Infection control

The nurse has instructed a client diagnosed with tuberculosis about how to prevent the spread of infection after discharge from the hospital. The nurse determines that the client needs further reinforcement of information if the client makes which statement?

"I should use disposable plates, forks, and knives." Because tuberculosis is transmitted by droplet, it cannot be carried on clothing, eating utensils, or other possessions. It is not necessary to discard any of these. The client should cover the mouth with a tissue when laughing, coughing, or sneezing and should dispose of tissues carefully. The client also may need to wear a mask as advised by the health care provider. It is important to perform proper hand washing after contact with body substances, tissues, or face masks.

The nurse teaches the mother of a child diagnosed with bacterial conjunctivitis about measures to prevent transmission of the infection. Which statement by the mother indicates a need for further teaching?

"It is all right to share towels and washcloths as long as they are bleached after use." Bacterial conjunctivitis is highly contagious, and infection control measures should be taught. These measures include frequent hand washing and not sharing towels and washcloths, regardless of the bleaching process. Options 2 and 4 are also correct treatment measures.

The nurse provides home care instructions to a client with hepatitis B. Which statement made by the client indicates the best understanding of how to prevent transmission of the disease?

"My wife should get the vaccine." The vaccine is used as a preventive measure and is recommended for both sexual and household contacts of the person with hepatitis B. Hepatitis B can be transmitted through intimate contact, such as kissing. The vaccine is used for prevention. This disease is not transmitted through the use of towels.

The nurse is caring for a client with meningitis and implements which transmission-based precautions for this client?

Private room or cohort client Meningitis is transmitted by droplet infection. Precautions for this disease include a private room or cohort client and use of a standard precaution mask. Private negative airflow pressure rooms and personal respiratory protection devices are required for clients with airborne disease such as tuberculosis. When appropriate, a mask must be worn by the client and not the staff when the client leaves the room.

The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which items when performing this care?

The nurse who is in contact with a client with tuberculosis should wear an individually fitted particulate respirator. The nurse also would wear gloves as per standard precautions. The nurse wears a gown when the possibility exists that the clothing could become contaminated, such as when giving a bed bath.

A client with tuberculosis whose status is being monitored in an ambulatory care clinic asks the nurse when it is permissible to return to work. What factor should the nurse include when responding to the client?

Three sputum cultures are negative. The client with tuberculosis must have sputum cultures performed every 2 to 4 weeks after initiation of antituberculosis medication therapy. The client may return to work when the results of three sputum cultures are negative because the client is considered noninfectious at that point. Options 1, 3, and 4 are not reliable determinants of a noninfectious status.

The nurse is preparing a group of Cub Scouts for an overnight camping trip and instructs the Scouts about the methods to prevent Lyme disease. Which statement by one of the Scouts indicates a need for further instruction?

"I should not use insect repellents because it will attract the ticks." In the prevention of Lyme disease, individuals need to be instructed to use an insect repellent on the skin and clothes when in an area where ticks are likely to be found. Long-sleeved tops and long pants, closed shoes, and a hat or cap should be worn. If possible, heavily wooded areas or areas with thick underbrush should be avoided. Socks can be pulled up and over the pant legs to prevent ticks from entering under clothing.

A client is seen in the health care clinic, and a diagnosis of acute sinusitis is made. The nurse provides home care instructions to the client regarding measures that will promote sinus drainage and comfort. Which statement by the client indicates a need for further instruction?

"I should use a hot mist vaporizer to liquefy secretions." The nurse provides instructions to the client regarding measures to promote sinus drainage, comfort, and resolution of the infection. The client should be instructed to use a humidifier to help liquefy secretions and promote drainage. Consumption of large amounts of fluids is important to help liquefy secretions. Sleeping with the head of the bed elevated to a 45-degree angle will assist in promoting drainage. The nurse instructs the client to apply heat in the form of wet packs over the affected sinuses to promote comfort and help resolve the infection.

The nurse is caring for a client with newly diagnosed human immunodeficiency virus (HIV). Besides preventing the transmission of the disease, what are the goals of medication therapy? Select all that apply.

Decreasing the viral load Delaying disease progression Maintaining or increasing CD4+ T cell counts Preventing HIV-related symptoms and opportunistic diseases Besides preventing HIV transmission, the goals of medication therapy include decreasing the viral load, delaying disease progression, maintaining or increasing CD4+ T cell counts, and preventing HIV-related symptoms and opportunistic diseases. Administering the HIV vaccine and eliminating the use of illegal drugs are not included in the goals of medication therapy. Antiretroviral therapy (ART) can delay disease progression, and when taken consistently and correctly, ART can reduce viral loads by 90% to 99%. This makes adherence to treatment regimens extremely important. Although it is usually not possible to eradicate opportunistic diseases once they occur, prophylactic medications can significantly decrease morbidity and mortality rates.

The nurse is giving a bed bath to a client and discovers that an additional washcloth and towel are needed. Which is the most appropriate action to take to obtain the needed items?

Wash hands, leave the client's room, and obtain the needed items. To avoid spreading the client's germs, the nurse's hands must be washed before leaving. By going to the linen room without washing the hands first, the nurse will spread those germs into the clean linen. It is not appropriate to ask the unit secretary or a family member to obtain the supplies. It is never appropriate to borrow other clients' supplies because this action may spread germs.

An unlicensed assistive personnel (UAP) is caring for a client who has an indwelling urinary catheter. Which action by the UAP would indicate the need for further instruction in the care of the client?

Allowed the drainage tubing to rest under the leg Proper care of an indwelling urinary catheter is especially important to prevent infection in the client. The drainage tubing is not placed under the client's leg; for the same reason, the drainage bag is kept below the level of the bladder to prevent urine from being trapped in the bladder. The tubing must drain freely at all times. The perineal area is cleansed thoroughly, using mild soap and water at least twice a day and following a bowel movement. The nurse and all caregivers must use strict aseptic technique when emptying the drainage bag or obtaining urine specimens.

The nurse is assisting a female client to collect a midstream urine specimen. How should the nurse implement aseptic technique?

Making sure that the fingers avoid touching the inside of the collection container The inside of the container is sterile, and sterility must be maintained. Fingers touching the inside of the container would cause the container to become unsterile. The meatus should be cleansed from front to back (toward the anus). Upward strokes would bring bacteria from the anal region toward the urinary meatus. The labia should remain open during the procedure. If they are allowed to close, this tissue will have to be cleansed again with the antiseptic pads. The client should void a small amount into the toilet before urinating into the specimen container, to allow some of the organisms near the meatus to leave the area.

Which action by the parent of an infant with respiratory syncytial virus infection who is receiving ribavirin would indicate a need for further instruction regarding the management of the disease process?

Telling the infant's aunt, who is pregnant, that it is acceptable to visit the infant When an infant is receiving ribavirin, exposure precautions need to be observed. Anyone entering the infant's room should wear a gown, mask, gloves, and hair covering. Anyone who is pregnant or considering pregnancy and anyone with a history of respiratory problems or airway disease should not care for or visit the infant who is receiving ribavirin. Hand washing is absolutely necessary before leaving the room to prevent the spread of germs.

A client with tuberculosis (TB) asks the nurse about precautions to take after discharge to prevent infection of others. The nurse develops a response to the client's question based on which correct understanding of TB transmission?

The disease is transmitted by droplet nuclei. TB is spread by droplet nuclei or via the airborne route. The disease is not carried on objects such as clothing, eating utensils, linens, or furniture. It is unnecessary to remove carpeting from the home. Bleaching of clothing and linens is unnecessary, although the client and family members should use good hand-washing technique.

The nursing instructor is observing a student nurse donning a pair of sterile gloves and preparing a sterile field. Which observation made by the instructor indicates the need for further teaching?

The student dons the sterile gloves without washing the hands. Hands must always be washed (even though sterile gloves are used) to keep germs from spreading. The order of placing gloves on is up to the user, as long as sterile technique is not broken. The inside wrapper provides an excellent area for use because it is sterile. If the gloves touch anything unsterile, they must be considered contaminated, and a new package of gloves must be obtained and used.

The nurse prepares to give a bath and change the bed linens of a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which would the nurse incorporate into the plan during the bathing of this client?

Wearing a gown and gloves Gowns and gloves are required if the nurse anticipates contact with soiled items such as those with wound drainage, or is caring for a client who is incontinent with diarrhea or a client who has an ileostomy or colostomy. Masks are not required unless droplet or airborne precautions are necessary. Regardless of the amount of wound drainage, a gown and gloves must be worn

Methicillin-resistant Staphylococcus aureus (MRSA)

A bacterium that causes infections in different parts of the body and is often resistant to commonly used antibiotics; can be found on the skin, in surgical wounds, in the bloodstream, lungs, and urinary tract. Precautions: Gloves,gown,goggles,and a mask or face shield

The nurse is caring for a client with acute viral hepatitis A who resides in a group home. Which outcome indicates that the most important goal has been achieved?

Avoids transmitting the virus to others in the group home All of the options are expected outcomes of care for this client. However, because the disease is communicable to others, one of the most important goals in management of acute viral hepatitis is preventing the spread of infection.

A client with active tuberculosis demonstrates less-than-expected interest in learning about the prescribed medication therapy. The nurse assesses that this client may ultimately need which intervention as a last resort?

Directly observed therapy Tuberculosis is a highly communicable disease that is reportable to the local public health department. This agency has regulations that may be enforced to ensure compliance with tuberculosis therapy. Ultimately the client may be required to have directly observed therapy to reduce the risk to the public. This involves having a responsible person actually observe the client taking the medication each day.

The school nurse prepares a list of home care instructions for the parents of schoolchildren diagnosed with pediculosis capitis. Which instruction should the nurse include in the list?

Vacuum floors, play areas, and furniture to remove any hairs that might carry live nits. Pediculosis capitis is an infestation of the hair and scalp with lice. Thorough home cleaning is necessary to remove any lice or nits that may fall from the host. Combs and brushes should be soaked in hot water for 10 minutes or a pediculicide for 1 hour. Anti-lice sprays are unnecessary and may be harmful. In addition, they should never be used on a child or on bedding or linens. Bedding and linens should be washed with hot water and dried on a hot setting. Items that cannot be washed should be dry cleaned or sealed in plastic bags in a warm place for 2 weeks.

Anthrax

bacillus anthracis, a spore forming gram positive bacillus. humans are infected through skin contact, ingestion or inhalation. Flu like, interim improvement, abrupt resp. failure, shock, hemodynamic collapse and death within 24 -36 hours

Two nurses are leaving the room of a client whose care required them to wear a gown, mask, and gloves. Which action by these nurses could lead to the spread of infection?

Removing the gown without rolling it from inside out The gown must be rolled from inside out to prevent the organisms on the outside of the gown from contaminating other areas. Gloves are considered the dirtiest piece of equipment and therefore must be removed first. Hands must be washed after removal of the protective garb to remove any unwanted germs still present. Ungloved hands should be used to remove the gown to prevent contaminating the back of the gown with germs from the gloves.

A client is being discharged to home after 2 weeks with a diagnosis of tuberculosis and is worried about the possibility of infecting family members and others. How should the nurse respond to provide reassurance?

The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy. Family members or others who have been in close contact with a client diagnosed with tuberculosis are placed on prophylactic therapy(preventative Theraphy) with isoniazid for 6 to 12 months. The client usually is not contagious after taking the medication for 2 to 3 consecutive weeks. However, the client must take the full course of therapy (for 6 months or longer) to prevent reinfection or medication-resistant tuberculosis.