Asepsis and Infection Control Chapter 24 Questions And Rationales

Chapter 24: Asepsis and Infection Control 1.A nurse is caring for a client who is diagnosed with tuberculosis. Which nursing intervention promotes infection control based on nursing practice standards for safety? The nurse places the client in a private room with monitored negative air pressure. When a client is diagnosed with tuberculosis it is important for the nurse to remember that the client should be placed in a private room with monitored negative air pressure. The client should not be placed in a room with the door open. The nurse must wear the appropriate respirator when caring for the client, but visitors must wear masks. Simply being 3 feet away will not keep the visitor from being exposed to the client. The nurse would use airborne precautions, not droplet precautions when caring for a client diagnosed with tuberculosis. 2.Which term describes foreign particles that enter a host and stimulate the body's immune response? Antigen Antigens are foreign particles, such as microbes, that enter a host. 3. What is the primary goal of the observable action associated with the removal of contaminated gloves? Prevent contamination of ungloved hand The outside of gloves are considered contaminated and care must be take to prevent contamination of the ungloved hand during the glove removal process. Sliding fingers of the ungloved hand under the remaining glove at the wrist helps avoid contact with the contaminated outer surface of the remaining glove. While proper removal of the contaminated glove does preserve the cleanliness of the ungloved hand, contamination and not general cleanliness, is the primary focus of the ungloving process. Neither speed nor tearing is the focus of this process. 4. The nurse is educating a client with human immunodeficiency virus (HIV) about ways the virus can be transmitted. Which statements made by the client demonstrates the education provided was effective? Select all that apply. "If someone is exposed to my blood, I may transmit the virus to him or her." "I may transmit the virus to my child during pregnancy and childbirth." "I may transmit the virus if I share needles with another person." The client has demonstrated that an understanding of the transmission of the virus may occur through exposure to blood, during pregnancy and childbirth, and through sharing of needles. Transmission of the virus does not occur through sweat or by exposure on a toilet seat. The virus is fragile and does not live on inanimate objects. 5. A client has sexual intercourse with someone infected with HIV. The vehicle of transmission is: semen. Vehicle transmission involves the transfer of microorganisms by way of vehicles, or contaminated items that transmit pathogens. For example, food can carry Salmonella. In this case, semen can carry human immunodeficiency virus. 6. The nurse manager for a long-term facility notes an increase in infection rates among residents. Which would be the best to implement? Review the current infection control protocols. The nurse manager that notes an increase in infection rates should first review the current infection control protocols. Reviewing the protocols can identify if the protocols are appropriate and being implemented by the staff. Prescribing antibiotics to all new residents will not decrease infections rates, but may increase the rate of antibiotic resistant bacteria. Culturing all residents and staff would identify infection, but not decrease the rates. Restricting visitors would not decrease rates. 7. The nurse must assign a room for a client admitted with endocarditis and methicillin-resistant Staphylococcus aureus (MRSA) in the blood. A client with which diagnosis can share a room with this client? MRSA in the wound In many situations, clients with like infections can be placed together. The presence of similar causative microorganisms negates the risks of crosscontamination. Each of the other listed clients would encounter a risk for MRSA. 8. What is the primary purpose for the demonstrated glove application? Cover exposed wrist skin Gloves are intended to protect hands and wrists from exposure to microorganisms. This is best accomplished by extending the gloves up the arm to cover the cuffs of the gown. While the proper application of the gloves does anchor the cuffs, the primary purpose is directed at the risk management of microorganism expose to the wrists. This application has no value to adjusting for glove size or to prevent tearing of the glove. 9. Which client would require a negative flow room? an 81-year-old man with active tuberculosis and a productive cough Active tuberculosis always requires a negative flow room. 10. After educating students about changes in the immune system and risk for infection as people age, the instructor determines that the education was successful when the students identify: decreased cellular immunity. As a person ages, there is a decline in cellular and humoral immunity, decreased effectiveness of phagocytosis, and an increased susceptibility to infection. 11. The most common infection in children is: respiratory. The most common infections in early childhood are respiratory infections. 12. Upon review of a client's microbiology culture results, the nurse recognizes which organism as indicative of normal flora? Escherichia coli in the intestinal tract Escherichia coli resides in the intestinal tract, is normal flora, and does not cause harm or infection in the client. Shigellosis is an infectious disease caused by a group of bacteria called Shigella, closely related to E. coli. Most people who are infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria. 13. An experienced nurse is teaching a student nurse about the proper use of hand hygiene. Which guideline should the nurse provide to the student? Hand hygiene is needed after contact with objects near the client. Hand hygiene must be performed when moving from a contaminated body site to a clean body site during client care and after contact with inanimate objects near the client. Using gloves does not eliminate the need for hand hygiene and, in some cases, gloves must still be used after hand hygiene. Lotions may be used to prevent irritation. 14. A nurse has sustained a puncture wound on the hand from a scalpel blade that was left on a used procedure tray. What is the first action by the nurse? wash the area with soap and water The first action by the nurse should be to wash the hands gently with soap and water to reduce exposure of blood or pathogens to the wound. Filling out a risk management form is required but should be done after immediate first aid care. Finding out who left the blade on the tray is not relevant at this time, but further education for the unit may be required at a later time. Going to employee health is the step that will be taken after immediate first aid 15. A nurse is preparing an operating room theatre for a surgical procedure. Which point regarding the principles of surgical asepsis should the nurse keep in mind when preparing sterilized surgical instruments? A commercially packaged surgical item is not considered sterile if past expiration date. When preparing the operation theater for a surgical procedure, the nurse should remember that a commercially packaged surgical item is not considered sterile if it has passed its recommended expiration date. When a sterile item touches an item that is not sterile, then the sterile item is contaminated. If a sterile item touches another sterile item, it is not considered contaminated. A partially uncovered sterile package is considered contaminated. 16. When preparing a sterile field, the nurse notes that the bottle of sterile saline was opened 48 hours ago and is half full. What action does the nurse take to ensure that the saline used is sterile? Discard the bottle and get a new one because the saline has expired. Once a bottle of sterile saline is open, the contents must be used within 24 hours of opening. Lipping the opening of the bottle and pouring the saline into a sterile container by holding it 6 in (15 cm) above the container would be appropriate, but contents in the bottle are expired. The nurse should discard the bottle and get a new one. 17. A nurse is taking care of a client with tuberculosis who has developed resistance to the ordered antibiotic. Which type of client is most likely at increased risk for infection? older adult Long-term care residents and older adult hospitalized clients are at increased risk for antibiotic-resistant infections. Pneumonia, influenza, urinary tract and skin infections, and TB are common in older people, especially residents of long-term care facilities. These infectious diseases are not commonly seen in young adults, children, or pregnant women admitted to health care facilities. 18. A nurse is caring for a client with ringworm. Which microorganism causes ringworm in a client? Fungi Ringworm is caused by a fungal infection. Fungi include yeasts and molds, which cause infections in the skin, mucous membranes, hair, and nails. Rickettsiae are microorganisms that resemble bacteria but cannot survive outside of another living species. They are responsible for Lyme disease. Protozoans are single-celled animals classified according to their ability to move. They do not cause ringworm. Helminths are infectious worms that may or may not be microscopic. They include roundworms, tapeworms, and flukes. 19. A client with cancer has been receiving chemotherapy for the past few weeks. The nurse is concerned about infection and is reviewing the white blood cell count (WBC) in the chart. Which result supports this concern? WBC of 25,000 mcL Leukocytes, also called white blood cells (WBCs), and the inflammatory response make up the second line of defense to microbial invasion. A normal WBC count is 5,000 to 10,000 cells/mm3. A count above this range is indicative of infection. 20. A client with a wound infection asks the nurse, "What causes this puslike drainage in my wound?" Which response by the nurse would be most appropriate? "Your white blood cells have increased in the area." Purulence or pus in an area of infection results from the migration of white blood cells to the area of infection. Purulent drainage is usually thicker than normal and is often foul smelling because it contains a great deal of cellular debris from the inflammatory response. Pain results when inflammation causes swelling within an enclosed area or when normal function is impeded. Although purulent drainage is a sign of an infection, this does not provide the client with the information being requested. Increased metabolism leads to an increase in the rate and depth of respiration as the body attempts to rid itself of excess wastes produced due to this increased metabolism. 1. About which public health principle should the nurse educate clients to prevent the spread of West Nile virus? Avoid contact with mosquitoes Biologic vectors are living creatures that carry pathogens that transmit disease. West Nile virus is transmitted via mosquitoes, so the nurse should teach avoidance of mosquitoes to prevent the spread of West Nile virus. A hand sanitizer prevents the spread of a virus spread by contact with surfaces. Self-quarantine is not necessary to prevent the spread of West Nile virus; avoidance of mosquitos is the best way to accomplish this. Blood and body fluid precautions are used to prevent the spread of diseases spread through contact with these fluids. West Nile virus is not spread by airborne or droplet transmission so use of a face mask is not appropriate. 2. The patient has asked the nurse to explain her WBC level of 8,000 cells/mm3. The nurse would identify the level of WBCs as: within normal limits A normal white blood cell count is 5,000 to 10,000 cells/mm3. 3. The nurse is preparing to perform handwashing. Place the following steps in the correct order. Use all options.       Turn on the faucet and adjust force and temperature of the water. Wet the hand and wrists. Apply soap. Wash the palms and backs of the hands for at least 20 seconds. Pat the hands dry with a paper towel. Turn the faucet off with a paper towel. The correct steps to hand washing are as follows. Turn on the faucet and adjust force and temperature of the water. Wet the hand and wrist areas. Apply soap product. Wash the palms and back of the hands for at least 15 seconds. Pat hands dry with a paper towel. Finally, turn the faucet off with a paper towel. 4. The nurse is caring for a client with tuberculosis. The prior shift’s nurse has placed the client in droplet precautions. Which is the appropriate nursing action? change to airborne precautions Tuberculosis is transmitted via the air, so airborne precautions are required. The other answers are incorrect. 5. The nurse uses a small amount of sterile solution from a large, multiuse bottle to moisten gauze in a sterile field. What technique does the nurse use? Pour the liquid into a sterile container within the sterile field. The solution container should be held outside the edge of the sterile field and poured steadily from a height of 4 to 6 inches into a sterile container previously added to the sterile field and positioned at the side of the sterile field. This assures minimal splashing, as moisture contaminates the sterile field, and maintains sterility of the bottle and solution. 6. Which term describes foreign particles that enter a host and stimulate the body's immune response? Antigen Antigens are foreign particles, such as microbes, that enter a host. 7. What is the primary purpose for the demonstrated glove application? Cover exposed wrist skin Gloves are intended to protect hands and wrists from exposure to microorganisms. This is best accomplished by extending the gloves up the arm to cover the cuffs of the gown. While the proper application of the gloves does anchor the cuffs, the primary purpose is directed at the risk management of microorganism expose to the wrists. This application has no value to adjusting for glove size or to prevent tearing of the glove. 8. An experienced nurse is teaching a student nurse about the proper use of hand hygiene. Which guideline should the nurse provide to the student? Hand hygiene is needed after contact with objects near the client. Hand hygiene must be performed when moving from a contaminated body site to a clean body site during client care and after contact with inanimate objects near the client. Using gloves does not eliminate the need for hand hygiene and, in some cases, gloves must still be used after hand hygiene. Lotions may be used to prevent irritation. 9. The nurse is caring for an older adult with pneumonia. What action by the nurse will help the client prevent further pulmonary infections? Immunize the client with the pneumococcal vaccination once in a lifetime Pneumococcal vaccination should occur once in a lifetime; influenza vaccination should occur annually. The client should not take prophylactic antibiotics, which can cause resistant bacterial strains and does not prevent pneumonia. Corticosteroids may lower the resistance and allow pathogens easier entrance from immunosuppression. Encourage fluid intake to thin secretions when coughing and congestion begins. 10. Which of the following are considered the building blocks of the immune system? T lymphocytes T and B lymphocytes are the building blocks of the immune system, accumulate in lymph nodes along lymphatic vessels, and are exposed to all antigens except those that enter the bloodstream directly. 11. A new perioperative nurse is being educated regarding surgical asepsis. What observations by the preceptor would indicate that there is a need for reinforcement of the principles of asepsis? Select all that apply.    The nurse is talking with the scrub nurse over the sterile field. The nurse touches an unsterile object to the instrument tray. The nurse's back is facing the sterile field. Principles of surgical asepsis include never turning one's back on a sterile field. The nurse should avoid talking, coughing, or sneezing over the field and keep sterile objects above waist level. Sterile objects may only be touched by other sterile objects. Most solutions are considered sterile for 24 hours after they are opened 12. The nurse is caring for assigned clients who are all stable. Which client should the nurse see first to minimize the spread of infection? the client who is 48-hours postsurgical procedure Medical asepsis, also called clean technique, are practices that confine and reduce the number of microorganisms. To minimize the spread of infection between clients, the nurse should see clients from the "clean" to "dirty." The nurse should see the client who has no signs of infection first. Among these clients, the nurse should begin with the client who is postoperative, then see the other clients who have symptoms of infections. 13. The nurse is reviewing the plan of care for assigned clients. Which client has the highest risk for developing an infection? an older adult client with a history of heart failure Many factors affect the risk for infection, including age, sex, race, and heredity. Neonates and older adults, especially those who have pre-existing illnesses, appear to be more vulnerable to infection. School-age children are exposed to potential infections, but immunizations protect the child. An adolescent with a fracture or middle-aged adult taking medication to control blood pressure could develop an infection, but these clients are not at the highest risk. 14. The student nurse observes another nurse wash her hands in the client's bathroom before exiting the room. This client's stool came back positive (+) for Clostridium Difficile (C diff). Why is this behavior incorrect? The bathroom is highly contaminated with the Clostridium difficile bacteria. Hand hygiene and sterile technique are two significant measures to prevent the occurrence and transmission of infection in healthcare settings. Although healthcare professionals know the importance of handwashing in preventing the spread of infection, studies show that the rate of compliance continues to be less than 100%, sometimes as low as 50% to 60% (Ruef, 2009). The bathroom has a high concentration of pathogens since the patient's stool is disposed in the toilet. Recontamination after handwashing in the patient's bathroom will occur. 15. A client has tested positive for methicillin-resistant Staphylococcus aureus after being swabbed on admission to the hospital. Bacterial resistance to antibiotics is an example of: Survival adaptation An example of adaptation for survival is the development of antibioticresistant bacterial strains of Staphylococcus aureus, Enterococcus faecalis, E. faecium, and Streptococcus pneumoniae. Bacterial resistance is not demonstrated by aerobic activity. Spore production is another form of adaptation. Means of transmission is a component of the chain of infection, not an example of bacterial resistance. 16. What is an accurate guideline for the use of PPE? Replace gloves if they are visibly soiled. If gloves become torn or heavily soiled, they should be removed and replaced. PPE should be put on before entering the client's room and glasses should not be substituted for protective eyewear. Work should progress from “clean” areas to “dirty” areas 17. A nurse in an oncology care unit is reviewing the laboratory test results of several clients. The nurse identifies that the client with which leukocyte count most likely has an infection? 18,000 cells/mm The leukocyte count of 18,000 cells/mm indicates infection in the client. A rise in circulating white blood cells (WBCs) above the normal adult range of 5,000 to 10,000 cells/mm is called leukocytosis. A count of 8,000 cells/mm, 5,000 cells/mm, and 10,000 cells/mm would be considered normal. 18. The nurse caring for clients at an outpatient clinic determines that which client is at greatest risk for infection? an 80-year-old woman Age, race, sex, and heredity all influence susceptibility to infection. Neonates and older adults tend to be most vulnerable to infection, so the 80-year-old woman is the client most at risk for infection. A neonate is defined as a child less than 4 weeks of age. An adolescent is a child aged 9 to 12 years. A toddler is a child who is 12 to 36 months or 1 to 3 years of age. 19. The nurse reminds the visitor of a client with an antibiotic-resistant infection that gloves are necessary. The visitor states, “I need to directly hold my loved one’s hand without a barrier.” What essential information does the nurse need to explain to the visitor to prevent transmission of the organism? “The glove is an important barrier in preventing the transmission of your loved-one’s antibiotic-resistant infection to you or other people you come in contact with.” Contact precautions, which are not optional, block transmission of pathogens by direct or indirect contact. Explaining that the loved-one understands is not teaching information. Educating the visitor about drug-resistant infections is important but does not explain how to prevent transmission of the infection. Telling the visitor that he or she will get the infection if the visitor does not wear gloves is incorrect, the visitor is at a greater risk of getting and spreading the infection. Wearing gloves decreases the chance of the contaminating organism to be spread to the visitors via hands or clothing 20. When preparing to take a client’s blood pressure, the nurse notes that the sphygmomanometer is visibly soiled. What is the correct action by the nurse? Cleanse and disinfect the sphygmomanometer. The nurse should cleanse and disinfect the sphygmomanometer. A sphygmomanometer is another name for a blood pressure cuff. As this equipment is used on the outside of the arm versus entering a sterile body part, there is no need to have the equipment sterilized. It would be inappropriate for the nurse to use the visibly soiled blood pressure cuff or to throw it in the trash. 1. What is an accurate guideline for the use of PPE? Replace gloves if they are visibly soiled. If gloves become torn or heavily soiled, they should be removed and replaced. PPE should be put on before entering the client's room and glasses should not be substituted for protective eyewear. Work should progress from “clean” areas to “dirty” areas. 2. A nurse is caring for a 55-year-old postoperative client. The client returns to the ICU after surgery intubated and mechanically ventilated with a Salem sump nasogastric tube, a Foley catheter, and a PICC line in place. Based on the nurse’s knowledge of the most common hospital-acquired infections, which apparatus is most important to remove first? urinary catheter Urinary catheters account for the highest percentage (26%) of hospitalassociated infections. The four most common types of HAIs are related to invasive devices or surgical procedures: catheter-associated urinary tract infection (CAUTI), central line–associated bloodstream infection (CLABSI), surgical site infection (SSI), and ventilator-associated events (VAEs). A peripherally inserted catheter is an invasive line. Nasogastric tubes and endotracheal tubes are not associated with HAIs. 3. When an 86-year-old client reports an inability to concentrate, uneasiness, lightheadedness, weakness, muscle and joint discomfort, and demonstrates normal temperature, the clinic nurse recalls that: An older adult can have an infection without a fever. Older adults may not show a fever or may produce only a low-grade fever when an infection is present.