Chapter 24: Asepsis and Infection Control
The nurse is caring for a client who requires droplet precautions. Which statement made by the client would indicate further teaching is required?
"I can leave my room any time I want as long as I wear a mask."
The nurse is providing an in-service educational program for the interprofessional health care team about infection control precautions. What teaching will the nurse include? Select all that apply.
- Wear personal protective equipment (PPE). - Practice hand hygiene. - Keep client's environment clean.
Which clients are at a heightened risk for infection? Select all that apply.
- client with gastric tube feeding - client with an indwelling catheter - client with an IV catheter
A nurse has finished giving care to a client who has a communicable respiratory infection. In which order should the personal protective equipment (PPE) be removed? 1. Gloves 2. Respirator 3. Gown 4. Goggles
1, 4, 3, 2
The nurse is preparing to don sterile gloves for a procedure that requires surgical asepsis. Place the following steps in the order that the nurse should take when donning sterile gloves. Use all options
- Carefully open the inner package taking care not to touch the inner surface of the package or the gloves. - With the thumb and forefinger, grasp the folded cuff of the glove, insert fingers while pulling the glove over thee hand. - Place the fingers of the gloved hand inside the cuff of the remaining glove and insert the fingers while stretching it over the hand. - Adjust gloves on both hands if necessary, touching only sterile areas with other sterile areas.
Which are the names of the transmission-based precautions defined by the Centers for Disease Control and Prevention (CDC)? Select all that apply.
- airborne precautions - droplet precautions - contact precautions
The nurse triaged a number of clients in the emergency department. Which clients would the nurse identify as Risk for Infection? Select all that apply.
- the client who has AIDS and is taking antiretroviral medications - the client who reports abdominal pain for 1 day and exhibits an elevated white blood cell count - the client who has breast cancer, is receiving chemotherapy, and has a low white blood cell (WBC) count - the older adult client who is cachetic in appearance
The parent of a pediatric client tells the nurse, "I do not believe in vaccinations." What is the appropriate nursing response?
"Help me understand your perspective about vaccinating."
An acute medicine unit of a hospital currently has a number of clients who have tested positive for methicillin-resistant Staphylococcus aureus (MRSA). Which measures should the nursing staff prioritize in preventing the spread of MRSA to clients who are currently MRSA-negative?
diligent handwashing practices
A nurse has finished providing care for a client who is on contact precautions. When removing the protective gown, the nurse should take which action?
Avoid touching the outer surfaces of the gown.
When preparing to take a client's blood pressure, the nurse notes that the sphygmomanometer is visibly soiled. What is the correct action by the nurse?
Cleanse and disinfect the sphygmomanometer.
The nurse is caring for a client with a draining abscess. Which precautions will the nurse begin?
Contact
The nurse is caring for an older adult with a recurrent wound infection. Which precautions will the nurse begin?
Contact
A nurse is providing care to a client diagnosed with impetigo. The nurse would institute which type of infection control?
Contact precautions
What is the primary purpose for the demonstrated glove application?
Cover exposed wrist skin
The nurse has completed an intervention with a client. There is no visible soiling on the nurse's hands. Which technique is recommended by infection control practice standards for hand hygiene?
Decontaminate hands using an alcohol-based hand rub.
The nurse is providing care for a client with varicella. What action should the nurse perform?
Ensure the client is housed in a negative pressure room.
Upon review of a client's microbiology culture results, the nurse recognizes which organism as indicative of normal flora?
Escherichia coli in the intestinal tract
A nurse is caring for a client with ringworm. Which microorganism causes ringworm in a client?
Fungi
An experienced nurse is teaching a student nurse about the proper use of hand hygiene. Which guideline should the nurse provide to the student?
Hand hygiene is needed after contact with objects near the client.
Unbeknownst to him, a nursing student has inhaled droplets containing common cold viruses and is soon to develop a cold himself. Place the following stages of infection in the sequence in which they will occur.
Incubation period Prodromal stage Full stage of illness Convalescent period
Recently the United States and Canada have seen the development of West Nile virus. It is carried to humans by:
Mosquitoes
The nurse has completed a client's personal care and is now removing personal protective equipment. What is the nurse's best action when removing gloves?
Picture of nurse holding glove at the end
The nurse is preparing to help mobilize a client with an abdominal wound that is colonized by methicillin-resistant Staphylococcus aureus (MRSA). Which of the shown actions should the nurse perform before assisting the client?
Picture of nurse with gloves over gown
Nurses working in bed management are assigning clients from the emergency room to semiprivate rooms. Clients with which two diagnoses are appropriate to room together, based on safety and infection control standards?
Reactive airway disease and exacerbation of chronic obstructive pulmonary disorder (COPD)
What is an accurate guideline for the use of PPE?
Replace gloves if they are visibly soiled.
An infection or the products of infection carried throughout the body by the blood is called:
Septicemia.
A client is to have an indwelling urinary catheter inserted. Which precaution is followed during this procedure?
Surgical asepsis technique
A client has tested positive for methicillin-resistant Staphylococcus aureus after being swabbed on admission to the hospital. Bacterial resistance to antibiotics is an example of:
Survival adaptation
The nurse is teaching a new nurse about preparing a sterile field. Which action made by the new nurse would indicate further teaching is required?
The new nurse touches 1.5 in. (4 cm) from the outer edges.
A nurse prefers to use an alcohol-based hand rub when providing care for clients. In which case is this practice contraindicated?
The nurse is caring for a client with a C. difficile infection.
The nurses on a busy surgical ward use hand hygiene when caring for postsurgical patients. Which action represents an appropriate use of hand hygiene?
The nurse keeps fingernails less than 1/4 in (0.63 cm) long.
The nurse conducting a hand hygiene in-service determines that the participants need additional education when they state that the use of an alcohol-based hand rub is appropriate in which situation?
When hands are visibly soiled
In which situation is an alcohol-based rub an inappropriate option for hand hygiene?
When the nurse's hands are visibly soiled
Surgical asepsis is defined as:
absence of all microorganisms.
The nurse caring for clients at an outpatient clinic determines that which client is at greatest risk for infection?
an 80-year-old woman
A lead nurse is removing personal protective equipment after dressing the infected wounds of a client. Which is the priority nursing action?
handwashing before leaving the client's room
The nurse is caring for a client who developed pneumonia while hospitalized. How will the nurse document this condition?
health care-associated infection (HCAI)
To eliminate needlesticks as potential hazards to nurses, the nurse should:
immediately deposit uncapped needles into a puncture-proof plastic container.
The nurse is caring for a client who became very ill after ingesting seafood. How will the nurse document this condition?
noncommunicable disease
A nurse is working with a 55-year-old woman diagnosed with human immunodeficiency virus (HIV). This nurse has another client that day who has an upper respiratory infection. What is the most important thing the nurse can do to prevent the client with HIV from acquiring the upper respiratory infection?
perform hand hygiene before and after entering the client's room
The nurse observes an unlicensed assistive personnel (UAP) collecting a urine specimen from a client with Staphylococcus aureus infection. Which action by the UAP would require the nurse to intervene?
removes gloves and walks out of the room
A client has an inguinal hernia repair and later develops a methicillin-resistant Staphylococcus aureus (MRSA) infection. What is the most important factor to prevent this infection?
surgical asepsis
The nurse is caring for assigned clients who are all stable. Which client should the nurse see first to minimize the spread of infection?
the client who is 48-hours postsurgical procedure
A nurse has sustained a puncture wound on the hand from a scalpel blade that was left on a used procedure tray. What is the first action by the nurse?
wash the area with soap and water
Which care intervention should the nurse anticipate when providing care to a client admitted with a possible diagnosis of tuberculosis (TB)?
wearing a particulate respirator for all client care and interaction
The nurse is caring for a client who is to have a sterile dressing change to a wound. A student nurse enters the client's room and notices the nurse preparing the sterile field. After reviewing the image, which response by the student nurse to the nurse is the most accurate understanding of this procedure?
"The way you are doing it helps to minimize contamination of the non-waterproof side."
A nurse is implementing the principles of surgical asepsis while inserting a client's indwelling urinary catheter. Which action should the nurse perform?
Hold sterile objects above waist level to prevent accidental contamination.
A client is admitted to the hospital with tuberculosis. Which statement by the nurse explains how to reduce the risk of transmission to others?
"All visitors who enter the room must wear special masks."
