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ISB: Hygiene
Nightingale BSN 205, Week 5 ISB, Hygiene (Infection Control)
| Question | Answer |
|---|---|
| A patient was dx’d with UTI. Pt has been drinking fruit juice and increased intake of fluids but failed to take antibiotic as prescribed because of gastric upset. 3 days later, pt presents with fever, malaise, nausea, and vomiting. What might you suspect? | The patient may now have a systemic infection. |
| The nurse is preparing to insert a urinary catheter. To perform this procedure, the nurse will use: | Surgical asepsis (sterile technique). |
| Nurse is working in busy ER. Entering station 1, nurse dons disposable gloves. Nurse sees that the pt has a gunshot wound to the chest and is concerned of splattering of infectious materials. Nurse applies goggles, a mask, and a gown. What is this called? | Following standard precautions. |
| A nurse assists a patient with a Foley catheter to ambulate down the hall. The nurse holds the catheter bag below the level of the patient s bladder. What link in the chain of infection is the nurse breaking by doing so? | Portal of entry. |
| The nurse manager is reviewing the use of standard precautions with the staff. Which of the following should be included in the review? (Select all that apply.) | Standard precautions are used to protect you from potential contact with blood and body fluids. Standard precautions should be observed in every patient encounter. |
| A small group of nursing students is giving a teaching presentation on the principles of surgical asepsis. Which of the following standards are appropriate to include in the presentation? (Select all that apply.) Correct! | A sterile barrier that has been permeated by moisture must be considered contaminated. A sterile object or field out of the range of vision or an object held below a person’s waist is considered contaminated……. |
| Continued…. If there is any doubt about an item’s sterility, the item is considered to be unsterile. All items used within a sterile field must be sterile | |
| A nurse is teaching infection control to a group of daycare workers. Which of the following should the nurse include in the instruction? | Immunizations help protect children from being susceptible hosts. |
| The nurse is caring for four individuals. Which patient would be most at risk for infection? | The patient who is receiving immunosuppressive medication. |
| Nurse reads documentation in a pt’s EHR: 92 yr old female complains of frequent nonproductive cough. Reports taking steroids as prescribed. Denies having pneumonia vaccine. B. Jones, What factors place pt at risk for being susceptible host? (Select all) | Hospitalized. Age. Vaccination status. Medical therapy. |
| The nurse is preparing an in-service on medical asepsis. Which of the following should be included in the presentation? (Select all that apply.) | If worn, fingernail polish should not be chipped. Cough hygiene practices should be followed. Always know a patient’s susceptibility to infection. |
| When should you perform hand hygiene? (Select all that apply.) | Before applying gloves to insert an IV. After moving a patient up in bed. Before assessing a patient’s vital signs. |
| Turn on water, temp warm. Set pressure to strong spray. Wet hands, apply soap and rub together. Interlace fingers, rub palms & backs of hands, circular motion. Keep hands w/ fingertips down and rinse. Turn off faucet. Dry w/ paper towel. Incorrect steps? | The force of the water. The method used to turn off the faucet. |
| Why are the hands rinsed with the fingertips held lower than the wrist? | Water flows from the least to the most contaminated area, rinsing microorganisms into the sink. |
| What is the best nursing practice to reduce the potential transmission of microorganisms within the health care setting? | Performing hand hygiene. |
| Under which circumstance(s) should hand washing be repeated? (Select all that apply.) | Hands touch the sink during hand washing. Areas under fingernails remain soiled. |
| When is it acceptable to use antiseptic hand rub rather than soap and water? (Select all that apply. | After adjusting as Al cannula on a patient. After removing gloves after changing a wound dressing. After moving patient’s belonging son the bedside table. |
| The nurse is observing the NAP perform hand hygiene. Which of the following, if performed by the NAP, requires intervention by the nurse? (Select all that apply.) The NAP: | Takes the patient’s blood pressure and leaves the room to document. Puts the patient's socks on, then begins to feed the patient. Has an uncovered cut on the back of the nondominant hand. |
| The NAP complains of his hands hurting and skin being chapped. What would be appropriate suggestions for the NAP? (Select all that apply.) | Use hand lotion from an individual use container. Be sure to rinse and dry hands thoroughly. Avoid excessive amounts of soap or antiseptic. |
| Prepare sterile field. Open kit pulling outermost flap toward body, then other flaps. Add sterile items, placing on at an angle, don’t allow wrapper to touch. Pour saline from opened bottle into sterile receptacle. Actions performed incorrectly? | Opening the outermost flap. Pouring a sterile solution |
| The nurse is preparing a sterile field. Which of the following would be considered contamination of the field? (Select all that apply.) | Some of the sterile normal saline spills onto the sterile barrier. No sterile items are added to the sterile field. The nurse prepares the sterile field and leaves the room to get more sterile supplies. |
| The nurse is reviewing with the surgical technician how to prepare a sterile field. Which of the following is incorrect and should not be included in the review? | Place the drape so the top half of the drape is over the top half of the work surface. |
| The nurse is preparing to set up a sterile field for a patient who is going to have a sterile dressing change. Which of the following assessment measures would be unnecessary at this time? | The nurse asks the patient if he has ambulated in the hall today |
| One evaluation measure of creating and maintaining a sterile field involves monitoring the patient for developing signs and symptoms of localized or systemic infection. Which of the following is cause for concern? | Temperature of 102.5° F (39.2° C). |
| A nurse is preparing a medication for subcutaneous administration. As the nurse recaps the needle using the scoop method, the nurse accidentally touches the table with the uncovered needle. What is the nurse’s best action? | Discard the needle and replace with a new one before administration |
| The nurse is adding a dry sterile gauze dressing to the sterile field. The dressing bounces on the surface and lands on the outer 1-inch border of the sterile field. What action is appropriate at this time | The nurse opens another sterile gauze dressing and adds it to the sterile field, but does not use the first one. |
| The nurse is applying sterile gloves. Which series of steps would require correction? | Hold gloved hands at sides of body, below waist level, until beginning the sterile procedure. |
| Which of the following is a correct description of glove removal? | Grasp the outside of one cuff with the other gloved hand and pull the glove off, turning inside out, place it in gloved hand. Take fingers of bare hand and tuck inside glove cuff. Peel glove off inside out and over the previously removed glove. Discard |
| The nursing instructor is asking the nursing students to share their knowledge regarding sterile gloving. Which statement, if made by a student, would require correction? | Once sterile gloves are applied, the inside of the glove is still considered sterile. |
| Which of the following are symptoms of latex allergy? (Select all that apply.) | Skin redness. Itching. Edema. Difficulty breathing. |
| Elderly patient is admitted for back surgery. Retired but, was a RN. Reports allergy to morphine and pcn. Hx of 5 laminectomies from scoliosis as a child. Has 3 children who visit. Requires a cane. Which factors considered high-risk for latex allergy? | History of multiple surgeries as a child. Occupation. |
Created by:
alishalynne93
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