NP Ch 23 Promoting Asepsis & Preventing Infecton

23. The nurse caring for several patients on the intermediate care unit considers which of the following patients to be most at risk for developing an infection? A patient with a/an: a) Centrally venous catheter b) Indwelling urinary catheter c) Colostomy d) Nasoenteric feeding tube

ANS: A A central venous catheter is an invasive intravenous line that is advanced into the central circulation near the heart and may serve as a portal of entry for pathogens to enter a patient's body. Also a risk for infection, but to a lesser degree, an indwelling urinary catheterization may injure the fragile urethral mucosa, provide a direct pathway for pathogens into the bladder, and prevent the normal flushing of the urethra. As normal flora in the intestine that protect the body against infection, a nasoenteric tube into the gut as well as an ostomy (colostomy) are less likely to lead to infection.

21. The nurse has just administered a subcutaneous insulin injection to her diabetic patient. What is the next immediate action by the nurse? a) Dispose of the needle/syringe uncapped into a disposable sharps container. b) Recap the syringe with needle and dispose into a sharps container. c) Dispose the needle/syringe into a biohazard bag inside the patient's room. d) Separate the needle and syringe and place them into a sharps container.

ANS: A Always place disposable needles, syringes, and other sharp items such as broken glass in a special disposable, sharps container immediately after their use. Never recap or handle any contaminated needle. Biohazard bags are used for contaminated items and equipment related to body fluids that are not to be placed in regular trash containers.

11. A patient asks the nurse why there is no vaccine available for the common cold. Which response by the nurse is correct?" a) "The virus mutates too rapidly to develop a vaccine." b) "Vaccines are developed only for very serious illnesses." c) "Researchers are focusing efforts on an HIV vaccine." d) "The virus for the common cold has not been identified."

ANS: A More than 200 viruses are known to cause the common cold. These viruses mutate too rapidly to develop a vaccine. Although some researchers are focusing efforts on a vaccine for HIV infection, others continue to research the common cold.

19. The patient in the intensive care unit has developed a urinary tract infection related to the indwelling urinary catheter. Which of the following best describes this type of infection? a) Nosocomial b) Healthcare associated c) Multidrug-resistant organisms (MDRO) d) Unavoidable occurrence

ANS: A Nosocomial infections refer specifically to hospital-acquired infections. Healthcare-associated infections (HAIs) refer to infections associated with healthcare given in any setting (hospitals, long-term care facilities); however, nosocomial is more specific. A multi-drug-resistant organism (MDRO) is a bacterium that is resistant to many antibiotics. Examples of MDROs include methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Indwelling urinary catheters are needed in many circumstances, and might be unavoidable in that sense. However, the infection itself is not unavoidable because it can be prevented in most instances with meticulous nursing care. Therefore "unavoidable occurrence" is an incorrect option.

22. Should a bioterrorism event occur, what factor is most important in minimizing the effects of such an event? a) Rapidly recognize unusual disease patterns and detect the presence of unusual infectious diseases. b) Communicate any extraordinary events to the organization's safety officer. c) Report any suspicious findings to the Centers for Disease Control and Prevention. d) Institute a community-wide education program for standard precautions and handwashing.

ANS: A Should a biological event occur, either as a result of bioterrorism or a naturally occurring epidemic, a key factor in minimizing its effects is the ability to quickly recognize unusual disease patterns and detect the presence of infectious diseases. This is the best answer to minimize effects of an event. However, the healthcare worker would also follow a reporting process of notifying the safety officer of the facility along with the CDC.

5. A patient becomes infected with oral candidiasis (thrush) while receiving intravenous antibiotics to treat a systemic infection. Which type of infection has the patient developed? a) Endogenous nosocomial b) Exogenous nosocomial c) Latent d) Primary

ANS: A Thrush in this patient is an example of an endogenous nosocomial infection. This type of infection arises from suppression of the patient's normal flora as a result of some form of treatment, such as antibiotics. Normal flora usually keep yeast from growing in the mouth. In exogenous nosocomial infection, the pathogen arises from the healthcare environment. A latent infection causes no symptoms for long periods. An example of a latent infection is HIV infection. A primary infection is the first infection that occurs in a patient.

7. The nurse assists a surgeon with central venous catheter insertion. Which action is necessary to help maintain sterile technique? a) Closing the patient's door to limit room traffic while preparing the sterile field b) Using clean procedure gloves to handle sterile equipment c) Placing the nonsterile syringes containing flush solution on the sterile field d) Remaining 6 inches away from the sterile field during the procedure

ANS: A To maintain sterile technique, the nurse should close the patient's door and limit the number of persons entering and exiting the room because air currents can carry dust and microorganisms. Sterile gloves, not clean gloves, should be used to handle sterile equipment. Placing nonsterile syringes on the sterile field contaminates the field. One foot, not 6 inches, is required between people and the sterile field to prevent contamination.

6. The Centers for Disease Control and Prevention (CDC) is a federal agency devoted to infection control and prevention in healthcare settings. What are the goals of the CDC? Select all that apply. a) Reduce catheter-associated adverse events (infections) by 50% b) Reduce targeted antimicrobial-resistant bacterial infections by 50% c) Reduce all healthcare-associated infections by 75% d) Establish guidelines for safety, knowledge, and skills to reduce infections

ANS: A, B The Centers for Disease Control and Prevention (CDC) is a federal agency devoted to infection control and prevention in healthcare settings. Many healthcare facilities' policies and procedures are based on the CDC guidelines. Among its many goals for healthcare facilities, the CDC is advocating for a reduction in catheter-associated adverse events (infections) of 50% and a reduction of targeted antimicrobial-resistant bacterial infections of 50%. Guidelines specific to safety, knowledge, and skills to reduce infections are nursing competencies related to QSEN.

10. The nurse is obtaining her patient's health history related to infections. What are appropriate questions the nurse will ask the patient? Select all that apply. a) "Have you recently traveled out of the country?" b) "How would you describe your current stress level?" c) "Do you know your approximate weight?" d) "What is your normal blood pressure and heart rate?"

ANS: A, B To elicit information related to infection, ask the patient about any exposure to pathogens in the environment, recent travel outside the country, ingestion of any unusual foods, medications, current stress level, immunization history, and symptoms of any illness. Asking the patient about her weight and normal BP and heart rate are important information but these questions will not elicit the information needed related to infection.

7. What statements best describe the association between smoking and pulmonary infections? Select all that apply. a) Smoking interferes with respiratory functions, including the ability to move the chest, cough, and sneeze. b) Smoking increases alveolar elasticity, leading to overproduction of mucus that leads to pulmonary infections. c) Smoking decreases movement of the cilia in the lower airways, creating a favorable environment for bacterial growth. d) Nonsmokers chronically exposed to secondhand smoke have minimal risk for pulmonary infections.

ANS: A, C Smoking is a major risk factor for pulmonary infections. Smoking interferes with normal respiratory functioning, including the ability to move the chest, cough, sneeze, or have full air exchange. Smoking reduces alveolar elasticity; this interferes with oxygen exchange and reduces the lungs' effectiveness in clearing mucus, leading to pulmonary infections. Chemicals in tobacco paralyze cilia; thus, secretions pool in the lower airways, creating a hospitable environment for bacterial growth. Although tobacco users are most profoundly affected by these changes, people chronically exposed (bartenders, children of smokers) are also affected by these changes and are at increased risk for infection.

3. The nurse is teaching a group of newly hired nursing assistive personnel (NAP) about proper handwashing. The nurse will know that the teaching was effective if the NAP demonstrate which of the following? Select all that apply. a) Uses a paper towel to turn off the faucet b) Holds fingertips above the wrists while rinsing off the soap c) Removes all rings and watch before washing hands d) Cleans underneath each fingernail

ANS: A, C, D Handwashing requires at least 15 seconds of washing, which includes lathering all surfaces of the hands and fingers to be effective. The fingers should be held lower than the wrists.

4. Alcohol-based solutions for hand hygiene can be used to combat which types of organisms? Select all that apply. a) Viruses b) Bacterial spores c) Yeasts d) Molds

ANS: A, C, D If there is potential for contact with bacterial spores, hands must be washed with soap and water; alcohol-based solutions are ineffective against bacterial spores.

9. The hospital nurse educator is preparing an orientation class for those newly hired on the surgical suite. Which of the following will the educator include in the orientation curriculum regarding hand and fingernail care? Select all that apply. a) Healthcare staff must routinely inspect their hands for breaks in skin. b) Artificial nails are permitted if properly secured to the nailbed. c) Wristwatches be may be worn as long as they are all metal. d) Healthcare staff are to avoid wearing nail polish at all times.

ANS: A, D Infection control and prevention measures regarding hands and nails in the surgical suite and in all areas of most healthcare facilities include keeping fingernails short and clean; avoiding nail polish and artificial nails; checking skin condition of the hands; and removing all wristwatches and rings, as they are sources for bacteria.

15. As a general rule, how much liquid soap should the nurse use for effective handwashing? At least: a) 2 mL b) 3 mL c) 6 mL d) 7 mL

ANS: B APIC guidelines dictate that 3 to 5 mL of liquid soap are necessary for effective handwashing.

12. A patient who has a temperature of 101°F (38.3°C) most likely requires: a) Acetaminophen (Tylenol) b) Increased fluids c) Bedrest d) A tepid bath

ANS: B Fever, a common defense against infection, increases water loss; therefore, additional fluid is needed to supplement this loss. Acetaminophen and a tepid bath are not necessary for this low-grade fever because fever is beneficial in fighting infection. Adequate rest, not necessarily bedrest, is necessary with a fever.

10. What type of immunity is provided by intravenous (IV) administration of immunoglobulin G? a) Cell mediated b) Passive c) Humoral d) Active

ANS: B Intravenous administration of immunoglobulin G provides the patient with passive immunity. Immunoglobulin G does not provide cell-mediated, humoral, or active immunity. Cellular (cell-mediated) immune response acts directly to destroy pathogens without using antibodies. The humoral immune response (or antibody-mediated response) protects the body by circulating antibodies to fight against pathogens (e.g., bacteria). Passive immunity occurs when antibodies are transferred by antibodies from an immune host, such as from a placenta to a fetus. Passive immunity is short lived. Active immunity is longer lived and comes from the host itself. Humoral immunity occurs by secreted antibodies binding to antigens. Cell-mediated immunity does not involve antibodies but instead fights infection from macrophages that kills pathogens.

14. How should the nurse dispose of the breakfast tray of a patient who requires airborne isolation? a) Place the tray in a specially marked trashcan inside the patient's room. b) Place the tray in a special isolation bag held by a second healthcare worker at the patient's door. c) Return the tray with a note to dietary services so it can be cleaned and reused for the next meal. d) Carry the tray to an isolation trash receptacle located in the dirty utility room and dispose of it there.

ANS: B Patients who require airborne isolation are served meals on disposable dishes and trays. To dispose of the tray, the nurse inside the room must wear protective garb and place the tray and its contents inside a special isolation bag that is held by a second healthcare worker at the patient's door. The items must be placed on the inside of the bag without touching the outside of the bag.

20. The mother of a 6-year-old child says to the pediatric nurse, "My son had such a bad case of the measles. I hope he doesn't get them again." What is the most appropriate response by the nurse? a) "It sounds like he was very sick. Let's hope he doesn't get them again." b) "Measles is a disease that once you've had it, you won't get it again. The body has learned to make cells that will fight off any future exposures." c) "Would you like me to prepare a plan for you with ways you can prevent future episodes of measles?" d) "It will be important for you to keep your son away from other children with measles, as he is now more susceptible."

ANS: B People who recover from some infectious diseases such as measles and chickenpox never get the disease again, even if they are repeatedly exposed to the virus. The reason is "specific immunity": the process by which the body's immune cells learn to recognize and destroy pathogens they have encountered before. Keeping a child who has had measles away from a child who currently has measles will have no effect on the child acquiring measles.

18. The nurse is removing personal protective equipment (PPE). Which item should be removed first? a) Gown b) Gloves c) Face shield d) Hair covering

ANS: B The gloves are removed first because they are usually the most contaminated PPE and must be removed to avoid contamination of clean areas of the other PPE during their removal. The gown is removed second, then the mask or face shield, and finally, the hair covering.

17. While donning sterile gloves, the nurse notices the edges of the glove package are slightly yellow. The yellow area is more than 1 inch away from the gloves and only appears to be on the outside of the glove package. What is the best action for the nurse to take at this point? a) Continue using the gloves inside the package because the package is intact. b) Remove gloves from the sterile field and use a new pair of sterile gloves. c) Throw all supplies away that were to be used and begin again. d) Use the gloves and make sure the yellow edges of the package do not touch the client.

ANS: B The gloves should be thrown away because the gloves are likely to be contaminated from an outside source. The supplies do not have to be thrown away because they have not been contaminated.

4. A patient is admitted to the hospital with tuberculosis. Which precautions must the nurse institute when caring for this patient? a) Droplet transmission b) Airborne transmission c) Direct contact d) Indirect contact

ANS: B The organisms responsible for measles and tuberculosis, as well as many fungal infections, are spread through airborne transmission. Neisseria meningitidis, the organism that causes meningitis, is spread through droplet transmission. Pathogens that cause diarrhea, such as Clostridium difficile, are spread by direct contact. The common cold can be spread by indirect contact or droplet transmission.

8. The community health nurse is preparing a teaching plan for emergency preparedness in the instance of a major disease outbreak. Which of the following will the nurse include in the plan for the home setting? Select all that apply. a) Keep a supply of broad-spectrum antibiotics. b) Have nonprescription drugs available. c) Store a 2-week supply of bottled water. d) Obtain an annual influenza vaccination.

ANS: B, C, D Teaching patients emergency preparedness in case of disease outbreaks is an important nursing role. This role has become increasingly important with the recent outbreaks of anthrax, pertussis, and H1N1. In preparing for a major disease outbreak, the nurse should teach patients and families to establish an exit and preparedness plan; keep a 2-week supply of bottled water and nonperishable foods on hand; check regular prescriptions and be sure to have enough on hand; keep some over-the-counter medications available, such as vitamins, antidiarrheal medications, and ibuprofen; and obtain an annual influenza vaccine. There is no recommendation to have a supply of a broad-spectrum antibiotics on hand. In fact, there is growing concern regarding the overuse and overprescribing of antibiotics because this has now been shown to contribute to the rise of microbial-resistant diseases.

Why is a lotion without petroleum preferred over a petroleum-based product as a skin protectant? It: a) Prevents microorganisms from adhering to the skin b) Facilitates the absorption of latex proteins through the skin c) Decreases the risk of latex allergies d) Prevents the skin from drying and chaffing.

ANS: C Non-petroleum-based lotion is preferred because it prevents the absorption of latex proteins through the skin, which can cause latex allergy. Both types of lotion help prevent the skin from drying and becoming chafed. Neither prevents microorganisms from adhering to the skin.

1. Which of the following behaviors indicates the highest potential for spreading infections among clients? The nurse: a) Disinfects dirty hands with antibacterial soap b) Allows alcohol-based rub to dry for 10 seconds c) Washes hands primarily after leaving each room d) Uses cold water for medical asepsis

ANS: C Patients acquire infection by contact with other patients, family members, and healthcare equipment. But most infection among patients is spread through the hands of healthcare workers. Handwashing interrupts the transmission and should be done before and after all contact with patients, regardless of the diagnosis. When the hands are soiled, healthcare staff should use antibacterial soap with warm water to remove dirt and debris from the skin surface. When no visible dirt is present, an alcohol-based rub should be applied and allowed to dry for 10 to 15 seconds.

2. What is the most frequent cause of the spread of infection among institutionalized patients? a) Airborne microbes from other patients b) Contact with contaminated equipment c) Hands of healthcare workers d) Exposure from family members

ANS: C Patients are exposed to microbes by contact (direct contact, airborne, or otherwise) with other patients, family members, and contaminated healthcare equipment. Some of these are pathogenic (cause illness) and some are nonpathogenic (do not cause illness). But most microbes causing infection among patients are spread by direct contact on the hands of healthcare workers.

8. A patient develops localized heat and erythema over an area on the lower leg. These findings are indicative of which secondary defense against infection? a) Phagocytosis b) Complement cascade c) Inflammation d) Immunity

ANS: C The classic signs of inflammation, a secondary defense against infection, are erythema (redness) and localized heat. The secondary defenses of phagocytosis (process by which white blood cells engulf and destroy pathogens) and the complement cascade (process by which blood proteins trigger the release of chemicals that attack the cell membranes of pathogens) do not produce visible findings. Immunity is a tertiary defense that protects the body from future infection.

6. A patient admitted to the hospital with pneumonia has been receiving antibiotics for 2 days. His condition has stabilized, and his temperature has returned to normal. Which stage of infection is the patient most likely experiencing? a) Incubation b) Prodromal c) Decline d) Convalescence

ANS: C The stage of decline occurs when the patient's immune defenses, along with any medical therapies (in this case antibiotics), are successfully reducing the number of pathogenic microbes. As a result, the signs and symptoms of infection begin to fade. Incubation is the stage between the invasion by the organism and the onset of symptoms. During the incubation stage, the patient does not know he is infected and is capable of infecting others. The prodromal stage is characterized by the first appearance of vague symptoms. Convalescence is characterized by tissue repair and a return to heal as the organisms disappear.

1. In which situation would using standard precautions be adequate? Select all that apply. a) While interviewing a client with a productive cough b) While helping a client to perform his own hygiene care c) While aiding a client to ambulate after surgery d) While inserting a peripheral intravenous catheter

ANS: C, D Standard precautions should be instituted with all clients whenever there is a possibility of coming in contact with blood, body fluids (except sweat), excretions, secretions, mucous membranes, and breaks in the skin (e.g., while inserting a peripheral IV). If the disease is not spread by air or droplets, then there is no likelihood of the nurse's encountering body fluids when interviewing a client. If the disease is spread by air or droplets, then droplet or airborne precautions would be needed in addition to standard precautions. If giving a complete bed bath or performing oral hygiene, the nurse would need to use standard precautions (gloves); if merely assisting a client to perform ADLs, it is not necessary. No exposure to body fluids is likely when helping a client to ambulate after surgery.

5. A patient with tuberculosis is scheduled for computed tomography (CT). How should the nurse proceed? Select all that apply. a) Question the order because the patient must remain in isolation. b) Place an N-95 respirator mask on the patient and transport him to the test. c) Place a surgical mask on the patient and transport him to CT lab. d) Notify the computed tomography department about precautions prior to transport.

ANS: C, D Transporting a patient who requires airborne precautions should be limited; however, when necessary the patient should wear a surgical mask (an N-95 respirator mask is not required) that covers the mouth and nose to prevent the spread of infection. Moreover, the department where the patient is being transported should be notified about the precautions before transport.

9. The patient is just beginning to feel symptoms after being exposed to an upper respiratory infection. Which antibody would be most likely to be found in a test of immunoglobulin levels? a) IgA b) IgE c) IgG d) IgM

ANS: D IgM antibodies are the first to be made in response to infection. IgE is the antibody primarily responsible for this allergic response. IgA antibodies protect the body in fighting viral and bacterial infections, and appear later. IgG antibodies also appear later— perhaps up to 10 days later.

3. A patient infected with a virus but who does not have any outward sign of the disease is considered a: a) Pathogen b) Fomite c) Vector d) Carrier

ANS: D Some people might harbor a pathogenic organism, such as HIV, within their body and yet do not acquire the disease/infection. These individuals, called carriers, have no outward sign of active disease, yet they can pass the infection to others. A pathogen is an organism capable of causing disease. A fomite is a contaminated object that transfers a pathogen, such as pens, stethoscopes, and contaminated needles. A vector is an organism that carries a pathogen to a susceptible host through a portal for entry into the body. An example of a vector is a mosquito or tick that bites or stings.

16. To assure effectiveness, when should the nurse stop rubbing antiseptic hand solution over all surfaces of the hands? a) When fingers feel sticky b) After 5 to 10 seconds c) When leaving the client's room d) Once fingers and hands feel dry

ANS: D The nurse should rub the antiseptic hand solution over all surfaces of the hands until the solution dries, usually 10 to 15 seconds, to ensure effectiveness.