Question 1

A student has just performed a physical assessment on a patient who has an infection with B. anthracis. The student uses an alcohol hand rub while preparing to leave the room. Which action should the nurse take?

A) Ask the student to wash with soap and water before exiting the room.
B) Discuss the matter with the student later in a quiet area.
C) No action is required.
D) Report the student's action to the instructor.

Accepted Answer

The student should be asked to wash with soap and water before leaving the room. Alcohol-based hand rubs are ineffective against B. anthracis spores. Reporting the action to the student's instructor will not prevent the student from having immediate contact with another patient and spreading the disease; neither will discussing the problem later with the student.

Question 2

For which patient would a topical antiseptic be most appropriate?&#10;A) A patient with a systemic infection&#10;B) A patient with a medium-sized abscess&#10;C) A patient who has a wound with moderate exudate&#10;D) A patient who needs to have wounds cleansed for prophylaxis

Accepted Answer

Antiseptics are useful as prophylaxis; when applied properly,they can help cleanse wounds and reduce microbial contamination. A patient with a systemic infection is treated with a systemic anti-infective drug. An abscess must be incised and drained,and a topical agent cannot significantly penetrate the skin to be effective. A wound with moderate exudates requires antibiotic therapy.

Question 3

A nurse is teaching a nursing student how to care for patients in the perioperative period. Which statement by the student about preventing postoperative infections indicates a need for further teaching?

A) "Applying hexachlorophene to the operative site preoperatively will help prevent infection."
B) "It is important to ensure that all surgical instruments have been sterilized appropriately."
C) "Operating room personnel should all perform a presurgical scrub with antimicrobial soap."
D) "Preventing contamination by microorganisms in the environment is the most important perioperative measure."

"Applying hexachlorophene to the operative site preoperatively will help prevent infection."

Accepted Answer

Although bathing a patient's skin area with antiseptic agents reduces the number of surface bacteria,this measure has not been shown to reduce the incidence of postoperative infection. Disinfecting surgical instruments,antimicrobial surgical scrubbing for operating room personnel,and disinfection of other surfaces in the environment have been shown to be effective measures for preventing postoperative infection.

Question 4

A patient arrives in the emergency department after a bicycle-automobile accident with multiple dirty abrasions. Which product might be used initially to cleanse this patient's wounds?&#10;A) Hydrogen peroxide&#10;B) Isopropanol (isopropyl alcohol)&#10;C) Povidone iodine [Betadine]&#10;D) Soap and water

Accepted Answer

Hydrogen peroxide does not have good antiseptic properties,because the antimicrobial component is destroyed by catalase in tissues. It is useful initially because the frothing that occurs when catalase liberates oxygen loosens debris and facilitates cleansing of a dirty wound. Isopropanol is irritating to the skin. Povidone iodine is used on intact skin. Soap and water can be used,but hard scrubbing is necessary on a dirty abrasion and can be painful.

Question 5

A nursing student asks a nurse why systemic antibiotics and not topical antiseptic agents are used to treat localized skin infections. Which statement by the student indicates a need for further teaching?

A) "Systemic agents are not affected by wound exudates."
B) "Systemic agents penetrate to the site of infection."
C) "Topical agents can damage inflamed or abraded tissues."
D) "Topical agents work only against established local infections."

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Accepted Answer

Topical antiseptics are not used to treat established local infections. Systemic agents are more effective,because they are not affected by wound exudates. They penetrate to the site of infection,and they do not damage inflamed or abraded tissues.

Question 6

Which compound can be used to treat localized skin infections and to irrigate wounds?&#10;A) Benzalkonium chloride (BAC)&#10;B) Hexachlorophene (pHisoHex)&#10;C) Oxychlorosene sodium (Clorpactin WCS90)&#10;D) Sodium hypochlorite

Accepted Answer

Oxychlorosene sodium can be used to treat localized infections caused by drug-resistant microbes and to irrigate wounds. Benzalkonium chloride can cause severe local injury,so it is not widely used. Hexachlorophene has central nervous system (CNS)effects when absorbed through the skin and is not used in open areas such as wounds. Sodium hypochlorite is too irritating for application to the skin.

Question 7

A patient has an abrasion,and the nurse is preparing to cleanse the area with iodine. Which preparation will the nurse use?&#10;A) Free elemental iodine&#10;B) Iodine solution&#10;C) Iodine tincture&#10;D) Povidone iodine

Accepted Answer

Iodine solution should be used for the treatment of wounds and abrasions,because it does not contain alcohol,which can irritate and damage the tissue. Free elemental iodine is released from iodine preparations after administration. Iodine tincture contains alcohol and is used on intact skin only. Povidone iodine is used prophylactically to prevent postoperative infection.

Question 8

A nurse is caring for a patient with an infection caused by Bacillus anthracis. What action is most important for reducing the transmission of this disease?&#10;A) Disinfecting the bedpan with an antiseptic solution&#10;B) Using antibacterial hand soap when washing the hands&#10;C) Using an alcohol-based hand rub after each patient contact&#10;D) Wearing gloves while caring for the patient

Accepted Answer

All of these measures are appropriate for this patient; however,using an antibacterial hand soap is the most important,because only an antimicrobial soap is effective against a spore-forming bacterium,such as B. anthracis.

Question 9

A patient has developed a local infection at an IV insertion site. Before the IV was inserted,the site was cleansed with a product with an ethanol concentration of 70%. The nurse will report the local infection to the provider and expect to receive an order to:

A) administer a systemic antimicrobial agent.
B) apply a topical antiseptic agent to the infected area.
C) culture the site to assess for C. difficile.
D) use a topical agent containing 95% ethanol.

Accepted Answer

Once an infection has occurred,systemic antimicrobials are recommended as treatment. Topical antiseptics will not be as effective. C. difficile occurs in the intestines. Concentrations of ethanol greater than 70% are less effective,and ethanol should not be applied to open wounds because of the risk of tissue damage and coagulation of proteins.

Question 10

A clinic nurse is preparing to sterilize instruments used in clinic procedures. The nurse will place the instruments in glutaraldehyde [Cidex-7]. Which actions are necessary when using this product? (Select all that apply.)

A) Acidifying the solution to improve its antiseptic properties
B) Cleansing the hands with an alcohol-based hand rub
C) Ensuring adequate ventilation in the room where the solution is used
D) Removing blood from the instruments before soaking them
E) Soaking the instruments for 10 hours or longer

Accepted Answer

To completely eliminate bacterial spores,all blood first should be removed from the instruments and equipment,which then should be immersed in glutaraldehyde for at least 10 hours. Because fumes from the solution can irritate the respiratory tract,adequate ventilation is essential. The solution works best at an alkaline pH. Cleansing the hands is always a good idea but is not necessary to ensure proper sterilization of the instruments.

Deck 96: Antiseptics and Disinfectants