Chapter 5 Preventing / Controlling the Transmission of Infectious Agents

Question 1

A woman in active labor with confirmed influenza has been admitted to an acute care facility. Recommendations for preventing influenza transmission between hospitalized infected mothers and their infants include all of the following except:

a. The mother should be placed on Droplet Precautions.
b. The baby should stay in the same room as the mother.
c. Keep the isolette at least 3 feet away from the mother when she is not interacting with the baby.
d. The baby should receive formula during the 5-day period following the mother’s symptom onset.

Answer 1

The baby should receive formula during the 5-day period following the mother’s symptom onset.

APIC Influenza

Question 2

Most healthcare-associated pathogens are transmitted from patient to patient via:

a. Improper isolation practices.
b. Inadequate sterilization of medical instruments.
c. Hands of Healthcare personnel.
d. Ineffective disinfection of medical devices.

Answer 2

Hands of Healthcare personnel.

APIC Legal Issues

Question 3

A patient is admitted with pruritic lesions on the hands, webs of fingers, wrists, extensor surfaces of elbows and knees, and the outer surfaces of the feet, armpits, buttocks and waist. What type of isolation does this person require?

a. Contact
b. Droplet
c. Airborne
d. No isolation required

Answer 3

Contact

APIC Parasites

Question 4

An autopsy is ordered on a patient who was diagnosed with tuberculosis (TB). Which of the following statements is correct regarding postmortem care of the deceased TB patient?

a. Autopsy rooms should be at positive pressure with respect to adjacent areas, and room air must be exhausted directly outside.
b. An oscillating autopsy saw should be used to reduce the infectious aerosols.
c. An approved mask is necessary for respiratory protection.
d. Standard precautions are sufficient because Mycobacterium tuberculosis needs a living host to survive.

Answer 4

An approved mask is necessary for respiratory protection.

APIC Postmortem Care

Question 5

Which of the following patients is not at high risk for healthcare-associated fungal infection?

a. Burn patient
b. Premature baby in the Neonatal Intensive Care Unit
c. Bone marrow transplant patient
d. Patient who underwent joint replacement surgery

Answer 5

Patient who underwent joint replacement surgery

Question 6

The Infection Preventionist (IP) receives a call from a nurse who is scheduling a patient for surgery at her ambulatory surgery center. The nurse tells the IP that the patient is colonized with MRSA. Which of the following best describes colonization?

a. The presentation of clinical signs of illness or inflammation.
b. An Acute bacterial disease caused by an obligate anaerobic, non-spore-forming rod
c. The permanent presence of bacteria that is part of the normal flora
d. The presence of microorganisms without the signs/symptoms of an infection

Answer 6

The presence of microorganisms without the signs/symptoms of an infection

APIC Microbiology basics

Question 7

What type of respiratory protection (mask) is recommended for immune and non-immune healthcare personnel when caring for a patient with smallpox?

a. Surgical mask
b. Exam mask
c. N95 or higher level respirator
d. Procedure mask

Answer 7

N95 or higher level respirator

APIC Isolation Precautions

Question 8

An outbreak of aspergillosis is suspected after several oncology patients are identified with positive cultures. The IP suspects a heating, ventilation, and air conditioning (HVAC) malfunction and begins an outbreak investigation. The IP has been asked to make recommendations for environmental cultures. All of the following needs to be considered EXCEPT:

a. Identifying the purpose of culturing and appropriate methods beforehand
b. Meeting with the facility legal staff to discuss notification of the patients
c. Anticipating decisions and planned actions to results of culturing before undertaking the process
d. Determining whether there are existing standards to interpret results

Answer 8

Meeting with the facility legal staff to discuss notification of the patients

APIC Heating, Ventilation, and Air Conditioning

Question 9

The U.S. Pharmacopoeia (USP) recommends that multi-dose vials be disposed of:

a. 14 days after opening
b. 30 days after opening
c. 28 days after opening
d. When all the medication has been used

Answer 9

28 days after opening

APIC Pharmacy Services

Question 10

The policy for therapy animals in healthcare facilities should include all of the following EXCEPT:

a. Hand hygiene must be performed after contact with the animal.
b. Animal must be bathed within 24 hours prior to visiting the healthcare facility.
c. Animals must be healthy and current with immunizations.
d. Small animals are never allowed to sit on a patient’s bed.

Answer 10

Small animals are never allowed to sit on a patient’s bed.

APIC Animals Visiting

Question 11

An IP has been asked to provide infection prevention consultation to a long-term care facility (LTCF). As a part of this consultation, she checks to make sure which of the following program components are in place:

1) Decolonizing residents with MRSA
2) Establishing an antimicrobial stewardship program
3) Implementing an annual influenza vaccination program
4) Collecting environmental cultures of high-touch areas.

a. 1,2 b. 2,3 c. 3,4 d. 1,4

Answer 11

Establishing an antimicrobial stewardship program
Implementing an annual influenza vaccination program

APIC Long-term care

Question 12

A hospital is beginning a major construction project. The IP has been asked to join the planning team to assist with the development of the Infection Control Risk Assessment (ICRA) for the project. What is the purpose of the ICRA?

a. Develop and oversee the construction project schedule
b. Minimize infectious hazards for patients and healthcare personnel
c. Provide direction for level three and four projects only
d. Coordinate systems start-ups

Answer 12

Minimize infectious hazards for patients and healthcare personnel

APIC Construction and Renovation

Question 13

An “antibiotic time out” occurs

a. Daily
b. Weekly
c. Within 24 to 48 hours of culture results being available
d. Within 96 hours of culture results being available

Answer 13

Within 24 to 48 hours of culture results being available

Doctors must review dose, duration of therapy and indication for treatment.

Question 14

Of the following methods of disinfection and sterilization, which will kill organisms, including all bacterial spores?

1) Pasteurization
2) Orthophthaladhyde
3) Steam Sterilization
4) Ethylene oxide

a. 1,2 b. 2,3 c. 1,3 d. 3,4

Answer 14

Steam Sterilization
Ethylene oxide

APIC Cleaning, Disinfection and Sterilization

Question 15

Hydrogen peroxide vapor (HPV) has been shown to be effective for decontamination of patient rooms and is known to kill spores and other microbes. Despite its benefits, there are some drawbacks to using HPV. Which of the following could be a major drawback to using HPV to clean patient rooms?

a. It is effective in decontaminating surfaces but not equipment
b. It leaves a residue that, over time, can damage equipment in the room
c. It lengthens room turnover because it takes a prolonged period of time to complete room treatment
d. It is most effective for areas closer to the unit and less effective around the edges of the room

Answer 15

It lengthens room turnover because it takes a prolonged period of time to complete room treatment

APIC Cleaning, Disinfecting and Sterilization

Question 16

While making rounds in one of the ICU’s, the IP observes a patient who has just been intubated and is on a ventilator. He notes that the patient is in a supine position. Which of the following positions should he recommend to the nurse in order to be compliant with a pneumonia prevention bundle?

a. The patient should be turned to his side to facilitate drainage of secretions
b. The patient should be placed in reverse Trendelenburg position
c. The patient’s head of the bed should be elevated to an angle of 30 to 45 degrees
d. The patient should sit upright at a 60 to 75 degree angle

Answer 16

The patient’s head of the bed should be elevated to an angle of 30 to 45 degrees

APIC Pneumonia

Question 17

A patient with bacterial meningitis due to Neisseria meningitidis requires what type of Transmission-based Precautions?

a. Contact Precautions
b. Standard Precautions
c. Droplet Precautions
d. Airborne Precautions

Answer 17

Droplet Precautions

APIC Isolation Precautions

Question 18

Which federal agencies in the U.S. have published regulations pertaining to infection and medical or regulated waste?

1) U.S. Environmental Protection Agency (EPA)
2) U.S. Occupational Safety and Health Administration (OSHA)
3) U.S. Food and Drug Administration
4) U.S. Department of Transportation (DOT)

a) 1, 2, 3 b) 2,3,4 c) 1,2,4 d) 1,3,4

Answer 18

U.S. Environmental Protection Agency (EPA)
U.S. Occupational Safety and Health Administration (OSHA)
U.S. Department of Transportation (DOT)

APIC Waste Management

Question 19

Exposure to contaminated healthcare waste does not necessarily result in infection. The following factors must be present for contaminated waste to be capable of causing infection:

1) Dose and host susceptibility
2) Portal of entry
3) Portal of exit
4) Presence and virulence of a pathogen

a) 1,3,4 b) 1,2,4 c) 2,3,4 d) 1,2,3

Answer 19

Dose and host susceptibility
Portal of entry
Presence and virulence of a pathogen

APIC Waste Management

Question 20

Which of the following statements is TRUE regarding the storage of sterilized items in the Sterile Processing Department?

1) Sterilized items should be stored on a shelf with a solid bottom.
2) Sterilized items should be stored in high traffic areas for easy access
3) Sterilized items should be stored in a room with positive air pressure
4) Sterilized items should be stored 8 to 10 inches from the floor
a) 1,2,3 b) 1,3,4 c) 2,3,4 d) 1,2,4

Answer 20

Sterilized items should be stored on a shelf with a solid bottom.

Sterilized items should be stored in high traffic areas for easy access

Sterilized items should be stored 8 to 10 inches from the floor

APIC Sterile Processing

Question 21

Which of the following situations present the greatest risk for the transmission of pathogens via healthcare personnel hands?

1) Unit secretary with artificial nails
2) Environmental services worker with unchipped nail polish
3) Nurse practitioner with artificial nails
4) Registered nurse with chipped nail polish

a) 1,2 b) 2,3 c) 3,4 d) 1,4

Answer 21

Nurse practitioner with artificial nails
Registered nurse with chipped nail polish

Hand Hygiene in Health-Care Settings.

Question 22

Which of the following does NOT meet the requirements for an airborne isolation room?

a. Negative airflow isolation room
b. At least 15 - 20 air exchanges per hour
c. Direct exhaust to the outside
d. Daily monitoring of the air pressure with visual indicators

Answer 22

At least 15 - 20 air exchanges per hour

APIC Isolation Precautions

Question 23

According to the CDC, central venous catheters (CVCs) should be replaced:

a. Every 72 to 96 hours
b. Every 7 days
c. Every month
d. if malfunctioning

Answer 23

if malfunctioning

APIC Intravascular Device infections

Question 24

The IP has been asked to join the Antimicrobial Stewardship Team at his facility. The IP reviews current recommendations and understands that effective strategies to curb antimicrobial resistance include all of the following EXCEPT:

a. Formulary restriction
b. Administer antibiotics with overlapping activity
c. Automatic stop orders
d. Antimicrobial cycling

Answer 24

Administer antibiotics with overlapping activity

APIC Antimicrobials and Resistance

Question 25

When coordinating an active surveillance culture (ASC) plan, the IP should incorporate all of the following recommendations from the CDC EXCEPT:

a. Provide additional personnel to obtain cultures and additional laboratory personnel to process the cultures
b. Monitor adherence to Standard Precautions
c. Provide a mechanism for communicating results to healthcare providers
d. Measure outcome to evaluate the effectiveness of the ASC program and Contact Precautions

Answer 25

Monitor adherence to Standard Precautions

APIC Isolation Precautions

Question 26

Numerous outbreaks of infectious have been attributed to unsafe injection practices. The IP designs an educational program to review safe injection
practices with all nursing staff. These practices include:

1) Use single-dose vials whenever possible and avoid using multi-dose vials
2) Discard saline bags used for IV flushes for multiple patients after 1 hour
3) Enter medication vials with a new needle and syringe, even on the same patient
4) Use needles and syringes for only one patient
a. 1,2,3 b. 1,3,4 c. 1,2,4 d. 2,3,4

Answer 26

Use single-dose vials whenever possible and avoid using multi-dose vials

Enter medication vials with a new needle and syringe, even on the same patient

Use needles and syringes for only one patient

APIC Risk factors facilitating Transmission of Infectious Agents

Question 27

Respiratory hygiene/cough etiquette includes all but the following:

a. Covering the mouth and nose with the hands when coughing and sneezing
b. Offering a surgical mask to a coughing patient
c. Discarding used masks and tissues appropriately and performing hand hygiene
d. Posting signs in public areas in languages appropriate to the population served and educating healthcare staff, patients, and visitors

Answer 27

Covering the mouth and nose with the hands when coughing and sneezing

APIC Isolation Precautions

Question 28

Which type of isolation always requires a private room?

a. Contact Precautions
b. Standard Precautions
c. Airborne Precautions
d. Droplet Precautions

Answer 28

Airborne Precautions

APIC Isolation Precautions

Question 29

Which of the following is recommended for use when inserting a central venous catheter or a peripherally inserted catheter?

a. A cap
b. A clean gown
c. Nonsterile gloves
d. Small drapes

Answer 29

A cap

APIC Intravascular Device Infections

Question 30

During an influenza outbreak in an acute care setting, all of the following measures should be implemented EXCEPT:

a. Perform rapid influenza virus testing of patients and personnel with recent onset of symptoms suggestive of influenza
b. Implement Airborne Precautions for all patients with suspected or confirmed influenza
c. Restrict staff movement from areas of the facility having outbreaks
d. Restrict or limit elective medical and surgical admissions

Answer 30

Implement Airborne Precautions for all patients with suspected or confirmed influenza

APIC Influenza

Question 31

Which of the following veins, when used for catheter insertion, has been associated with a lower incidence of central line-associated bloodstream infection (CLABSI)?

a. Brachial
b. Femoral
c. Internal Jugular
d. Subclavian

Answer 31

Subclavian

APIC Intravascular Device infections

Question 32

All of the following methods for measuring hand hygiene adherence are acceptable EXCEPT:

a. Using electronic systems that allow continuous monitoring over time and automatic data download and analysis
b. Monitoring the volume of gloves per 1,000 patient days
c. Monitoring adherence to artificial fingernail policies
d. Periodically conducting an observational study to determine the rate of adherence (number of hand hygiene episodes performed/number of hand hygiene opportunities) by ward or service

Answer 32

Monitoring the volume of gloves per 1,000 patient days

APIC Han Hygiene

Question 33

Which of the following does NOT describe indirect contact transmission?

a. Mites from a scabies-infested patient
b. Equipment that is not cleaned, disinfected, or sterilized adequately between patients
c. Food and water supplies that are not prepared and maintained according to sanitation standards
d. Inadequate hand hygiene performed by a care provider

Answer 33

Mites from a scabies-infested patient

APIC Risk Factors Facilitating Transmission of Infectious Agents

Question 34

The CDC recommendations for decreasing CLABSI include all of the following EXCEPT:

a. Educational programs
b. Routine replacement of catheters
c. The use of chlorhexidine for skin antisepsis
d. The use of maximal sterile barrier precautions

Answer 34

Routine replacement of catheters

APIC Intravascular Device Infections

Question 35

An RN is caring for a patient who presented to the Emergency Department with symptoms consistent with influenza. When caring for this patient, she should use which of the following types of precautions?

a. Standard Precautions
b. Standard and Droplet Precautions
c. Airborne Precautions
d. Droplet Precautions if influenza is confirmed

Answer 35

Standard and Droplet Precautions

APIC Influenza

Question 36

Coughing, sneezing, and talking are best associated with which form of disease transmission?

a. Airborne transmission
b. Direct contact transmission
c. Droplet transmission
d. Indirect contact transmission

Answer 36

Droplet transmission

APIC Risk Factors Facilitating Transmission of Infectious Agents

Question 37

All of the following are true and should be communicated to patients before administering influenza vaccination EXCEPT:

a. The vaccine is formulated annually to protect against influenza strains likely to circulate in the U.S. in the upcoming winter
b. Inactivated influenza vaccine contains noninfectious viral components and cannot cause influenza
c. Patients who received specific antivirals with in the preceding 24 hours should not receive influenza vaccination
d. Fever, malaise, myalgia, and other systemic symptoms can occur after vaccination

Answer 37

Patients who received specific antivirals with in the preceding 24 hours should not receive influenza vaccination

APIC Influenza

Question 38

Elements of a VAP prevention bundle that have been suggested by the Institute for Healthcare Improvement (IHI) include all of the following practices EXCEPT:

a. Elevation of the head of the bed
b. Weekly “sedation vacations” and assessment of readiness to extubate
c. Peptic ulcer disease prophylaxis
d. Deep venous thrombosis prophylaxis

Answer 38

Peptic ulcer disease prophylaxis

APIC Pneumonia

Question 39

Which of the following statements is TRUE regarding CVCs?

a. Anticoagulant therapy can reduce the risk of catheter related infection
b. Positioning at the insertion site minimizes catheter tip malposition
c. The CVC should be sutured in place
d. Stopcock can increase the contamination rate

Answer 39

Stopcock can increase the contamination rate

APIC Intravascular Device Infections

Question 40

The CDC and WHO guidelines for hand hygiene recommend the use of an alcohol-based hand rub in all of the following situations EXCEPT:

a. After direct patient contact
b. Before donning sterile glove
c. When hands are visibly soiled
d. When moving from a contaminated body site to a clean body site during patient care

Answer 40

When hands are visibly soiled

APIC Hand Hygiene

Question 41

What percentage of Creutzfeldt-Jakob disease (CJD) cases are sporadic (vs. familial)?

a. 65 percent
b. 85 percent
c. 15 percent
d. 1 percent

Answer 41

85 percent

APIC Creutzfeldt-Jakob Disease and Other Prion Diseases

Question 42

Which of the following is NOT part of the bundle practices to reduce VAP?

a. Keeping the head of the bed raised to 30 to 45 degrees elevation unless medically contraindicated.
b. Performing regular oral care on a ventilated patient
c. Taking sedation “vacations” to assess patients’ ability to breathe on their own
d. Changing ventilator circuits every 48 hours

Answer 42

Changing ventilator circuits every 48 hours

APIC Pneumonia

Question 43

Which of the following bio-terrorism agents has the highest fatality rate?

a. Q fever
b. Ricin
c. Smallpox
d. Sever acute respiratory syndrome (SARS)

Answer 43

Ricin

APIC Infectious Disease Disasters: Bio-terrorism

Question 44

The epidemiological triangle includes a model of dynamic interaction, where a change in any component alters the existing equilibrium. This model is particularly useful in the study of infectious disease. How can IPs use the epidemiological triangle during outbreak investigations?

a. Examination of host factors such as increasing antimicrobial resistance as a result of antibiotic pressure.
b. Examination of host factors such as changes in immunity or diagnostic/therapeutic procedures within populations served
c. Consideration of agent factors such as improving influenza vaccination rates for healthcare workers
d. Consideration for agent factors such as change in cleaning agents in the hospital environment

Answer 44

Examination of host factors such as changes in immunity or diagnostic/therapeutic procedures within populations served

APIC General Principles of Epidemiology

Question 45

The IP should recommend all of the following prevention measures for a pregnant influenza-infected patient during delivery EXCEPT:

a. During labor and delivery, the patient should wear a mask
b. The patient should be placed on Droplet Precautions
c. After the infant is born, the mother should wear a surgical mask and then practice hand hygiene before handling the baby
d. All persons who come within 3 feet of the mother should wear a surgical mask and practice hand hygiene before and after contact with the mother

Answer 45

During labor and delivery, the patient should wear a mask

APIC Influenza

Question 46

An urban community is experiencing an outbreak of Bordetella pertussis. Several employees have contacted the IP at their healthcare facility for information on the tetanus, diphtheria, and pertussis (Tdap) vaccine. They question the need for the vaccine because they received it as a child. The IP should inform them that the Advisory Committee for Immunization Practices (ACIP) recommends that:

a. All adults aged 9 and older should receive at least one does of Tdap
b. If the employee is pregnant, she should not receive the vaccine
c. All individuals must receive the vaccine every 10 years
d. Individuals who have had the disease do not need to receive the vaccine.

Answer 46

All adults aged 9 and older should receive at least one does of Tdap

CDC Recommendations for use of Tetanus Toxoid

Question 47

Antimicrobial stewardship promotes the judicious use of antimicrobials to:

a. Increase antimicrobial selective pressure
b. Ensure that the right therapy is given to the right patient with the right dose and duration
c. Support the development of new antimicrobials
d. Contain healthcare costs

Answer 47

Ensure that the right therapy is given to the right patient with the right dose and duration

APIC Antimicrobial and REsistance

Question 48

What is NOT considered a risk factor for young girls to develop a urinary tract infection?

a. Bubble baths and prolonged soaking in the bathtub
b. Direction of wiping with toilet paper (from back to front)
c. Excessive holding of urine
d. Delayed bladder emptying

Answer 48

Direction of wiping with toilet paper (from back to front)

APIC Urinary tract infection

Question 49

All of the following maternal infections would require withholding breast milk from the newborn EXCEPT:

a. Breast Milk
b. Human Immunodeficiency virus (HIV)
c. West Nile virus
d. Hepatitis C

Answer 49

Hepatitis C

APIC Perinatal Care

Question 50

While the IP performs environmental rounds in the Pharmacy, she observes a pharmacy technician using poor technique while working under the laminar airflow hood. She reviews the Pharmacy’s policy for the frequency of training on aseptic technique for employees preparing sterile solutions. Which of the following is the best recommended frequency of infection prevention and control training for unlicensed employees who prepare sterile solutions?

a. Monthly until the employee can demonstrate proficiency by return demonstration
b. Every 6 months for 1 year after the date of hire
c. Annually on employee’s anniversary date of hire with other training programs
d. Annually and whenever unacceptable technique is observed

Answer 50

Annually and whenever unacceptable technique is observed

APIC Pharmacy Services