Infection Control
4. Respirator Rationale: Patients with pulmonary tuberculosis require airborne precautions because the droplets are smaller than 5 microns and remain for long periods in the air. Therefore a respirator is the most appropriate PPE that the nurse should use. Gowns and gloves are most important when a nurse performs a physical examination to avoid a contact infection. A head cap is applied when the nurse is in a surgical room.
A patient is diagnosed with pulmonary tuberculosis. Which personal protective equipment (PPE) is the most important to wear when entering the patient's room? 1. Gown 2. Gloves 3. Head cap 4. Respirator
2. Blood 3. Semen 5. Vaginal secretions Rationale: The major reservoirs of HIV are blood, semen, and vaginal secretions. The major reservoir of the hepatitis A virus is feces. The major reservoir of the herpes simplex virus type 1 is mouth lesions.
Human immunodeficiency virus (HIV) is transmitted via which major reservoir? Select all that apply. One, some, or all responses may be correct. 1. Feces 2. Blood 3. Semen 4. Mouth lesions 5. Vaginal secretions
1. Increased fatigue Rationale: An infection does not always have the typical signs and symptoms in all patients. The nurse should expect an older adult to have increased fatigue more so than a younger patient. Older adults also have decreased, not increased, pain sensitivity. Colored productive sputum is a typical sign of pneumonia among all age-groups. Infections often cause an unexplained increase, rather than decrease, in the heart rate.
The nurse is caring for an older adult with suspected pneumonia. Which difference does the nurse expect in the signs and symptoms of such an infection in an older adult compared to someone who is much younger? 1. Increased fatigue 2. Increased pain sensitivity 3. Colored productive sputum 4. Unexplained decrease in heart rate
4. Performing hand hygiene before and after patient care Rationale: Performing hand hygiene is the most effective basic technique in preventing and controlling the transmission of infection. Reverse isolation protects the patient from infection, not from infecting others; protective eyewear and gown and gloves are also useful but not the most effective means of preventing the spread of infections.
The nurse provides education for a group of nursing students about the prevention of health care-associated infections (HAIs). The nurse recognizes that which intervention is the most effective way to break the chain of infection? 1. Placing patients in reverse isolation 2. Using protective eyewear while bathing patients 3. Donning gown and gloves before entering patient rooms 4. Performing hand hygiene before and after patient care
2. Respiratory tract Rationale: The influenza virus is released from the body via the respiratory tract when an infected person sneezes or coughs. Organisms that cause communicable diseases, such as hepatitis B and human immunodeficiency virus (HIV) exit from wounds and bloody stool. Organisms such as Neisseria gonorrhoeae 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.
The portal of exit for the influenza virus is which area? 1. Blood 2. Respiratory tract 3. Reproductive tract 4. Skin and mucous membrane
3. Droplet 5. Airborne Rationale: If a patient is not isolated, he or she may spread a tuberculosis infection through droplet nuclei and airborne particles during coughing, sneezing, and talking. Infections such as human immunodeficiency virus (HIV) are transmitted through indirect contact, such as needles. Malaria may be transmitted through vectors such as mosquitoes. Vehicles such as blood may transmit infections like hepatitis B, HIV, and hepatitis C
Tuberculosis is spread through which method of transmission? Select all that apply. One, some, or all responses may be correct. 1. Indirect 2. Vectors 3. Droplet 4. Vehicles 5. Airbone
1. The field is lower than the nurse's waist. 2. The package is slightly damp on the bottom. 4. An instrument is out of the nurse's line of sight. 5. The syringe tip touches the nurse's clean glove. Rationale: A sterile object becomes contaminated when a nurse touches the sterile object with clean gloves, when the sterile objects are out of the nurse's line of sight or below the nurse's waist, or when the package becomes damp. The edges of the sterile field are considered contaminated, so avoiding them prevents contamination.
Which action performed during a sterile aseptic procedure indicates potential contamination? Select all that apply. One, some, or all responses may be correct. 1. The field is lower than the nurse's waist. 2. The package is slightly damp on the bottom. 3. The nurse avoids touching the edges of the field. 4. An instrument is out of the nurse's line of sight. 5. The syringe tip touches the nurse's clean glove.
2. a communicable disease Rationale: When an infectious disease can be transmitted directly from one person to another, it is called a communicable disease. No vector is necessary for transmission. A susceptible host is someone who is more prone to develop an infectious disease process. The port of entry is where microorganisms enter the body and the portal of exit is where microorganisms exit a host such as blood or the skin.
Which can be transmitted directly from one person to another? 1. A susceptible host 2. A communicable disease 3. A port of entry to a host 4. A port of exit from the reservior
1. Bacteria 2. Neutrophils 3. Monocytes 4. White blood cells Rationale: Accumulation of fluid, dead tissue cells, and WBCs form a purulent exudate at the site of inflammation. Exudate may be serous (clear, like plasma), sanguineous (containing red blood cells), or purulent (containing WBCs and bacteria). Neutrophils and monocytes are types of WBC, and as such, can be components of purulent exudate. Red blood cells are not part of purulent exudate.
Which cellular component makes up purulent exudate? Select all that apply. One, some, or all responses may be correct. 1. Bacteria 2. Neutrophils 3. Monocytes 4. White blood cells 5. Red blood cells
1. Swelling 2. Redness 3. Pain Rationale: The local manifestations of inflammation include swelling, redness, and pain. These manifestations are caused by protective vascular reactions that help combat inflammation. Anorexia and vomiting are systemic manifestations of inflammation.
Which clinical manifestation would the nurse expect to indicate a local inflammation? Select all that apply. One, some, or all responses may be correct. 1. Swelling 2. Redness 3. Pain 4. Anorexia 5. Vomiting
4. Hepatitis B virus Rationale: Vehicles such as blood may transmit the hepatitis B virus. Chickenpox, scarlet fever, and tuberculosis can be transmitted through the air or droplet nuclei.
Which disease can be transmitted when a nurse is drawing blood from a patient with an infection? 1. Chickenpox 2. Scarlet fever 3. Tuberculosis 4. Hepatitis B virus
4. Hepatitis C virus (HCV) Rationale: HCV is a communicable disease that can be asymptomatic. Viral meningitis and pneumonia have a low or no risk of transmission and are not considered communicable diseases. Tuberculosis is a communicable and symptomatic disease.
Which disease is communicable and can be asymptomatic? 1. Meningitis 2. Pneumonia 3. Tuberculosis 4. Hepatitis C virus (HCV)
1. Scabies Rationale: Scabies spreads through skin contact, and the nurse should take contact precautions. Measles require airborne precautions. Diphtheria and pharyngitis require droplet precautions.
Which disease requires contact precautions? 1. Scabies 2. Measles 3. Diphtheria 4. Pharyngitis
1. An infectious agent 3. The source of pathogen growth 5. A susceptible host Rationale: 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.Test-Taking Tip: The computerized National Council Licensure Examination (NCLEX®) is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass.
Which element is part of the chain of infection? Select all that apply. One, some, or all responses may be correct. 1. An infectious agent 2. A vaccine schedule 3. The source of pathogen growth 4. A clean surrounding 5. A susceptible host
1. pH of 3.0 Rationale: 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° C to 43° C.
Which environment would limit bacteria growth? 1. pH of 3.0 2. Under dressings 3. Moist surgical wounds 4. Temperature of 38^C
2. Paper face mask 3. Protective eyewear 5. Surgical scrub sponge Rationale: A paper face mask, protective eyewear, and surgical scrub sponges are required during surgical hand asepsis. Sterile gloves and a countertop surface are required for the preparation of a sterile field.
Which equipment is required for surgical hand asepsis? Select all that apply. One, some, or all responses may be correct. 1. Sterile gloves 2. Paper face mask 3. Protective eyewear 4. Countertop surface 5. Surgical scrub sponge
1. Sterile drape 3. Countertop surface Rationale: Sterile drapes and countertop surfaces are required to prepare a sterile field. Paper face masks, protective eyewear, and surgical scrub sponges are required for surgical asepsis.
Which equipment is required for the preparation of a sterile field? Select all that apply. One, some, or all responses may be correct. 1. Sterile drape 2. Paper face mask 3. Countertop surface 4. Protective eyewear 5. Surgical scrub sponge
3. Vehicles Rationale: Human immunodeficiency virus (HIV) infections are transmitted through vehicles such as blood and body fluids. Vectors, such as mosquitoes, transmit malaria. Infections such as Ebola and tuberculosis are transmitted by droplet nuclei. Infections such as influenza, Ebola, and tuberculosis are airborne.
Which is a mode of transmission for the human immunodeficiency virus (HIV) infection? 1. Vectors 2. Droplet 3. Vehicles 4. Airborne
4. Clostridium perfringens Rationale: C. perfringens causes gas gangrene. E. coli causes gastroenteritis and urinary tract infection. N. gonorrhoeae causes gonorrhea and pelvic inflammatory disease. S. aureus causes wound infection and pneumonia.
Which microorganism causes gas gangrene? 1. Escherichia coli 2. Neisseria gonorrhoeae 3. Staphylococcus aureus 4. Clostridium perfringens
3. Neisseria gonorrhoeae Rationale: N. gonorrhoeae exits through a man's urethral meatus or a woman's vaginal canal during sexual contact. Ebola virus is transmitted through blood or body fluids. C. difficile causes antibiotic-induced diarrhea. L. pneumophila grows only at certain temperatures.
Which microorganism exits through a man's urethral meatus during sexual contact? 1. Ebola virus 2. Clostridium difficile 3. Neisseria gonorrhoeae 4. Legionella pneumophila
4. Salmonella Rationale: 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. Test-Taking Tip: Remember Latin and Greek word parts. For this question, the prefix exo means "out" or "outside." That is the clue that exogenous means an infection from a microorganism that is not part of the normal flora in humans.
Which microorganism is associated with an exogenous infection? 1. Staphylococci 2. Enterococci 3. Streptococci 4. Salmonella
3. Bacteroides fragilis Rationale: Bacteroides fragilis is a part of the normal flora of the human colon. This microorganism can cause infections if it enters the bloodstream or tissue during injury or surgery. Escherichia coli causes gastroenteritis in the colon. Candida albicans causes candidiasis, pneumonia, and sepsis. Plasmodium falciparum causes malaria.
Which normal flora of the human colon can cause an infection when it enters the bloodstream? 1. Escherichia coli 2. Candida albicans 3. Bacteroides fragilis 4. Plasmodium falciparum
1. Scrubbing the hands for 5 minutes Rationale: 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 as watches and rings. The hands should be above the elbows while performing a surgical scrub.
Which nursing action is appropriate in surgical hand asepsis? 1. Scrubbing the hands for 5 minutes 2. Washing over the rings and watch 3. Keeping the hands and arms below the elbows 4. Allowing the water to flow from the elbows to the hands
4. Anesthesia equipment Rationale: Phenolics are used for high-level disinfection. Semicritical items such as anesthesia equipment, endoscopes, and endotracheal tubes require high-level disinfection or sterilization. Noncritical items such as stethoscopes require a disinfection of surfaces. Critical items such as urinary catheters and surgical instruments require sterilization.Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items with four options. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.
Which objects would require high-level disinfection with phenolics? 1. Stethoscopes 2. Urinary catheters 3. Surgical instruments 4. Anesthesia equipment
4. Anterior surface of the sleeves Rationale: The anterior surface of the sleeves is considered sterile. The back of the gown, the area below the waist, and the underside of the sleeves are not considered sterile.
Which part of a sterile gown is actually considered sterile? 1. Back of gown 2. Area below the waist 3. Underside of the sleeves 4. Anterior surface of the sleeves
1. Linens 3. Stethoscopes 4. Blood pressure cuffs Rationale: 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.Test-Taking Tip: Be alert for details about what you are being asked to do. In this question type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.
Which piece of equipment is considered a noncritical item that should be disinfected? Select all that apply. One, some, or all responses may be correct. 1. Linens 2. Implants 3. Stethoscopes 4. Blood pressure cuffs 5. Intravascular catheters
3. Intravenous (IV) fluid 4. Food 5. Water Rationale: Infections from vehicle transmissions are transmitted through IV fluids, food, and water. These act to help the microorganisms spread from one person to another. Mosquitoes and flies are vectors and can spread infection through external and internal transmission.
Which source is a vehicle for infection transmission? Select all that apply. One, some, or all responses may be correct. 1. Mosquitoes 2. Flies 3. Intravenous (IV) fluid 4. Food 5. Water
4. Promoting a reduction in microorganisms Rationale: Drying the hands and forearms with a paper towel can promote a reduction in microorganisms on the hands and arms. Repeated drying and dropping the towel into a linen hamper after a surgical hand scrub can prevent accidental contamination. Scrubbing the arm by dividing it into thirds can eliminate transient microorganisms and reduce the resident hand flora. Performing hand hygiene twice in a row ensures complete antiseptic coverage on all the surfaces of the hand.
Which statement describes the rationale for drying hands and forearms after performing a prescrub wash? 1. Preventing accidental contamination 2. Eliminating transient microorganisms 3.Ensuring complete antiseptic coverage 4. Promoting a reduction in microorganisms
4. The nurse should wear a sterile gown while assisting a health care provider during surgery. Rationale: The nurse should wear a sterile gown while caring for a patient with large open wounds and while assisting the health care 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.
Which statement is true regarding donning a sterile gown? 1. The circulatory nurse should wear a sterile gown. 2. Nurses should wear sterile gowns before applying masks. 3. The anterior surface of the sleeves of a gown is also considered sterile. 4. The nurse should wear a sterile gown while assisting a health care provider during surgery.
1. The immune system matures as the child grows. Rationale: As the child grows, the immune system matures. An infant has immature defenses against infection, but the infant's defenses against infection change with aging. Breastfed infants often have greater immunity than do bottle-fed infants because they receive their mothers' antibodies through the breast milk. Born with only the antibodies provided by the mother, the infant's immune system is incapable of producing necessary immunoglobulins
Which statement is true regarding the infant immune system? 1. The immune system matures as the child grows. 2. The immune defenses of an infant are already mature. 3. The immunity of bottle-fed infants is greater than that of breastfed infants. 4. The infant immune system is capable of producing necessary immunoglobulins.
1. Give oral medication using a paper cup. 2. Wash hands with soap and water. 4. Discard safety needles into the sharps container. 5. Wear gloves when administering an injection. Rationale: Using a paper (disposable) cup, hand hygiene, wearing gloves for an injection, and discarding needles into a sharps container are all procedural guidelines for a patient with an infectious disease. A respirator is needed for diseases with airborne precautions such as tuberculosis, not C. difficile.
Which step would the nurse take to prevent contamination when administering medication to a patient with Clostridium difficile? Select all that apply. One, some, or all responses may be correct. 1. Give oral medication using a paper cup. 2. Wash hands with soap and water. 3. Wear a respirator mask while in the room. 4. Discard safety needles into the sharps container. 5. Wear gloves when administering an injection.
4. Preparation of a sterile field Rationale: AP are not authorized to prepare a sterile field. AP can perform open gloving, perform surgical hand asepsis, and apply a sterile gown.
Which task cannot be delegated to assistive personnel (AP)? 1. Open gloving 2. Surgical hand asepsis 3. Applying a sterile gown 4. Preparation of a sterile field
2. Drainage collection devices Rationale: Boiling is done outside health care agencies for items such as drainage collection devices. Endoscopes and respiratory therapy equipment are cleaned by chemical disinfectants in health care settings. Heat-tolerant surgical instruments are cleaned by autoclaves in the health care agency.
Which type of medical equipment is cleaned outside the health care agency? 1. Endoscopes 2. Drainage collection devices 3. Respiratory therapy equipment 4. Heat-tolerant surgical instruments
1. Stool Rationale: Stool specimens are collected with sterile tongue blades. Urine specimens are collected with needleless safety syringes. Blood specimens are collected with 20-mL needle-safe syringes. Wound specimens are collected with sterile cotton-tipped swabs or syringes and collection tubes.
Which type of specimen is collected by using a sterile tongue blade? 1. Stool 2. Urine 3. Blood 4. Wound
2. Contact precautions Rationale: Contact precautions require a gown and gloves because the handling of contaminated body fluids may cause infections. Droplet precautions require a surgical mask within 3 feet (0.9 m) 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.Test-Taking Tip: Identifying content and what is being asked about that content is critical to you choosing the correct response. Be alert for words in the question that are the same or similar in nature to those in one or two of the answer choices.
Which type of transmission-based precaution requires a gown and gloves? 1. Droplet precautions 2. Contact precautions 3. Airborne precautions 4. Protective environment precautions
