Deck 1 Chapter 29 - Infection Prevention and Control

Question 1

The nurse and a new nurse in orientation are caring for a patient with pneumonia. Which statement by the new nurse will indicate a correct understanding of this condition?

a. “An infectious disease like pneumonia may not pose a risk to others.”
b. “We need to isolate the patient in a private negative-pressure room.”
c. “Clinical signs and symptoms are not present in pneumonia.”
d. “The patient will not be able to return home.”

Answer 1

a. “An infectious disease like pneumonia may not pose a risk to others.”

Rationale: Infections are infectious and/or communicable. Infectious diseases may not pose a risk for transmission to others, although they are serious for the patient. Pneumonia is not a communicable disease—a disease that is transmitted directly from one individual to the next, so there is no need for isolation. A private negative–air pressure room is used for tuberculosis, not pneumonia. Clinical signs and symptoms are present in pneumonia. Frequently, patients with pneumonia do return home unless there are extenuating circumstances.

Question 2

The patient and the nurse are discussing Rickettsia rickettsii—Rocky Mountain spotted fever. Which patient statement to the nurse indicates understanding regarding the mode of transmission for this disease?

a. “When camping, I will use sunscreen.”
b. “When camping, I will drink bottled water.”
c. “When camping, I will wear insect repellent.”
d. “When camping, I will wash my hands with hand gel.”

Answer 2

c. “When camping, I will wear insect repellent.”

Rationale: Rocky Mountain spotted fever is caused by bacteria transmitted by the bite of ticks. Wearing a repellent that is designed for repelling ticks, mosquitoes, and other insects can help in preventing transmission of this disease. Drinking plenty of uncontaminated water, wearing sunscreen, and using alcohol-based hand gels for cleaning hands are all important activities to participate in while camping, but they do not contribute to or prevent transmission of this disease.

Question 3

The nurse is providing an educational session for a group of preschool workers. The nurse reminds the group about the most important thing to do to prevent the spread of infection. Which information did the nurse share with the preschool workers?

a. Encourage preschool children to eat a nutritious diet.
b. Suggest that parents provide a multivitamin to the children.
c. Clean the toys every afternoon before putting them away.
d. Wash their hands between each interaction with children.

Answer 3

d. Wash their hands between each interaction with children.

Rationale: The single most important thing that individuals can do to prevent the spread of infection is to wash their hands before and after eating, going to the bathroom, changing a diaper, and wiping a nose and between touching each individual child. It is important for preschool children to have a nutritious diet; a healthy individual can fight infection more effectively. A health care provider, along with the parent, makes decisions about dietary supplements. Cleaning the toys can decrease the number of pathogens but is not the most important thing to do in this scenario.

Question 4

The nurse is admitting a patient with an infectious disease process. Which question will be most appropriate for a nurse to ask about the patient’s susceptibility to this infectious process?

a. “Do you have a spouse?”
b. “Do you have a chronic disease?”
c. “Do you have any children living in the home?”
d. “Do you have any religious beliefs that will influence your care?”

Answer 4

b. “Do you have a chronic disease?”

Rationale: Multiple factors influence a patient’s susceptibility to infection. Patients with chronic diseases such as diabetes mellitus and multiple sclerosis are also more susceptible to infection because of general debilitation and nutritional impairment. Other factors include age, nutritional status, trauma, and smoking. The other questions are part of an admission assessment process but are not pertinent to the infectious disease process.

Question 5

The patient experienced a surgical procedure, and Betadine was utilized as the surgical prep. Two days postoperatively, the nurse’s assessment indicates that the incision is red and has a small amount of purulent drainage. The patient reports tenderness at the incision site. The patient’s temperature is 100.5° F, and the WBC is 10,500/mm3. Which action should the nurse take first?

a. Plan to change the surgical dressing during the shift.
b. Utilize SBAR to notify the primary health care provider.
c. Reevaluate the temperature and white blood cell count in 4 hours.
d. Check to see what solution was used for skin preparation in surgery.

Answer 5

b. Utilize SBAR to notify the primary health care provider.

Rationale: The nursing assessment indicates signs and symptoms of infection, requiring the primary health care provider to be notified of the patient’s needs. SBAR—Situation, Background, Assessment, and Recommendation—can be utilized to organize thoughts and data and to provide a thorough explanation of the patient’s current status. The reevaluation of temperature is a good choice, but it will take longer than 4 hours to make a change in the white blood cells. Changing the dressing may be a need during the shift but is not a first priority. Checking to see about the skin preparation used 2 days ago may or may not be useful information at this time.

Question 6

The nurse is providing an education session to an adult community group about the effects of smoking on infection. Which information is most important for the nurse to include in the educational session?

a. Smoke from tobacco products clings to your clothing and hair.
b. Smoking affects the cilia lining the upper airways in the lungs.
c. Smoking can affect the color of the patient’s fingernails.
d. Smoking tobacco products can be very expensive.

Answer 6

b. Smoking affects the cilia lining the upper airways in the lungs.

Rationale: A normal defense mechanism against infection in the respiratory tract is the cilia lining the upper airways of the lungs and normal mucus. When a patient inhales a microbe, the cilia and mucus trap the microbe and sweep them up and out to be expectorated or swallowed. Smoking may alter this defense mechanism and increase the patient’s potential for infection. Smoking can be expensive, the smell does cling to hair and clothing, and the tar within the smoke can alter the color of a patient’s nails. This information can be included in the education but does not constitute the most important point.

Question 7

A female adult patient presents to the clinic with reports of a white discharge and itching in the vaginal area. A nurse is taking a health history. Which question is the priority?

a. “When was the last time you visited your primary health care provider?”
b. “Has this condition affected your eating habits in any way?”
c. “What medications are you currently taking?”
d. “Are you able to sleep at night?”

Answer 7

c. “What medications are you currently taking?”

Rationale: Antibiotics and oral contraceptives can disrupt normal flora in the vagina, causing an overgrowth of Candida albicans in that area. It is important to ask the patient about current medications to obtain information that may assist with diagnosis. The body contains normal flora (microorganisms) that live on the surface of skin, saliva, oral mucosa, gastrointestinal tract, and genitourinary tract. The normal flora of the vagina causes vaginal secretions to achieve a low pH, inhibiting the growth of many microorganisms. Visiting the primary health care provider is important for the patient’s health maintenance but is not the priority. Learning about the patient’s eating and sleeping habits will assist in the plan of care but is not the priority.

Question 8

The nurse is caring for a school-aged child who has injured the right leg after a bicycle accident. Which signs and symptoms will the nurse assess for to determine if the child is experiencing a localized inflammatory response?

a. Malaise, anorexia, enlarged lymph nodes, and increased white blood cells
b. Chest pain, shortness of breath, and nausea and vomiting
c. Dizziness and disorientation to time, date, and place
d. Edema, redness, tenderness, and loss of function

Answer 8

d. Edema, redness, tenderness, and loss of function

Rationale: The body’s cellular response to an injury is seen as inflammation. Signs of localized inflammation include swelling, redness, heat, pain or tenderness, and loss of function in the affected body part. Systemic signs of inflammation include fever, malaise, and anorexia, as well as enlarged lymph nodes and increased white blood cells. Chest pain, shortness of breath, and nausea and vomiting are signs and symptoms of a cardiac alteration. Dizziness and disorientation to time, date, and place may indicate a neurologic alteration.

Question 9

Which interventions utilized by the nurse will indicate the ability to recognize a localized inflammatory response?

a. Vigorous range-of-motion exercises
b. Turn, cough, and deep breathe
c. Orient to date, time, and place
d. Rest, ice, and elevation

Answer 9

d. Rest, ice, and elevation

Rationale: Signs of localized inflammation include swelling, redness, heat, pain or tenderness, and loss of function in the affected body part. One sign of the inflammatory response, particularly after an injury, is swelling or edema. Resting the affected injured area, using ice as ordered, wrapping the area to provide support—particularly if it is an extremity—and elevating the injured area will help to decrease swelling or edema. Turning, coughing, and deep breathing are utilized for postoperative patients and for immobilized patients to help prevent an infectious process such as pneumonia. Orientation to date, time, and place is an intervention utilized with many different types of patients who may be confused. Vigorous range of motion would irritate the inflammatory process. Range of motion is utilized for individuals who need to improve movement of their extremities, including immobilized patients.

Question 10

The nurse is caring for a group of medical-surgical patients. Which patient is most at risk for developing an infection?

a. A patient who is in observation for chest pain
b. A patient who has been admitted with dehydration
c. A patient who is recovering from a right total hip surgery
d. A patient who has been admitted for stabilization of heart problems

Answer 10

c. A patient who is recovering from a right total hip surgery

Rationale: The patient who is recovering from a right total hip surgery has a large incision from the surgery. This break in the skin increases the likelihood of infection. Any break in the integrity of the skin and mucous membranes allows pathogens to enter and exit the body. The patient has had anesthesia, which depresses the respiratory system and has the potential to decrease the expansion of alveoli and to increase the chance of infection in the respiratory system. A patient who is having chest pain, experiencing dehydration, or being admitted with heart problems does not have open incisions that break the skin; therefore, his or her infection risk is lower.

Question 11

The nurse is caring for a patient with leukemia and is preparing to provide fluids through a vascular access (IV) device. Which nursing intervention is a priority in this procedure?

a. Review the procedure with the patient.
b. Position the patient comfortably.
c. Maintain surgical aseptic technique.
d. Gather available supplies.

Answer 11

c. Maintain surgical aseptic technique.

Rationale: You maintain surgical aseptic technique at the patient’s bedside (e.g., when inserting IV or urinary catheters, suctioning the tracheobronchial airway, and sterile dressing changes) because patients with disease processes of the immune system are at particular risk for infection. These diseases include leukemia, AIDS, lymphoma, and aplastic anemia. These disease processes weaken the defenses against an infectious organism. Reviewing the procedure with the patient, positioning the patient, and gathering the supplies are all important steps in the procedure but are not the priority in the procedure since the patient already has a compromised immune response.

Question 12

The nurse is caring for an adult patient in the clinic who has been evacuated and is a victim of flooding. The nurse teaches the patient about rest, exercise, and eating properly and how to utilize deep breathing and visualization. What is the primary rationale for the nurse’s actions related to the teaching?

a. Topics taught are standard information taught during health care visits.
b. The patient requested this information to teach the extended family members.
c. Stress for long periods of time can lead to exhaustion and decreased resistance to infection.
d. These techniques will help the patient manage the pain and loss of personal belongings.

Answer 12

c. Stress for long periods of time can lead to exhaustion and decreased resistance to infection.

Rationale: The body responds to emotional or physical stress by the general adaptation syndrome. If stress extends for long periods of time, this can lead to exhaustion, whereby energy stores are depleted and the body has no defenses against invading organisms. Techniques of deep breathing and visualization may be helpful with pain, but they are not the primary reason. The teachings listed are not all standard interventions taught at every health care visit. There is no data to indicate the patient requested this information for the family.

Question 13

The nurse is caring for a patient who is susceptible to infection. Which instruction will the nurse include in an educational session to decrease the risk of infection?

a. Teaching the patient about fall prevention
b. Teaching the patient to take a temperature
c. Teaching the patient to select nutritious foods
d. Teaching the patient about the effects of alcohol

Answer 13

c. Teaching the patient to select nutritious foods

Rationale: A patient’s nutritional health directly influences susceptibility to infection. A reduction in the intake of protein and other nutrients such as carbohydrates and fats reduces body defenses against infection and impairs wound healing. This is the only teaching point that directly influences risk. Teaching the patient how to take a temperature can help the patient assess if there is a fever, but it is not related to decreasing the individual’s risk for infection. Teaching the patient about fall prevention or about the effects of alcohol does not decrease the risk of infection.

Question 14

A diabetic patient presents to the clinic for a dressing change. The wound is located on the right foot and has purulent yellow drainage. Which action will the nurse take to prevent the spread of infection?

a. Position the patient comfortably on the stretcher.
b. Explain the procedure for dressing change to the patient.
c. Review the medication list that the patient brought from home.
d. Don gloves and other appropriate personal protective equipment.

Answer 14

d. Don gloves and other appropriate personal protective equipment.

Rationale: Localized infections are most common in the skin or with mucous membrane breakdown. Wear gloves and other personal protective equipment as appropriate when examining or providing treatment to localized infected areas to create a protective barrier. Positioning the patient, explaining the procedure, and reviewing the medication list are all tasks that need to be completed, but they do not prevent the spread of infection.

Question 15

A patient presents with pneumonia. Which priority intervention should be included in the plan of care for this patient?

a. Observe the patient for decreased activity tolerance.
b. Assume the patient is in pain and treat accordingly.
c. Provide the patient ice chips as requested.
d. Maintain the room temperature at 65° F.

Answer 15

a. Observe the patient for decreased activity tolerance.

Rationale: Systemic infection, like pneumonia, causes more generalized symptoms than local infection. This type of infection can result in fever, fatigue, nausea and vomiting, and malaise; be alert for changes in the patient’s level of activity and responsiveness. Nurses do not assume but assess and communicate with the patient about pain. While providing the patient with ice chips may be appropriate, it is not a priority and there is no reason for the patient to be limited to ice. Maintaining the room temperature at 65° F is too cold.

Question 16

The nurse is caring for a patient in an intensive care unit who needs a bath. Which priority action will the nurse take to decrease the potential for a health care–associated infection?

a. Use local anesthetic on reddened areas.
b. Use nonallergenic tape on dressings.
c. Use a chlorhexidine wash.
d. Use filtered water.

Answer 16

c. Use a chlorhexidine wash.

Rationale: The Centers for Disease Control and Prevention (CDC) recommends the use of chlorhexidine (CHG) bathing for patients in intensive care units, patients who are scheduled for surgery, and all patients with invasive central line catheters as part of MRSA reduction efforts. Using local anesthetics, nonallergenic tape, and filtered water does not affect the cause of a health care–associated infection by, for example, decreasing microbial counts like a CHG bath.

Question 17

The infection control nurse is reviewing data for the medical-surgical unit. The nurse notices an increase in postoperative infections from Aspergillus. Which type of health care–associated infection will the nurse report?

a. Vector
b. Exogenous
c. Endogenous
d. Suprainfection

Answer 17

b. Exogenous

Rationale: An exogenous infection comes from microorganisms found outside the individual such as Salmonella, Clostridium tetani, and Aspergillus. They do not exist as normal floras. A vector transmits microorganisms and is usually a type of insect or organism. Endogenous infection occurs when part of the patient’s flora becomes altered and an overgrowth results (e.g., staphylococci, enterococci, yeasts, and streptococci). This often happens when a patient receives broad-spectrum antibiotics that alter the normal floras. A suprainfection develops when broad-spectrum antibiotics eliminate a wide range of normal flora organisms, not just those causing infection.

Question 18

The patient has contracted a urinary tract infection (UTI) while in the hospital. Which action will most likely increase the risk of a patient contracting a UTI?

a. Reusing the patient’s graduated receptacle to empty the drainage bag.
b. Allowing the drainage bag port to touch the graduated receptacle.
c. Emptying the urinary drainage bag at least once a shift.
d. Irrigating the catheter infrequently.

Answer 18

b. Allowing the drainage bag port to touch the graduated receptacle.

Rationale: Allowing the urinary drainage bag port to touch contaminated items (graduated receptacle) may introduce bacteria into the urinary system and contribute to a urinary tract infection. The urinary drainage bag should be emptied at least once a shift. Patients should have their own receptacle for measurement to prevent cross-contamination. Repeated catheter irrigations increase the chance so irrigating infrequently will be beneficial in reducing the risk.

Question 19

Which nursing action will most likely increase a patient’s risk for developing a health care–associated infection?

a. Uses surgical aseptic technique to suction an airway
b. Uses a clean technique for inserting a urinary catheter
c. Uses a cleaning stroke from the urinary meatus toward the rectum
d. Uses a sterile bottled solution more than once within a 24-hour period

Answer 19

b. Uses a clean technique for inserting a urinary catheter

Rationale: Using clean technique (medical asepsis) to insert a urinary catheter would place the patient at risk for a health care–associated infection. Urinary catheters need to be inserted using sterile technique, which is also referred to as surgical asepsis. Surgical aseptic technique (also called sterile technique) should be used when suctioning an airway because it is considered a sterile body cavity. Washing from clean to dirty (urinary meatus toward rectum) is correct for decreasing infection risk. Bottled solutions may be used repeatedly during a 24-hour period; however, special care is needed to ensure that the solution in the bottle remains sterile. After 24 hours, the solution should be discarded.

Question 20

The nurse is caring for a patient in labor and delivery. When near completing an assessment of the patient’s cervix, the electronic infusion device being used on the intravenous (IV) infusion alarms. Which sequence of actions is most appropriate for the nurse to take?

a. Complete the assessment, remove gloves, and silence the alarm.
b. Discontinue the assessment, silence the alarm, and assess the intravenous site.
c. Complete the assessment, remove gloves, wash hands, and assess the intravenous infusion.
d. Discontinue the assessment, remove gloves, use hand gel, and assess the intravenous infusion.

Answer 20

c. Complete the assessment, remove gloves, wash hands, and assess the intravenous infusion.

Rationale: Completing the assessment while wearing gloves, removing gloves, washing hands after contact with body fluids, and then assessing the intravenous infusion will assist in the prevention and transfer of any potential organisms to this intravenous line. Completing the assessment, removing gloves, and silencing the alarm leaves out the crucial step of decontaminating and washing the hands. Discontinuing the assessment and assessing the IV leaves out removing the gloves and decontamination, as well as completing the assessment for the patient. Discontinuing the assessment, removing gloves, using hand gel, and assessing the IV is incorrect because upon exposure to body fluids, washing hands is appropriate.

Question 21

The nurse is dressed and is preparing to care for a patient in the perioperative area. The nurse has scrubbed hands and has donned a sterile gown and gloves. Which action will indicate a break in sterile technique?

a. Touching clean protective eyewear
b. Standing with hands above waist area
c. Accepting sterile supplies from the surgeon
d. Staying with the sterile table once it is open

Answer 21

a. Touching clean protective eyewear

Rationale: Touching nonsterile (clean) protective eyewear once gowned and gloved with sterile gown and gloves would indicate a break in sterile technique. Sterile objects remain sterile only when touched by another sterile object. Standing with hands folded on the chest is common practice and prevents arms and hands from touching unsterile objects. Accepting sterile supplies from the surgeon who has opened them with the appropriate technique is acceptable. Staying with a sterile table once opened is a common practice to ascertain that no one or nothing has contaminated the table.

Question 22

The nurse is caring for a patient with an incision. Which actions will best indicate an understanding of medical and surgical asepsis for a sterile dressing change?

a. Donning clean goggles, gown, and gloves to dress the wound
b. Donning sterile gown and gloves to remove the wound dressing
c. Utilizing clean gloves to remove the dressing and sterile supplies for the new dressing
d. Utilizing clean gloves to remove the dressing and clean supplies for the new dressing

Answer 22

c. Utilizing clean gloves to remove the dressing and sterile supplies for the new dressing

Rationale: Utilize clean gloves (medical asepsis) to remove contaminated dressings and sterile supplies, including gloves and dressings (surgical asepsis–sterile technique) to reapply sterile dressings. Wearing sterile gowns and gloves is not necessary when removing soiled dressings. Donning clean gloves to dress a sterile wound would contaminate the sterile supplies. Utilizing clean supplies for a sterile dressing would not help in decreasing the number of microbes at the incision site.

Question 23

The nurse is caring for a patient in the endoscopy area. The nurse observes the technician performing these tasks. Which observation will require the nurse to intervene?

a. Washing hands after removing gloves
b. Disinfecting endoscopes in the workroom
c. Removing gloves to transfer the endoscope
d. Placing the endoscope in a container for transfer

Answer 23

c. Removing gloves to transfer the endoscope

Rationale: Standard precautions are used to prevent and control the spread of infection. Transferring contaminated equipment without the protection of gloves can assist in the spread of microbes to inanimate objects and to the person doing the transfer; therefore, the nurse must intervene. Utilizing gloves, washing hands, covering contaminated supplies during transfer, and disinfecting equipment in the appropriate way in the appropriate places utilize principles of basic medical asepsis and standard precautions and can break the chain of infection.

Question 24

The nurse is caring for a patient who is at risk for infection. Which action by the nurse indicates correct understanding about standard precautions?

a. Teaches the patient about good nutrition
b. Dons gloves when wearing artificial nails
c. Disposes an uncapped needle in the designated container
d. Wears eyewear when emptying the urinary drainage bag

Answer 24

d. Wears eyewear when emptying the urinary drainage bag

Rationale: Standard precautions include the wearing of eyewear whenever there is a possibility of a splash or splatter, like when emptying the urinary drainage bag. Teaching the patient about good nutrition is positive but does not apply to standard precautions. Standard precautions apply to contact with blood, body fluid (except sweat), nonintact skin, and mucous membranes from all patients. Artificial nails are not worn when using standard precautions. Any needles should be disposed of uncapped, or a mechanical safety device is activated for recapping.

Question 25

The nurse is caring for a patient who has just delivered a neonate. The nurse is checking the patient for excessive vaginal drainage. Which precaution will the nurse use?

a. Contact
b. Droplet
c. Standard
d. Protective environment

Answer 25

c. Standard

Rationale: Standard precautions apply to contact with blood, body fluid, nonintact skin, and mucous membranes of all patients. Contact precautions apply to individuals with infections that can be transmitted by direct or indirect contact. Protective environment precautions apply to individuals who have undergone transplantations and gene therapy. Droplet precautions focus on diseases that are transmitted by large droplets.

Question 26

The nurse is caring for a patient in the hospital. The nurse observes the nursing assistive personnel (NAP) turning off the handle faucet with bare hands. Which professional practice principle supports the need for follow-up with the NAP?

a. The nurse is responsible for providing a safe environment for the patient.
b. Different scopes of practice allow modification of procedures.
c. Allowing the water to run is a waste of resources and money.
d. This is a key step in the procedure for washing hands.

Answer 26

a. The nurse is responsible for providing a safe environment for the patient.

Rationale: The nurse is responsible for providing a safe environment for the patient. The effectiveness of infection control practices depends on conscientiousness and consistency in using effective aseptic technique by all health care providers. After washing hands, turn off a handle faucet with a dry paper towel, and avoid touching the handles with your hands to assist in preventing the transfer of microorganisms. Wet towels and hands allow the transfer of pathogens from faucet to hands. The principles and procedures for washing hands are universal and apply to all members of health care teams. Being resourceful and aware of the cost of health care is important, but taking shortcuts that may endanger an individual’s health is not a prudent practice.

Question 27

The nurse is caring for a patient who becomes nauseated and vomits without warning. The nurse has contaminated hands. Which action is best for the nurse to take next?

a. Wash hands with an antimicrobial soap and water.
b. Clean hands with wipes from the bedside table.
c. Use an alcohol-based waterless hand gel.
d. Wipe hands with a dry paper towel.

Answer 27

a. Wash hands with an antimicrobial soap and water.

Rationale: The Centers for Disease Control and Prevention (CDC) recommends that when hands are visibly soiled, one should wash with a non-antimicrobial soap or with antimicrobial soap. Cleaning hands with wipes or using waterless hand gel does not meet this standard. If hands are not visibly soiled, use an alcohol-based waterless antiseptic agent for routinely decontaminating hands. Wiping hands with a dry paper towel will occur after the nurse has washed both hands.

Question 28

The nurse is performing hand hygiene before assisting a health care provider with insertion of a chest tube. While washing hands, the nurse touches the sink. Which action will the nurse take next?

a. Inform the health care provider and recruit another nurse to assist.
b. Rinse and dry hands, and begin assisting the health care provider.
c. Extend the handwashing procedure to 5 minutes.
d. Repeat handwashing using antiseptic soap.

Answer 28

d. Repeat handwashing using antiseptic soap.

Rationale: The inside of the sink and the edges of the sink, faucet, and handles are considered contaminated areas. If the hands touch any of these areas during handwashing, repeat the handwashing procedure utilizing antiseptic soap. There is no need to inform the health care provider or be relieved of this assignment. If the hands are contaminated when touching the sink, drying hands and proceeding with the procedure could possibly contaminate and contribute to increased microbial counts during the procedure, resulting in infection for the patient. Extending the time for washing the hands (although this is what will happen when the procedure is repeated) is not the focus. The focus is to repeat the whole hand hygiene procedure utilizing antiseptic soap.

Question 29

The nurse on the surgical team and the surgeon have completed a surgery. After donning gloves, gathering instruments, and placing in the transport carrier, what is the next step in handling the instruments used during the procedure?

a. Sending to central sterile for cleaning and sterilization
b. Sending to central sterile for cleaning and disinfection
c. Sending to central sterile for cleaning and boiling
d. Sending to central sterile for cleaning

Answer 29

a. Sending to central sterile for cleaning and sterilization

Rationale: Surgical instruments need to be cleaned and sterilized. Disinfecting, boiling, or cleaning is not utilized on critical items that will be reused on patients in the hospital environment. Items that are used on sterile tissue or in the vascular system present a high risk of infection if they become contaminated with bacteria.

Question 30

The nurse is observing a family member changing a dressing for a patient in the home health environment. Which observation indicates the family member has a correct understanding of how to manage contaminated dressings?

a. The family member places the used dressings in a plastic bag.
b. The family member saves part of the dressing because it is clean.
c. The family member removes gloves and gathers items for disposal.
d. The family member wraps the used dressing in toilet tissue before placing in trash.

Answer 30

a. The family member places the used dressings in a plastic bag.

Rationale: Contaminated dressings and other infectious, disposable items should be placed in impervious plastic or brown paper bags and then disposed of properly in garbage containers. Gloves should be worn during this process. Parts of the dressing should not be saved, even though they may seem clean, because microbes may be present.

Question 31

The nurse is caring for a group of patients. Which patient will the nurse see first?

a. A patient with Clostridium difficile in droplet precautions
b. A patient with tuberculosis in airborne precautions
c. A patient with MRSA infection in contact precautions
d. A patient with a lung transplant in protective environment precautions

Answer 31

a. A patient with Clostridium difficile in droplet precautions

Rationale: A patient with Clostridium difficile should be on contact precautions, not droplet; therefore, the nurse will see this patient first to correct the precautions. All the rest are on correct precautions. Patients with tuberculosis belong in airborne precautions; patients with MRSA infection belong in contact precautions; and patients with lung transplants belong in protective environment precautions.

Question 32

The home health nurse is teaching a patient and family about hand hygiene in the home. Which situation will cause the nurse to emphasize washing hands before and after?

a. Shaking hands
b. Performing treatments
c. Opening the refrigerator
d. Working on a computer

Answer 32

b. Performing treatments

Rationale: Patients and family members should perform hand hygiene before and after treatments and when coming in contact with body fluids. Shaking hands does not require washing of hands before and after. Washing hands before and after opening the refrigerator and using the computer is not required.

Question 33

The surgical mask the perioperative nurse is wearing becomes moist. Which action will the perioperative nurse take next?

a. Apply a new mask.
b. Reapply the mask after it air-dries.
c. Change the mask when relieved by next shift.
d. Do not change the mask if the nurse is comfortable.

Answer 33

a. Apply a new mask.

Rationale: After the mask is worn for several hours, it can become moist. The mask should be changed as soon as possible because moisture does not provide a barrier to microorganisms and is ineffective. Waiting to change the mask, air-drying it, or wearing it because it is comfortable does not support the principles of infection control.

Question 34

The nurse is caring for a patient on contact precautions. Which action will be most appropriate to prevent the spread of disease?

a. Place the patient in a room with negative airflow.
b. Wear a gown, gloves, face mask, and goggles for interactions with the patient.
c. Transport the patient safely and quickly when going to the radiology department.
d. Use a dedicated blood pressure cuff that stays in the room and is used for that patient only.

Answer 34

d. Use a dedicated blood pressure cuff that stays in the room and is used for that patient only.

Rationale: Contact precautions are a type of isolation precaution used for patients with illness that can be transmitted through direct or indirect contact. Patients who are on contact precautions should have dedicated equipment wherever possible. This would mean, for example, that one blood pressure cuff and one stethoscope would stay in the room with the patient and would be used for that patient only. A gown and gloves may be required for interactions with a patient who is on contact precautions. A face mask and goggles are not part of contact precautions. A room with negative airflow is needed for patients placed on airborne precautions; it is not necessary for a patient on contact precautions. When a patient on contact precautions needs to be transported, the patient should wear clean gown, and hands cleaned, and the infectious material is contained or covered.

Question 35

The nurse is caring for a patient who has cultured positive for Clostridium difficile. Which action will the nurse take next?

a. Instruct assistive personnel to use soap and water rather than sanitizer.
b. Wear an N95 respirator when entering the patient room.
c. Place the patient on droplet precautions.
d. Teach the patient cough etiquette.

Answer 35

a. Instruct assistive personnel to use soap and water rather than sanitizer.

Rationale: Clostridium difficile is a spore-forming organism that can be transmitted through direct and indirect patient contact. Because Clostridium difficile is a spore-forming organism, hand sanitizer is not effective in preventing its transmission. Hands must be washed with soap and water to prevent transmission. This organism is not transmitted via the droplet route; therefore, droplet precautions are not needed. An N95 respirator is used primarily for patients with airborne illness, especially tuberculosis. While all patients should be taught cough etiquette, this action is not specifically related to the patient having Clostridium difficile.

Question 36

The nurse is changing linens for a postoperative patient and feels a prick in the left hand. A nonactivated safe needle is noted in the linens. For which condition is the nurse most at risk?

a. Diphtheria
b. Hepatitis B
c. Clostridium difficile
d. Methicillin-resistant Staphylococcus aureus

Answer 36

b. Hepatitis B

Rationale: Bloodborne pathogens such as those associated with hepatitis B and C are most commonly transmitted by contaminated needles. Clostridium difficile and MRSA are spread by contact. Diphtheria is spread by droplets when one is within 3 feet of the patient.

Question 37

The nurse is caring for a patient who has a bloodborne pathogen. The nurse splashes blood above the glove to intact skin while discontinuing an intravenous (IV) infusion. Which step(s) will the nurse take next?

a. Obtain an alcohol swab, remove the blood with an alcohol swab, and continue care.
b. Immediately wash the site with soap and running water, and seek guidance from the manager.
c. Do nothing; accidentally getting splashed with blood happens frequently and is part of the job.
d. Delay washing of the site until the nurse is finished providing care to the patient.

Answer 37

b. Immediately wash the site with soap and running water, and seek guidance from the manager.

Rationale: After getting splashed with blood from a patient who has a known bloodborne pathogen, it is important to cleanse the site immediately and thoroughly with soap and running water and notify the manager for guidance on next steps in the process. Removing the blood with an alcohol swab, delaying washing, and doing nothing because the splash was to intact skin could possibly spread the blood within the room and could spread the infection. Contain contamination immediately to prevent contact spread.

Question 38

Which process will be required after exposure of a nurse to blood by a cut from a used scalpel in the operative area?

a. Placing the scalpel in a needle safe container
b. Testing the patient and offering treatment to the nurse
c. Removing sterile gloves and disposing of in kick bucket
d. Providing a medical evaluation of the nurse to the manager

Answer 38

b. Testing the patient and offering treatment to the nurse

Rationale: Follow-up for risk of infection begins with patient testing. Patients should be tested for HIV and hepatitis B and C. Testing of the nurse is dependent on the results of patient testing; if the patient is positive for one of these infections, the nurse will be started on testing and treatment. Removing sterile gloves and placing sharps in appropriate containers are always part of the perioperative process and are not the process for postexposure. A confidential medical evaluation is provided to the nurse, not the manager.

Question 39

The nurse is caring for a patient who needs a protective environment. The nurse has provided the care needed and is now leaving the room. In which order will the nurse remove the personal protective equipment, beginning with the first step?

1. Remove eyewear/face shield and goggles.
2. Perform hand hygiene, leave room, and close door.
3. Remove gloves.
4. Untie gown, allow gown to fall from shoulders, and do not touch outside of gown; dispose of properly.
5. Remove mask by strings; do not touch outside of mask.
6. Dispose of all contaminated supplies and equipment in designated receptacles.

a. 3, 1, 4, 5, 6, 2
b. 1, 4, 5, 3, 6, 2
c. 1, 4, 5, 3, 2, 6
d. 3, 1, 4, 5, 2, 6

Answer 39

d. 3, 1, 4, 5, 2, 6

Rationale: The correct order for removing personal protective equipment for a patient in a protective environment and for performing associated tasks is to remove gloves, remove eyewear, remove gown, remove mask, perform hand hygiene, leave room and close doors, and dispose of all contaminated supplies and equipment in a manner that prevents the spread of microorganisms.

Question 40

The nurse manager is evaluating current infection control data for the intensive care unit. The nurse compares past patient data with current data to look for trends. The nurse manager examines the infection chain for possible solutions. In which order will the nurse arrange the items for the infection chain beginning with the first step?

1. A mode of transmission
2. An infectious agent or pathogen
3. A susceptible host
4. A reservoir or source for pathogen growth
5. A portal of entry to a host
6. A portal of exit from the reservoir

a. 3, 2, 4, 1, 5, 6
b. 1, 3, 5, 4, 6, 2
c. 4, 2, 1, 6, 3, 5
d. 2, 4, 6, 1, 5, 3

Answer 40

d. 2, 4, 6, 1, 5, 3

Rationale: For spread of infection, the chain has to be uninterrupted with an infectious agent, a reservoir and portal of exit, a mode of transmission, a portal of entry, and a susceptible host. The nurse manager is evaluating the chain of infection to determine actions that could be implemented to influence the spread of infection in the intensive care unit. Understanding the spread of infection and directing actions toward those steps have the potential to decrease infection in the setting.

Question 41

1. The nurse is caring for a patient in protective environment. Which actions will the nurse take? (Select all that apply.)

a. Wear an N95 respirator when entering the patient’s room.
b. Maintain airflow rate greater than 12 air exchanges/hr.
c. Place in special room with negative-pressure airflow.
d. Open drapes during the daytime.
e. Listen to the patient’s interests.
f. Place dried flowers in a plastic vase.

Answer 41

b. Maintain airflow rate greater than 12 air exchanges/hr.
d. Open drapes during the daytime.
e. Listen to the patient’s interests.

Rationale: This form of isolation requires a specialized room with positive airflow. The airflow rate is set at greater than 12 air exchanges/hr, and all air is filtered through a HEPA filter. Isolation disrupts normal social relationships with visitors and caregivers. Take the opportunity to listen to a patient’s concerns or interests. Open drapes or shades and remove excess supplies and equipment. Patients are not allowed to have dried or fresh flowers or potted plants in these rooms. All health care personnel wear an N95 respirator every time they enter the room for patients, and a private room with negative airflow is required for patients on airborne precautions.

Question 42

The nurse is assessing a new patient admitted to home health. Which questions will be most appropriate for the nurse to ask to determine the risk of infection? (Select all that apply.)

a. “Can you explain the risk for infection in your home?”
b. “Have you traveled outside of the United States?”
c. “Will you demonstrate how to wash your hands?”
d. “What are the signs and symptoms of infection?”
e. “Are you able to walk to the mailbox?”
f. “Who runs errands for you?”

Answer 42

a. “Can you explain the risk for infection in your home?”
b. “Have you traveled outside of the United States?”
c. “Will you demonstrate how to wash your hands?”
d. “What are the signs and symptoms of infection?”

Rationale: In the home setting, the objective is that the patient and/or family will utilize proper infection control techniques. Asking the patient and family about handwashing, risk of infection, recent travel, and signs and symptoms of infection is important in evaluating the patient’s knowledge based on infection control strategies. Activity assessment is important for evaluation of the overall status of the patient, and knowing who runs errands gives you information on who is helping to meet the needs of the patient, but neither of these relates to decreasing the risk of infection.

Question 43

The circulating nurse in the operating room is observing the surgical technologist while applying a sterile gown and gloves to care for a patient having an appendectomy. Which behaviors indicate to the nurse that the procedure by the surgical technologist is correct? (Select all that apply.)

a. Ties the back of own gown
b. Touches only the inside of gown
c. Slips arms into arm holes simultaneously
d. Extended fingers fully into both of the gloves
e. Uses hands covered by sleeves to open gloves
f. Applies surgical cap and face mask in the operating suite

Answer 43

b. Touches only the inside of gown
c. Slips arms into arm holes simultaneously
d. Extended fingers fully into both of the gloves
e. Uses hands covered by sleeves to open gloves

Rationale: To maintain sterility, the surgical technologist (ST) touches the inside of the gown that will be against the body. Arms are slipped simultaneously into the gown to prevent contamination. Using the sleeves covering the hands maintains the principle of sterile only touching sterile to open gloves. Extending the fingers fully into both gloves ensures that the ST has full dexterity while using the sterile gloved hand. Surgical cap, face mask, and eye wear are applied before entering the surgical area and completing the surgical scrub. Reaching behind to tie the back of the gown will contaminate the sterile area of the gown.

Question 44

The nurse is preparing to insert a urinary catheter. The nurse is using open gloving to apply the sterile gloves. Which steps will the nurse take? (Select all that apply.)

a. While putting on the first glove, touch only the outside surface of the glove.
b. With gloved dominant hand, slip fingers underneath second glove cuff.
c. Remove outer glove package by tearing the package open.
d. Lay glove package on clean flat surface above waistline.
e. Glove the dominant hand of the nurse first.
f. After second glove is on, interlock hands.

Answer 44

b. With gloved dominant hand, slip fingers underneath second glove cuff.
d. Lay glove package on clean flat surface above waistline.
e. Glove the dominant hand of the nurse first.
f. After second glove is on, interlock hands.

Rationale: Sterile objects held below the waist are considered contaminated. Gloving the dominant hand helps to improve dexterity. Slipping the fingers underneath the second glove cuff helps to keep the gloved fingers sterile. Interlocking fingers ensures a smooth fit over the fingers. Sterile supplies are opened by carefully separating and peeling apart the sides of the package. This prevents the sterile contents from accidentally opening and touching contaminated objects. While putting on the first glove, touching only the outside surface of the glove will contaminate the sterile item; touch only the inside of the glove—the piece that will be against the skin.

Question 45

The nurse has received a report from the emergency department that a patient with tuberculosis will be coming to the unit. Which items will the nurse need to care for this patient? (Select all that apply.)

a. Private room
b. Negative-pressure airflow in room
c. Surgical mask, gown, gloves, eyewear
d. N95 respirator, gown, gloves, eyewear
e. Communication signs for droplet precautions
f. Communication signs for airborne precautions

Answer 45

a. Private room
b. Negative-pressure airflow in room
d. N95 respirator, gown, gloves, eyewear
f. Communication signs for airborne precautions

Rationale: Caring for this patient requires a private room, negative-pressure airflow in room, and wearing an N95 respirator that has been fit-tested, gloves, gown, and eyewear. Tuberculosis is a disease that is transmitted by droplets that remain in the air for long periods of time, requiring airborne precautions. This patient will not be in droplet precautions and instead requires airborne precaution signs. This type of patient requires more than the average surgical mask for protection.

Question 46

The nurse and the student nurse are caring for two different patients on the medical-surgical unit. One patient is in airborne precautions, and one is in contact precautions. The nurse explains to the student different interventions for care. Which information will the nurse include in the teaching session? (Select all that apply.)

a. Dispose of supplies to prevent the spread of microorganisms.
b. Wash hands before entering and leaving both of the patients’ rooms.
c. Be consistent in nursing interventions since there is only one difference in the precautions.
d. Apply the knowledge the nurse has of the disease process to prevent the spread of microorganisms.
e. Have patients in airborne precautions wear a mask during transportation to other departments.
f. Check the working order of the negative-pressure room for the airborne precaution patient on admission and at discharge.

Answer 46

a. Dispose of supplies to prevent the spread of microorganisms.
b. Wash hands before entering and leaving both of the patients’ rooms.
d. Apply the knowledge the nurse has of the disease process to prevent the spread of microorganisms.
e. Have patients in airborne precautions wear a mask during transportation to other departments.

Rationale: Washing hands, properly disposing of supplies, applying knowledge of the disease process, and having patients in airborne precautions wear a mask during transfer are all principles to follow when caring for patients in isolation. Multiple differences are evident among these types of isolation, including the type of room used for the patient and what the nurse wears while caring for the patient. It is important to check the working order of a negative-pressure room before admitting a patient to the room, each shift the patient is in the room, and if and when the device alarms. Checking the working order of the negative-pressure rooms at discharge is not necessary.