Asepsis PrepU

The nurse is caring for a postpartum mother who delivered her second child yesterday. The mother states her older child has just been diagnosed with chickenpox. She is concerned her newborn will develop the disease. How will the nurse likely respond?

"Have you had chickenpox?"

The parent of a pediatric client tells the nurse, "I do not believe in vaccinations." What is the appropriate nursing response?

"Help me understand your perspective about vaccinating."

A client who has been diagnosed with a cold is upset that antibiotic therapy was not prescribed. Which nursing response is most appropriate?

"The common cold is a virus and will not respond to antibiotics."

The client presents to the Emergency Department reporting fever, chills, and a productive cough. The chest x-ray shows an area of infiltrate, and the primary care provider prescribes a broad spectrum antibiotic. Which client teaching statement from the nurse is most appropriate regarding the prescribed drug?

"This antibiotic is the best choice since the causative organism is not known."

The nurse has admitted a client on airborne precautions onto the medical-surgical unit. When the client asks, "When will these airborne precautions be removed?" what is the appropriate nursing response?

"When your sputum culture is negative."

A pregnant woman with a history of genital herpes infection who is near term asks the nurse why she must have a cesarean section when she has not had an outbreak in a "long time". The nurse responds -"You will likely have an outbreak due to the stress of labor and delivery." -"A cesarean section will prevent a herpes outbreak." -"You may have infection in your birth canal that you are unaware of." -"Have you discussed this with your physician?"

"You may have infection in your birth canal that you are unaware of."

In which order should the following steps for putting the first hand into a sterile glove be performed?

1. Carefully open the inner package. Fold open the top flap, then the bottom and sides. 2. Place the inner package on the work surface with the side labeled "cuff end" closest to the body. 3. With the thumb and forefinger of the nondominant hand, grasp the folded cuff of the glove for the dominant hand, touching only the exposed inside of the glove. 4. Keeping the hands above the waistline, lift and hold the glove up and off the inner package with fingers down. 5. Place the sterile glove package on a clean, dry surface at or above your waist. 6. Carefully insert dominant hand palm up into the glove and pull it on. 7. Open the outside wrapper by carefully peeling the top layer back and remove inner package, handling only the outside of it.

Which nursing actions will the nurse perform to assist in the prevention of health care-associated infections (HCAIs)? (Select all that apply.) You Selected:

1.Wash hands between caring for clients. 2.Recommend vaccinations to clients. 3.Educate clients regarding why antibiotics are not used for viral illnesses.

Which practice is a correct application of infection control practices?

A nurse performs hand washing each time the nurse removes a pair of gloves.

Which practice is a correct application of infection control practices? A nurse performs hand washing each time the nurse removes a pair of gloves. A nurse dons a pair of gloves prior to any client contact. A nurse uses an alcohol-based handrub each time that the nurse's hands are visibly soiled. A nurse ensures that the nurse rinses the hands thoroughly after the application of an alcohol-based handrub.

A nurse performs hand washing each time the nurse removes a pair of gloves.

Which patient would the nurse consider the most infectious?

A patient who is in the prodromal stage

The nurse applies an alcohol-based hand rub upon entering the client's room. The client becomes upset stating, "You did not wash your hands!" Which response by the nurse is most appropriate?

Alcohol based hand rub provides the greatest reduction in microbial counts on the skin."

The nurse caring for clients at an outpatient clinic determines that which client is at greatest risk for infection?

An 80-year-old woman

A nursing student is alarmed to learn that the patient whom she has been assigned to provide care is positive for HIV. What infection control strategy should the student apply when caring for this patient?

Apply routine precautions in the same manner as when caring for other patients.

A nurse observed a colleague enter a patient's room to respond to a call bell. The nurse believes that the colleague did not perform hand hygiene prior to giving care. What is the nurse's most appropriate action?

Ask the colleague if he performed hand hygiene before giving care.

The nurse is preparing to don a gown to care for a client requiring contact precautions. When should the nurse don the gown?

Before entering the client's room

A nurse is preparing an operation theater for a surgical procedure. Which of the following points regarding the principles of surgical asepsis should the nurse keep in mind when preparing sterilized surgical instruments? a) Sterility may not be preserved even when one sterile item touches another sterile item. b) When a sterile item touches something that is not sterile, it may not be contaminated. c) A commercially packaged surgical item is not considered sterile if past expiry date. d) Any partially uncovered sterile package need not be considered contaminated.

C

Surgical asepsis is defined as a) Absence of all virulent microorganisms b) Use of handwashing, gowning, and gloving c) Absence of all microorganisms d) Slowed growth of microorganisms

C

When preparing to take a client's blood pressure, the nurse notes that the sphygmomanometer is visibly soiled. What is the correct action by the nurse? -Use the sphygmomanometer. -Send the sphygmomanometer for sterilization. -Cleanse and disinfect the sphygmomanometer. - -Discard the sphygmomanometer in the trash.

C

Which of the following clients should the nurse determine to be at the greatest risk for hospital-acquired infection (HAI)?

Client with a urinary catheter

A nurse is providing care to several clients. The nurse performs handwashing with soap and water instead of an alcohol-based hand sanitizer for a client infected with which pathogen? Select all that apply.

Clostridium difficile Norovirus

When a nurse picks up a client's contaminated tissue without gloves and fails to wash the hands sufficiently, the nurse provides for the client's organisms to be spread by which type of transmission?

Contact

You are donning a pair of sterile gloves. You correctly don the first glove, but inadvertently insert the thumb and index finger into the thumb hole of the second glove. The glove remains intact. Which of the following actions is most appropriate?

Continue to don the glove, then use the other gloved hand to carefully insert the finger into the proper hole.

What is the primary purpose for the demonstrated glove application?

Cover wrist skin

A client has a diagnosis of HIV and has been admitted to the hospital with an opportunistic infection that originated with the client's normal flora. Why did this client most likely become ill from his resident microorganisms? A) the client's normal flora began producing spores B) the client's normal flora proliferated because of nutritional deficit C) the resident microorganisms mutated and have became virulent D) the client's immune system became further weakened

D

The nurse planning to insert an indwelling urinary catheter into a client should utilize which of the following techniques? a) Medical asepsis b) Contact precautions c) Universal precautions d) Surgical asepsis

D

The nurse has completed an intervention with a client. There is no visible soiling on the nurse's hands. Which technique is recommended by infection control practice standards for hand hygiene?

Decontaminate hands using an alcohol-based hand rub.

The nurse is setting up a sterile field to perform a catheterization when the client touches the end of the sterile field. What would be the nurse's next appropriate action?

Discard the sterile field and the supplies and start over

The nurse has finished caring for a client on contact precautions. Which nursing action regarding the stethoscope used to auscultate this client's lungs and bowel sounds is appropriate?

Disinfect it with alcohol swabs

The nurse is inserting a foley catheter for a client. Which nursing action is appropriate if the sterile field is broken during this procedure?

Don another pair of sterile gloves.

Which nursing action carries the greatest likelihood of contributing to the spread of vancomycin-resistant enterococci (VRE)?

Emptying the Foley catheter bag of a client with VRE and then helping the client in the next bed transfer to a chair

Upon review of a client's microbiology culture results, the nurse recognizes which organism as indicative of normal flora?

Escherichia coli in the intestinal tract

Which of the following masks should the nurse don when caring for a client with tuberculosis?

Filtered respirator

A nurse is caring for a client with ringworm. Which microorganism c

Fungi

A child who appears to have a cold sneezes repeatedly in the waiting room without covering the mouth. Which action should the nurse take?

Give the child a box of tissues and ask to cover the face with a tissue every time he sneezes.

An experienced nurse is teaching a student nurse about the proper use of hand hygiene. Which of the following guidelines should the nurse provide to the student? -Hand hygiene is needed after contact with objects near the client. -The use of hand hygiene eliminates the need for gloves. -Hand lotions should not be used after hand hygiene. -The use of gloves eliminates the need for hand hygiene.

Hand hygiene is needed after contact with objects near the client.

A nurse follows surgical asepsis techniques for inserting an indwelling urinary catheter in a client. What is an accurate guideline for using this technique?

Hold sterile objects above waist level to prevent inadvertent contamination.

Unbeknown to him, a nursing student has inhaled droplets containing common cold viruses and is soon to develop a cold himself. Place the following stages of infection in the sequence in which they will occur.

Incubation period Prodromal stage Full stage of illness Convalescent period

A nurse is taking stock of the equipment in the room of an older adult client with pneumonia who has been on parenteral nutrition for a long time. Which equipment can transmit infection to older adult clients?

Indwelling catheter

A nurse changing the linens of a client bed is exposed to urine and performs hand hygiene. Which is a guideline for performing this skill properly following this client encounter?

Keep hands lower than elbows to allow water to flow toward fingertips.

The nurse must assign a room for a client admitted with endocarditis and methicillin-resistant Staphylococcus aureus (MRSA) in the blood. A client with which diagnosis can share a room with this client?

MRSA in the wound

Any microorganism capable of disrupting normal physiologic body processes.

Pathogen

A nurse is working with a 55-year-old woman diagnosed with human immunodeficiency virus (HIV). This nurse also has another client today who has an upper respiratory infection. What is the most important thing the nurse can do to prevent the client with HIV from acquiring the upper respiratory infection?

Perform hand hygiene before and after entering the client's room.

The nurse is caring for a client who has active tuberculosis (TB) and is in Airborne Precautions. The primary care provider orders a computed tomography (CT) examination of the chest. Which action by the nurse is appropriate?

Place a surgical mask on the client and transport to the CT department at the specified time.

The nurse is caring for a client who has active tuberculosis (TB) and is in Airborne Precautions. The primary care provider orders a computed tomography (CT) examination of the chest. Which action by the nurse is appropriate? -Request that the examination be done at the bedside. -Notify the CT department in advance so other clients and staff can be removed from the area. -Place a surgical mask on the client and transport to the CT department at the specified time. -Question the need for the examination, because the client must remain under airborne precautions.

Place a surgical mask on the client and transport to the CT department at the specified time.

The nurse is caring for a client with a latex sensitivity. Which of the following resources would be the most appropriate for the nurse to access when developing the client's plan of care? -Policy for clients with latex sensitivity -The emergency room charge nurse -The infectious disease nurse -Human resources department

Policy for clients with latex sensitivity

The nurse notices a student preparing to enter the room of a client with pulmonary tuberculosis with only gloves on. What is the appropriate nursing intervention?

Remind the student that a fitted N95 respirator is required.

The nurse is caring for a client who has been placed in strict isolation. Which nursing action is appropriate?

Remove fresh fruit from the room.

The nurse begins a task and then realizes that personal protective equipment (PPE) is needed. What is the correct action by the nurse?

Stop and obtain appropriate PPE

A client has an inguinal hernia repair and later develops a methicillin-resistant Staphylococcus aureus (MRSA) infection. What is the most important factor to prevent this infection?

Surgical asepsis

A client is to have an indwelling urinary catheter inserted. Which precaution is followed during this procedure

Surgical asepsis technique

A client has tested positive for methicillin-resistant Staphylococcus aureus after being swabbed on admission to the hospital. Bacterial resistance to antibiotics is an example of Means of transmission Aerobic activity Spore production Survival adaptation

Survival adaptation

A client has tested positive for methicillin-resistant Staphylococcus aureus after being swabbed on admission to the hospital. Bacterial resistance to antibiotics is an example of:

Survival adaptation

A nurse prefers to use an alcohol-based hand rub when providing care for patients. In which case is this practice contraindicated?

The nurse is caring for a client with a C. difficile infection

The nurses on a busy surgical ward use hand hygiene when caring for postsurgical patients. Which action represents an appropriate use of hand hygiene? -The nurse refrains from using hand moisturizer following hand hygiene. -The nurse keeps fingernails less than 1/4 in (0.63 cm) long. -The nurse uses hand hygiene instead of gloves when in contact with blood. -The nurse uses gloves in place of hand hygiene.

The nurse keeps fingernails less than 1/4 in (0.63 cm) long.

A nurse is caring for a client who is diagnosed with tuberculosis. Which nursing intervention promotes infection control based on nursing practice standards for safety?

The nurse places the client in a private room with monitored negative air pressure.

A nurse has finished providing morning care for a patient and is now planning to perform hand hygiene. Alcohol-based hand rub would be inappropriate in which of the following circumstances?

The nurse's hands are visibly soiled.

Personal protective equipment (PPE) is used in health care facilities for primarily which reason?

To protect both the staff and clients from becoming infected by one another

Personal protective equipment (PPE) is used in health care facilities to protect the staff from potentially infected clients.

True

The nurse is preparing to perform handwashing. Place the following steps in the correct order. Use all options.

Turn on the faucet and adjust force and temperature of the water. Wet the hand and wrist areas. Apply soap product. Wash the palms and back of the hands for at least 15 seconds. Pat hands dry with a paper towel. Turn the faucet off with a paper towel.

The nurse is caring for a client with tuberculosis who has been placed in airborne precautions. The nurse has not yet been fitted with an N95 respirator. Which nursing action is appropriate? You Selected:

Use a powered air purifying respirator (PAPR).

The nurse conducting a hand hygiene in-service determines that the participants need additional education when they state that the use of an alcohol-based handrub is appropriate in which of the following situations?

When hands are visibly soiled

Surgical asepsis is defined as

absence of all microorganisms

The nurse is caring for a client with tuberculosis. Which precautions will the nurse select for this client? airborne droplet contact standard

airborne

Which client presents the most significant risk factors for the development of Clostridium difficile infection?

an 81-year-old client who has been receiving multiple antibiotics for the treatment of sepsis

The nurse is reviewing the plan of care for assigned clients. Which client has the highest risk for developing an infection?

an older adult client with a history of heart failure

The nurse conducting a hand hygiene in-service determines that the participants need additional education when they state that the use of an alcohol-based hand rub is appropriate in which situation? a) Before direct contact with clients b) When hands are visibly soiled c) After completing a wound dressing d) After direct contact with clients

b

A client suffers from bloody diarrhea after eating contaminated food at a local restaurant. The client has been infected with a(an): You Selected:

bacteria.

The nurse is caring for a client with a acute viral conjunctivitis. Which precautions will the nurse begin?

contact

An acute medicine unit of a hospital currently has a number of clients who have tested positive for methicillin-resistant Staphylococcus aureus (MRSA). Which measures should the nursing staff prioritize in preventing the spread of MRSA to clients who are currently MRSA-negative?

diligent handwashing practices

Which of the following are names of the transmission-based precautions defined by the Centers for Disease Control (CDC)? Select all that apply.

droplet precautions airborne precautions contact precautions

The nurse and a colleague have admitted a client who is on contact precautions. The nurse and colleague are removing their personal protective equipment and the nurse sees the colleague perform the pictured action. What is the nurse's most appropriate response?

encourage the colleague to remove the glove by grasping the cuff

Which nursing action is a component of medical asepsis?

handwashing after removing gloves

A student nurse is performing hand washing in the clinical setting. Which observation would require the nursing instructor to intervene?

has manicured nails that are 1-in (2.5-cm) long

What is the most common reason people contact health care providers?

infectious disease

The nurse is receiving a confused client with a draining wound onto the medical-surgical unit. Which room assignment will the nurse make? -with a client with a myocardial infarction -into a private room -with another client with a draining wound -with a client with pneumonia

into a private room

The nurse is caring for a client who became very ill after ingesting seafood. How will the nurse document this condition? infectious disease noncommunicable disease contagious disease communicable disease

noncommunicable disease

Any microorganism capable of disrupting normal physiologic body processes is a:

pathogen.

A nursing student is donning sterile gloves to perform routine tracheostomy care for a client. Which behavior by the student would require immediate intervention from the instructor

reaches down to the bed to pick up a sterile drape

The nurse notices a student preparing to enter the room of a client with pulmonary tuberculosis with only gloves on. What is the appropriate nursing intervention? -remind the student that a fitted N95 respirator is required -do nothing, as the precautions observed are appropriate -offer the student a mask -teach that a gown and shoe coverings must be worn in addition to gloves

remind the student that a fitted N95 respirator is required

A client has sexual intercourse with someone infected with HIV. The vehicle of transmission is

semen

A client has a systemic infection that resulted from an untreated urinary tract infection. The client has malaise and is confused. The client is:

septic

An infection or the products of infection carried throughout the body by the blood is called

septicemia.

The nurse who is caring for a client in contact isolation is preparing to conduct an assessment. How will the nurse listen to the client's heart?

stethoscope that remains in the client's room

The nurse is caring for assigned clients who are all stable. Which client should the nurse see first to minimize the spread of infection?

the client who is 48-hours post-surgical procedure

The nurse performs hand hygiene with soap and water before caring for a client. What is the primary rationale for this action?

to eliminate disease-producing organisms from the nurse's skin Explanation:

When the client who has been diagnosed with hepatitis B has been hospitalized, the type of isolation the nursing staff should observe is:

universal precautions.

A nurse has sustained a puncture wound on the hand from a scalpel blade that was left on a used procedure tray. What is the first action by the nurse? -fill out a risk management form -go to employee health for testing -wash the area with soap and water -find out who left the scalpel blade on the procedure tray

wash the area with soap and water