NCLEX-RN Infection Control

The nurse is providing home care instructions to the mother of a child who has bacterial conjunctivitis. The nurse should provide the mother with which information?

1. The child may attend school if antibiotics have been started. 2. Any unused eye medication should be saved in case a sibling gets the eye infection. 3.The child's towels and washcloths should not be used by other members of the household. 4.Any crusted material should be wiped from the eye with a cotton ball soaked in warm water, starting at the outer aspect of the eye and moving toward the inner aspect. 3 Rationale: Bacterial conjunctivitis is highly contagious, and infection control measures should be taught. These include good hand washing and not sharing towels or washcloths with others.

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?

1. The student puts on the right glove and then the left glove. 2.The student dons the sterile gloves without washing the hands. 3.The student uses the inner wrapper of the gloves as a sterile field. 4.The student touches a glove on the overbed table, removes both gloves, and dons another sterile pair. 2 Rationale: Hands must always be washed (even though sterile gloves are used) to keep germs from spreading.

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?

1. "I should drink large amounts of fluids." 2."I should use a hot mist vaporizer to liquefy secretions." 3."I should try to sleep with the head of the bed elevated." 4."I should apply heat, such as a wet pack, over the sinuses." 2 Rationale: 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.

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?

1. "I should use disposable plates, forks, and knives." 2."I should cough into tissues and throw them away carefully." 3."It's important to cover my mouth if I laugh, sneeze, or cough." 4."It's very important to wash my hands after I touch my mask, tissues, or body fluids." 1 Rationale: 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 nurse participating in a health fair is setting up a booth on prevention of human immunodeficiency virus (HIV) transmission. A poster is planned that will list sexual behaviors in 1 of 2 columns, "safe" and "not safe." Which behavior should the nurse place in the "not safe" column?

1. Abstinence 2. Mutual monogamy 3. Use of latex condoms 4. Use of natural skin condoms 4 Rationale: The use of natural skin condoms is not considered safe because the pores in the condom are large enough for the virus to pass through.

The client seen in the health care clinic has tested positive for gonorrhea. The nurse anticipates that which medication will be prescribed based on this finding?

1. Acyclovir 2.Ceftriaxone 3.Azithromycin 4.Penicillin G benzathine 2 Rationale: Treatment for gonorrhea consists of antibiotic therapy, usually with ceftriaxone and doxycycline.

The nurse is conducting a community surveillance study for the purpose of communicable disease control. The nurse knows that performing an active surveillance method of assessment is best for what reason?

1. Always results in clear indicators for interventions 2.Results in detection of a more accurate number of cases 3.Reflects an upward swing if a certain disease is current news 4.Relies solely on the initiative of health care providers (HCPs) to report cases 2 Rationale: The best outcome of any type of surveillance is accuracy. An active surveillance method focuses on assessment rather than interventions and is best because it results in detection of a more accurate number of cases.

The community health nurse is providing a teaching session about anthrax to members of the community and asks the participants about the methods of transmission. Which answers by the participants would indicate that teaching was effective? Select all that apply.

1. Bites from ticks or deer flies 2.Inhalation of bacterial spores 3.Through a cut or abrasion in the skin 4.Direct contact with an infected individual 5.Sexual contact with an infected individual 6.Ingestion of contaminated undercooked meat 2, 3 & 6 Rationale: Anthrax is caused by Bacillus anthracis and can be contracted through the digestive system or abrasions in the skin, or inhaled through the lungs.

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

1. Cleansing the meatus with antiseptic pads using upward strokes 2.Letting go of the labia once this tissue is cleansed, to allow the client to urinate 3.Making sure that the fingers avoid touching the inside of the collection container 4.Instructing the client to urinate in the container after the labia have been cleansed 3 Rationale: 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.

A man has been admitted to the surgical unit after hernia repair surgery. The medical record reports that the client is human immunodeficiency virus (HIV) positive. The nurse should implement which precautions for this client?

1. Contact precautions 2. Droplet precautions 3.Airborne precautions 4.Standard precautions 4 Rationale: Having an HIV-positive status does not warrant a special type of precaution; instead, the nurse will implement standard precautions. Contact, droplet, and airborne precautions are implemented with specific types of infections or diseases but are not necessary for clients who are HIV positive unless some additional specific infection is present.

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?

1. Five blood cultures are negative. 2.Three sputum cultures are negative. 3.A blood culture and a chest x-ray are negative. 4.A sputum culture and a tuberculin skin test are negative. 2 Rationale: 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.

A female client seen in the ambulatory care clinic has a history of syphilis infection. The nurse assessing the client for reinfection would expect to observe a lesion on the labia that has which characteristic?

1. Is painless and indurated 2.Has a cauliflower-like appearance 3.Is erythematous and papular in appearance 4.Appears as 1 or more vesicles that then rupture 1 Rationale: The characteristic lesion of syphilis is painless and indurated. The lesion is referred to as a chancre. Genital warts are characterized by cauliflower-like growths or growths that are soft and fleshy. Scabies is characterized by erythematous, papular eruptions. Genital herpes is accompanied by the presence of 1 or more vesicles that then rupture and heal.

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?

1. Surgical mask and gloves 2.Particulate respirator, gown, and gloves 3.Particulate respirator and protective eyewear 4.Surgical mask, gown, and protective eyewear 2 Rationale: 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 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?

1. The family does not need therapy, and the client will not be contagious after 1 month of medication therapy. 2.The family does not need therapy, and the client will not be contagious after 6 consecutive weeks of medication therapy. 3.The family will be treated prophylactically, and the client will not be contagious after 1 continuous week of medication therapy. 4.The family will be treated prophylactically, and the client will not be contagious after 2 to 3 consecutive weeks of medication therapy. 4 Rationale: Family members or others who have been in close contact with a client diagnosed with tuberculosis are placed on prophylactic therapy 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.

The nurse is instructing a postpartum client with endometritis about preventing the spread of infection to the newborn infant. Which statement should the nurse make to the client?

1. Visitors are not allowed to hold the baby. 2.There is no danger of the newborn contracting the disease. 3.Hands should be washed thoroughly before holding the infant. 4.The newborn infant will not be allowed in the mother's room at all. 3 Rationale: Hand washing is one of the most effective methods of preventing the transmission of infectious diseases.

The nurse is providing orientation to a newly graduated nurse. During a discussion of isolation procedures, which statement by the graduate nurse indicates a need for further review of isolation guidelines?

1. "A client with tuberculosis will be placed on airborne precautions." 2."I will wear a mask when working with an isolated client who has a tracheostomy." 3."I can reuse a gown if it's not dirty, as long as I hang it up inside the client's room." 4."I will remove the gown and gloves and wash my hands before leaving the client's room." 3 Rationale: Centers for Disease Control and Prevention (CDC) guidelines require that gowns used in isolation rooms be discarded after each use and not reused, even for the same client. The other options reflect correct isolation guidelines.

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?

1. "Hands need to be washed frequently." 2."A clean washcloth can be used to wipe my child's eyes." 3."It is all right to share towels and washcloths as long as they are bleached after use." 4."The eye drops must be given as prescribed, and hands need to be washed before and after instillation." 3 Rationale: 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 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?

1. "I need to bring a hat to wear during the trip." 2."I should wear long-sleeved tops and long pants." 3."I should not use insect repellents because it will attract the ticks." 4."I need to wear closed shoes and socks that can be pulled up over my pants." 3 Rationale: 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.

The nursing instructor determines that the nursing student understands the purposes of standard and transmission-based precautions if which statements are made? Select all that apply.

1. "They prevent transmission of organisms from client to client." 2."They prevent transmission of organisms from health care providers to clients." 3."They prevent transmission of organisms from clients to health care providers." 4."They prevent transmission of organisms from hospital visitors to in-hospital clients." 5."They prevent transmission of organisms from hospital visitors to health care providers." 6."They prevent transmission of organisms from health care providers and clients to people outside of the hospital." 1, 2, 3, & 6 Rationale: The purpose of these precautions is to prevent the transmission of organisms from clients to health care providers (HCPs), from HCPs to clients, from client to client, and from HCPs and clients to people outside of the hospital. Hospital visitors are not included in these infection-based precautions.

The nurse employed on a medical unit in a hospital receives a telephone call from the admission office and is told that a client with a diagnosis of mycoplasmal pneumonia will be admitted to the unit. The nurse prepares for the admission and obtains the necessary supplies to place the client on which type of transmission-based precautions?

1. Droplet precautions 2.Enteric precautions 3.Contact precautions 4.Protective isolation 1 Rationale: Droplet precautions are required for a client with mycoplasmal pneumonia because this type of pneumonia is transmitted by droplet nuclei larger than 5 mm.

A client with tuberculosis (TB), whose status is being monitored in an ambulatory care clinic, asks the nurse when it is permissible to return to work. The nurse replies that the client may resume employment when which occurs?

1. Five sputum cultures are negative. 2.Three sputum cultures are negative. 3.A sputum culture and a chest x-ray are negative. 4.A sputum culture and a tuberculin skin test are negative. 2 Rationale: The client 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 3 sputum cultures are negative because the client is considered noninfectious at that point.

Contact precautions are initiated for a client with a health care-associated (nosocomial) infection caused by methicillin-resistant Staphylococcus aureus. The nurse prepares to provide colostomy care and should obtain which protective items to perform this procedure?

1. Gloves and gown 2. Gloves and goggles 3.Gloves, gown, and shoe protectors 4.Gloves, gown, goggles, and a mask or face shield 4 Rationale: Splashes of body secretions can occur when providing colostomy care. Goggles and a mask or face shield are worn to protect the face and mucous membranes of the eyes during interventions that may produce splashes of blood, body fluids, secretions, or excretions. In addition, contact precautions require the use of gloves, and a gown should be worn if direct client contact is anticipated. Shoe protectors are not necessary.

The nurse places a hospitalized client with active tuberculosis in a private, well-ventilated isolation room. In addition, which action should the nurse take before entering the client's room?

1. Wash hands and don a surgical mask. 2.Wash hands and wear a gown and gloves. 3.Wash hands and place a high-efficiency particulate air (HEPA) respirator mask over the nose and mouth. 4.The nurse needs no precautions. The client is instructed to cover the mouth and nose when coughing. 3 Rationale: The nurse wears an HEPA respirator mask when caring for a client with active tuberculosis.

The home health nurse visits a client with suspected scabies. Which precaution should the nurse institute during the assessment of the client?

1. Wear gloves only. 2.Wear a mask and gloves. 3.Wear a gown and gloves. 4.Avoid touching the client's home furnishings. 3 Rationale: The Centers for Disease Control and Prevention recommends wearing gowns and gloves for close contact with a client infested with scabies.

The nurse is preparing to care for a client with acquired immunodeficiency syndrome (AIDS). In planning infection control for this client, the nurse should implement which form of isolation to prevent the spread of the AIDS virus to others?

1.Strict isolation 2.Enteric precautions 3.Contact precautions 4.Blood and body fluid precautions 4 Rationale: The AIDS virus is transmitted through contact with oral secretions, sexual contact with infected semen or vaginal secretions, through contact with infected blood or blood products, from mother to fetus during childbirth, or during breast-feeding.