Infection Prevention and Control

1.The nurse has had a nasal culture performed and has been found to be MRSA positive. Because the nurse has not been ill from the bacteria, the nurse’s nasal cavity can best be described as a:

a.
susceptible host.
b.
reservoir.
c.
portal of entry.
d.
mode of transmission.

ANS: B

A place in which microorganisms survive, multiply, and wait to transfer to a susceptible host is called a reservoir. Common reservoirs are humans and animals (hosts), insects, food, water, and organic matter on inanimate surfaces (fomites). Frequent reservoirs for health care–acquired infections (HAIs) include health care workers (especially their hands), patients’ body excretions and secretions, equipment, and the health care environment. A susceptible host is one who will get an infection. Susceptibility to an infection depends on the individual’s degree of resistance to pathogens. The fact that the nurse has not become ill indicates that he or she is not very susceptible. Portal of entry describes how the organism entered the body. Although the MRSA may have used the nasal cavity as the portal of entry, it now resides there so the nasal cavity is now the reservoir. Mode of transmission refers to how the organism is passed from one person to another. This can be from touch, sneezing, coughing, and so on. The nasal cavity is a place, not a mode of transmission.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF: 240 | 241 OBJ: Describe characteristics of each link of the infection chain.

TOP: Nursing Process: Assessment MSC: NCLEX: Safety and Infection Control

2.The nursing assistive personnel (NAP) is working on a busy pediatric unit in a hospital. She has a cut on her hand that has not been kept covered. It hurts her to wash her hands or sanitize them, so she has been providing patient care without performing hand hygiene. Several of the patients on the pediatric unit have suffered hospital-associated infections of rotavirus. This was thought to be a result of the NAP’s lack of hand hygiene. This type of disease transmission can best be described as:

a.
indirect.
b.
natural active immunity.
c.
direct.
d.
natural passive immunity.

ANS: C

Hands of health care workers often transmit microorganisms. This mode of transmission is called direct transmission. Indirect transmission occurs when microorganisms are transferred to health care workers’ hands from contaminated items that are part of patient care, such as a blood pressure cuff or a bedside table. Natural active immunity results from having a certain disease, such as measles, and mounting an immune response that usually lasts a lifetime. Natural passive immunity is the acquisition of an antibody by one person from another, such as a baby born with its mother’s antibodies. The baby acquires these antibodies through the placenta during the last months of pregnancy. This type of immunity is of short duration, usually lasting only a few weeks to months.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF: 241 | 242 OBJ: Identify the body’s normal defenses against infection.

TOP: Nursing Process: Assessment MSC: NCLEX: Safety and Infection Control

3.The nurse is working for a postsurgical unit. He is caring for four postsurgical patients, all of whom have been in the hospital for 3 days or more. Which of the following patients should he be most concerned about regarding a health care–associated infection?

a.
An asymptomatic elderly patient with bacteria in his urine
b.
A middle-aged woman with a white blood cell count of 10,000/mm3
c.
A young adult woman who is 1 day postoperative with redness at incision site
d.
A middle-aged man with temperature of 101.3° F and complaints of malaise

ANS: D

By assessing existing signs and symptoms (e.g., the condition of a wound, the presence of fever), you will determine whether a patient’s clinical condition indicates the onset or extension of a systemic infection. The patient with an elevated temperature such as 101.3° F and a feeling of malaise is demonstrating signs of infection. When assessing laboratory data, consider the age of the patient. For example, in an older adult, bacterial growth in urine without clinical symptoms does not always indicate the presence of a urinary tract infection. Normal white blood cell count is 5000 to 10,000/mm3, so a patient with that level would not be showing a sign of infection unless he or she were already immunosuppressed. Redness at the incision site is a sign of inflammation, and the body’s inflammatory response is a protective reaction that neutralizes pathogens and repairs body cells.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:243 | 245 | 246

OBJ:Assess patients at risk for acquiring an infection.

TOP: Nursing Process: Evaluation MSC: NCLEX: Safety and Infection Control

4.A patient with a history of poor nutrition and chronic illness is admitted to the medical unit. The nurse caring for this patient is preparing to provide the patient with a bed bath and recalls that normal body flora:

a.
are only found on the skin surface.
b.
are beneficially aided by the use of antibiotics.
c.
are primary sources of infection when balanced.
d.
help to maintain health.

ANS: D

Normal flora usually does not cause disease, but instead help to maintain health. The number and variety of flora maintain a sensitive balance with other microorganisms to prevent infection. The body’s normal flora is made up of a large numbers of microorganisms residing on the surface and deep layers of the skin, in the saliva and oral mucosa, and in the intestinal walls. Any factor that disrupts this balance places a person at increased risk for infection. For example, the use of broad-spectrum antibiotics for the treatment of infection eliminates or changes normal bacterial flora, often leading to suprainfection. Microorganisms resistant to antibiotics then cause serious infection.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:243

OBJ: Explain conditions that promote development of health care–associated infections.

TOP: Nursing Process: Planning MSC: NCLEX: Safety and Infection Control

5.An emergency department nurse is caring for a patient with a laceration on the lower leg that has become infected. On assessment the nurse realizes that a sign of an inflammatory response consists of:

a.
wound blanching.
b.
coolness at the site of injury.
c.
a vascular reaction that delivers fluid, blood, and nutrients to the area.
d.
decreased pain sensation.

ANS: C

Inflammation is a protective vascular reaction that delivers fluid, blood products, and nutrients to interstitial tissues in an area of injury. This process neutralizes and eliminates pathogens or necrotic tissues and establishes a means of repairing body cells and tissues. Signs of inflammation include swelling, redness (not blanching), heat, pain or tenderness, and loss of function in the affected body part.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF:243

OBJ: Explain conditions that promote development of health care–associated infections.

TOP:Nursing Process: Assessment

MSC: NCLEX: Health Promotion and Maintenance

6.There was an outbreak of Salmonella poisoning at a nursing home. Several residents were hospitalized as a result of their infections. What is the best term to describe this infection?

a.
Exogenous infection
b.
Endogenous infection
c.
Community-acquired infection
d.
Asepsis

ANS: A

An exogenous infection comes from microorganisms found outside the individual, such as Salmonella, Clostridium tetani, and Aspergillus. They do not exist as normal flora. An endogenous infection occurs when part of the patient’s flora becomes altered and overgrowth results (e.g., staphylococci, enterococci, yeasts, streptococci). This often happens when a patient receives broad-spectrum antibiotics that alter normal flora. When sufficient numbers of microorganisms normally found in one body site move to another site, an endogenous infection develops. A community-acquired infection is one that was present at the time of admission to a health care setting. The term asepsis means the absence of disease-producing microorganisms.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:243

OBJ: Explain conditions that promote development of health care–associated infections.

TOP: Nursing Process: Assessment MSC: NCLEX: Safety and Infection Control

7.A nurse is assigned to multiple patients on a busy surgical unit. To minimize the onset and spread of infection, the nurse should:

a.
insert indwelling catheters to prevent incontinence.
b.
use aseptic technique when performing procedures.
c.
use barriers sparingly to reduce the patient’s sense of isolation.
d.
keep mucus membranes dry to prevent maceration.

ANS: B

Invasive treatment devices such as intravenous (IV) catheters or indwelling urinary catheters impair or bypass the body’s natural defenses against microorganisms. Because of increased attention to the prevention of infection, the Centers for Disease Control and Prevention (CDC) (2007) and the Occupational Safety and Health Administration (OSHA) (1991) have stressed the importance of barrier protection. Efforts to minimize the onset and spread of infection are based on the principles of aseptic technique. Aseptic technique is an effort to keep the patient as free from exposure to infection-causing pathogens as possible. The term asepsis means the absence of disease-producing microorganisms. When a person ages, normal physiological changes occur that influence susceptibility to infection. These changes include decreased immunity, dry mucous membranes, decreased secretions, and decreased elasticity in tissues. Because of these changes, the older adult is predisposed to infections.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:243 | 247

OBJ: Describe nursing interventions designed to break each link in the infection chain.

TOP: Nursing Process: Implementation MSC: NCLEX: Safety and Infection Control

8.The infection control nurse is presenting an in-service presentation on infection prevention and control. A participating nurse identifies what patient as most susceptible to acquiring an infection?

a.
An 81-year-old patient with a fractured hip
b.
A 10-month-old patient with a first-degree burned hand
c.
A 40-year-old patient with a recent uncomplicated laparoscopic cholecystectomy
d.
A 16-year-old athlete with a repair of the medial collateral ligament

ANS: A

When a person ages, there are normal physiological changes that influence susceptibility to infection. First-degree burns leave the skin intact and do not breach the barrier to infection. Any surgical procedure involves a break in the body’s defenses against infection, and procedures such as cholecystectomy and ligament repair pose a risk for infection; however, the age of the patients place them at a lower level of risk.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 247 OBJ: Assess patients at risk for acquiring an infection.

TOP: Nursing Process: Evaluation MSC: NCLEX: Safety and Infection Control

9.A senior nursing student is working on a community health project for the local homeless shelter. There are several indigent men who come to the shelter in cold weather to sleep for the night. The student nurse knows that these men do not bathe on a regular basis. One of the men has been sick several times recently with skin infections. Which of the following is the best way for the student nurse to explain the importance of personal hygiene to this individual?

a.
“You don’t have to shower every day. You only need to take a shower when you feel like you’re going to be sick.”
b.
“Take a shower. If you don’t take a shower, you will continue to get sick.”
c.
“Showering regularly will remove germs that cause skin infections. What do you think we should do about these skin infections of yours?”
d.
“Showering with warm water is enough to wash away bacteria. Soap is not needed if you don’t like it.”

ANS: C

Identify patients’ expectations about their care, and involve them in planning their care. Encourage patients to verbalize their expectations so that you are able to establish interventions to meet patients’ priorities. Waiting until “you feel like you’re going to be sick” may be too late. Telling the patient that he will get sick may sound like a threat and cause the patient to withdraw. Use soap and water to remove drainage, dried secretions, or excess perspiration.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:247 | 251

OBJ: Explain conditions that promote development of health care–associated infections.

TOP: Nursing Process: Implementation MSC: NCLEX: Reduction of Risk Potential

10.The student nurse who is developing a plan of care for a postoperative patient who underwent abdominal surgery to remove a tumor. The student has chosen Risk for Infection as a nursing diagnosis. Which of the following is the most appropriate goal for this diagnosis?

a.
The patient’s wound drainage will decrease in 2 days.
b.
The patient will report decrease in incisional pain by discharge.
c.
The progression of infection will be controlled or decreased.
d.
The patient will describe signs/symptoms of wound infection.

ANS: C

In an acute care setting the goal for the diagnosis Risk for Infection is “to control or decrease the progression of infection.” An outcome is “The patient’s wound drainage will decrease in 2 days.” Decreased incisional pain is an expectation postsurgically and not directly related to infection. Having the patient describe the signs/symptoms of infection will aid in early detection, but not in preventing infection.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 248 OBJ: Assess patients at risk for acquiring an infection.

TOP: Nursing Process: Planning MSC: NCLEX: Management of Care

11.The student nurse caring for a postsurgical patient who has developed a health care–acquired wound infection that has become systemic. Which of the following should be the student nurse’s top priority?

a.
Providing emotional support
b.
Managing vital signs
c.
Providing patient education
d.
Providing personal hygiene

ANS: B

Give special attention to any urgent needs the infection creates. For example, if the patient’s infection becomes systemic, a nurse will need to manage fever and prevent dehydration. Once the infection begins to resolve and vital signs are stable, then the priorities are hygiene, patient education, and emotional support.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:248

OBJ: Describe nursing interventions designed to break each link in the infection chain.

TOP: Nursing Process: Planning MSC: NCLEX: Management of Care

12.A nursing student is working on a surgical unit in the hospital. Included in her job description is to assist in the cleaning and disinfection of equipment stored on the unit. Which of the following is the best explanation of disinfection?

a.
Removing organic material
b.
Removing inorganic material
c.
Eliminating almost all pathogenic organisms
d.
Destroying all forms of microbial life

ANS: C

Disinfection eliminates almost all pathogenic organisms, with the exception of bacterial spores. Sterilization eliminates or destroys all forms of microbial life, including spores. Cleaning involves removing organic material such as blood or inorganic material such as soil from objects. Generally this involves the use of water, a detergent/disinfectant, and proper mechanical scrubbing action. Cleaning occurs before disinfection and sterilization procedures.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 250 OBJ: Identify principles of medical and surgical asepsis.

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care

13.A patient is admitted for treatment of a home-acquired pressure ulcer. The patient is incontinent of urine and has Alzheimer disease. A Foley catheter is inserted. The nurse recognizes that the best way to break the infection chain is to:

a.
discontinue the Foley as soon as possible.
b.
wear a mask when working with the patient if she or he has a cold.
c.
wear sterile gloves if there is a chance of contact with blood.
d.
use surgical asepsis when handling body fluids.

ANS: A

To control or eliminate infection in reservoir sites, eliminate sources of body fluids, drainage, or solutions that possibly harbor microorganisms such as a Foley collection bag. Try not to work with patients who are highly susceptible to infection if you have a cold or other communicable infection. Another way of controlling the exit of microorganisms is by using standard precautions when handling body fluids such as urine, feces, and wound drainage. Wear clean gloves if there is a chance of contact with any blood or body fluids, and perform hand hygiene after providing care. Be sure to bag contaminated items appropriately.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:250

OBJ: Describe nursing interventions designed to break each link in the infection chain.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

14.The nurse and is very concerned about infection control in the Surgery Department. Recently she provided education to the surgery staff on ways to eliminate transient hand flora. The most precise description for this is hand:

a.
hygiene.
b.
washing.
c.
antisepsis.
d.
rub.

ANS: C

Hand hygiene is a general term that applies to hand washing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis. Hand washing refers to washing hands with plain soap and water. An antiseptic handwash means washing hands with water and soap or other detergents containing an antiseptic agent. An antiseptic hand rub means to apply an antiseptic hand rub product, such as alcohol, to all surfaces of the hands to reduce the number of microorganisms present. Surgical hand antisepsis is an antiseptic handwash or antiseptic hand rub that surgical personnel perform preoperatively to eliminate transient and reduce resident hand flora.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF: 251 OBJ: Perform proper procedures for hand hygiene.

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care

15.Standard precautions involve using personal protective equipment with all patients regardless of the presence of infections. Therefore when obtaining a blood sample, the nurse must wear:

a.
a mask.
b.
gloves.
c.
gloves and a mask.
d.
gloves, a mask, and a gown.

ANS: B

Apply disposable gloves when there is a risk for exposing the hands to blood as in blood drawing, body fluids, mucous membranes, non-intact skin, or potentially infectious material on objects or surfaces. In addition, use gloves when you have scratches or breaks in the skin and when performing venipuncture or finger or heel sticks. Wear a mask or respirator if you anticipate splashing or spraying of blood or body fluids. This is not common when drawing blood. The mask also protects you from inhaling microorganisms from a patient’s respiratory tract and prevents the transmission of pathogens from your respiratory tract. Gowns should be worn if soiling of the skin or clothing is likely from contact with blood, body fluids, or if patient has uncontained secretions. You may wear gloves alone or in combination with other PPE; however, obtaining a blood sample does not usually require more than gloves.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:259 | 260OBJ:Perform proper barrier isolation techniques.

TOP: Nursing Process: Implementation MSC: NCLEX: Reduction of Risk Potential

16.The nurse has noticed slight redness when washing her hands. She is concerned about developing a latex allergy. To prevent this, the nurse should:

a.
wear only powdered gloves to help protect her skin.
b.
wear gloves constantly to decrease the number of handwashings.
c.
apply only oil-based hand care products to her hands.
d.
report to employee health services and/or seek immediate medical care.

ANS: D

The Association of Perioperative Registered Nurses (2009) suggests that nurses report to employee health services to seek medical treatment immediately if a reaction or dermatitis occurs. They are also advised to wear powder-free gloves whenever possible (they are lower in protein allergens), wear gloves only when indicated, wash with a pH-balanced soap immediately after removing gloves, and apply only non–oil-based hand care products (oil-based products break down latex allergens).

PTS:1DIF:Cognitive Level: Applying (Application)

REF:260OBJ:Perform proper barrier isolation techniques.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

17.Which of the following situations is most likely to contribute to a health care–acquired infection?

a.
A closed urinary drainage system
b.
Use of aseptic technique during dressing changes
c.
Foley catheter drainage bag touching the floor
d.
Changing IV access site when site is red and warm

ANS: C

Causes of health care–acquired infection include contact between drainage bag port and contaminated surface, an open urinary drainage system, failure to use aseptic technique during dressing changes, and failure to change IV access site when inflammation first appears.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:245

OBJ: Explain conditions that promote development of health care–associated infections.

TOP: Nursing Process: Assessment MSC: NCLEX: Reduction of Risk Potential

18.A nurse is concerned with the chain of infection when taking care of contaminated care items. Semicritical items that require disinfection include:

a.
linens.
b.
bedpans.
c.
blood pressure cuffs.
d.
gastrointestinal endoscopes.

ANS: D

Semicritical items are objects that come in contact with mucous membranes or nonintact skin and present a risk. These objects must be free of all microorganisms (except bacterial spores). Semicritical items must be high-level disinfected (HLD) or sterilized. Some of these items include respiratory and anesthesia equipment, endoscopes, endotracheal tubes, gastrointestinal endoscopes, and diaphragm fitting rings. After rinsing, items must be dried and stored in a manner to protect from damage and contamination. Noncritical items are objects that come in contact with intact skin but not mucous membranes and must be clean. Noncritical items must be disinfected. Some of these items include bedpans, blood pressure cuffs, bed rails, linens, and stethoscopes.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:250

OBJ: Describe nursing interventions designed to break each link in the infection chain.

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care

19.A nurse is coaching a student on the proper method of applying surgical gloves. One step in the proper donning of sterile gloves requires the nurse to:

a.
with thumb and first two fingers of nondominant hand, touch only the glove’s outer surface.
b.
with gloved dominant hand, slip fingers inside the second glove and pull onto the nondominant hand.
c.
carefully pull the glove over the dominant hand, leaving a cuff and being sure the cuff rolls up over the wrist.
d.
carefully pull the glove over the dominant hand, leaving a cuff and being sure the cuff does not roll up over the wrist.

ANS: D

Carefully pull glove over dominant hand, leaving a cuff and being sure the cuff does not roll up wrist. With thumb and first two fingers of the nondominant hand, grasp the edge of the cuff of the glove for the dominant hand and touch only the glove’s inside surface. With the gloved dominant hand, slip the fingers underneath the second glove’s cuff.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:263

OBJ: Apply and remove a surgical mask and gloves using correct technique.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

20.An 89-year-old patient who lives in a nursing home has been admitted to the hospital for observation after falling, and is exhibiting confusion and malaise in the nursing home. He had a urinary catheter inserted 2 weeks ago when he complained of difficulty urinating. Lab work was ordered and the nurse notes that his neutrophil count is elevated. She knows that this, combined with the other clinical signs and symptoms, most likely indicates what condition?

a.
Tuberculosis
b.
Parasitic infection
c.
Acute bacterial infection
d.
Viral infection

ANS: C

Neutrophil counts are elevated in the presence of acute bacterial infection. Lymphocytes are increased in viral infections. Monocytes are elevated in tuberculosis infections. Eosinophils are usually elevated in parasitic infections.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 247 OBJ: Identify the body’s normal defenses against infection.

TOP: Nursing Process: Evaluation MSC: NCLEX: Management of Care

21.The nurse is admitting a patient with a methicillin-resistant Staphylococcus aureus (MRSA) infection isolated in his stage III pressure ulcer. The nurse places the patient on:

a.
contact precautions.
b.
airborne precautions.
c.
droplet precautions.
d.
protective environment.

ANS: A

Contact precautions (direct patient or environmental contact) is used for patients with colonization or infection with multidrug-resistant organisms such as VRE and MRSA, Clostridium difficile, shigella, and other enteric pathogens; major wound infections; herpes simplex; scabies; varicella zoster (disseminated); or respiratory syncytial virus in infants, young children, or immunocompromised adults. Airborne precautions (droplet nuclei smaller than 5 microns) are used for patients who have measles; chickenpox (varicella); disseminated varicella-zoster; pulmonary or laryngeal tuberculosis. Droplet precautions (droplets larger than 5 microns; being within 3 feet of the patient) is used for patients with diphtheria (pharyngeal), rubella, streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children, pertussis, mumps, Mycoplasma pneumonia, meningococcal pneumonia or sepsis, or pneumonic plague. A protective environment is used to protect patients receiving allogeneic hematopoietic stem cell transplants.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:255

OBJ: Describe nursing interventions designed to break each link in the infection chain.

TOP: Nursing Process: Implementation MSC: NCLEX: Management of Care

MULTIPLE RESPONSE

1.A nurse sets up a sterile field. A break in the sterile field occurs when the nurse does which of the following? (Select all that apply.)

a.
Drops a sterile capped needle onto the sterile field
b.
Spills solution onto the sterile field
c.
Keeps the top of the table above waist level
d.
Keeps sterile objects within a 1-inch border of the field

ANS: B, D

A sterile object or field becomes contaminated by capillary action when a sterile surface comes in contact with a wet contaminated surface. Moisture seeps through a sterile package’s protective covering, allowing microorganisms to travel to the sterile object. When stored sterile packages become wet, discard the objects immediately or send the equipment to be sterilized again. Spilling solution over a sterile drape contaminates the field unless the drape cannot be penetrated by moisture. The edges of a sterile field or container are contaminated. A 2.5-cm (1-inch) border around a sterile towel or drape is considered contaminated. A sterile object remains sterile only when touched by another sterile object. Place only sterile objects, such as sterile needles, on a sterile field. A sterile object or field out of the range of vision or an object held below a person’s waist is contaminated. Never turn your back on a sterile tray or leave it unattended. Any object held below waist level is considered contaminated because you cannot view it at all times. Keep sterile objects either on or out over the sterile field.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 262 | 264 OBJ: Identify principles of medical and surgical asepsis.

TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care