Fundamentals: Infection Prevention - Clinical Questions

A patient is admitted in the hospital with a diagnosis of meningococcal pneumonia. Which is the priority nursing intervention in this condition? A - Isolating the patient B - Performing oral hygiene C - Providing antimicrobial therapy D - Keeping the patient well hydrated

ANS: A Meningococcal pneumonia is an infectious droplet infection. Therefore, the patient should be isolated first to prevent the transmission of the disease. The nurse should isolate the patient before performing oral hygiene. The nurse should provide antimicrobial therapy after isolating the patient. The nurse should maintain adequate hydration to promote the patients' health and reduce the risk of infections.

Which equipment is used to sterilize surgical instruments? A - Autoclave B - Boiling water C - Chemical sterilants D - Ethylene oxide (ETO) gas

ANS: A Autoclaves use moist heat to kill pathogens and spores on surgical instruments to prevent infections. Boiling water is used to clean urinary catheters, suction tubes, and drainage collection devices. Chemical sterilants are used to disinfect heat-sensitive instruments and equipment such as endoscopes and respiratory therapy equipment. Ethylene oxide (ETO) gas is used for medical materials.

A nursing student performs surgical hand asepsis after assisting a registered nurse in a surgical procedure. Which action made by the nursing student needs correction? A - Keeping the hands below the waist level B - Turning off the faucet using the knees C - Using a continuous motion to rinse from the fingertips to the elbows D - Using a rotary motion to move the towel from the fingers to the elbows

ANS: A Because the area below the waist level is considered unsterile, the nurse should keep his or her hands above the waist. The faucet should be closed by using the knees to prevent contamination of the hands. The nurse should use a continuous motion to rinse from the fingertips to the elbows, allowing water to run off at the elbows. The nurse should use a rotary motion to move the towel from the fingers to the elbows during drying to dry the skin from the hands to the elbows.

Which is the most effective way to break the chain of infection? A - Hand hygiene B - Wearing gloves C - Placing patients in isolation D - Providing private rooms for patients

ANS: A Hands become contaminated through contact with the patient's environment. Clean hands interrupt the transmission of microorganisms. Wearing gloves, placing patients in isolation and providing private rooms also can help break the chain of infection, but hand hygiene is the most effective method.

Which nursing intervention requires surgical asepsis? A - Suctioning the tracheobronchial airway B - Emptying and disposing drainage suction bottles C - Keeping drainage tubes and collection bags patent D - Placing needleless systems into puncture-proof containers

ANS: A Surgical asepsis prevents contamination of an open wound and isolates an operative area from the unsterile environment. Thus the nurse would use surgical asepsis at the patient's bedside for suctioning the tracheobronchial airway. Emptying and disposing of drainage suction bottles, keeping drainage tubes and collection bags patent, and placing needleless systems into puncture-proof containers indicates that the nurse is reducing reservoirs of infection.

A 47-year-old patient has arrived at the clinic after accidentally cutting his forearm with a pair of scissors. Which clinical manifestations would the nurse expect to indicate a local inflammation? Select all that apply. A - Swelling B - Redness C - Vomiting D - Anorexia E - Pain

ANS: A, B, E The local manifestations of inflammation include swelling, redness, and pain. These manifestations are caused by protective vascular reactions that help to combat inflammation. Anorexia and vomiting are systemic manifestations of inflammation.

Which symptoms indicate the presence of a systemic infection? Select all that apply. A - Fatigue B - Redness C - Swelling D - Warmth E - Malaise

ANS: A, E Fatigue, malaise, fever, and vomiting are the generalized symptoms of systemic infections. Localized infections can be assessed by redness, warmth, and swelling due to inflammation.

Which disease is a communicable disease that can be asymptomatic? A - Meningitis B - Pneumonia C - Tuberculosis D - Hepatitis C virus

ANS: D Hepatitis C virus (HCV) is a communicable disease that can be asymptomatic. Viral meningitis and pneumonia have a low or no risk for transmission and are not considered communicable diseases. Tuberculosis is a communicable and symptomatic disease.

Which microorganism is associated with an exogenous infection? A - Staphylococci B - Enterococci C - Streptococci D - Salmonella

ANS: D The microorganisms associated with an exogenous infection are those that do not exist as normal flora in humans such as salmonella. Staphylococci, enterococci, and streptococci are responsible for endogenous infection and exist as normal flora in an individual.

Which instrument used by the nurse requires surface disinfection? A - Endoscope B - Cardiac catheter C - Urinary catheter D - Blood pressure cuff

ANS: D There are two types of disinfection: disinfection of surfaces and high-level disinfection. Noncritical items such as blood pressure cuffs require a surface disinfection. Semi-critical items such as endoscopes require high-level disinfection. Critical items such as cardiac and urinary catheters require sterilization.

Which type of transmission-based precaution requires a gown and gloves? A - Droplet precautions B - Contact precautions C - Airborne precautions D - Protective environment precautions

ANS: B Contact precautions require a gown and gloves because the handling of contaminated body fluids may cause infections. Droplet precautions require a surgical mask within three feet (0.9 meters) of a contagious patient. Airborne precautions require a specially equipped room with a negative airflow, referred to as an airborne infection isolation room. Protective environment precautions require a specialized room with a positive airflow set to greater than 12 air exchanges per hour.

When the nurse is performing surgical hand asepsis, where should the nurse keep his or her hands? A - Below the elbows B - Above the elbows C - At a 45-degree angle D - In a comfortable position

ANS: B Keeping the hands above the elbows when performing a surgical scrub prevents contaminated water from coming into contact with the hands.

What is the portal of exit of the influenza virus? A - Blood B - Respiratory tract C - Reproductive tract D - Skin and mucous membrane

ANS: B The influenza virus is released from the body via the respiratory tract when an infected person sneezes or coughs. Organisms that cause communicable disease such as Hepatitis B and HIV exit from wounds and bloody stool. Organisms such as Neisseria gonorrheae and HIV exit through the reproductive tract during sexual contact. Any break in the skin and mucous membranes allows pathogens to exit the body; the influenza virus does not exit through the skin.

During which stage is a patient capable of spreading a disease because microorganisms are growing and multiplying? A - Illness stage B - Prodromal stage C - Incubation period D - Convalescence stage

ANS: B The prodromal stage is the time interval of onset of nonspecific symptoms to more specific symptoms. During this stage, microbes grow and multiply and the patient is capable of spreading the disease to others. The illness stage is the time interval when a patient manifests signs and symptoms specific to the type of infection. The incubation period is the time interval between the entrance of a pathogen into the body and the appearance of the first symptoms. The convalescence stage is the time interval when acute symptoms of infection disappear.

Which normal flora of the human colon can cause an infection when it enters the bloodstream? A - Escherichia coli B - Candida albicans C - Bacteroides fragilis D - Plasmodium falciparum

ANS: C Bacteroides fragilis is a part of the normal flora of the human colon. This microorganism can cause infections if it enters the blood stream or tissue during injury or surgery. Escherichia coli causes gastroenteritis in the colon. Candida albicans causes candidiasis, pneumonia, and sepsis. Plasmodium falciparum causes malaria.

A patient's surgical wound has become swollen, red, and tender. You note that the patient has a new fever and leukocytosis. What is the best, immediate intervention? A - Notify the healthcare provider and use surgical technique to change the dressing. B - Reassure the patient and recheck the wound later. C - Notify the healthcare provider and support the patient's fluid and nutritional needs. D - Alert the patient and caregivers to the presence of an infection to ensure care after discharge

ANS: C Early intervention can reduce the risk of sepsis caused by the progression of the infection. Therefore, it is important to notify the healthcare provider for further orders and support the patient's fluid and nutritional needs. Fever depletes body fluid stores, which can result in an increased risk of dehydration; providing proper nutrition promotes healing.

After reviewing the laboratory reports of a patient, the nurse suspects that the patient has an acute suppurative infection. What would be the patient's neutrophil count? A - 60% B - 65% C - 70% D - 75%

ANS: D The normal range of neutrophils in a healthy adult ranges from 55% to 70%. A high neutrophil count (such as 75%) would indicate an acute suppurative infection.

A licensed practical nurse is preparing to assist in a sterile procedure. Which nursing action is appropriate in surgical hand asepsis? A - Scrubbing the hands for 5 minutes B - Washing over the rings and watch C - Keeping the hands and arms below the elbows D - Allowing the water to flow from the elbows to the hands

ANS: A While performing surgical hand asepsis, the nurse should scrub the hands for 5 minutes to eliminate transient microorganisms and reduce resident hand flora. During a sterilizing procedure, the nurse should remove all jewelry and accessories, such watches and rings. The hands should be above the elbows while performing a surgical scrub.

Arrange the steps of adding sterile items chronologically. A - Carefully peel the wrapper B - Open the sterile item C - Dispose of the outer wrapper D - Be sure the outer wrapper does not fall on the sterile field

ANS: B, A, D, C While adding sterile items, the sterile item should first be opened by holding the outside wrapper in the nondominant hand. Then, the wrapper should be peeled away on the nondominant hand. Next, the nurse should be sure that the wrapper does not fall on the sterile field. Finally, the outer wrapper should be disposed of.

The nurse is instructed to clean artery forceps contaminated with blood. Arrange the steps of cleaning in the appropriate order. A - Dry the artery forceps. B - Rinse the artery forceps with cold water. C - Rinse the artery forceps with warm water. D - Wash the artery forceps with soap and water.

ANS: B, D, C, A Any object contaminated with organic material like blood should be rinsed with cold running water. If hot water is used in the beginning, the protein in the organic material would coagulate and stick to the object. This may make cleaning difficult. After rinsing with cold water, the object should be washed with soap and water. Next, the object should be rinsed in warm water, and finally dried for reuse.

What major infections are caused by Escherichia coli? Select all that apply. A - Hepatitis A B - Pneumonia C - Gastroenteritis D - Food poisoning E - Urinary tract infections

ANS: C, E Gastroenteritis and urinary tract infections are major infections caused by Escherichia coli. The hepatitis A virus causes Hepatitis A. Pneumonia and food poisoning are major infections caused by Staphylococcus aureus.

A patient is diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Which type of isolation precaution is most appropriate for this patient? A - Droplet precautions B - Contact precautions C - Airborne precautions D - Standard precautions

ANS: A Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is transmitted via droplets larger than 5 microns. Pneumonia causes deep chest pain with a cough that transmits the infection. Therefore, the nurse should follow droplet precautions to prevent the infection transmission. The nurse should follow contact precautions if the infection transmits by direct patient or environmental contact. Airborne precautions are used to prevent infections that transmit through droplet nuclei smaller than 5 microns. Standard precautions are used to prevent infections that may be caused by blood, blood products, body fluids, secretions, nonintact skin, and mucous membranes.

Which environment would limit the growth of bacteria? A - Bacteria growing in a pH of 3.0 B - Bacteria growing under dressings C - Bacteria growing in a moist surgical wound D - Bacteria growing in at a temperature of 38° C

ANS: A Most bacteria prefer an environment within a pH range of 5.0 to 7.0. Therefore, bacterial growth may be prevented in a pH of 3.0. Bacteria grow vigorously in dark environments such as under dressings and within body cavities. Most bacteria require water or moisture for survival. Therefore, bacteria can grow in a moist surgical wound. Bacteria can grow vigorously if the temperature is 38° C because most bacteria grow in an ideal temperature that ranges from 20° to 43° C.

Which disease requires contact precautions? A - Scabies B - Measles C - Diphtheria D - Pharyngitis

ANS: A Scabies spreads through skin contact and the nurse should take contact precautions. Measles require airborne precautions. Diphtheria and pharyngitis require droplet precautions.

A registered nurse is teaching a student nurse about the various stages of infections. Which statement made by the student nurse indicates a need for additional teaching? A - "The incubation period for mumps is 1 to 5 days." B - "The acute symptoms of malaria will disappear during the convalescence stage." C - "Group A beta-hemolytic Streptococcus causes a sore throat, pain, and swelling at the illness stage." D - "Herpes simplex at the prodromal stage begins with itching at the site before the lesion appears."

ANS: A The incubation period for mumps is 12 to 26 days. The recovery of the patient is noticed during the convalescence stage of malaria. Acute infections are noticed during the illness stage. Group A beta-hemolytic Streptococcus causes strep throat manifested by a sore throat, pain, and swelling. Herpetic whitlow is the infection caused by the herpes simplex virus. The nonspecific signs and symptoms, such as itching and tingling, develop during the prodromal stage at the site before the appearance of the lesions.

A patient reporting sore throat and pain while swallowing arrives at the hospital. The laboratory reports revealed the presence of beta-hemolytic group A streptococcus. What would be the patient's stage of infection? A - Illness stage B - Convalescence C - Prodromal stage D - Incubation period

ANS: A The interval when a patient manifests signs and symptoms (such as a sore throat and pain while swallowing) that are specific to a type of infection is the illness stage. Convalescence is the interval when acute symptoms of infection disappear. The prodromal stage is the interval from the onset of nonspecific signs and symptoms to more specific symptoms. The incubation period is the first stage of the infection process. It is the interval between the entrance of a pathogen into body and the appearance of the first symptoms.

While communicating with a patient who has an infection, the nurse says, "Tell me about your recent major lifestyle change that has occurred." Which factor is the nurse trying to assess? A - Stressors B - Risk factors C - Recent travel history D - Possible existing invitations

ANS: A The nurse is asking about a patient's recent lifestyle changes to learn more about the stressors that may have contributed to a patient's infection. Increased stress results in increased cortisone levels, resulting in decreased resistance to infection. The nurse would not inquire about a patient's lifestyle changes to assess risk factors, recent travel history, or possible existing infections to assess the cause for infections.

Which statement regarding vascular and cellular responses is true? A - Vasodilation occurs at the site of injury. B - Chronic inflammation is an immediate response to cellular injury. C - Increased blood flow leads to coldness at the site of inflammation. D - The cellular response involves red blood cells at the site of infection.

ANS: A Vasodilation occurs at the site of injury resulting in excessive blood loss at the site. The immediate response to a cellular injury is an acute inflammation. Increased blood flow at the site of inflammation leads to redness and warmth at the site of inflammation. The cellular response involves white blood cells at the site of inflammation.

Which action increases the risk of contamination while applying a sterile gown? A - Lifting the gown upward and stepping forward near the table B - Grasping the inside front of the gown with both hands just below neckband C - Asking the circulating nurse to tie the back of the gown at the neck and waist D - Slipping both arms into the armholes with the hands at shoulder level

ANS: A While applying a sterile gown, the nurse should lift the gown directly upwards and step backwards (not forward) away from the table to provide a wide margin of safety. The nurse can ask the circulating nurse to tie the back of the gown at the neck and waist; this action can reduce the risk of contamination. Clean hands can touch the inside of the gown without contaminating the outer surface. With the hands at shoulder level, the nurse should slip both arms into the armholes simultaneously to prevent contamination.

A registered nurse evaluates the nursing assistive personnel who is wearing a mask. Which action made by the nursing assistive personnel indicates a need for correction? A - Having a casual conversation while wearing a mask B - Changing an unused mask due to a moist feeling C - Tying the two top ties at the back of the head and above the ears D - Wearing the mask such that the top of the mask fits below the glasses

ANS: A While wearing a mask, talking should be kept to a minimum to reduce respiratory airflow. A mask that has become moist does not provide a barrier to microorganisms and should be discarded. While wearing a mask, the two top ties should be tied at the back of the head and above the ears. The top of the mask should fit below the glasses.

A registered nurse evaluates a nursing student's actions. Which nursing actions indicate that the nursing student is following precautions to eliminate reservoirs of infection? Select all that apply. A - Changing soiled dressings B - Emptying urinary drainage bags every 4 hours C - Covering the mouth and nose when coughing or sneezing D - Instructing the patient to maintain adequate fluid intake E - Wearing disposable gloves while making contact with patients

ANS: A, B The nurse should follow certain precautions to prevent infection and control reservoirs of infection. Soiled dressings, body fluids, and urinary drainage bags act as reservoirs of infection. Changing the soiled dressings and emptying the urinary drainage bags help to eliminate the reservoirs of infection and controls infection. The mouth and nose should be covered when coughing or sneezing to prevent the spread of airborne infections. The nurse instructs the patient to maintain adequate fluid intake to promote normal urine formation and outflow to flush the bladder and urethral lining of microorganisms. Wearing disposable gloves while making contact with patients indicates that the nurse is following contact precautions.

The nurse is teaching a group of nursing students about the normal defense mechanisms of the body against infections. Which statements are true about the skin as a primary defense against infections? Select all that apply. A - It provides a barrier to microorganisms. B - It helps in removing organisms when they adhere to outer layers of the skin. C - It contains fatty acids that have an antibacterial action. D - It helps in washing away particles containing microorganisms. E - It contains microbial inhibitors.

ANS: A, B, C The multilayered surface of the skin acts as a barrier against microorganisms. The periodic shedding of outer layers of the skin helps in removing organisms that adhere to the outer layers of the skin. The sebum secreted from the skin glands contains fatty acids that have antibacterial action. The skin does not help in washing away particles containing microorganisms or have microbial-inhibiting action. Saliva in the oral cavity helps to perform these actions.

The nurse works in a hospital. The nurse understands that health care-associated infections (HAIs) are difficult to treat. Which patient may be at increased risk of developing an HAI? Select all that apply. A - A patient who underwent bronchoscopy B - A patient who receives broad-spectrum antibiotics C - A patient who has an indwelling urinary catheter D - A patient who suffers from diabetes mellitus E - A patient who has a fever

ANS: A, B, C, D Bronchoscopy bypasses the natural defenses of the body and predisposes the patient to HAIs. Broad-spectrum antibiotics suppress the normal flora and promote growth of resistant strains of microorganisms. An indwelling urinary catheter bypasses the natural defenses and also serves as a port of entry for microorganisms. Diabetes mellitus suppresses the body's immunity and increases the risk of HAIs. Fever does not affect the natural defense mechanism and therefore does not increase the risk of HAIs.

A head nurse is teaching cough etiquette to staff members at the hospital. What should the nurse include in the instructions? Select all that apply. A - Cover the nose and mouth with a tissue when coughing. B - Dispose of any contaminated tissue promptly. C - Maintain a distance of at least 2 feet from persons with respiratory infections. D - Maintain a distance of greater than 3 feet from persons with respiratory infections. E - Place a surgical mask on a patient if it does not compromise respiratory function.

ANS: A, B, D, E Cough etiquette involves covering the nose and mouth with a tissue when coughing. It helps to prevent the spread of infections. Disposing of contaminated tissue promptly helps to contain the microbes. Spatial separation of greater than 3 feet from persons with respiratory infections helps to avoid contracting the infection through droplets. Placing a surgical mask on a patient if it does not compromise respiratory function helps to prevent infection in the patient. A distance of 2 feet is too close and promotes the spread of infection through droplets.

What equipment is required for the preparation of a sterile field? Select all that apply. A - Sterile drape B - Paper face mask C - Counter top surface D - Protective eyewear E - Surgical scrub sponge

ANS: A, C Sterile drapes and counter top surfaces are required to prepare a sterile field. Paper face masks, protective eyewear, and surgical scrub sponges are required for surgical asepsis.

Which pieces of equipment in the health care facility are considered noncritical items that should be disinfected? Select all that apply. A - Linens B - Implants C - Stethoscopes D - Blood pressure cuffs E - Intravascular catheters

ANS: A, C, D Linens, stethoscopes and blood pressure cuffs are considered noncritical items that should be disinfected. Implants and intravascular catheters are critical items that should be sterilized.

The nurse is assessing a group of patients in a health screening program. What should the nurse evaluate when assessing the infection risk in these patients? Select all that apply. A - Inquire about diet and appetite. B - Compare monthly earnings. C - Assess immunization details. D - Inquire about travel history. E - Inquire about medication history.

ANS: A, C, D, E A patient's nutritional health directly affects the patient's susceptibility to infection. Assessing immunization details is important to understand which vaccines have been given as preventive measures. The travel history can reveal important information regarding the risk of exposure to communicable diseases. The medication history will help to identify any medications that can increase the susceptibility of infections. Comparing monthly earnings is unrelated to assessment of risk for contracting an infection.

The nurse is caring for a patient who has a respiratory infection. The nurse understands that an infection occurs in a cycle and involves several elements. What are the elements in the chain of infection? Select all that apply. A - An infectious agent B - A vaccine schedule C - The source of pathogen growth D - A clean surrounding E - A susceptible host

ANS: A, C, E An infectious agent is the main pathogen or infection-causing organism that spreads through the chain of infection . The source for pathogen growth is the reservoir where the pathogens can multiply, survive, and wait until they are transferred to a susceptible host. A susceptible host is the element in the chain of infection that receives the pathogens and is in a favorable condition for their growth and transmission. A vaccine schedule is the plan of immunization and is not an element in the chain of infection. A clean surrounding is an ideal situation to prevent the spread of pathogens and is not an element in the chain of infection.

A patient is diagnosed with a methicillin-resistant Staphylococcus aureus (MRSA) infection of the respiratory system and has a productive cough. The nurse auscultates the lungs and finds that the breath sounds are clear. The disposable thermometer used by the nurse indicates fever. The nurse collects a urine specimen of the patient as ordered. What interventions should the nurse perform to prevent the spread of infection? Select all that apply. A - Confirm fever using an electronic thermometer. B - Clean the bell and diaphragm of the stethoscope with soap and water. C - Place specimen containers on a clean paper towel in the patient's bathroom. D - Label the specimen in the bathroom where samples of patients are collected. E - Review agency policies and precautions necessary for the specific isolation system.

ANS: A, C, E The nurse should be aware of the equipment used in an isolation room and the indications for isolation. If the disposable thermometer indicates fever, it is important to confirm it using an electronic thermometer. The nurse also needs to review agency policies and procedures. Methicillin-resistant Staphylococcus aureus (MRSA) can cause a health care-associated infection (HAI). Therefore, the nurse has to take precautions to prevent the spread of infections within the hospital.Specimen containers are to be kept in the patient's bathroom appropriately. If a stethoscope is to be reused, the diaphragm or bell should be cleaned with alcohol, rather than soap, and should be set aside on a clean surface to dry completely. After the sample is collected, labeling on the specimen container is to be done at the bedside of the patient to avoid errors.

The nurse is educating a patient on how to prevent the spread of infections. Which patient habits should be discouraged to prevent infections? Select all that apply. A - Eating thawed meat that is partially cooked B - Covering the mouth or nose when coughing or sneezing C - Washing hands after using the toilet D - Removing a contaminated wound dressing by oneself E - Covering food with lids to avoid flies

ANS: A, D A partially cooked, thawed piece of meat is more likely to cause infection because frozen meat is typically stored for a longer time, and partially cooked meat can transmit certain infections. Also, the wound dressing may have bacteria and removing the dressing by oneself can cause infection. Airborne infection may spread while sneezing; hence sneezes should be covered. Washing hands after using the toilet and covering foods with lids are some of the measures to prevent infection.

A registered nurse teaches a student nurse about how age influences infection prevention and control. Which statements made by the nursing student indicate the need for further learning? Select all that apply. A - "The immune system declines as the child grows." B - "Adults in old-age have decreased cell-mediated immunity." C - "Middle-aged adults have refined defenses against infections." D - "An infant's immune system produces a large amount of immunoglobulins." E - "Infants who are breastfed have greater immunity than bottle-fed infants."

ANS: A, D The immune system of the child matures with age. An infant's immune system is incapable of producing immunoglobulins and white blood cells. Cell-mediated immunity decreases with an increase in age because older adults experience alterations in the structure and function of body parts. Young and middle-aged adults have refined defenses and immunity against infections. Breastfed infants receive antibodies through breast milk; these infants have greater immunity than infants who are bottle-fed.

The nurse cares for a patient who has chickenpox. Which protection barriers should the nurse use? Select all that apply. A - Mask B - Gloves C - Gowns D - Goggles E - N95 respirator

ANS: A, E Airborne precautions should be taken while caring for patients with chicken pox. For this case, the nurse should use a mask and a N95 respirator. Gloves and gowns should be used while in direct contact with patients who are infected with multidrug resistant organisms, such as Clostridium difficile. Goggles should be worn while caring for patients with eye conditions such as conjunctivitis.

A nurse cares for a patient who is diagnosed with tuberculosis. Which nursing interventions would be most appropriate to reduce the risk of transmission? Select all that apply. A - Wearing an N95 respirator B - Maintaining a positive airflow in the room C - Wearing a surgical mask when the patient is 5 feet away or less D - Wearing a mask while outside of the patient's room E - Wearing gloves while performing a physical examination of the patient

ANS: A, E Diseases such as tuberculosis are transmitted by small droplets that remain in the air for longer periods of time. The nurse should wear an N95 respirator whenever entering the patient's room. The nurse should also wear gloves while performing a physical examination to reduce the transmission of infection by direct contact. A specially equipped room with a negative airflow is referred to as an airborne infection isolation room; this room is used to reduce the risk of airborne transmission. Positive airflow is used with patients with allogeneic hematopoietic stem cell transplants as a protective environment precaution. A surgical mask is applied when the patient is 3 feet away or less to reduce the risk of transmission through larger droplet nuclei. The patient, not the nurse, should wear a mask when he or she is outside of his or her room as a protective environment precaution.

A registered nurse evaluates a nursing student after teaching the nursing skills required during sterilization disinfection and cleaning of equipment. Which statements made by the nursing student indicates a need for further teaching? Select all that apply. A - "Implants are considered noncritical items and must be disinfected." B - "Stethoscopes are considered noncritical items and must be disinfected." C - "Surgical instruments are considered critical items and must be sterilized." D - "Endotracheal tubes are considered semi-critical items and must be sterilized." E - "Urinary catheters are considered semi-critical items and must be disinfected."

ANS: A, E Implants are considered critical items and must be sterilized. Urinary catheters are considered critical items and must be sterilized. Stethoscopes are considered noncritical items and must be disinfected. Surgical instruments are considered critical items and must be sterilized. Endotracheal tubes are considered semi-critical items and must be sterilized.

Which statement is true regarding the donning and removing of caps, masks, and eyewear? A - Surgical masks and eyewear should be worn only inside the sterile field. B - Eyewear should be worn only when the procedure has a risk of splashing. C - Surgical masks should be worn first and then a clean cap should be worn to cover the hair. D - Surgical masks should be removed after the completion of the procedure even if it takes several hours.

ANS: B Eyewear protects the eyes from procedures that have a risk of splashing. Surgical masks and eyewear should be worn in the general nursing units. The hair should be covered with a cap first before putting on the mask and eyewear. If the mask gets moist, the mask should be removed and another mask should be worn even if the procedure takes several hours to complete.

While performing hand hygiene, the nurse avoids wearing rings. What is the rationale behind this action? A - To ensure complete antimicrobial action B - To prevent a Staphylococcus aureus infection C - To prevent an increase in the number of bacteria residing on the hands D - To provide enough time for the antimicrobial solution to be effective

ANS: B Gram-negative bacilli such as Enterobacter and Staphylococcus aureus are more common under rings; therefore, the nurse should not wear rings to avoid infections. The nurse rubs the hands together by covering all the surfaces of the hands and fingers with antiseptic to ensure complete antimicrobial action. The nurse's fingernails should be less than a quarter-inch long to decrease the number of bacteria residing on hands. The nurse rubs his or her hands together with an antiseptic for several seconds and allows his or her hands to dry before applying gloves to provide enough time for the antimicrobial solution to be effective.

A patient is diagnosed with a bronchial airway obstruction after performing a bronchoscopy. Which type of infection may the patient contract after performing the test? A - Suprainfection B - Iatrogenic infection C - Exogenous infection D - Endogenous infection

ANS: B Iatrogenic infections are caused by an invasive diagnostic or therapeutic procedure. Patients who underwent a bronchoscopy and are treated with broad-spectrum antibiotics are at a greater risk of developing this type of infection. The use of broad-spectrum antibiotics for the treatment of infection may cause a suprainfection. An exogenous infection is caused by organisms that are found outside of an individual. Endogenous infections occur when a patient receives broad-spectrum antibiotics that alter the normal flora.

In the home setting, what is the best method to sterilize a straight urinary catheter and suction tube? A - Use an autoclave. B - Use boiling water. C - Use ethylene oxide gas. D - Use chemicals for disinfection.

ANS: B The best sterilizer in a home setting is boiling water. Most homes do not come equipped with an autoclave. Chemicals for disinfection are used for sterilizing heat-sensitive equipment in the hospital setting and would not be appropriate for a urinary catheter.

Which action should the nurse avoid while opening a sterile item on a flat surface? A - Keeping the inner contents sterile before use B - Grasping 3.5 cm of the border to maneuver the field on the table surface C - Holding the item with one hand while pulling the wrapper away with the other hand D - Using 1 inch of the inner surface of the package border as a sterile field to add sterile items

ANS: B The nurse should grasp only 2.5 cm (1 inch) of the border to maneuver the field on a table surface while opening a sterile item on a flat surface. The inner contents should be kept sterile before use to prevent infection. The nurse should hold the item in one hand while pulling the wrapper away with the other hand. The nurse should use nearly 1 inch of the inner surface of the package border around the edges as a sterile field to add sterile items.

A patient who is diagnosed with laryngeal tuberculosis requires isolation precautions. The nurse finds that the patient is depressed, angry, and rejected. What is the most appropriate nursing intervention that would provide relief to the patient? A - Provide a dark, quiet room to calm the patient B - Explain the isolation procedures to provide meaningful stimulation C - Disallow visits by the patient's family members to reduce the risk of spreading the infection D - Avoid explaining the patient's risk for depression to the patient's family members

ANS: B When a patient who has laryngeal tuberculosis is on isolation process, the nurse should follow certain measures to improve the patient's stimulation. The nurse should explain the isolation procedures that are used to maintain infection prevention and control practices and he or she should discuss ways to provide meaningful stimulation to the patient. Darkening the room can increase the patient's sense of isolation. The nurse should allow family members to visit as long as they follow infection precautions. The nurse should explain the patient's risk for depression or anger to the patient's family so they can provide proper emotional support.

Arrange the steps followed by the nurse while performing open gloving chronologically. A - Remove the outer glove package wrapper B - Perform hand hygiene C - Slip the fingers underneath the cuff of the second glove D - Grasp the edge of the cuff of the glove for the dominant hand E - Open the package and identify the right and left gloves F - Interlock the fingers of the gloved hands and hold them away from the body above waist level G - Grasp the inner package and lay it on a clean surface above waist level

ANS: B, A, G, E, D, C, F While performing the skill of open gloving, the nurse should perform thorough hand hygiene and then remove the outer glove package wrapper by carefully separating and peeling apart sides. Then, the nurse should grasp the inner package and place it on a clean, flat surface just above waist level to prevent contamination. The package should be opened and the nurse should identify the right and left gloves. With the thumb and first two fingers of the nondominant hand, the nurse grasps the edge of the cuff of the glove for the dominant hand and carefully pulls the glove over the dominant hand. Next, the nurse should carefully pull the second glove over the nondominant hand. After the second glove is on, the nurse interlocks the fingers of the gloved hands and holds them away from the body above waist level to prevent accidental contamination.

A registered nurse teaches a nursing student about the nursing skills required to care for patients with infections. Which statements made by the nursing student indicate the need for further learning? Select all that apply. A - "I should use only cleaned equipment." B - "I only need gloves when there is a risk of a splash." C - "I should use a mask while touching a patient's mucous membranes." D - "I should ensure that patients cover their mouths and noses when coughing and sneezing." E - "I should keep bedside surfaces clean and dry while performing aseptic procedures."

ANS: B, C When there is a risk of a splash, a nurse should use a gown, mask, and eye protection. The nurses should use clean glove when caring for a patient's mucous membranes. The nurses should use only cleaned equipment. The nurses should instruct and ensure that patients cover their mouths and noses when they cough and sneeze. The nurses should keep bedside table surfaces clutter-free, clean, and dry while performing aseptic techniques.

The nurse is assessing a group of patients in a health screening program. A patient complains of itching and irritation under the right arm and the nurse suspects a localized infection. What assessments should be done on this patient? Select all that apply. A - Examine for paleness of skin. B - Palpate the area for tenderness. C - Inquire about pain and tightness. D - Inspect the area for redness and swelling. E - Inquire about gastrointestinal disturbances.

ANS: B, C, D Gentle palpation of the infected area may reveal some degree of local tenderness due to inflammation. Inquiring about pain and tightness is important, because they may be caused by edema. Infected areas generally appear red and swollen due to inflammation. Paleness of skin is not a manifestation of infection. Gastrointestinal disturbances are not related to localized infection and may sometimes be found in systemic infections.

The nurse in a postoperative surgical unit is instructed to perform wound care for a patient with an open fracture to his right tibia. What steps are included in wound cleaning? Select all that apply. A - Clean inward from a wound site. B - Clean outward from a wound site. C - When applying antiseptic, wipe around the wound edge first. D - When applying antiseptic, wipe outward and away from the wound first. E - Use clean gauze for each revolution around the wound's circumference.

ANS: B, C, E The surgical wound is considered sterile. To prevent entry of microorganisms into the wound, the nurse should always clean outward from a wound site . When applying an antiseptic or cleaning with soap and water, the nurse should wipe around the wound edge first and then clean outward and away from the wound. The nurse should use clean gauze for each revolution around the circumference of the wound.

A patient with influenza is admitted to a hospital. Which safety precautions should the nurse take to prevent an infection? Select all that apply. A - Wearing gloves while reviewing the medical report B - Wearing a surgical mask within 3 feet of the patient C - Wearing a sterile gown while entering the patient's room D - Maintaining proper hand hygiene during the assessment E - Placing the patient in an airborne infection isolation room

ANS: B, D Influenza is an example of a droplet infection that is transmitted by large droplets. Therefore, droplet precautions are required, which include wearing a surgical mask within 3 feet of the patient and maintaining hand hygiene during the assessment. While reviewing the patient's medical report, the nurse does not need to wear gloves. The patient should be placed in an airborne infection isolation room to prevent airborne infections. Contact precautions require a gown and gloves.

A patient who had a hysterectomy 10 days ago has come for a follow-up visit. The patient is experiencing pain and itching at the incision site. After assessment, the health care provider suspects the incision site is infected. Which interventions would help control infection? Select all that apply. A - Reduce water intake. B - Administer antibiotics. C - Administer anxiolytics. D - Provide adequate nutrition. E - Monitor response to drug therapy.

ANS: B, D, E Antibiotics should be administered to control the wound infection. Adequate nutrition is a supportive therapy, which helps in wound healing and recovery from infection. The response to drug therapy should be monitored to plan further management. Reducing water intake is not advisable; instead adequate water intake should be encouraged. Administration of anxiolytics is only considered for anxious patients and not for wound infection.

The nurse is analyzing the laboratory results of a hospitalized patient. The nurse reads the differential count of white blood cells and makes a note that the eosinophils, basophils, and monocytes are within normal limits. The neutrophilic count, which should be between 55% and 70%, is increased to 90%. The lymphocytes, which should be between 20% and 40%, are increased to 60%. What does the increased count indicate? Select all that apply. A - Sepsis B - Viral infection C - Tuberculous infection D - Chronic bacterial infection E - Acute suppurative infection

ANS: B, D, E Lymphocytes are increased when there is chronic viral and bacterial infection. Neutrophils are white blood cells that ingest and destroy microorganisms by a process called phagocytosis. They are increased in cases of acute suppurative infection. Lymphocytes are decreased when there is sepsis, while monocytes increase in tuberculous infection.

Which is the most effective way to control the transmission of infection in health care facilities? A - Vaccinations B - Isolation precautions C - Hand hygiene practices D - Use of clean equipment

ANS: C Hand hygiene practices are the most effective way to break the chain of infection and control the transmission of infection. Vaccinations are effective measures to prevent the occurrence of infection in an individual. Even if a patient is isolated, the nurse caring for the patient has a risk of infection. Therefore, the nurse should perform hand hygiene before and after providing patient care. The use of clean equipment without hand hygiene may spread infection.

Which statement is true regarding the illness stage of an infection? A - The illness stage is the time interval when acute symptoms of infection disappear. B - The illness stage is the time interval from the onset of nonspecific symptoms to more specific symptoms. C - The illness stage is the time interval when the patient has signs and symptoms specific to the infection type. D - The illness stage is the time interval between the entrance of the pathogen into the body and the appearance of the first symptoms.

ANS: C The illness stage is the time interval when patient manifests signs and symptoms specific to the type of infection. The convalescence stage is the time interval when acute symptoms of infection disappear. During the prodromal stage, the onset of nonspecific signs and symptoms to more specific symptoms occur. The incubation period is the time interval between the entrance of a pathogen into the body and the appearance of the first symptoms.

A nurse reviews the laboratory test reports of a postoperative patient. Which finding indicates the presence of infection? A - Eosinophils: 3% B - Neutrophils: 65% C - White blood cells (WBC): 18,000/mm3 D - Erythrocyte sedimentation rate (ESR): 15 mm/hr

ANS: C The normal white blood cell (WBC) values range from 5000 to 10,000/mm3. An increased WBC count of 18,000/mm3 indicates acute infection. The normal levels of eosinophils range from 1% to 4%. Normal neutrophil levels range from 55% to 70%. The normal erythrocyte sedimentation rate (ESR) is 15 mm/hr for men and 20 mm/hr for women.

Following a procedure in an isolation room, the nurse first removes eye protection and gloves, followed by removal of the mask, and then hand washing. The nurse then comes out of the isolation room and removes the gown. Which action was performed correctly? A - Removing gloves B - Removing mask after gloves C - Removing gown outside the isolation room D - Performing hand hygiene in the isolation room

ANS: C The nurse who has performed a procedure in an isolation room should remove all the protective wear outside the room. The order in which the nurse should have left the isolation room, removed the gloves first, then the eyewear or face shield, followed by the gown. These items should be placed in the designated bag before finally removing the mask and adding that to the bag as well. The nurse should have then performed hand hygiene. The nurse should then dispose of all contaminated equipment.

A registered nurse teaches a patient about measures to control the exit and entry of microorganisms. Which statement made by the patient needs correction? A - "I will brush my teeth regularly." B - "I will apply lotion to my skin appropriately." C - "I will apply water-insoluble ointment to my lips." D - "I will clean my perineal area by wiping from the urinary meatus toward the rectum."

ANS: C The patient should maintain the integrity of his or her skin and mucous membranes to reduce the risk of microorganism infections. The patient should apply water-soluble ointment to the lips to keep them lubricated and maintain skin integrity. The patient should brush his or her teeth regularly to prevent the drying of mucous membranes. The patient should apply lotion to the skin appropriately to keep the skin lubricated. The patient should clean the perineal area from the urinary meatus toward the rectum to prevent the entry of infectious microorganisms into the urinary tract.

A patient reporting itching and tingling arrives at the hospital. The nurse suspects a herpes simplex infection and keeps the patient in an isolation room. What would be the patient's stage of infection? A - Illness stage B - Convalescence C - Prodromal stage D - Incubation period

ANS: C The prodromal stage is the interval from onset of nonspecific signs and symptoms to more specific symptoms. During this stage, microorganisms grow and multiply and the patient may be capable of spreading the disease to others. Therefore, the patient may be in an isolation room to reduce the spread of infection. The illness stage is the interval when a patient manifests signs and symptoms that are specific to a type of infection. The convalescence stage is the interval when acute symptoms of an infection disappear. The incubation period is the first stage of the infection process; it is the Interval between the entrance of the pathogen into the body and the appearance of the first symptoms.

A nursing student performs hand hygiene. Which action made by the nursing student may allow the transfer of pathogens? A - Drying hands with a warm air dryer B - Discarding a paper towel in the proper receptacle C - Using wet paper towels to turn off taps after washing D - Cleaning the area under the fingernails with the fingernails of the other hand

ANS: C Wet paper towels allow the transfer of pathogens from the faucet to the hands. Drying hands with a warm air dryer prevents chapping and roughened skin. Paper towels should be discarded in a proper receptacle to prevent contamination. Cleaning the area under the fingernails with the fingernails of the other hand prevents contamination.

While using an antiseptic hand rub to perform hand hygiene, the nurse feels dryness in his or her hands after rubbing them together for 10 to 15 seconds. What is the reason for this dryness? A - Occurrence of an allergic reaction B - Insufficient time taken to rub hands C - Insufficient antiseptic solution applied D - Complete antimicrobial action maintained

ANS: C While maintaining hand hygiene, if the nurse's hands are dry after rubbing them together for 10 to 15 seconds, an insufficient volume of product was likely applied. Dryness of the hands does not indicate allergic reaction. Ten to 15 seconds is a sufficient amount to time to rub the hands the together. Complete antimicrobial action is not achieved if an insufficient antiseptic solution is applied.

A patient is suspected of having mumps. In which order do the stages of infection occur? A - Occurrence of pain and a headache B - Identification of rubella virus C - Invasion of the pathogen into the body D - Disappearance of a high fever and parotid swellings E - Occurrence of a high fever and parotid swelling F - Occurrence of symptoms such as malaise and fatigue

ANS: C, A, F, E, B, D The incubation period is the first stage of the infection process. This period is marked by pain and a headache. This is followed by the prodromal stage, the interval from the onset of nonspecific signs and symptoms such as malaise and fatigue to more specific symptoms. The interval when a patient manifests signs and symptoms specific to type of infection, such as a high fever and parotid swelling is the illness stage. The causative agent may be identified. Convalescence is the interval when acute symptoms of infection disappear.

The nurse is teaching student nurses about the inflammatory response to an injury. Arrange the events in the order of their occurrence in a response to injury. A - Formation of granulation tissue B - Formation of exudate at site of injury C - Rapid vasodilation at site of injury D - Accumulation of fluid at site of injury

ANS: C, D, B, A When a tissue is injured, a series of well-coordinated events occurs including vascular and cellular responses, formation of inflammatory exudates, and tissue repair. Acute inflammation is an immediate response to an injury. Rapid vasodilatation occurs, allowing more blood near the location of the injury. An injury causes tissue damage and possibly necrosis. As a result, the body releases chemical mediators that increase the permeability of small blood vessels; thus fluid, protein, and cells enter interstitial spaces. The accumulation of fluid appears as localized swelling. The accumulation of fluid, dead tissue cells, and white blood cells (WBCs) form an exudate at the site of inflammation. In the last step of tissue repair, granulation tissue formation occurs.

The nurse works in a hospital. What precautions are necessary to help prevent health care-associated infections? Select all that apply. A - Frequently irrigate urinary catheters. B - Insert drug additives to IV fluids. C - Ensure a closed, urinary catheter drainage system. D - Change the IV access site if inflamed. E - Use aseptic technique when suctioning the airway.

ANS: C, D, E A closed urinary catheter drainage system helps to contain microorganisms and prevent the spread of infection. An IV access site should be changed as soon as signs of inflammation appear. Inflammation can lead to infection. Microorganisms can be introduced into the airway if aseptic technique is not followed for suctioning. Repeated catheter irrigation may increase the risk for contracting an infection because irrigation bypasses the normal defenses of the body. Adding drug additives to IV fluids also increases the risk of infections.

Which precautions should the nurse follow while performing surgical asepsis? Select all that apply. A - Rearranging the linen after a sterile object becomes exposed B - Holding the item close to the sterile field by touching the sterile surface C - Avoiding touching the sterile tip to the surface of a clean disposable glove D - Discarding objects immediately when stored sterile packages become wet E - Opening sterile packages when a minimum number of people are walking into an area

ANS: C, D, E Touching the sterile tip to the clean disposable glove leads to contamination. The nurse should discard objects immediately or send equipment for resterilization when sterile items become wet. Sterile packages should be opened when a minimum number of people are walking in an area to prevent contamination of the package. The nurse should avoid activities such as excessive movements or rearranging linens after a sterile object or field becomes exposed. While opening sterile packages, the nurse should hold the item closely to the sterile field without touching the sterile surface.

A surgeon applies a sterile gown before a procedure. Which actions should the circulating nurse perform? Select all that apply. A- Covering the sterile flap by touching it B - Touching the inside of the gown towards the body C - Opening the sterile pack containing the sterile gown D - Tying the back of the gown securely at the neck and waist E - Preparing the glove package by peeling the outer wrapper

ANS: C, D, E While a surgeon is applying a sterile gown, the circulating nurse should tie the back of the surgeon's gown securely at the neck and waist. The circulating nurse should prepare the glove package by peeling the outer wrapper. The circulating nurse can open the sterile pack containing the sterile gown. The circulating nurse should not touch the sterile flap, because it may get contaminated. While applying a sterile gown, the surgeon should keep the inside of the gown towards the body.

A registered nurse teaches a nursing student about cleaning instruments before sterilization. Which statement made by the nursing student needs correction? A - "I will use a brush to wash the objects." B - "I will wash the objects with warm water." C - "I will dry the objects before disinfection." D - "I will rinse the contaminated objects in hot water."

ANS: D Contaminated objects should be rinsed with cold water. Hot water should not be used because it causes the protein in organic material to coagulate and stick to objects, which makes removal difficult. The nurse should use a brush to remove dirt or material in grooves or seams. The nurse should wash objects with soap and warm water. Objects should be dried before disinfection or sterilization.

In the hospital setting, what is the most likely means of transmitting infection between patients? A - Exposure to another patient's cough B - Sharing equipment among patients C - Disposing of soiled linen in a shared linen bag D - Contact with a healthcare worker's hands

ANS: D Hands become contaminated through contact with the patient and the environment and serve as an effective vector of transmission. Exposure to another patient's cough and the sharing of equipment between patients can also lead to cross infection between patients, but proper hand hygiene by all healthcare workers is the most effective way to break the chain of infection.

A community nurse is conducting an awareness program for sex workers and community members with substance abuse problems. What should the nurse tell the attendees about prevention of the spread of the hepatitis C virus? A - A symptomatic patient cannot transmit hepatitis C. B - Hepatitis C can be transmitted through the fecal-oral route. C - Only symptomatic patients can transmit the virus. D - Both symptomatic and asymptomatic patients can transmit the virus.

ANS: D Hepatitis C is a communicable disease. A person with or without symptoms can transmit the virus. It is present in blood and body fluids. It can be spread through sexual contact but not through the fecal-oral route.

A registered nurse teaches a nursing student about normal flora. Which statement of the nursing student indicates a need for further learning? A - Normal flora of the large intestine exist in large numbers. B - Normal flora maintain a sensitive balance with other microbes. C - A healthy person excretes trillions of microbes daily through the intestines. D - Normal flora may cause disease when residing in their usual area of the body.

ANS: D Normal flora do not usually cause disease when they reside in their usual area of the body. Normal flora exist in large numbers in the large intestine without causing any illness. These flora maintain a sensitive balance with other microorganisms to prevent infection. A person normally excretes trillions of microbes daily through the intestines

The nurse is changing the dressing of a patient with cellulitis who has been admitted to the hospital. Meanwhile, another health care provider in the same unit asks for the nurse's help with the blocked intravenous line of another patient. What should the nurse do? A - Leave the first patient, immediately flush the IV line and restore its patency. B - Inform the other health care provider to leave the IV line as it is. C - Complete the dressing and then go to the next patient. D - Leave the first patient, perform hand hygiene, and then ensure the patency of the IV line.

ANS: D Nurses should be aware of the routes through which transmission of infections can occur. During the procedure of changing a dressing, if the nurse handles the IV line of the other patient without performing hand hygiene, the infection is likely to spread to the other patient. Therefore, the nurse should perform hand hygiene before handling the IV line. Restoring the patency of the IV line requires the nurse to flush the IV line, which may increase the risk for contracting an infection if performed before hand hygiene. The IV line needs to be unblocked immediately, so the nurse should attend to the patient with the blocked IV line before completing the dressing of the patient with cellulitis.

When does the nurse wear a gown? A - The patient's hygiene is poor. B - The nurse is assisting with medication administration. C - The patient has acquired immunodeficiency syndrome (AIDS) or hepatitis. D - Blood or body fluids may get on the nurse's clothing from a task that he or she plans to perform.

ANS: D The gown serves as a barrier between the patient's blood and/or body fluids and potential contact with the caregiver's skin. In some cases, if the patient's hygiene is unacceptable, it may require the nurse to wear a gown, but it is not the best answer. It is not necessary to wear a gown during medication administration or if the patient has AIDS or hepatitis.

A registered nurse teaches a group of nursing students about home care considerations for patients with infections. Which statement made by the nursing student indicates the need for further learning? A - "I should determine potential sources of contamination." B - "I should evaluate hand washing facilities in the patient's home." C - "I should anticipate the need for alternative hand washing products." D - "I should see if cold running water faucets are available."

ANS: D The nurse should check if warm running water faucets at the patient's home. The nurse should determine potential sources of contamination and possible preventive measures. The nurse should evaluate all hand washing facilities in the patient's home. The nurse should anticipate the need for alternative hand washing products for use in emergency and immediate situations.

Which statement is true regarding donning a sterile gown? A - The circulatory nurse should also wear sterile gown. B - Nurses should wear sterile gowns before applying masks. C - The anterior surface of the sleeves of a gown is also considered sterile. D - The nurse should wear sterile gowns while assisting a health care provider during surgery.

ANS: D The nurse should wear a sterile gown while caring for a patient with large open wounds and while assisting the healthcare provider during invasive procedures, such as inserting an arterial catheter. A circulatory nurse generally does not wear a sterile gown. Nurses should not apply a sterile gown until after applying a mask and surgical cap. Only certain areas of the gown are considered sterile; the collar and the anterior surface of the sleeves may not be considered sterile.

What would a nurse use for a high-level disinfection? A - Moist heat B - Boiling water C - Ethylene oxide gas D - Hydrogen peroxide

ANS: D The nurse uses chemical sterilants such as hydrogen peroxide, iodophors, phenolics, and quaternary ammonium compounds for high-level disinfection. Moist heat, boiling water, and ethylene oxide gas are used for sterilization.

The nurse pours a sterile liquid into a container. Which action made by the nurse is appropriate? A - Holding the bottle with its label pointed outside the palm of the hand B - Placing the cap with the inner surface facing down on the table C - Keeping the edge of the bottle close to the edge of the container D - Pouring a small amount in a disposable cap before pouring in the container

ANS: D While pouring a sterile liquid into a container, a small amount of liquid should be poured in a disposable cap before it is poured into the container because the discarded solution cleans the lip of the bottle. The cap should be placed with its inner surface facing upwards on the table because the inner surface should not be contaminated. The nurse should hold the bottle with its label in the palm of the hand to prevent the possibility of the solution wetting and fading the label. The edge of the bottle should be kept away from the container.

While caring for a patient with an infectious disease, the nurse understands the need for personal protective equipment (PPE). Arrange the personal protective measures taken by the nurse in correct order. A - Applying a mask B - Putting on gloves C - Putting on protective eyewear D - Performing hand hygiene E - Applying a gown

ANS: D, E, A, C, B When full personal protective equipment (PPE) is necessary, the nurse should first perform hand hygiene. Then, the nurse applies a gown, followed by a mask, protective eyewear, and finally gloves.

In which order does the chain of infection cycle occur chronologically? A - Susceptible Host B - Portal to exit C - Reservoir D - Portal to entry E - Infectious agent F - Mode of transmission

ANS: E, C, B, F, D, A Infection occurs in a cycle that depends on the presence infectious agents, reservoirs, portal to exit, mode of transmission, portal to entry, and host. First, infectious agents choose a reservoir to multiply. After multiplying, they exit through sites such as the skin, urinary tract, and reproductive tract. These agents find different modes of transmission to enter the host.

Arrange the steps of the preparation of a sterile field chronologically. A - Open the outermost flap away from the body B - Grasp the outer edge of the first side C - Stand away from the sterile package and pull flap back D - Open the outside cover and grasp the outer edge of the tip of the outermost flap E - Place the sterile kit on a work surface above the waist level F - Open the side flap by pulling the side and allow it to lie flat on the table surface G - Grasp the outer edge of second side flap and outer edge of the last and innermost flap

ANS: E, D, A, B, F, G, C First, the sterile kit containing the sterile items should be placed on a work surface above waist level and the outside cover should be opened and placed on the work surface. The outer edge of the tip of the outermost flap should be grasped and the outermost flap should be opened away from the body while keeping the arm stretched away from the sterile field. The outer edge of the first side of the flap should be grasped and the side flap should be opened by pulling the side. The nurse should allow the kit to lie flat on the table surface. The arm should not be extended over the sterile surface. The outer edge of the second side of the flap should be grasped and the opening of the second side of the package should be pulled. The outer edge of the last and innermost flap should be grasped. Finally, the nurse should stand away from the sterile package and the flap should be pulled back, allowing the items to fall on the work surface.