Week 13

Reusable items are washed thoroughly before reusing in the care of clients. FALSE TRUE

FALSE

In-the-ear devices are small, self-contained aids that fit in the outer ear. FALSE TRUE

True

The Centers for Disease Control and Prevention (CDC) has tightened its recommendations concerning double bagging, insisting that two bags be used. FALSE TRUE

FALSE

The epidermis contains the secretory glands. FALSE TRUE

FALSE

The last link in the chain of infection is the exit route. FALSE TRUE

FALSE

A nurse is explaining the process of infection to a nursing student. Place the process in the most appropriate order. 1. transmission mode 2. a reservoir 3. susceptible host 4. entry portal 5. infectious agent 6. an exit route

5. infectious agent 2. a reservoir 6. an exit route 1. transmission mode 4. entry portal 3. susceptible host Rationale: The infectious process begins with an infectious agent. Then the infection needs a reservoir or place to grow. Once it grows, it needs a way out so that it can be transmitted. With transmission (e.g., sneezing), it needs an entry portal into a susceptible host.

______________ is a condition in which microorganisms are present, but the host does not manifest any signs or symptoms of infection.

Colonization

___________ teeth are teeth which begin to erupt at about 6 months of age and continue to do so for 2 to 2.5 more years.

Deciduous

A denture is a dental appliance that replaces one or several teeth and is fixed permanently to other natural teeth so that it cannot be removed. TRUE FALSE

FALSE

Aerobic bacteria exist without oxygen. FALSE TRUE

FALSE

An ophthalmologist is a person who prescribes corrective lenses. FALSE TRUE

FALSE

_______ is an aseptic practice that involves scrubbing the hands with soap, water, and friction.

Handwashing

_________infections are infectious disorders among people with compromised health.

Opportunistic

__________________ disease is a condition that results in the destruction of the tooth-supporting structures and bones that make up the jaw.

Periodontal

_______asepsis refers to measures that render supplies and equipment totally free of microorganisms.

Surgical

Airborne and contact precautions are required for some infectious diseases, such as chickenpox, smallpox, COVID-19, and SARS. FALSE TRUE

TRUE

Fingernails and toenails are made of keratin, which is in concentrated amounts, giving them their tough texture. FALSE TRUE

TRUE

Nonpathogens assume one of two relationships with their human host: mutually beneficial or neither harming nor helping the host. FALSE TRUE

TRUE

Older clients are more susceptible to infections because of an age-related decrease in immune system functioning. FALSE TRUE

TRUE

Pathogens have a high potential for causing infectious communicable diseases. FALSE TRUE

TRUE

Use of proper aseptic techniques for indwelling urinary catheters is essential for preventing the introduction of microorganisms. TRUE FALSE

TRUE

Viruses can pass through very small barriers. FALSE TRUE

TRUE

__________disinfection is more thorough than concurrent disinfection and consists of measures used to clean a client's environment after discharge.

Terminal

The nurse is providing hygiene education for a family who will soon take an older adult client home from the hospital. Which statement by a family member requires further nursing instruction? a. "I should provide soap for daily bathing to remove debris and keep my loved one's skin moist." b. "I should obtain a tub or shower seat because my loved one has mobility issues." c. "I should check the bath water temperature before allowing my loved one to bathe." d. "I should install grab bars in the shower or tub at arm level of my loved one."

a. "I should provide soap for daily bathing to remove debris and keep my loved one's skin moist." Rationale: Soap should not be used on a daily basis since it can have a very drying effect on the skin. Therefore, the nurse should re-educate the family on this information. Thus, the family should check the temperature of bath water before immersing an older adult client because with aging there is a diminished ability to sense temperature changes. Grab bars and shower chairs are a safety measure to assist the client in and out of the tub or shower.

Hand __________ means the removal and destruction of transient microorganisms without soap and water.

antisepsis

A sitz bath would be most appropriate for which client? a. 33-year-old who is one day postpartum b. 69-year-old with impaired circulation to the lower extremities c. 41-year-old with intractable migraines d. 57-year-old who has just had surgery to repair a hernia

a. 33-year-old who is one day postpartum Rationale: A sitz bath includes the immersion of the buttocks and perineum in a small basin of continuously circulating water. This removes blood, serum, stool, or urine. The client who has given birth would benefit from this type of cleansing treatment. The other clients do not benefit as much, or at all, from the sitz bath.

An 80-year-old woman tells the nurse that she just itches all the time and her skin seems very dry. How do these symptoms relate to aging skin? a. Activity of the glands in the skin lessens. b. Skin gland activity increases, leading to acne. c. The symptoms are indicators of a disease. d. The symptoms are unrelated to aging skin.

a. Activity of the glands in the skin lessens. Rationale:As a person ages, the activity of sebaceous and sweat glands decreases. Perspiration is decreased, skin becomes dryer, and pruritus (itching) may result.

A nurse is caring for a female client with diarrhea. What information does the nurse teach the client about perineal care and self-care a. Clean the perineal area from the front to back. b. Bathe the perineal area with a mild soap and water. c. Insert any suppository medication prior to cleaning the perineal area. d. Wear gloves while performing perineal self-care.

a. Clean the perineal area from the front to back. Rationale: The nurse should instruct the client to clean the perineal area from the front to back toward the rectal area to prevent urinary tract infections. Bathing with a mild soap and water are not specific perineal hygiene instructions, and washing the perineal area. Having the client wear gloves while performing perineal self-care is unnecessary. Inserting any suppository medication prior to cleaning is not required.

A nurse is caring for a female client with diarrhea. What information does the nurse teach the client about perineal care and self-care? a. Clean the perineal area from the front to the back. b. Wear gloves while performing perineal self-care. c. Insert any suppository medication prior to cleaning the perineal area d. Bathe the perineal area with mild soap and water.

a. Clean the perineal area from the front to the back. Rationale: The nurse should instruct the client to clean the perineal area from the front to back toward the rectal area to prevent urinary tract infections. Bathing with a mild soap and water are not specific perineal hygiene instructions, and washing the perineal area. Having the client wear gloves while performing perineal self-care is unnecessary. Inserting any suppository medication prior to cleaning is not required.

Following an increase in the incidence of nosocomial infections, the nurse educator has conducted a brief in-service with the nurses at the hospital in order to remind them of the key principles of asepsis. Which is a principle of asepsis that the nurses should integrate into care? a. Frequent hand hygiene is one of the most effective ways of reducing the transmission of microorganisms. b. Cleaning should begin with dirty areas and proceed to cleaner areas. c. Antibiotics should be used in noninfected clients to reduce the transmission of disease. d. Surfaces and objects are considered to be sterile unless there is evidence of contamination.

a. Frequent hand hygiene is one of the most effective ways of reducing the transmission of microorganisms. Rationale: Frequent hand hygiene and maintaining intact skin are the best methods for reducing the transmission of microorganisms. Microorganisms exist everywhere except on sterilized equipment, and cleaning should proceed from clean to dirty surfaces. Antibiotics should be used judiciously and are not normally provided to uninfected clients.

An elderly client has worn an artificial eye since advanced glaucoma necessitated enucleation (removal of the eye). What action should the nurse perform immediately before assisting the client with the reinsertion of the artificial eye? a. Gently rinse the client's eye socket with clean water or normal saline. b. Carefully wash the artificial eye and apply a layer of petroleum jelly to the surfaces that will contact the client's skin. c. Apply a water-based lubricant to the perimeter of the client's eye socket. d. Apply a thin, even layer of antibiotic ointment to the surface of the artificial eye

a. Gently rinse the client's eye socket with clean water or normal saline. Rationale: The nurse irrigates the eye socket with water or saline before reinserting the artificial eye. Antibiotic ointments and petroleum jelly are not applied to the artificial eye and lubricants are not applied to the client's eye socket

The nurse is preparing to care for a client diagnosed with a urinary tract infection and a sacral wound. Which action(s) will require the nurse to don examination (unsterile) gloves? Select all that apply. a. Removing a soiled dressing b. Inserting an indwelling urinary catheter c. Changing the central line dressing d. Administering an IV injection to the client e. Changing a brief that has urine and feces on it

a. Removing a soiled dressing d. Administering an IV injection to the client e. Changing a brief that has urine and feces on it Rationale: The nurse should always wear examination gloves when there is any contact possible with blood or body fluids such as changing a brief with urine and feces, administering an IV injection, and removing a soiled dressing. The nurse also uses these gloves to protect the nurse as well as to prevent the transmission of microorganisms from the client's skin or mucous membranes. The nurse should wear sterile gloves whenever inserting an indwelling catheter as well as changing a central line dressing because these are both high-risk activities that could easily lead to infection.

After changing the bed linens for a client, the nurse uses an alcohol-based hand rub to perform hand antisepsis. What is the proper way to use an alcohol-based hand rub? a. Rub the product between the hands until they are dry. b. Apply a drop of the hand rub, scrub, and rinse with water. c. Distribute the product over the nails and wash with soap. d. Rub the product between the hands for 5 seconds.

a. Rub the product between the hands until they are dry. Rationale: When decontaminating with an alcohol-based hand rub, the nurse should apply about a nickel- to quarter-sized amount of the product to the palm of one hand, distribute the product to cover all surfaces of the hands and fingers, and rub the product between the hands for 15 to 25 seconds until they are dry. The nurse need not rinse the hands with water after using an alcohol rub.

The nurse is providing preventative education to clients in the community regarding HIV transmission. Which teaching point will the nurse include in the education session? a. There is a high risk for transmission through sexual intercourse with an infected person. b. HIV is a vector-borne illness and can be transmitted through insect bites. c. Inhaling droplets resulting from a sneeze or cough of an infected person can transmit the infection. d. High rates of HIV transmission have been traced back to public swimming pools.

a. There is a high risk for transmission through sexual intercourse with an infected person. Rationale: Human immunodeficiency virus (HIV) is a sexually transmitted infection that mounts an attack on an individual's immune system, rendering the individual highly susceptible to other infections and diseases. This virus is only transmitted through an exchange of blood and body fluids, mainly semen and vaginal fluid. The primary routes of transmission are through various forms of sexual intercourse, injections, needlestick injuries, birth, infected blood product transfusions, contaminated equipment, artificial insemination with HIV-positive semen and donated organs for transplant. The first of these two routes are the most common. When providing preventative education to clients in the community, the nurse uses caution to provide accurate evidence to dispel myths about routes of transmission because this can help to reduce the stigma associated with the disease. While many myths about how this virus is transmitted exist in the general population, evidence supports the fact that HIV cannot be transmitted through swimming pools, physical contact without sex, droplets, aerosols, or insects.

The client presents to the Emergency Department reporting fever, chills, and a productive cough. The chest x-ray shows an area of infiltration, and the primary care provider prescribes a broad-spectrum antibiotic. Which client teaching statement from the nurse is most appropriate regarding the prescribed drug? a. This antibiotic is the best choice since the causative organism is not known." b. "Drug resistance can develop when the wrong antibiotic is used for pneumonia." c. "Pneumonia is usually caused by multiple organisms." d. This antibiotic causes fewer side effects than a narrow spectrum antibiotic."

a. This antibiotic is the best choice since the causative organism is not known." Rationale: Broad-spectrum antibiotics are appropriate when the client is symptomatic and the causative bacteria is not yet known. These agents produce the best chance of effectiveness. The side effects of all antibiotics are similar. The antibiotic can cause resistance when used excessively in the absence of infection. Pneumonia may or may not be caused by multiple organisms; however, this isn't the best answer regarding the medication.

Which personal protective equipment (PPE) should the nurse don to enter the room of a client who is diagnosed with Clostridium difficile? a. gown and gloves b. goggles and gloves c. respirator mask and gown d. mask and shoe covers

a. gown and gloves Rationale: A client with Clostridium difficile requires contact isolation. Gown and gloves are the most appropriate options for this client; more so than goggles and gloves, respirator masks and gowns, and masks and shoe covers.

A nurse is providing care to a client who has developed an infection due to Candida. The infection is resistant to several medications. The client asks the nurse how he may have developed this infection. When responding to the client, the nurse would incorporate an understanding of which factor is contributing to the organism's resistance. a. overprescription of antibiotics b. less use of pasteurizing agents in milk c. a decrease in the use of antibiotics in farming d. low intake of meat and poultry products

a. overprescription of antibiotics Rationale: Factors that contribute to the evolution of resistant microbial strains in a person include the overprescription of antibiotics. The use of antibiotics even after symptoms subside does not contribute to resistance, but the use of inappropriate antibiotics for the infecting organism and incomplete use of antibiotic prescriptions as symptoms subside do contribute to resistant microbial strains. Low intake of meat and poultry products is not a contributing factor, but increased use of antibiotics in farming and increased pasteurizing agents contaminate meat and milk; this also contributes to the evolution of resistant microbial strains.

The nurse is preparing to delegate a bath for a 90-year-old client who is nonresponsive and has mild skin breakdown. Which type of bath will the nurse delegate to the unlicensed assistive personnel (UAP) a. traditional bed bath with linen change b. bag bath c. tub bath d. shower with assist

a. traditional bed bath with linen change Rationale: A traditional bed bath with linen change provides the greatest opportunity for full cleansing. The client is unable to perform assistance with a shower, and is not a candidate for a bed bath. Although a bag bath may be useful, the traditional bed bath with linen change provides the best opportunity for infection control in observance of the mild skin breakdown that has been noted.

The nurse observes slight bruising on the client's left thigh during a bed bath and palpates a lump on the anterior surface of the thigh. Which will the nurse document on the electronic health record (EHR)? a. "Bed bath completed." b. "During bed bath, slight bruising noted on left thigh. 5 cm hard lump palpated on the anterior surface of the thigh." c. "Client has to bruise on the left thigh from previous fall." d. "During bed bath, nurse palpated 5-cm lump on client's left thigh."

b. "During bed bath, slight bruising noted on left thigh. 5 cm hard lump palpated on the anterior surface of the thigh." Rationale: Bathing promotes assessment of the client's physical condition by noting injured areas, such as bruises, rashes, or any other unusual signs. Documentation should be complete and factual. Documentation that includes objective findings, such as slight bruising noted to the left thigh and a 5 cm hard lump noted on palpation on the anterior aspect of the left thigh, is complete and factual. Documenting just that the bed bath is completed and only documenting either the bruising or the lump is incomplete documentation.

The nurse is helping a client perform oral hygiene. When asked whether the client flosses, the client states, "I don't like to floss because it makes my gums bleed." What is the appropriate nursing response? Select all that apply. a. "I understand; flossing makes my gums bleed too." b. "Flossing removes plaque and food debris that a toothbrush may miss. c. "When flossing, be certain to choose waxed floss." d. "The chance of tooth and gum disease can be reduced by flossing." e. "You can use flossing in place of brushing your teeth."

b. "Flossing removes plaque and food debris that a toothbrush may miss. d. "The chance of tooth and gum disease can be reduced by flossing." Rationale: Although conscientious oral hygiene does not prevent dental problems completely, it reduces the incidence of tooth and gum disease. Flossing removes plaque and food debris from the surfaces of teeth that a manual or electric toothbrush may miss. The choice of unwaxed or waxed floss is personal. Waxed floss is thicker and more difficult to insert between teeth; unwaxed floss frays more quickly. The nurse should not share his or her own personal experiences, but rather, educate the patient on the need to use flossing in addition to brushing to maintain good oral hygiene.

The nurse is teaching a community group about the transmission of HIV. Which client statement by a community member demonstrates that further teaching is needed? a. "I should not share razors or toothbrushes with others." b. "I can catch HIV by swimming in pools." c. "HIV is transmitted through sexual contact." d. "Someone can be exposed to this virus by sharing needles."

b. "I can catch HIV by swimming in pools." Rationale: HIV is not transmitted through swimming pools; further teaching is needed to clarify this point. The other client statements appropriately reflect how HIV is transmitted and do not require further teaching.

The acute care nurse is talking with a client who just finished performing oral care. The client states, "I have some whitish-yellow patches on my tongue. Should I be concerned?" How should the nurse respond first? a. "Did you drink milk during your last meal? These patches often occur after drinking whole milk." b. "Let me assess the patches. They may indicate the development of a fungal infection." c. "Is this the first time you noticed them? These types of patches are a normal finding in most adults." d. "The patches are probably the result of ineffective brushing. I will get you a new toothbrush."

b. "Let me assess the patches. They may indicate the development of a fungal infection." Rationale: When assessing client changes, the nurse will avoid making assumptions and normalizing new clinical findings until a focused assessment is complete. By informing the client that further assessment is need to rule out a common condition that is associated with the client's presenting symptoms, the nurse has recognized and analyzed cues and is now prioritizing a hypothesis about what the change could be related to. In forming the nursing care plan, the nurse also includes the client in the assessment process. While the other responses are not necessarily incorrect, with these statements, the nurse either minimizes or assumes without gathering more data.

A client who has been diagnosed with a cold is upset that antibiotic therapy was not prescribed. Which nursing response is most appropriate? a. "Antibiotics have too many side effects anyway." b. "The common cold is a virus and will not respond to antibiotics." c. "Sometimes antibiotics work for colds and sometimes they do not." d. "We can ask the PCP for an antiviral medication."

b. "The common cold is a virus and will not respond to antibiotics." Rationale: The best response from the nurse is to educate the client about the common cold and how it is treated. An antiviral medication is not effective for the common cold. Antibiotics do not work to cure colds as a virus causes them. While antibiotics do cause side effects they are not appropriate for use in this client.

Admission testing has revealed that a client is a carrier of an antibiotic resistant microorganism. The client is alarmed at this revelation and is eager to learn more. How should the nurse explain this client's health status? a. "We'll be monitoring you closely while you're in the hospital to make sure your condition doesn't deteriorate." b. "This means that the bacteria are present on surfaces of your body, but you don't actually have an infection." c. "Your care team will tell you soon what treatment options are available since antibiotics won't be effective." d. "Many people have these infections but most people are able to fight off the infection without the use of drugs."

b. "This means that the bacteria are present on surfaces of your body, but you don't actually have an infection." Rationale: Asymptomatic clients or animals that harbor pathogens but do not show evidence of an infectious disease are known as carriers. Treatment is thus unnecessary in most cases.

What is the correct rationale for using body substance precautions? a. Only actively infected clients are considered contagious. b. All body substances are considered potentially infectious. c. Disease-specific isolation procedures are adequate protection. d. The risk of transmitting HIV in sputum and urine is nonexistent.

b. All body substances are considered potentially infectious. Rationale: Body substance precautions are an extension of universal precautions. These precautions consider all body substances potentially infectious, regardless of a person's diagnosis. The consistent use of barriers whenever health care personnel have contact with moist body substances, mucous membranes, and nonintact skin is highly recommended. The risk of transmitting HIV in sputum and urine is real but at a much lower concentration than that in blood. Disease-specific isolation procedures are inadequate precautions, and at times additional measures should be used as in the exposure to blood and body fluids. Nurse should be aware that all clients have potentially infectious organisms that are transferable in blood and body fluids

Which general nursing practice guideline should the nurse follow when caring for clients in any health care facility? a. Isolate clients whenever possible and keep the room's doors closed. b. Avoid wearing long or artificial nails. c. Shake linens properly when changing a client's bed. d. Avoid physical contact with an infected client.

b. Avoid wearing long or artificial nails. Rationale: The nurse should avoid wearing artificial nails to avoid the spread of pathogens. The nurse should avoid physical contact with the infected client only when the disease is known to be transmitted through physical contact. The nurse should practice isolation of the client if a clear indication exists. The nurse should avoid shaking linens when changing the beds because this causes spread of dust and pathogens.

The nurse is inserting a foley catheter for a client. Which nursing action is appropriate if the sterile field is broken during this procedure? b. Don another pair of sterile gloves. c. Notify the primary care provider. d. No action is needed. e. Complete a sentinel event report.

b. Don another pair of sterile gloves. Rationale: If the nurse realizes that the sterile field is broken, the most appropriate response is to stop and don another pair of sterile gloves. A sentinel event has not occurred, and calling the PCP is unnecessary. Doing nothing and moving forward with foley insertion places the client at greater risk of infection and is not an appropriate action

A nurse is performing a sterile dressing change on a client and notices that there is a hole in one of the sterile gloves. Which would be the appropriate action to take to maintain a sterile field? a. Stop the procedure, remove damaged gloves, and put on new sterile gloves. b. Stop the procedure, remove damaged gloves, perform handwashing, and put on new sterile gloves. c. Finish the procedure and perform hand washing immediately afterward. d. Finish the procedure, remove damaged gloves, and put on new sterile gloves.

b. Stop the procedure, remove damaged gloves, perform handwashing, and put on new sterile gloves. Rationale: If a hole or tear is noticed in one of the gloves during the procedure, the nurse should stop the procedure, remove damaged gloves, wash hands or perform hand hygiene (depending on whether soiled or not), and put on new sterile gloves. Finishing the procedure after a break in sterility could cause an infection in the client. Hand washing is critical after the removal of the damaged gloves to protect the nurse from blood and/or body fluids.

A 79-year-old client reports brittle fingernails. What may be the cause of the client's problem?Top of Form a. presence of dry skin near the nails b. lack of keratin on the nails c. concentrated amount of keratin d. lack of skin near the nails

b. lack of keratin on the nails Rationale: The client's fingernails could be brittle due to lack of keratin on the nails. Fingernails and toenails are made of keratin, which in concentrated amounts gives them their tough texture. Skin is not made of keratin. Lack of skin or presence of dry skin near the nails does not affect the texture of the nails.

A nurse is believed to have become infected by inhaling the spores of a bacterium. What precaution should have been applied when the nurse was working with the client who had this illness? a. respirator b. mask c. gloves d. gown

b. mask Rationale: A mask is normally sufficient to prevent the inhalation of spores; a respirator would not be deemed necessary. Gloves and gowns would not prevent inhalation of spores.

Which care intervention should the nurse anticipate when providing care to a client admitted with a possible diagnosis of tuberculosis (TB)? a. wearing a face mask when entering and staying at a distance from the client b. wearing a particulate respirator for all client care and interaction c. placing the client in a regular, private room d. wearing protective eye wear for all client contact

b. wearing a particulate respirator for all client care and interaction Rationale: To prevent the transmission of TB, the National Institute for Occupational Safety and Health recommends the use of a particulate air filter respirator that fits snugly to the face for all client care and interaction. A face mask does not block small TB particles effectively. Protective eyewear is only needed if contact with bodily fluids is expected. The client would be placed in a negative pressure room to prevent the potential spread of TB

Specimens are delivered to laboratories in sealed containers in plastic _______ bags.

biohazard

The nurse has completed teaching regarding pediculosis. Which client statement requires further nursing teaching a. "A pediculicide shampoo is needed to treat this condition." b. "I will look for eggs on hairs ¼ to ½ in (0.5 to 1.5 cm) from the scalp and skin surfaces." c. "I will use conditioner so that the lice eggs will slide off my hair." d. "Lice can be spread by direct contact."

c. "I will use conditioner so that the lice eggs will slide off my hair." Rationale: Hair conditioner coats the hairs and protects the nits. The nurse must intervene to teach the client to only use the pediculicide shampoo; not conditioner. Eggs may attach to hairs ¼ to ½ in (0.5 to 1.5 cm) from the scalp and skin surfaces, and lice can be spread by direct contact.

Which general nursing practice guideline should the nurse follow when caring for clients in any health care facility? a. Isolate clients whenever possible and keep the room's doors closed. b. Avoid physical contact with an infected client. c. Avoid wearing long or artificial nails. d. Shake linens properly when changing a client's bed.

c. Avoid wearing long or artificial nails. Rationale: The nurse should avoid wearing artificial nails to avoid the spread of pathogens. The nurse should avoid physical contact with the infected client only when the disease is known to be transmitted through physical contact. The nurse should practice isolation of the client if a clear indication exists. The nurse should avoid shaking linens when changing the beds because this causes spread of dust and pathogens.

The nurse is caring for an older adult client who has refused a bath for several days and has now developed a rash on the buttocks. What is the priority nursing intervention? a. Schedule a bath in the morning or evening according to client's preferred bathing time. b. Offer a choice of types of soap and shampoo. c. Explain that cleanliness helps to remove bacteria from skin, which can prevent infection. d. Encourage the client to help with self-hygiene as able.

c. Explain that cleanliness helps to remove bacteria from skin, which can prevent infection. Rationale: The client needs education about why bathing is important. Knowledge deficit, and fear of loss of independence and/or privacy, may be impacting the client's choice. The nurse will first provide information about the reason that bathing is important, and then assure the client that privacy will be maintained, empowerment will be given, and autonomy will be respected.

A 79-year-old client reports brittle fingernails. What may be the cause of the client's problem? a. presence of dry skin near the nails b. concentrated amount of keratin c. lack of skin near the nails d. lack of keratin on the nails

c. lack of skin near the nails Rationale: The client's fingernails could be brittle due to lack of keratin on the nails. Fingernails and toenails are made of keratin, which in concentrated amounts gives them their tough texture. Skin is not made of keratin. Lack of skin or presence of dry skin near the nails does not affect the texture of the nails.

Following an increase in the incidence of nosocomial infections, the nurse educator has conducted a brief in-service with the nurses at the hospital in order to remind them of the key principles of asepsis. Which is a principle of asepsis that the nurses should integrate into care? a. Antibiotics should be used in noninfected clients to reduce the transmission of disease. b. Cleaning should begin with dirty areas and proceed to cleaner areas. c. Frequent hand hygiene is one of the most effective ways of reducing the transmission of microorganisms d. Surfaces and objects are considered to be sterile unless there is evidence of contamination.

c. Frequent hand hygiene is one of the most effective ways of reducing the transmission of microorganisms Rationale: The best response from the nurse is to educate the client about the common cold and how it is treated. Antiviral medication is not effective for the common cold. Antibiotics do not work to cure colds as a virus causes them. While antibiotics do cause side effects they are not appropriate for use in this client.

A nursing student is performing a urinary catheterization for the first time on a female client and inadvertently contaminates the catheter by touching the bed linens. What should the nurse do next to maintain surgical asepsis for this procedure? a. Clean the client's genital area with disinfectant-soaked cotton swabs from inside to outside b. Clean the catheter with antiseptic wipes and allow it to dry c. Gather new sterile supplies and start over d. Connect the catheter to the drainage bag using sterile medical tubing

c. Gather new sterile supplies and start over Rationale: When following surgical asepsis, areas are considered contaminated if they are touched by any object that is not sterile. The correct nursing action to maintain surgical asepsis is to gather new sterile supplies and start over. Although the steps for following surgical asepsis while inserting an indwelling urinary catheter include cleaning the client's genital area with disinfectant-soaked cotton swabs from inside to outside, this is not the next step for the nurse; sterility of the catheter is disrupted and new sterile supplies must be gathered before proceeding. Connecting the catheter to the drainage bag using sterile medical tubing is appropriate only after gathering new sterile supplies and inserting the catheter in the client. Cleaning the catheter with antiseptic wipes is not an appropriate step as this does not maintain sterile asepsis. Washing hands and putting on sterile gloves will occur after gathering new sterile supplies and starting the procedure again, to maintain sterility.

A nurse is taking care of an older adult client who demonstrates good mobility but is unable to stand for long periods of time secondary to muscle weakness. What action will the nurse use to facilitate the client's self-care and safety? a. Assist the client in taking a stand-up shower b. Give the client a bed bath c. Obtain a shower chair so the client can take a sit-down shower d. Give the client a towel or bag bath

c. Obtain a shower chair so the client can take a sit-down shower Rationale: This client is still able to bathe by himself but has difficulty standing for long periods of time. In order to foster independence and provide the client with a safe bathing environment, a sit-down shower with a shower chair would be most appropriate.

Which interventions will be most effective in preventing the spread of infection in the health care setting? a. Sterilizing all client supplies b. Donning gloves for all client care c. Proper handwashing d. Frequent room air exchanges

c. Proper handwashing Rationale: The most effective means of preventing the spread of infection in the healthcare setting is through proper handwashing. Sterilizing all client supplies is not possible nor would it omit bacterial transmission on the hands of healthcare workers. Frequent room air exchanges are important if a client has an illness, such as influenza or tuberculosis. Donning gloves for all client care helps to protect the nurse and client from contaminants but is not the most effective means of preventing the spread of illness.:

A nurse is shaving the facial hair of a client confined to bed. What is a recommended guideline for this procedure? a. Apply shaving cream approximately 1 inch thick. b. Do not use aftershave or lotion on the area shaved. c. Shave with the direction of hair growth in downward, short strokes. d. Fill bath basin with cool water.

c. Shave with the direction of hair growth in downward, short strokes. Rationale: The procedure includes: Shave with the direction of hair growth in downward, short strokes. Fill bath basin with warm (43º to 46ºC [110º to 115ºF]) water. Dispense shaving cream into palm of hand. Rub hands together, then apply to area to be shaved in a layer approximately 0.5 inches thick. If the client requests, apply aftershave or lotion to the area shaved.

A nurse is aware of the vital importance of thorough hand hygiene and usually opts for alcohol-based hand sanitizer rather than soap and water. In which case would soap and water be more effective than alcohol-based hand sanitizer? a. The nurse has been wearing the same pair of gloves for more than 20 minutes. b. The nurse is performing hand hygiene for the last time at the end of a shift. c. The nurse's hands are visibly soiled with a client's body fluids. d. The nurse has been caring for a client who has a nosocomial infection.

c. The nurse's hands are visibly soiled with a client's body fluids. Rationale: Alcohol does not remove soil or dirt with organic material. Consequently, nurses should use soap and water when their hands are visibly soiled. In the other listed situations, both methods of performing hand hygiene are appropriate.

A nurse is aware of the vital importance of thorough hand hygiene and usually opts for alcohol-based hand sanitizer rather than soap and water. In which case would soap and water be more effective than alcohol-based hand sanitizer? a. The nurse is performing hand hygiene for the last time at the end of a shift. b. The nurse has been wearing the same pair of gloves for more than 20 minutes. c. The nurse's hands are visibly soiled with a client's body fluids. d. The nurse has been caring for a client who has a nosocomial infection.

c. The nurse's hands are visibly soiled with a client's body fluids. Rationale:Alcohol does not remove soil or dirt with organic material. Consequently, nurses should use soap and water when their hands are visibly soiled. In the other listed situations, both methods of performing hand hygiene are appropriate.

The nurse is caring for a client who is on warfarin therapy. Which teaching will the nurse provide? a. Reassure the client that prolonged bleeding of wounds and gums is normal b. Take aspirin for headaches that develop. c. Use an electric razor for shaving purposes. d. Buy a hard-bristled toothbrush to ensure proper oral hygiene.

c. Use an electric razor for shaving purposes. Rationale: Anticoagulant therapy increases the risk of bleeding. Using an electric shaver, in place of a safety razor, and a soft-bristled toothbrush will reduce bleeding during care of skin and gums. The client should not be advised to take aspirin, buy a hard-bristled toothbrush, or explain that prolonged bleeding is normal.

A nurse on an acute medical unit is responsible for providing assistance with hygiene for clients who are unable to do so independently. The nurse should be aware that the use of a safety razor for shaving is contraindicated for which client? a. man who requires frequent opioid analgesics to control the pain associated with acute pancreatitis b. a man who has a decreased level of consciousness due to a stroke that he suffered several days earlier c. a man who is receiving an intravenous infusion of an anticoagulant for the treatment of a pulmonary embolism d. a man who is receiving antibiotics through a central venous catheter that is situated in his right jugular vein

c. a man who is receiving an intravenous infusion of an anticoagulant for the treatment of a pulmonary embolism Rationale: Due to the risk of bleeding, individuals who are receiving anticoagulants should not be shaved with a safety razor. Decreased level of consciousness, heavy use of opioids, and the presence of a central line do not preclude the use of a safety razor.

A nurse needs to clean and bathe a client who has undergone surgery following a motor vehicle accident. What type of bath will negate the need to rinse the client a. shower b. bed bath c. bag bath d. tub bath

c. bag bath Rationale: Rinsing is not required during a bag bath. During a shower, tub bath, or bed bath, the nurse must remove soap residue in order to prevent skin irritation.

A nurse has provided hygiene to an elderly client who has Clostridium difficile-related diarrhea. The nurse has been careful to wear a gown and gloves while providing care and has performed a thorough hand washing afterward. These precautions address what component of the chain of infection? a. reservoir for growth and reproduction b. susceptible host c. means of transmission d. infectious agent

c. means of transmission Rationale: Gloves, gowns, and hand washing reduce the risk that the nurse will contract the infection or transmit it to another client. These measures do not directly address the infectious agent, a reservoir or the presence of a susceptible host.

Any microorganism capable of disrupting normal physiologic body processes is a: a. fomite. b. virus. c. pathogen. d. bacterium.

c. pathogen. Rationale: Microorganisms that are capable of harming people are called pathogens or pathogenic.

A nurse is explaining the importance of sterilization to the mother of a 6-month-old baby. Which method should the nurse ask the mother to follow when sterilizing food containers used for the baby at home? a. expose to sunlight b. apply dry heat c. place in boiling water use free-flowing steam

c. place in boiling water Rationale:The nurse should recommend sterilizing food containers used for the baby at home using boiling water. Contaminated equipment needs to be boiled for 15 minutes at 212°F (100°C). Food containers cannot be sterilized by exposure to sunlight; this method is used to eliminate microorganisms circulating in the air. Free-flowing steam is less reliable than boiling because exposing all surfaces to steam is difficult. Dry heat is a good technique for sterilizing sharp instruments and reusable syringes because moist heat damages cutting edges and the ground surfaces of glass.

A nurse is explaining the importance of sterilization to the mother of a 6-month-old baby. Which method should the nurse ask the mother to follow when sterilizing food containers used for the baby at home? a. use free-flowing steam b. expose to sunlight c. place in boiling water d. apply dry heat

c. place in boiling water Rationale:The nurse should recommend sterilizing food containers used for the baby at home using boiling water. Contaminated equipment needs to be boiled for 15 minutes at 212°F (100°C). Food containers cannot be sterilized by exposure to sunlight; this method is used to eliminate microorganisms circulating in the air. Free-flowing steam is less reliable than boiling because exposing all surfaces to steam is difficult. Dry heat is a good technique for sterilizing sharp instruments and reusable syringes because moist heat damages cutting edges and the ground surfaces of glass.

At which link in the chain of infection does the nurse need to provide special attention to the respiratory and gastrointestinal tracts? a. port of entry b. mode of transmission c. port of exit d. susceptible host

c. port of exit Rationale: In the port of exit, the nurse should provide special attention to the respiratory and gastrointestinal tracts and to body fluids. The mode of transmission involves careful nursing care that eliminates the transmission of pathogens between people. Port of entry involves nursing procedures that help prevent pathogens from being allowed to enter a client's system. Susceptible host involves nursing actions that are aimed at increasing the client's resistance to disease.

A nurse is caring for a female client with multiple health problems. Which intervention most significantly increases the client's risk of infection? a. use of a nasogastric tube for feedings b. placement in a shared room c. use of an indwelling urinary catheter d. insertion of a peripheral intravenous catheter

c. use of an indwelling urinary catheter Rationale: Urinary catheters are among the most common sources of pathogens in hospitalized clients; they pose a greater risk than IVs or being in a shared room. NG tubes enter the nose and extend into the client's stomach, but these sites are not normally sterile, so they are less vulnerable to infection.

A nurse at a long-term care facility is planning to trim the toenails of many residents, most of whom are unable to do this hygiene task independently. The nurse should consult with a podiatrist before cutting the toenails of a resident: a. who is currently taking oral antibiotics for the treatment of a skin infection. b. who has not received a seasonal influenza vaccination. c. who has a history of type 1 diabetes. d. whose dementia has resulted in several aggressive outbursts in recent weeks

c. who has a history of type 1 diabetes. Rationale: Individuals with diabetes are highly susceptible to developing foot infections, which can often originate with improperly cut toenails; the nurse should likely refer this resident's foot care to a podiatrist. Infections, lack of vaccination, and cognitive deficits do not prohibit the nurse from performing foot care.

Infectious diseases can be classified as________ or communicable diseases.

contagious

The parent of a pediatric client tells the nurse, "I do not believe in vaccinations." What is the appropriate nursing response? a. "Vaccinations have been shown to contribute to autism." b. "Why do you not want to vaccinate your child?" c. "Vaccines are the only way to halt disease." d. "Help me understand your perspective about vaccinating.

d. "Help me understand your perspective about vaccinating. Rationale: Seeking to understand the parent's perspective helps the nurse to collect assessment data and create a therapeutic relationship of trust. Vaccines have not been connected to autism; asking the parent "why" reflects demanding an answer; and vaccines are one of numerous ways to halt disease transmission.

A client who has been diagnosed with a cold is upset that antibiotic therapy was not prescribed. Which nursing response is most appropriate? a. "Antibiotics have too many side effects anyway." b. "We can ask the PCP for an antiviral medication." c. "Sometimes antibiotics work for colds and sometimes they do not." d. "The common cold is a virus and will not respond to antibiotics."

d. "The common cold is a virus and will not respond to antibiotics." Rationale: Frequent hand hygiene and maintaining intact skin are the best methods for reducing the transmission of microorganisms. Microorganisms exist everywhere except on sterilized equipment, and cleaning should proceed from clean to dirty surfaces. Antibiotics should be used judiciously and are not normally provided to uninfected clients.

The latest CDC guidelines designate standard precautions for all substances except: a. urine. b. blood. c. Vomitus d. . sweat.

d. . sweat. Rationale: Current CDC guidelines define standard precautions as those used in the care of all hospitalized individuals, regardless of their diagnosis or possible infection status. They apply to blood, all body secretions and excretions (except sweat), nonintact skin, and mucous membranes.

Following a demonstration to a family member on how to insert a straight catheter, the nurse instructs the family member to remove the gloves by inverting one glove into the other. Which step would the nurse instruct the family member to do next? a. Wrap all used materials together and discard in a biohazard container b. Use an appropriate lotion that does not interfere with the antimicrobial effect of gloves or soaps c. Don a new pair of gloves to dispose of materials d. Perform hand hygiene

d. Perform hand hygiene Rationale: Inverting the gloves into each other encloses the soiled surface and blocks a potential exit route for microorganisms. After removing gloves, the next step would be to perform hand hygiene which should be conducted before touching the loved one. Used materials are not always disposed of in biohazard containers. Donning new gloves should not be necessary as materials should have already been disposed of prior to removing the gloves. Lotions that work in conjunction with soaps and lotions should be used when applying lotion after performing hand hygiene but this is not the next step.

When pouring a sterile solution, what care should the nurse take to avoid contamination of the solution? a. Wash the inside surface of the cap of the container with water. b. Open and place the cap of the container inside down on a flat surface. c. Wipe the mouth of the container with a sterile cloth before and after use. d. Pour and discard a small amount of the solution before each use.

d. Pour and discard a small amount of the solution before each use. Rationale: The nurse should pour and discard a small amount of the solution before each use to wash away airborne contaminants from the mouth of the container. This is called "lipping" the container. The nurse need not wash the inside surface of the cap of the container with water, nor wipe the mouth of the container with a sterile cloth before and after use. The nurse should open and place the cap of the container upside down, not inside down on a flat surface.

A nurse is caring for a client who is receiving care for a traumatic head injury that has rendered the client unconscious. When providing mouth care for this client, the nurse must be cognizant of the client's risk for: a. Coughing b. fluid volume overload. c. dental caries. d. aspiration.

d. aspiration Rationale: Clients who are not alert are at risk for aspirating (inhaling) saliva and liquid oral hygiene products into their lungs. Aspirated liquids predispose clients to pneumonia. Therefore, the nurse uses special precautions to avoid getting fluid in the client's airway. Unconscious clients cannot cough, and providing mouth care does not create a risk for fluid overload. Dental caries are a concern, but not in the short term.

A nurse is caring for an older adult client who is weak and unable to care for his glasses and dentures. When assisting with cleaning the dentures, the nurse should a. avoid the use of a toothbrush to clean removable bridges. b. don gloves and free the dentures from the client's mouth. c. store the dentures in an open cup containing only mouthwash. d. clean the dentures over a plastic basin or towel.

d. clean the dentures over a plastic basin or towel. Rationale: The nurse should clean the dentures over a plastic basin or towel to prevent breakage if dropped. The nurse should don gloves and use a dry gauze square or clean face cloth to grasp and free the denture from the mouth. The nurse should use a toothbrush to clean removable bridges and store the dentures in a covered cup containing plain water.

The nurse is teaching a client the correct procedure for pouring a sterile solution. Which client action indicates the need for further education from the nurse? a. pouring the solution slowly b. pouring out a small amount of the solution and discarding c. placing the cap upside down on table d. holding the container off to the side

d. holding the container off to the side Rationale: The client should hold the bottle in front of them for the most control and to see what they are pouring. Pouring out a small amount of the solution is appropriate; this is called lipping. Holding the lid or placing it upside down prevents contamination when the lid is reapplied to the sterile solution. Splashing can contaminate the area around the client. Pouring slowly will avoid splashing.

Tuberculosis (TB) is a communicable disease transmitted by which method? a. using an infected person's eating utensils b. sexual contact c. using dirty needles d. inhaling droplets exhaled from an infected person

d. inhaling droplets exhaled from an infected person Rationale: The TB bacillus is airborne and carried in droplets exhaled by an infected person who is coughing, sneezing, laughing, or singing. Sexual contact and dirty needles don't spread the TB bacillus but may spread other communicable diseases. It is never advisable to use dirty utensils, but if they are cleaned normally, it isn't necessary to dispose of eating utensils used by someone infected with TB.

The nurse working at a long-term care facility supervises while the unlicensed assistive personnel (UAP) bathes an older adult client. The nurse determines the UAP requires intervention when the UAP a. tests the water temperature prior to helping the client into the tub. b. inspects the feet while bathing the client. c. bathes the client using gentle patting motions. d. places a large quantity of soap on the washcloth.

d. places a large quantity of soap on the washcloth. Rationale: The nurse should intervene when observing the UAP apply a large quantity of soap to the washcloth since soap is very drying to the older adult client and should be used sparingly. It is appropriate to use a gentle patting motion while bathing since older adults have thin skin, decreased skin elasticity, and increased fragility of blood vessels in the dermis. The feet of the older adult client should always be inspected during bathing and other times of assessment to detect lesions, foot ulcers, and other alterations in skin integrity. Testing water temperature prior to entering the tub is done to prevent burns or hypothermia.

A client who has been admitted in the health care facility has had surgery and is unconscious. The nurse needs to take care of the client's hygiene and oral care daily. The client's teeth and lips show dry crusts when there is a day's gap in the oral hygiene. What can best describe the client's oral condition? a. caries b. periodontal disease c. gingivitis d. sordes

d. sordes Rationale: The client has sordes, a condition in which the dried crusts containing mucus, microorganisms, and epithelial cells shed from the mucous membrane; the condition is common on the lips and teeth of unconscious clients. Caries, or cavities, is a condition that occurs when the combination of sugar, plaque, and bacteria eventually erode the tooth enamel. Gingivitis is a condition in which there is inflammation of the gums. Pockets of gum inflammation promote periodontal disease, a condition that results in the destruction of the tooth-supporting structures and jawbone. Gingivitis, caries, and periodontal diseases are not specific to unconscious clients.

A nurse needs to send the blood and urine specimen of a client with acute diarrhea to the pathology laboratory. Which precaution is the priority when collecting and delivering the specimens to the laboratory? a. use disposable cover gowns and goggles b. use a particulate air filter respirator c. use thoroughly washed gloves d. use sealed containers in a plastic biohazard bag

d. use sealed containers in a plastic biohazard bag Rationale:The nurse should deliver the specimens to the laboratory in sealed containers in a plastic biohazard bag to prevent pathogens from spreading when transporting laboratory specimens. Nurses wear a particulate air filter respirator if the pathogen is transmitted by the airborne or droplet route. The use of vacuum-impregnated equipment or cover gowns, goggles, and gloves is a standard precautionary measure nurses take for every client. Nurses usually discard gloves after one use; they do not wash contaminated gloves and reuse them.

A nurse at a long-term care facility is planning to trim the toenails of many residents, most of whom are unable to do this hygiene task independently. The nurse should consult with a podiatrist before cutting the toenails of a resident: a. whose dementia has resulted in several aggressive outbursts in recent weeks. b. who has not received a seasonal influenza vaccination. c. who is currently taking oral antibiotics for the treatment of a skin infection. d. who has a history of type 1 diabetes.

d. who has a history of type 1 diabetes. Rationale: Individuals with diabetes are highly susceptible to developing foot infections, which can often originate with improperly cut toenails; the nurse should likely refer this resident's foot care to a podiatrist. Infections, lack of vaccination, and cognitive deficits do not prohibit the nurse from performing foot care.

The collective structures that cover the surface of the body and its openings are known as the body's _____________ .

integument

Transmission-based precautions, which are measures for controlling the spread of highly transmissible or epidemiologically important infectious agents, are also known as ________ precautions.

isolation

Autoclaved items can be safely disposed off in __________ .

landfills

A medical doctor who treats eye disorders is known as an _________________ .

ophthalmologist

A_______________ is a person with special training in caring for feet.

podiatrist