Fundamentals Chapter 23 Asepsis & Infection

List at least three actions clients can take to help avoid infection when they are out in the community.

-Washing hands and not touching surfaces in a public bathroom -Carrying and using antibacterial hand gel, as needed, while in public places -Using an antibacterial wipe on the receiver and mouthpiece of public phones before making a call -Washing hands when returning home (e.g., from shopping) -Asking healthcare providers to wash their hands before physical contact, if they have not done so -Using tongs, not fingers, to get food from serving trays in grocery stores and restaurants -Asking for clean silverware or napkins if an item is dropped on the floor in a restaurant

A client with a stage II pressure ulcer has methicillin-resistant Staphylococcus aureus (MRSA) cultured from the wound. Contact precautions are initiated. Which rule must be observed to follow contact precautions? 1) A clean gown and gloves must be worn when in contact with the client. 2) Everyone who enters the room must wear an N-95 respirator mask. 3) All linen and trash must be marked as contaminated and sent to biohazard waste. 4) Place the client in a room with a client with an upper respiratory infection

1) A clean gown and gloves must be worn when in contact with the client. Rationale: A clean gown and gloves must be worn when any contact is anticipated with the client or with contaminated items in the room. A respirator mask is required only with airborne precautions, not contact precautions. All linen must be double-bagged and clearly marked as contaminated. The client should be placed in a private room or in a room with a client with an active infection caused by the same organism and no other infections.

You are responsible for sterilizing all critical items used in a recent surgery. Which of the following methods would be appropriate for this purpose? 1) Autoclave with moist heat 2) Chemical germicides 3) Water and detergents 4) Ultraviolet light

1) Autoclave with moist heat Sterilization is the elimination of all microorganisms (except prions) in or on an object. The most common sterilizing methods used in hospitals are (1) autoclaving with moist heat, (2) ethylene oxide gas at low heat, (3) dry heat, and (4) low temperature hydrogen peroxide gas.

You are providing teaching to a client who frequently develops upper respiratory infections. Which of the following lifestyle practices should you encourage her to adopt to support her immune defenses? 1) Drink more water than usual when you have a fever. 2) Maintain a healthy intake of protein during illness. 3) Sleep at least 5 hours per day. 4) Wash your hands frequently. 5) Exercise moderately. 6) Laugh often

1) Drink more water than usual when you have a fever. 2) Maintain a healthy intake of protein during illness. 4) Wash your hands frequently. 5) Exercise moderately. 6) Laugh often Feedback 1: Fever and increased secretions of mucus, which are common defenses against infection, increase water loss. Additional water is needed to supplement the lost fluid and to support the increased metabolic rate that occurs with a fever. Feedback 2: An acute infection depletes the body's nutritional stores. Therefore, it is important to monitor and support client nutrition, including protein, vitamins, minerals, and water. Nutrients are required to replace lost stores, to maintain production of white blood cells, and to repair damaged tissues. Feedback 3: Rest and sleep renew the body and mind and conserve strength. Sleep of 6 to 9 hours per night is considered fully restorative for most people. Feedback 4: Hygiene is crucial for maintaining intact skin, a primary host defense. Encourage frequent handwashing as well as regular showering or bathing to decreases the bacterial count on the skin. Feedback 5: Research demonstrates that exercise is just as important as rest and sleep. Too little activity causes circulation to slow and the lungs to supply less oxygen. Excessive exercise leads to fatigue and joint injury. Feedback 6: Whether physical or mental, stress decreases the body's immune defenses. Numerous studies demonstrate a correlation between increased stress and increased disease. Laughing, in contrast, increases oxygenation, promotes body movement, and increases immune responses.

You are caring for a 32-year-old client who is recovering from surgery and general anesthesia. You recognize that this client is at risk for pneumonia. Which of the following nursing activities would be most effective in preventing infection? 1) Encourage the client to cough and breathe deeply on a regular basis. 2) Provide special oral care to the client. 3) Encourage the client to be immunized. 4) Follow medical asepsis guidelines.

1) Encourage the client to cough and breathe deeply on a regular basis. For clients who have had surgery and general anesthesia or who are at risk for pneumonia, promote coughing and deep breathing on a regular basis. For clients being mechanically ventilated, provide special oral care designed to prevent ventilator-associated pneumonia. Encourage older adults, especially those who are frail or in a debilitated state and those living in a group residence, to receive immunizations that can help them to acquire immunity from some communicable diseases, such as influenza. For clients who have breaks in the skin or incision sites, provide regular assessment for infection status and follow appropriate medical or surgical asepsis guidelines.

You are the nurse caring for a patient who recently had abdominal surgery. Her daughter tells you that she wants her mother to keep her Foley catheter in place because it will be easier for her mother. What should you tell the patient and her daughter about catheter use and urinary tract infections? Select all that apply. 1) Long-term indwelling catheter use is associated with urinary tract infections. 2) Support the daughter in judging that the catheter needs to stay in place. 3) Explain that the patient can ask for assistance to walk to the bathroom. 4) Inform her that handwashing is the best way to prevent urinary tract infection.

1) Long-term indwelling catheter use is associated with urinary tract infections. 3) Explain that the patient can ask for assistance to walk to the bathroom. Rationale: Because patients are at a higher risk for acquiring urinary tract infection and other drug-resistant or multidrug-resistant infection when an invasive device is in place, such as a urinary catheter, this patient's indwelling urinary catheter needs to be removed as soon as possible after surgery. Although handwashing helps to reduce the risk for urinary tract infection, the priority action is to remove the indwelling urinary catheter, which is a vehicle for bacterial colonization and entry into the urinary tract. If the daughter is considering convenience as the compelling reason to keep the Foley catheter in place, the nurse would remind the patient's daughter that she can ask for assistance to walk to the bathroom, which is also an activity that will minimize the occurrence of other postsurgical complications.

You are the nurse caring for a patient who is on contact precautions for a wound infection. The patient's daughter comes to visit her mother, and comes out to the nurse's station wearing disposable gloves. What information do you give her daughter regarding contact precautions? 1) Perform hand hygiene on entering her mother's hospital room. 2) Review contact precautions, hand hygiene, and glove use. 3) Remove gloves when leaving her mother's hospital room. 4) Provide the daughter with an extra box of gloves for her mother's room.

1) Review contact precautions, hand hygiene, and glove use. Rationale: The daughter in this scenario is unclear about glove use and hand hygiene in the hospital setting. To improve family and patient compliance with contact precautions, the nurse needs to educate the daughter further about these topics while reviewing other measures for preventing the spread of infection from person to person in the healthcare setting. Hand hygiene should be performed when entering and leaving the patient's hospital room. Although removing gloves when leaving the hospital room is important, the daughter could also benefit from additional teaching about contact isolation precautions. Likewise, while having an adequate supply of gloves available in the room is important, the daughter appears to be lacking in understanding about how she could prevent the spread of infection between her mother and the hospital staff and other visitors.

Which of the following nursing activities is of highest priority for maintaining medical asepsis? 1) Washing hands 2) Donning gloves 3) Applying sterile drapes 4) Wearing a gown

1) Washing hands Rationale: Scrupulous handwashing is the most important part of medical asepsis. Donning gloves, applying sterile drapes before procedures, and wearing a protective gown may be needed to ensure asepsis, but they are not the most important aspect because microbes causing most healthcare-related infections are transmitted by lack of or ineffective handwashing.

A client requires protective isolation. Which client can be safely paired with this client in a client-care assignment? One 1) admitted with unstable diabetes mellitus. 2) who underwent surgical repair of a perforated bowel. 3) with a stage III sacral pressure ulcer. 4) admitted with a urinary tract infection.

1) admitted with unstable diabetes mellitus. Rationale: The client with unstable diabetes mellitus can safely be paired in a client-care assignment because the client is free from infection. Perforation of the bowel exposes the client to infection, requiring antibiotic therapy during the postoperative period. Therefore, this client should not be paired with a client in protective isolation. A client in protective isolation should not be paired with a client who has an open wound, such as a stage III pressure ulcer, or with a client who has a urinary tract infection.

What is the rationale for handwashing? Handwashing is expected to remove: 1) transient flora from the skin. 2) resident flora from the skin. 3) all microorganisms from the skin. 4) media for bacterial growth.

1) transient flora from the skin. Rationale: There are two types of normal flora: transient and resident. Transient flora are normal flora that a person picks up by coming in contact with objects or another person (e.g., when you touch a soiled dressing). You can remove these with handwashing. Resident flora live deep in skin layers where they multiply harmlessly. They are permanent inhabitants of the skin and cannot usually be removed with routine handwashing. Removing all microorganisms from the skin (sterilization) is not possible without damaging the skin tissues. To live and thrive in humans, microbes must be able to use the body's precise balance of food, moisture, nutrients, electrolytes, pH, temperature, and light. Food, water, and soil that provide these conditions may serve as nonliving reservoirs. Handwashing does little to make the skin uninhabitable for microorganisms, except perhaps briefly when an antiseptic agent is used for cleansing.

You are donning your personal protective equipment using sterile technique. Put the following steps in correct order. Perform the surgical scrub. Put on shoe covers, hair covers, and a mask. Don gloves using the closed method. Secure the waist tie on your gown. Keep your hands within your field of vision at all times. Don the gown, with assistance from a coworker.

1. Put on shoe covers, hair covers, and a mask. 2. Perform the surgical scrub. 3. Don the gown, with assistance from a coworker. 4. Don gloves using the closed method. 5. Secure the waist tie on your gown. 6. Keep your hands within your field of vision at all times.

Match the term to the example. Terms 1. Reservoir 2. Infectious agent 3. Portal of exit 4. Indirect contact 5. Vector (living) 6.Portal of entry Examples A. Seeping blood B. Mite C. Stethoscope D. Protozoa E. Bedside table F. Intramuscular injection site

1. Reservoir - E. Bedside table 2. Infectious agent - D. Protozoa 3. Portal of exit - A. Seeping blood 4. Indirect contact - C. Stethoscope 5. Vector (living) - B. Mite 6.Portal of entry - F. Intramuscular injection site

The nurse cares for a patient with AIDS who has acquired jiroveci pneumonia. Which of the following precautions levels is appropriate for this patient? 1. Standard precautions. 2. Contact precautions. 3. Droplet precautions. 4. Airborne precautions.

1. Standard precautions. Jiroveci pneumonia is an opportunistic infection that only occurs in immunocompromised patients. Anyone with normal immune system function cannot "catch" this infection.

A client exhibits all of the following during a physical assessment. Which of these is considered a primary defense against infection? 1) Fever 2) Intact skin 3) Inflammation 4) Lethargy

2) Intact skin Rationale: Intact skin acts as a primary defense against infection. Fever, the inflammatory response, and phagocytosis (a process of killing pathogens) are secondary defenses against infection.

Which of the following are examples of emerging infectious diseases?SELECT ALL THAT APPLY. 1) Microorganisms in humans that extend their host range to begin infecting animals 2) Newly identified diseases caused by an unrecognized microorganism 3) Diseases occurring in new geographical areas 4) Microbes that evolve to become more virulent 5) Known diseases that dramatically decrease in incidence 6) Organisms that are deliberately altered for bioterrorism

2) Newly identified diseases caused by an unrecognized microorganism 3) Diseases occurring in new geographical areas 4) Microbes that evolve to become more virulent 6) Organisms that are deliberately altered for bioterrorism Feedback 1: Emerging infectious diseases include microorganisms in animals that extend their host range to begin infecting humans (e.g., avian influenza, or "bird flu"; and the H1N1 virus), not vice versa. Feedback 2: Emerging infectious diseases include newly identified diseases caused by an unrecognized microorganism (e.g., the virus causing AIDS was unknown before 1980) or a known organism (e.g., Streptococcus infection causing toxic shock syndrome). Feedback 3: Emerging infectious diseases include those occurring in new geographical areas (e.g., West Nile virus in the Western hemisphere) or settings, such as Clostridium difficile, which was primarily a hospital-acquired infection and now occurs in the community. Feedback 4: Emerging infectious diseases include microbes that evolve to become more virulent (e.g., a strain of Escherichia coli, which now causes severe illness). Feedback 5: Emerging infectious diseases include known diseases that dramatically increase, not decrease, in incidence (e.g., mumps and pertussis, also known as whooping cough). Feedback 6: Emerging infectious diseases include organisms that are deliberately altered for bioterrorism (e.g., the contamination of some mail in the United States with Bacillus anthracis [anthrax] in 2001).

You are changing your patient's sterile dressing and reach across the sterile field. Which nursing action is most appropriate? 1) Remove your sterile gloves and tell the patient you will be right back. 2) Obtain new sterile supplies and set up a new sterile field. 3) Pick up the sterile dressing with your gloved hand and tape it in place. 4) Ring the call bell to ask someone to bring you another pair.

2) Obtain new sterile supplies and set up a new sterile field. Rationale: Be conscious of your body at all times, and never reach across a sterile field. The movement could cause your sleeve to contaminate the field. Avoid coughing, sneezing, and talking over a sterile field as these might cause air droplet contamination. If contamination occurs, you must start over with new gloves and sterile dressing supplies. New gloves (alone) are not sufficient. Keep the sterile field in constant view; never turn your back on a sterile field because inadvertently contamination can occur.

You are teaching a group of older adults in a senior center on factors that increase their susceptibility to infection. Which of the following should you mention?SELECT ALL THAT APPLY. 1) Living alone 2) Smoking cigarettes 3) Obesity 4) Immune-suppressing agents 5) Retirement 6) Urinary catheterization

2) Smoking cigarettes 4) Immune-suppressing agents 6) Urinary catheterization Feedback 1: Increased exposure to pathogens in one's living situation would occur when one is living in close proximity to many others, not living alone. Feedback 2: Smoking is a major risk factor for pulmonary infections. Feedback 3: Obesity is not associated with increased susceptibility to infection. Feedback 4: Some medications are given for the purpose of reducing the immune response, for example, to patients receiving organ or tissue transplants. Such medications increase one's susceptibility to infection. Feedback 5: Increased exposure to pathogens in one's work situation increases one's risk for infection. This occurs in work environments in which the person is around many people who are sick or vulnerable to becoming sick. Being retired would decrease one's susceptibility to infection. Feedback 6: Several procedures are associated with an increased risk of infection. For example, urinary catheterization may injure the fragile urethral mucosa, provide a direct pathway for pathogens into the bladder, and prevent the normal flushing of the urethra.

You are preparing to perform a physical examination of a healthy, young student athlete. Which type of precautions should be used with this client? 1) No precautions required 2) Standard 3) Contact 4) Droplet

2) standard Standard precautions are used with all clients, in all settings, regardless of suspected or confirmed presence of infection. Contact precautions are used for organisms spread by direct contact with the patient or his environment. This is the most common form of transmission. Droplet precautions are used for pathogens that spread through close respiratory or mucous membrane contact with respiratory secretions (e.g., sneezing, coughing, and talking) and that do not remain infectious over long distances

A 4-year-old child is seen in the emergency department with rashes mostly found on his torso. The nurse obtained a medical history from the mother and she said her child had fever before the rashes appeared. Other symptoms include loss of appetite and he began coughing and complains of a sore throat. With these objective data at hand, the nurse suspects that the child is having? 1. Measles. 2. Chicken pox. 3. German measles. 4. Shingles.

2. Chicken pox. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include: fever, loss of appetite, headache, cough and sore throat. Characteristics of chicken pox rash: Raised pink or red bumps (papules), which break out over several days. Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking. Crusts and scabs, which cover the broken blisters and take several more days to heal.

The nurse is correctly implementing the prescribed transmission-based precaution when she does the following: 1. The nurse placed a supply of clean masks in the child's room. 2. The nurse sends specimens to the laboratory in a zip-closure biohazard bag. 3. The nurse assigned the child in a semi-private room. 4. The nurse wipes the thermometer with alcohol every after use.

2. The nurse sends specimens to the laboratory in a zip-closure biohazard bag. The zip-closure prevents contamination of the environment during transportation.

You are caring for a client who has developed methicillin-resistant Staphylococcus aureus (MRSA). Which of the following risk factors related to this infection should you most suspect in this client? 1) Employment in a preschool 2) Multiple sexual partners 3) Multiple stays in the intensive care unit 4) Smoking

3) Multiple stays in the intensive care unit Although employment in a preschool places one at greater risk for infection in general, MRSA is typically acquired in hospitals. MRSA is not a sexually transmitted infection. Multidrug-resistant organisms are transmitted by the same routes as are other microorganisms. A major factor, though, is repeated contact with the healthcare system, especially acute care facilities, and especially intensive care units (where infection rates tend to be highest). Transmission of these organisms typically occurs via the hands of healthcare workers, especially for MRSA, Clostridium difficile, and vancomycin-resistant enterococci. Smoking is a major risk factor for pulmonary infections, not MRSA.

As a nurse in the intensive care unit, you realize that you are at high risk of transmitting multidrug-resistant organisms (MDROs) to patients. Given what you know about how these organisms are usually transmitted, which of the following infection prevention measures is most important for you to implement? 1) Wearing a mask 2) Wearing a gown 3) Performing hand hygiene 4) Following airborne precautions

3) Performing hand hygiene Evidence suggests that MDROs are carried from one person to another via the hands of healthcare personnel. Therefore, hand hygiene, glove use, and isolation precautions would be of highest priority, not wearing a mask. Evidence suggests that MDROs are carried from one person to another via the hands of healthcare personnel. Therefore, hand hygiene, glove use, and isolation precautions would be of highest priority, not wearing a gown. Evidence suggests that MDROs are carried from one person to another via the hands of healthcare personnel. Therefore, hand hygiene, glove use, and isolation precautions would be of highest priority. Evidence suggests that MDROs are carried from one person to another via the hands of healthcare personnel. Therefore, hand hygiene, glove use, and isolation precautions would be of highest priority, not following airborne precautions.

You are providing training on infection control to healthcare workers at your hospital. Which of the following should you mention as primary defenses of the body against infectious disease?SELECT ALL THAT APPLY. 1) Phagocytic white blood cells 2) Fever 3) The skin 4) B lymphocytes 5) Mucous membranes of the trachea 6) Acid in the stomach

3) The skin 5) Mucous membranes of the trachea 6) Acid in the stomach Feedback 1: Secondary defenses are protective biochemical processes that fight pathogens that enter the body. Phagocytosis is the process by which phagocytes (specialized white blood cells) engulf and destroy pathogens directly. Feedback 2: Secondary defenses are protective biochemical processes that fight pathogens that enter the body. Fever is a rise in core body temperature that increases metabolism, inhibits multiplication of pathogens, and triggers specific immune responses. Feedback 3: Primary defenses of the body against infection are the structural barriers, such as the skin. The surface of intact, healthy skin is tough and resilient and prevents entry of many pathogens. Feedback 4: Tertiary defenses include immunity against an infection, which is achieved through the presence of antibodies such as B lymphocytes that neutralize or destroy toxins or disease-producing organisms. Feedback 5: Primary defenses of the body against infection are the structural barriers, such as mucous membranes of the trachea. The nares, trachea, and bronchi are covered with mucous membranes that trap pathogens, which are then expelled. Feedback 6: Primary defenses of the body against infection are the structural barriers, such as acid in the stomach. Many pathogens that reach the stomach are destroyed in its acidic environment.

You are washing your hands in preparation for performing a standard physical examination on a client. Which of the following actions should you take?SELECT ALL THAT APPLY. 1) Wash the hands vigorously for 2 to 6 minutes. 2) Use hot water. 3) Use agency-approved soap. 4) Rub the backs of the hands and between the fingers. 5) Remove jewelry and clean areas underneath. 6) Clean underneath the fingernails using an orangewood stick.

3) Use agency-approved soap. 4) Rub the backs of the hands and between the fingers. 5) Remove jewelry and clean areas underneath. 6) Clean underneath the fingernails using an orangewood stick. Feedback 1: In a nonsurgical setting, wash the hands vigorously for at least 15 seconds, longer if hands are visibly soiled. In a surgical setting, wash for 2 to 6 minutes, depending on the soap or other product used. Feedback 2: Use warm water and rinse off soap completely. Hot water and soap increase the potential for skin breakdown. Feedback 3: Use agency-approved soap. Feedback 4: Rub all surfaces of the hands and wrists vigorously, including the backs of the hands and between the fingers. Feedback 5: Remove jewelry and clean areas underneath. Feedback 6: Clean underneath the fingernails using an orangewood stick.

You are caring for a client with tuberculosis. The pathogen associated with this disease is very small and remains infectious over long distances when suspended in the air. It is easily transmitted through ventilating systems. Which type of precautions should be used with a client with this disease? 1) Standard 2) Contact 3) Droplet 4) Airborne

4) Airborne Standard precautions are used with all clients, in all settings, regardless of suspected or confirmed presence of infection. Contact precautions are used for organisms spread by direct contact with the patient or his environment. This is the most common form of transmission. Droplet precautions are used for pathogens that spread through close respiratory or mucous membrane contact with respiratory secretions (e.g., sneezing, coughing, and talking) and that do not remain infectious over long distances. Airborne precautions are used for pathogens that are very small, remain infectious over long distances when suspended in the air, and are easily transmitted through air currents (e.g., fanning linens, ventilating systems).

Which action demonstrates a break in sterile technique? 1) Remaining 1 foot away from nonsterile areas 2) Placing sterile items on the sterile field 3) Avoiding the border of the sterile drape 4) Reaching 1 foot over the sterile field

4) Reaching 1 foot over the sterile field Rationale: Reaching over the sterile field while wearing sterile protective equipment breaks sterile technique. While observing sterile technique, healthcare workers should remain 1 foot away from nonsterile areas while wearing sterile garb; place sterile items needed for the procedure on the sterile drape; and avoid coming in contact with the 1-inch border of the sterile drape.

The medical/surgical nurse cares for a middle-aged patient with a wound infected with MRSA (Methicillin-resistant Staphylococcus aureus). Which of the following protective safety items, if worn by the nurse, would be considered appropriate? 1. Shoe covers, a gown, and gloves. 2. A mask, gown, and gloves. 3. Gloves only. 4. A gown and gloves.

4. A gown and gloves. A patient infected with MRSA requires contact precautions. Gown and gloves constitute contact precautions.

What part(s) of a sterile field are considered to be unsterile?

A 1-inch margin around the edges of the field and any material that extends beyond the horizontal plane are considered unsterile. You may also recall that a field is no longer sterile if it becomes wet, if you turn your back on it, or if someone not wearing sterile protective equipment comes within 1 foot of the sterile field.

If you needed to disinfect a sink in a client's home, what would you use?.

A solution of 1 part household bleach and 50 parts water.

When entering the clients room to change surgical dressing, a nurse notes that the client is coughing and sneezing. Which of the following actions should the nurse take one repair preparing a sterile field? A. keep the sterile field at least 6 feet away from the clients bedside B. instruct the client client to refrain from coughing and sneezing during the dressing change C. Place a mask on the client to limit the spread of micro organisms into the surgical wound D. keep a box of facial tissues nearby for the client to use during the dressing change

A. It would be difficult to maintain a sterile field away from the bedside. But more important, this might not have any effect on the transmission of some microorganisms. B. The client might be unable to refrain from coughing and sneezing during the dressing change. C. correct: placing a mask on the client prevent contamination of the surgical wound during the dressing change. D. keeping tissues close by for the client to use still allows contamination of the surgical wound.

Which of the following is not included in the body's secondary defense against a pathogen? A. Lysozymes in the saliva in the mouth B. Differentiation of monocytes into macrophages C. Release of histamine and other chemical mediators D. An oral temperature of 101.8°F (38.8°C)

A. Lysozymes in the saliva in the mouth Rationale: Lysozymes are an example of the body's primary defense.

A nurse has removed a sterile pack from its outside cover and placed it on a clean work surface in preparation for an invasive procedure. Which of the following flaps should the nurse unfold first? A the flap closest to the body B. the right side flap C. the left side flap D. the flap farthest from the body

A. The flap closest to the body is the innermost flap in the last one to unfold B. unfold the side flap that is closest to the top of the package before the one underneath it; however, there is another flap to unfold first. C. unfold the side flap that is closest to the top of the package before the one underneath it; however, there is another flap to unfold first D. correct: the priority goal in the setting up of a sterile field is to maintain stability and thus reduce the risk to the client safety. Unless the nurse pulls the top flap the one farthest from her body away from the body first, there is a risk of touching part of the inner surface of the wrap and thus contaminating it.

The herpes zoster virus requires a nurse to follow ________ precautions at all times.

Airborne precautions are added for clients who have illnesses that are transmitted by airborne droplet nuclei, such as chickenpox during the early stage of infection.

A 64-year-old patient has peripheral vascular disease. In assisting the patient to decrease her risk for infection, the clinic nurse would teach her to do which of the following? A. Change her bath habits and only bathe twice a week B. Begin an exercise program of yoga to decrease her stress C. Eat a high-fiber, low-protein, low-calorie diet D. Refuse the flu vaccine because it can be dangerous for her

B. Begin an exercise program of yoga to decrease her stress Rationale: Research has shown a positive correlation between stress and a decrease in immune functioning. Bathing only twice a week would not be enough to remove potentially harmful surface bacteria. Nutrients are needed to produce the cells of the immune system. Because this patient has a chronic illness, she should be encouraged to ask her healthcare provider for a flu shot; and flu vaccines are not considered dangerous.

A school nurse is performing an assessment of a student who states: "I'm too tired to keep my head up in class." The student has a low-grade fever. The nurse would interpret these findings as indicating which stage of infection? A. Incubation period B. Prodromal stage C. Full stage of illness D. Convalescent period

B. Prodromal stage

Which of the following actions violates a principle that is key to proper handwashing at the bedside? A. Washing your hands for 1 minute B. Shaking your hands dry over the sink C. Using warm, not very hot, water D. Using the soap provided by the agency

B. Shaking your hands dry over the sink Rationale: Shaking your hands will not completely remove the excess moisture, allowing for the reacquisition of bacteria on the area. In addition, it splashes water into the environment, which could be contaminated with organisms from the hands.

A patient comes to the physician's office complaining of generalized malaise and states, "I just don't feel well." The nurse knows that the patient is in what stage of infection? A. Decline B. Illness C. Prodromal D. Convalescence

C. Prodromal Rationale: The prodromal stage is characterized by complaints of vague, nonspecific symptoms.

A nurse is following the principles of medical asepsis when performing patient care in a hospital setting. Which nursing action performed by the nurse follows these recommended guidelines? A. The nurse carries the patients' soiled bed linens close to the body to prevent spreading microorganisms into the air. B. The nurse places soiled bed linens and hospital gowns on the floor when making the bed. C. The nurse moves the patient table away from the nurse's body when wiping it off after a meal. D. The nurse cleans the most soiled items in the patient's bathroom first and follows with the cleaner items.

C. The nurse moves the patient table away from the nurse's body when wiping it off after a meal.

A patient who is HIV positive and immunocompromised develops an eye infection caused by the cytomegalovirus. The retinitis would be considered which of the following types of infection? A. Endogenous infection B. Primary infection C. Vector infection D. Secondary infection

D. Secondary infection Rationale: The HIV infection is the primary infection. There is no vector involved in cytomegalovirus transmission, and it does not arise from the patient's own flora.

Secondary infections are one of the top 20 health problems in the United States. True or False

False Rationale: Healthcare-related infections are one of the top 20 health problems.

An example of an activity requiring contact precautions would be when the spread of an organism is thought to occur when sheets are fanned during bed making. True or False

False Rationale: Fanning sheets can lead to airborne transmission, requiring airborne precautions.

If a patient's lab work reveals that IgM, but not IgG, is present in the blood, what could you conclude about this infection?

IgM is present the first time an individual is exposed to a particular pathogen. If IgG is not present, you can conclude that the exposure occurred less than 10 days ago.

What is the role of normal flora?

Normal flora are nonpathogenic microorganisms that help to control the growth of pathogenic microorganisms. Normal flora in the intestine also aid digestion and, when they die, release vitamins important to human health.

What is a pathogen?

Pathogens are bacteria, viruses, fungi, and other organisms that cause disease.

Identify at least five reservoirs of infection.

Potential answers include the following reservoirs of infection: Human body Animals Insects Food Floors in healthcare facilities Bathrooms Raw sewage Stagnant water Garbage Diapers Used wound dressings

Under what circumstances are standard precautions used?

Standard precautions are used on all clients whenever there is a possibility of coming in contact with blood, body fluids (except sweat), excretions and secretions, mucous membranes, and any break in the skin.

What actions improve host ability to prevent infection?

The following activities decrease the likelihood of infection: -Adequate nutrition, including vitamins, minerals, and water, are essential for combating infection. Nutrients are required to form the components of the immune response. -Hygiene is a crucial aspect of maintaining skin integrity. Intact skin is one of the best defenses against infection. -Both rest and exercise are necessary to rejuvenate the body. -Stress, whether physical or mental, decreases the body's immune defenses. -For some diseases, immunizations have been developed. Immunizations expose the body to weakened or killed pathogens and stimulate the body to produce IgG. At a later date, if the natural pathogen is encountered, IgG and specialized T cells are available to ward off an infection.

What factors increase a client's risk for infection?

The following factors increase a client's risk for infection: -Very young children and older adults are at increased risk for infection. Young children have limited exposure to pathogens and immature active immunity. Older adults have declining function of the immune system and limited physiological reserve. -Any break in the skin also increases risk. -Illness and injury, especially chronic disease, limit an individual's ability to fight infection. -Smoking, substance abuse, and multiple sex partners increase the risk of infection. -Some medications inhibit the immune response of the body. -Environmental factors that increase exposure to pathogens increase risk for infection. -Finally, nursing and medical treatments often provide portals of entry and exit or bypass natural defense mechanisms

What are the six links in the chain of infection?

The following six links compose the chain of infection: Infectious agent Reservoir Portal of exit Mode of transmission Portal of entry Susceptible host

What kinds of microbes favor the human body as a reservoir of infection?

The human body provides a warm, moist environment. The microbes that are pathogenic to humans are so because they thrive at about the same temperature as the human body. To thrive in the human body, microbes also must be able to use the body's precise balance of moisture, nutrients, electrolytes, and pH to support their own reproduction.

Identify and describe the purpose of the body's three major lines of defense against infection.

The primary defense mechanisms prevent entry of pathogens into the body. Primary defense mechanisms include intact skin, mucous membranes at body openings, normal flora, and a rich vascular supply at potential sites of entry for infection, including the mouth and vagina. They also include processes such as crying, salivating, vomiting, peristalsis, and diarrhea. The secondary defense mechanisms are activated if a pathogen gains entry into the body. Secondary defense mechanisms include phagocytosis, the complement cascade, inflammation, and fever. Specific immunity, a third line of defense, protects against specific pathogens and builds immune "memory" in the process. The humoral response produces antibodies that inactivate invading antigens. The cell-mediated response results in the production of T cells that destroy body cells infected with invaders.

Below are the six links in the chain of infection. Put them in the correct order, beginning with the source of infection. Mode of transmission Susceptible host Reservoir Portal of entry Infectious agent Portal of exit

The process by which infections spread is commonly referred to as the chain of infection. It is made up of six links, all of which must be present for the infection to be transmitted from one individual to another. The six links are as follows: 1. Infectious agent 2. Reservoir 3. Portal of exit 4. Mode of transmission 5. Portal of entry 6. Susceptible host.

Below are the five stages of infection. Put them in the correct order. Decline Illness Incubation Convalescence Prodromal stage

The stages of infection are as follows: 1. Incubation 2. Prodromal stage 3. Illness 4. Decline 5. Convalescence.

Below are steps to take in the event of a biological epidemic. Put them in the correct order. Institute the appropriate level of standard precautions. Recognize an outbreak. Prepare clients for a pandemic. Notify the safety officer.

The steps to take in the event of a biological epidemic are as follows: 1. Recognize an outbreak 2. Notify the safety officer 3. Institute the appropriate level of standard precautions 4. Prepare clients for a pandemic.

A patient has acquired pneumonia after being hospitalized for 10 days. This is an example of a healthcare-related infection. True or False

True

The use of standard precautions protects both the nurse and the patient from infection due to the transmission of microorganisms. True or False

True

When will you need to don sterile gloves using the closed method?

When you are performing an activity that requires you to wear a sterile gown. The gloves must cover the gown cuffs.

The nurse is caring for a patient with pneumonia using ________ precautions.

droplet

Healthcare-associated infections (HAIs) refers to

infections associated with healthcare given in any setting (e.g., hospitals, home care, long-term care, and ambulatory settings).

The term nosocomial infections refers

specifically to hospital-acquired infections