Chapter 23: Asepsis, & Infection Control

An African-American international business traveler asks the public health nurse about his risks of acquiring malaria. The traveler states that he carries the sickle cell gene. The nurse explains:

"Carrying the sickle cell gene prevents you from acquiring malaria." Africans and African Americans living today who have inherited the genetic disease of sickle cell anemia do not contract malaria. This is because the sickled shape of the erythrocyte makes it impossible for the parasite causing malaria to grow and replicate.

A pediatric client's caregiver states, "I will never give my child vaccinations." What is the priority nursing response?

"Help me understand your thoughts about vaccinations."

The nurse is caring for four clients. Which client presents the most susceptibility for infection?

46-year old with a foley catheter following anesthesia Indwelling equipment, such as a urinary catheter, makes the client more susceptible to infection. Antibiotics, when used appropriately to treat a known illness such as strep, do not increase the risk of infection.

septicemia

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

A nurse is caring for four clients. Which client has the highest risk of infection?

An older male with an enlarged prostate can have urine trapped in the bladder leading to urinary tract infections.

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

The nurse is caring for a client with tuberculosis. The prior shift's nurse has placed the client in droplet precautions. Which is the appropriate nursing action?

Change to airborne precautions.

The client is an employee on the medical unit at the local children's hospital. The nurse is an occupational health nurse educating the client on various routes of exposure. The nurse knows that as a hospital employee, the client is most susceptible to infection by what mode of transmission?

Contact Contact may be either direct (pt) or indirect (inanimate object).

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

Hepatitis is classified as a virus that:

causes tissue damage.

Which clients are at a heightened risk for infection? Select all that apply.

client with gastric tube feeding client with an indwelling catheter client with an IV catheter

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

contact

When preparing a sterile field, the nurse notes that bottle of sterile saline was opened 48 hours ago and is half full. What should the nurse do?

discard the bottle

The nurse is caring for an older adult with influenza. Which precautions will the nurse begin?

droplet

Sepsis

means poisoning of tissues

A client comes to the emergency department reporting becoming very ill after consuming shrimp and lobster. How will the nurse document this condition?

noncommunicable disease A noncommunicable disease is caused by food or environmental toxin. Infections diseases, communicable disease, and contagious disease do not describe an illness that is contracted after eating food.

conjunctivitis

pink eye

Which is not appropriate regarding the use of gowns as PPE?

use of one gown per person per shift A new gown should be used by the nurse each time the nurse enters the room.

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. Holding a sterile object above waist level ensures the object is kept in sight and prevents accidental contamination. The outside of the sterile package and the outer 1 in (2.5 cm) of a sterile field are contaminated. Sterile packages should be opened so that the first edge of the wrapper is directed away from the nurse.

The nurse is educating a group of middle school students about viruses. Which of the following will the nurse include in the presentation? Select all that apply.

Immunization is available for some viruses. Viruses are associated with some cancers. The virus enters the host cell's metabolism and replicates itself. A virus invades a living cell many times its size, uses the cell's metabolism, and replicates itself while destroying the cell or changing the cell's genetic makeup. Viruses cause AIDS, chickenpox, colds, cold sores, encephalitis, hepatitis, herpes, HPV, influenza, measles, mononucleosis, mumps, polio, rabies, shingles, pneumonia, and many other diseases. They have been associated with some cancers and leukemias and with many autoimmune diseases.

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 has collected the blood, urine, and stool specimens of a client with meningococcal meningitis. Which precaution should the nurse take when transporting the specimens?

Place the specimens into plastic biohazard bags.

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. Fresh fruit and flowers can carry pathogens and chemicals to which the client should not be exposed. The number of visitors should be controlled to prevent exposure to multiple infection opportunities.

The student nurse asks the nursing instructor to explain why stress can increase the risk of infection. The instructor explains:

Stress causes the body to release cortisol, which can increase the risk of infection.

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 Clients are at risk for healthcare-associated infections when the health care staff does not follow safety guidelines. Medical and surgical asepsis are the primary safety interventions for preventing disease in the health care environment. Clients are at risk for healthcare-associated infections when the health care staff does not follow safety guidelines. Medical and surgical asepsis are the primary safety interventions for preventing disease in the health care environment.

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 12-year-old is being hospitalized for pneumonia. The nurse receives the client's culture and sensitivity report on her tracheal aspirate. The client is infected with a strain of Streptococcus pneumoniae, which is particularly prone to cause infections, also referred to as what?

Pathogenic Pathogenicity is an organism's ability to cause infections.

Surgical asepsis is defined as:

absence of all microorganisms. sterile technique and indicates procedures used to eliminate any microorganisms.

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. Transport clients in Airborne Precautions out of the room only when necessary and place a surgical mask on the client, if possible.

Which practice is a correct application of infection control practices?

A nurse performs hand washing each time the nurse removes a pair of gloves. Hand washing should be performed after the removal of a pair of gloves. Gloves are not required for each and every client contact and visibly soiled hands require a wash with soap and water. Alcohol-based handrubs are not followed by a rinse.

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.

An older adult client has been receiving care in a two-bed room that he has shared with another older, male client for the past several days. Two days ago, the client's roommate developed diarrhea that was characteristic of Clostridium difficile. This morning, the client himself was awakened early by similar diarrhea. The client may have developed which type of infection?

Exogenous healthcare-associated The client's suspected infection originated with another person (exogenous) and was contracted in the hospital (healthcare-associated). It was not the result of his treatment (iatrogenic) and C. difficile is not an antibiotic-resistant microorganism.

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. Hand hygiene is the most important way to prevent transmission of infection.

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

True

Standard precautions apply to blood; all body fluids, secretions, and excretions; intact and nonintact skin and mucous membranes.

True Standard precautions are used in the care of all hospitalized clients regardless of their diagnosis or possible infection status. These precautions apply to blood, all body fluids, secretions, and excretions except sweat (whether or not blood is present or visible), nonintact skin, and mucous membranes. Additions are respiratory hygiene/cough etiquette, safe injection practices, and directions to use a mask when performing high-risk prolonged procedures involving spinal canal punctures.

For which client would the use of standard precautions alone be appropriate?

an incontinent client in a nursing home who has diarrhea Standard precautions apply to blood and all body fluids, secretions, and excretions, except sweat. transmission-based precautions are used in addition to standard precautions for clients hospitalized with suspected infection by pathogens that can be transmitted by airborne, droplet, or contact routes, such as is the case in answers A, B, and D.

A nurse is in charge of care for a client who has MRSA. Which of the following is an accurate guideline for using transmission-based precautions when caring for this client?

Wear gloves whenever entering the client's room. Contact precautions are used for clients who are infected or colonized by a microorganism that spreads by direct or indirect contact, such as MRSA, VRE, or VISA. Gloves should be worn when entering the client's room.

The nurse is caring for an older adult with pulmonary tuberculosis. Which precautions will the nurse begin?

airborne

Which personal protective equipment (PPE) should the nurse don to enter the room of a client who is diagnosed with Clostridium difficile?

gown and gloves

The nurse is receiving a confused client with a draining wound onto the medical-surgical unit. Which room assignment will the nurse make?

into a private room The client with confusion and a draining wound would, as would other clients on the unit, benefit most from a private room. The client cannot be expected to assist in maintaining appropriate hygiene or environmental control, so placement with another client who has a susceptible condition is not appropriate.

The nurse observes an unlicensed assistive personal (UAP) collecting a urine specimen from a client with Staphylococcus aureus infection. Which action by the UAP would require the nurse to intervene?

removes gloves and walks out of the room Hand hygiene should be performed before and after wearing gloves and direct contact with clients

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 A dedicated stethoscope and blood pressure cuff should remain in the client's room when a client has been placed in contact isolation.