body fluids and potential contact with the caregiver's skin. In some cases, if the patient's hygiene is unacceptable, it may require the nurse to wear a gown, but it is not the best answer. It is not necessary to wear a gown during medication administration or if the patient has AIDS or hepatitis. pp. 459-460

A 47-year-old patient 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?

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. pp. 450-451

While communicating with a patient who has an infection, the nurse says, "Tell me about your recent major lifestyle change that has occurred." Which factor is the nurse trying to assess?

The nurse is asking about a patient's recent lifestyle changes to learn more about the stressors that may have contributed to a patient's infection. Increased stress results in increased cortisone levels, resulting in decreased resistance to infection. The nurse would not inquire about a patient's lifestyle changes to assess risk factors, recent travel history, or possible existing infections to assess the cause for infections. p. 450

A nurse reviews the data of patients with various infections. Which patient is at highest risk of transmitting infection to others?

While all the illnesses are potentially contagious, the nurse must analyze the data and prioritize which patient is most contagious. Mumps is a viral infection that is most contagious at least 5 days after salivary glands begin to swell. Strep throat is a bacterial infection that is usually no longer contagious after the patient has taken antibiotics for 24 hours. The patient diagnosed with influenza is able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. The transmission of infection for pneumonia varies depending on the cause. Most viral pneumonias resolve within 1 - 3 weeks but can result in a persistent cough for weeks after a person is no longer contagious. p. 446

The nurse is attending to a patient who has a pressure ulcer that needs a dressing change. What actions should the nurse perform to ensure preparation of a sterile field?

A clean, dry, work surface above waist level should be used because a sterile object that is held below the waist is considered contaminated. Bracelets and rings can harbor microorganisms and hence need to be removed. Performing hand hygiene before handling equipment helps to reduce the spread of microorganisms. Checking labels and the condition of the supply gives an idea of any previous opening as an open supply may cause soiling or contamination; also, labels provide information about the date of packaging and other important information about the sterility of the product. The outer edge of the outermost flap should be held when opening the commercial kit as the outer surface is considered unsterile but helps to keep the inner kit sterile. pp. 467-468

The nurse works in a hospital. What precautions are necessary to help prevent health care-associated infections?

A closed urinary catheter drainage system helps to contain microorganisms and prevent the 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 for contracting an infection because irrigation bypasses the normal defenses of the body. Adding drug additives to IV fluids also increases the risk of infections. pp. 447-448

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?

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. p. 464

The nurse cares for a patient who has chickenpox. Which protection barriers should the nurse use?

Airborne precautions should be taken while caring for patients with chicken pox. For this case, the nurse should use a mask and a N95 respirator. Gloves and gowns should be used while in direct contact with patients who are infected with multidrug resistant organisms, such as Clostridium difficile. Goggles should be worn while caring for patients with eye conditions such as conjunctivitis. p. 459

A registered nurse is teaching a student nurse about surgical hand asepsis. Which action of the student nurse can aggravate the risk for contracting an infection?

Allergic skin reactions may occur as a result of the accumulation of scrubbing agents or glove powder under wristwatches. Therefore, the nurse should remove the wristwatch while performing hand asepsis. Longer nails can puncture gloves; therefore the nurse maintains a nail length of less than ¼ inch to ensure safety. Jewelry can cause the accumulation of scrubbing agents or glove powder. Therefore, the nurse should remove bracelets and rings while performing surgical hand asepsis. Artificial nails are known to harbor gram-negative microorganisms and fungi. Therefore, to avoid contamination, the nurse should remove artificial nails before performing surgical hand asepsis. Chipped and old nail polish retains microorganisms. Therefore, the nurse should remove chipped and old nail polish to prevent infections. p. 476

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?

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. p. 445

Which equipment is used to sterilize surgical instruments?

Autoclaves use moist heat to kill pathogens and spores on surgical instruments to prevent infections. Boiling water is used to clean urinary catheters, suction tubes, and drainage collection devices. Chemical sterilants are used to disinfect heat-sensitive instruments and equipment such as endoscopes and respiratory therapy equipment. Ethylene oxide (ETO) gas is used for medical materials. p. 456

Which patients are at a low risk of disease transmission?

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. pg. 443

The nurse is assessing a group of patients in a health screening program. What should the nurse evaluate when assessing the infection risk in these patients?

A patient's nutritional health directly affects the patient's susceptibility to infection. Assessing immunization details is important to understand which vaccines have been given as preventive measures. The travel history can reveal important information regarding the risk of exposure to communicable diseases. The medication history will help to identify any medications that can increase the susceptibility of infections. Comparing monthly earnings is unrelated to assessment of risk for contracting an infection. pp. 449-450

What noncritical item used requires a surface disinfection?

A stethoscope is a noncritical item that requires disinfection. An endoscope is a semi-critical item that requires high-level disinfection. An intravascular catheter is a critical item that requires sterilization. Anesthesia equipment is a semi-critical item that requires high-level disinfection. p. 456

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 line of another patient. What should the nurse do?

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 patient without performing hand hygiene, the infection is likely to spread to the other patient. 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 for contracting an infection if performed before hand hygiene. The IV line needs to be unblocked immediately, so the nurse should attend to the patient with the blocked IV line before completing the dressing of the patient with cellulitis. p. 448

A 30-year-old patient with a history of irritable bowel syndrome complains of diarrhea. The nurse finds that the patient is infected with Clostridium difficile and is on appropriate treatment. What could be the most likely reason for the patient's current complaints of diarrhea?

The patient currently has diarrhea related to Clostridium difficile. Clostridium difficile is an organism that is increased in proportion to beneficial microorganisms by taking antibiotics. (The resulting diarrhea is known as antibiotic-induced diarrhea.) Therefore, the most likely reason for this particular patient's current complaints of diarrhea is the use of antibiotics. If a patient in a hospital setting acquires Clostridium difficile and has not been on antibiotics, the diarrhea is most likely due to cross contamination from another patient. A secondary viral infection could be a reason for diarrhea but not the most likely reason in this situation. Because the patient has a history of irritable bowel syndrome, which can cause diarrhea as well, it could also be a reason. However, Clostridium difficile is a more likely cause given that the patient is currently infected with it. Clostridium difficile is an anaerobic bacterium that thrives where little or no free oxygen is available. Aerobic bacteria require oxygen to survive and are not the cause of this patient's diarrhea. pp. 446-447, 460

A patient admitted to the hospital for fever, diarrhea, and vomiting receives the lab reports. The neutrophils are 20%. The patient becomes worried and asks the nurse about it. What is the probable reason for a reduced neutrophil count?

The patient has a reduced neutrophil count , which is seen in overwhelming bacterial infections such as sepsis. In these cases, more neutrophils are destroyed faster than they can be reproduced by the bone marrow. Allergy, viral infections, and mild food poisoning are not associated with low neutrophil counts. p. 451

A patient has an indwelling urinary catheter. Why does an indwelling urinary catheter present a risk for urinary tract infection?

The presence of a catheter in the urethra breaches the natural defenses of the body . The reflux of microorganisms up the catheter lumen from the drainage bag or backflow of urine in the tubing increases the risk of infection. A catheter can help in keeping an incontinent patient's skin dry, but that normally does not lead to a urinary tract infection. The catheter can become caught up in the linens or with other equipment, but that does not cause a urinary tract infection. A patient with a catheter is producing urine and urinating; thus the patient is staying hydrated and still urinating. p. 448

A patient reporting itching and tingling arrives at the hospital. The nurse suspects a herpes simplex infection and keeps the patient in an isolation room. What would be the patient's stage of infection?

The prodromal stage is the interval from onset of nonspecific signs and symptoms to more specific symptoms. During this stage, microorganisms grow and multiply and the patient may be capable of spreading the disease to others. Therefore, the patient may be in an isolation room to reduce the spread of infection. The illness stage is the interval when a patient manifests signs and symptoms that are specific to a type of infection. The convalescence stage is the interval when acute symptoms of an infection disappear. The incubation period is the first stage of the infection process; it is the Interval between the entrance of the pathogen into the body and the appearance of the first symptoms. p. 446

During which stage is a patient capable of spreading a disease because microorganisms are growing and multiplying?

The prodromal stage is the time interval of onset of nonspecific symptoms to more specific symptoms. During this stage, microbes grow and multiply and the patient is capable of spreading the disease to others. The illness stage is the time interval when a patient manifests signs and symptoms specific to the type of infection. The incubation period is the time interval between the entrance of a pathogen into the body and the appearance of the first symptoms. The convalescence stage is the time interval when acute symptoms of infection disappear. p. 446

The nurse is dressing the surgical wound of a patient in the intensive care unit of a hospital. Which skill should the nurse develop to ensure full dexterity while using gloved hands after applying a sterile gown?

To ensure full dexterity while performing the task with gloved hands, the nurse should wear the gloves with fingers completely extended into them. The nurse cannot dress the wound properly when the fingers do not extend into the gloves. The nurse should use the gloved, nondominant hand to pull on the other glove in order to maintain sterility, but this does not ensure full dexterity. To ensure sterility, the nurse picks up a glove for the nondominant hand by grasping the gown's folded cuff. The nurse should open the inner, sterile glove package with hands covered by gown sleeves to ensure sterility and avoid contamination. pp. 479-480