Question 1

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 $\bold{next}$?
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.

Accepted Answer

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 2

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.

Accepted Answer

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 3

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

Accepted Answer

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 4

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.

Accepted Answer

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 5

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

Accepted Answer

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 6

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.

Accepted Answer

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 7

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

Accepted Answer

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 8

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.

Accepted Answer

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 9

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

Accepted Answer

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 10

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

Accepted Answer

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 11

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

Accepted Answer

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 12

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

Accepted Answer

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 13

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

Accepted Answer

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 14

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

Accepted Answer

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 15

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.

Accepted Answer

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 16

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

Accepted Answer

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 17

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

Accepted Answer

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 18

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.

Accepted Answer

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 19

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

Accepted Answer

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 20

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

Accepted Answer

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.

Quiz 29: Infection Prevention and Control

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 $\bold{next}$ ?

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?

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

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?

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

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

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

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?

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?

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?

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?

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?

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

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?

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?

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

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?

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?