Chapter 23: Care of Patients with Infection Nursing School Test Banks

Chapter 23: Care of Patients with Infection
Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1. The nursing instructor explaining infection tells students that which factor is the best and most important barrier to infection?
a. Colonization by host bacteria
b. Gastrointestinal secretions
c. Inflammatory processes
d. Skin and mucous membranes
ANS: D
The skin and mucous membranes are the most important barrier against infection. The other options are also barriers, but are considered secondary to skin and mucous membranes.

DIF: Understanding/Comprehension REF: 400
KEY: Infection| physiology MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. A nursing manager is concerned about the number of infections on the hospital unit. What action by the manager would best help prevent these infections?
a. Auditing staff members hand hygiene practices
b. Ensuring clients are placed in appropriate isolation
c. Establishing a policy to remove urinary catheters quickly
d. Teaching staff members about infection control methods
ANS: A
All methods will help prevent infection; however, health care workers lack of hand hygiene is the biggest cause of healthcare-associated infections. The manager can start with a hand hygiene audit to see if this is a contributing cause.

DIF: Applying/Application REF: 401
KEY: Infection control| infection| hand hygiene
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

3. A student nurse asks why brushing clients teeth with a toothbrush in the intensive care unit is important to infection control. What response by the registered nurse is best?
a. It mechanically removes biofilm on teeth.
b. Its easier to clean all surfaces with a brush.
c. Oral care is important to all our clients.
d. Toothbrushes last longer than oral swabs.
ANS: A
Biofilms are a complex group of bacteria that function within a slimy gel on surfaces such as teeth. Mechanical disruption (i.e., toothbrushing with friction) is the best way to control them. The other answers are not accurate.

DIF: Understanding/Comprehension REF: 405
KEY: Infection| infection control| oral care
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

4. A client is admitted with possible sepsis. Which action should the nurse perform first?
a. Administer antibiotics.
b. Give an antipyretic.
c. Place the client in isolation.
d. Obtain specified cultures.
ANS: D
Prior to administering antibiotics, the nurse obtains the ordered cultures. Broad-spectrum antibiotics will be administered until the culture and sensitivity results are known. Antipyretics are given if the client is uncomfortable; fever is a defense mechanism. Giving antipyretics does not take priority over obtaining cultures. The client may or may not need isolation.

DIF: Applying/Application REF: 408
KEY: Infection| antibiotics| cultures
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

5. A client is hospitalized and on multiple antibiotics. The client develops frequent diarrhea. What action by the nurse is most important?
a. Consult with the provider about obtaining stool cultures.
b. Delegate frequent perianal care to unlicensed assistive personnel.
c. Place the client on NPO status until the diarrhea resolves.
d. Request a prescription for an anti-diarrheal medication.
ANS: A
Hospitalized clients who have three or more stools a day for 2 or more days are suspected of having infection with Clostridium difficile. The nurse should inform the practitioner and request stool cultures. Frequent perianal care is important and can be delegated but is not the priority. The client does not necessarily need to be NPO; if the client is NPO, the nurse ensures he or she is getting appropriate IV fluids to prevent dehydration. Anti-diarrheal medication may or may not be appropriate, and the diarrhea serves as the portal of exit for the infection.

DIF: Applying/Application REF: 412
KEY: Infection| cultures| communication
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

6. A nurse is observing as an unlicensed assistive personnel (UAP) performs hygiene and changes a clients bed linens. What action by the UAP requires intervention by the nurse?
a. Not using gloves while combing the clients hair
b. Rinsing the clients commode pan after use
c. Shaking dirty linens and placing them on the floor
d. Wearing gloves when providing perianal care
ANS: C
Shaking dirty linens (or even clean linens) can spread microbes through the air. Placing linens on the floor contaminates the floor surface and can lead to infection spread via shoes. The other actions are appropriate. If the client has a scalp infection or infestation, the UAP should wear gloves; otherwise it is not required.

DIF: Applying/Application REF: 403
KEY: Infection| infection control| supervision| unlicensed assistive personnel (UAP)
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

7. A hospital unit is participating in a bioterrorism drill. A client is admitted with inhalation anthrax. Under what type of precautions does the charge nurse admit the client?
a. Airborne Precautions
b. Contact Precautions
c. Droplet Precautions
d. Standard Precautions
ANS: D
Only Standard Precautions are needed. No other special precautions are required for the client because inhalation anthrax is not spread person to person.

DIF: Applying/Application REF: 411
KEY: Infection| infection control| Standard Precautions| bioterrorism
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

8. Which action by the nurse is most helpful to prevent clients from acquiring infections while hospitalized?
a. Assessing skin and mucous membranes
b. Consistently using appropriate hand hygiene
c. Monitoring daily white blood cell counts
d. Teaching visitors not to visit if they are ill
ANS: B
Consistent practice of proper hand hygiene is the best method to prevent infection, as most healthcare-associated infections are due to staff members contaminated hands. Assessing the client and monitoring laboratory values will help the nurse catch signs of infection quickly but will not prevent infection from occurring. Teaching visitors not to come see the client when they are ill will also help prevent infection, but not to the degree that hand hygiene will.

DIF: Applying/Application REF: 401
KEY: Infection| infection control| hand hygiene
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

9. A client is admitted with fever, myalgia, and a papular rash on the face, palms, and soles of the feet. What action should the nurse take first?
a. Obtain cultures of the lesions.
b. Place the client on Airborne Precautions.
c. Prepare to administer antibiotics.
d. Provide comfort measures for the rash.
ANS: B
This client has manifestations of smallpox, a public health emergency, and should be placed on Airborne Precautions first before other care measures are implemented.

DIF: Applying/Application REF: 403
KEY: Infection| Transmission-Based Precautions
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

10. A client has been placed on Contact Precautions. The clients family is very afraid to visit for fear of being contaminated by the client. What action by the nurse is best?
a. Explain to them that these precautions are mandated by law.
b. Inform them that the infection is the issue, not the client.
c. Reassure the family that they will not get the infection.
d. Tell the family it is important that they visit the client.
ANS: B
Families and clients often have negative reactions to isolation precautions. The nurse can explain that the infection is the problem, not the client, and encourage them to visit because following the precautions will prevent them from acquiring the infection. The other options do not give the family useful information to help them make an informed decision.

DIF: Applying/Application REF: 403
KEY: Infection| infection control| Transmission-Based Precautions| communication
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Psychosocial Integrity

11. A nurse is caring for a client who has methicillin-resistant Staphylococcus aureus (MRSA) infection cultured from the urine. What action by the nurse is most appropriate?
a. Prepare to administer vancomycin (Vancocin).
b. Strictly limit visitors to immediate family only.
c. Wash hands only after taking off gloves after care.
d. Wear a respirator when handling urine output.
ANS: A
Vancomycin is one of a few drugs approved to treat MRSA. The others include linezolid (Zyvox) and ceftaroline fosamil (Teflaro). Visitation does not need to be limited to immediate family only. Hand hygiene is performed before and after wearing gloves. A respirator is not needed, but if splashing is anticipated, a face shield can be used.

DIF: Remembering/Knowledge REF: 406
KEY: Infection| antibiotics
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A hospitalized client is placed on Contact Precautions. The client needs to have a computed tomography (CT) scan. What action by the nurse is most appropriate?
a. Ensure that the radiology department is aware of the isolation precautions.
b. Plan to travel with the client to ensure appropriate precautions are used.
c. No special precautions are needed when this client leaves the unit.
d. Notify the physician that the client cannot leave the room for the CT scan.
ANS: A
Clients in isolation should leave their rooms only when necessary, such as for a CT scan that cannot be done portably in the room. The nurse should ensure that the receiving department is aware of the isolation precautions needed to care for the client. The other options are not needed.

DIF: Applying/Application REF: 403
KEY: Infection| Transmission-Based Precautions| communication
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

13. A client has a wound infection to the right arm. What comfort measure can the nurse delegate to the unlicensed assistive personnel (UAP)?
a. Elevate the arm above the level of the heart.
b. Order a fan to help cool the client if feverish.
c. Place cool, wet cloths on top of the wound.
d. Take the clients temperature every 4 hours.
ANS: A
Elevating the extremity above the level of the heart will help with swelling and pain. Fans are not recommended as they can disperse microbes. Having a cool, wet cloth on the wound may macerate the broken skin. Taking the clients temperature provides data but does not increase comfort.

DIF: Applying/Application REF: 401
KEY: Infection| nonpharmacologic comfort measures| delegation| unlicensed assistive personnel (UAP) MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

14. A nurse receives report from the laboratory on a client who was admitted for fever. The laboratory technician states that the client has a shift to the left on the white blood cell count. What action by the nurse is most important?
a. Document findings and continue monitoring.
b. Notify the provider and request antibiotics.
c. Place the client in protective isolation.
d. Tell the client this signifies inflammation.
ANS: B
A shift to the left indicates an increase in immature neutrophils and is often seen in infections, especially those caused by bacteria. The nurse should notify the provider and request antibiotics. Documentation and teaching need to be done, but the nurse needs to do more. The client does not need protective isolation.

DIF: Applying/Application REF: 408
KEY: Infection| antibiotics| laboratory values
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

15. A client has been admitted to the hospital for a virulent infection and is started on antibiotics. The client has laboratory work pending to determine if the diagnosis is meningitis. After starting the antibiotics, what action by the nurse is best?
a. Assess the client frequently for worsening of his or her condition.
b. Delegate comfort measures to unlicensed assistive personnel.
c. Ensure the client is placed on Contact Precautions.
d. Restrict visitors to the immediate family only.
ANS: A
Meningitis is a disease caused by endotoxins, which are released with cell lysis. Antibiotics often work by lysing cell membranes, which would increase the amount of endotoxin present in the clients body. The nurse should carefully monitor this client for a worsening of his or her condition. Delegating comfort measures is appropriate for any client. Clients with meningitis are placed on Droplet Precautions, and initiating isolation should have been done on admission. The client does not need to have visitors restricted.

DIF: Analyzing/Analysis REF: 398
KEY: Infection| Transmission-Based Precautions| antibiotics
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

1. The student nurse caring for clients understands that which factors must be present to transmit infection? (Select all that apply.)
a. Colonization
b. Host
c. Mode of transmission
d. Portal of entry
e. Reservoir
ANS: B, C, D, E
Factors that must be present in order to transmit an infection include a host with a portal of entry, a mode of transmission, and a reservoir. Colonization is not one of these factors.

DIF: Remembering/Knowledge REF: 398
KEY: Infection| pathophysiology MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. Which statements are true regarding Standard Precautions? (Select all that apply.)
a. Always wear a gown when performing hygiene on clients.
b. Sneeze into your sleeve or into a tissue that you throw away.
c. Remain 3 feet away from any client who has an infection.
d. Use personal protective equipment as needed for client care.
e. Wear gloves when touching client excretions or secretions.
ANS: D, E
Standard Precautions implies that contact with bodily secretions, excretions, and moist mucous membranes and tissues (excluding perspiration) is potentially infectious. Always wear gloves when coming into contact with such material. Other personal protective equipment is used based on the care being given. For example, if face splashing is expected, you should also wear a mask. Wearing a gown for hygiene is not required. Sneezing into your sleeve or tissue is part of respiratory etiquette. Remaining 3 feet away from clients is also not part of Standard Precautions.

DIF: Remembering/Knowledge REF: 402
KEY: Infection| infection control| Standard Precautions
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

3. The student nurse learns that effective antimicrobial therapy requires which factors to be present? (Select all that apply.)
a. Appropriate drug
b. Proper route of administration
c. Standardized peak levels
d. Sufficient dose
e. Sufficient length of treatment
ANS: A, B, D, E
In order to be effective, antimicrobial therapy must use the appropriate drug in a sufficient dose, for a sufficient length of time, and given via the appropriate route. Some antimicrobials do require monitoring for peak and trough levels, but not all.

DIF: Remembering/Knowledge REF: 409
KEY: Infection| antibiotics MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A client is being admitted with suspected tuberculosis (TB). What actions by the nurse are best? (Select all that apply.)
a. Admit the client to a negative-airflow room.
b. Maintain a distance of 3 feet from the client at all times.
c. Order specialized masks/respirators for caregiving.
d. Other than wearing gloves, no special actions are needed.
e. Wash hands with chlorhexidine after providing care.
ANS: A, C
A client with suspected TB is admitted to Airborne Precautions, which includes a negative-airflow room and special N95 or PAPR masks to be worn when providing care. A 3-foot distance is required for Droplet Precautions. Chlorhexidine is used for clients with a high risk of infection.

DIF: Applying/Application REF: 400
KEY: Infection| infection control| Transmission-Based Precautions
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

5. A student nurse asks the nursing instructor why older adults are more prone to infection than other adults. What reasons does the nursing instructor give? (Select all that apply.)
a. Age-related decrease in immune function
b. Decreased cough and gag reflexes
c. Diminished acidity of gastric secretions
d. Increased lymphocytes and antibodies
e. Thinning skin that is less protective
ANS: A, B, C, E
Older adults have several age-related changes making them more susceptible to infection, including decreased immune function, decreased cough and gag reflex, decreased acidity of gastric secretions, thinning skin, and fewer lymphocytes and antibodies.

DIF: Remembering/Knowledge REF: 398
KEY: Infection| older adult| immunity MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

6. A client with an infection has a fever. What actions by the nurse help increase the clients comfort? (Select all that apply.)
a. Administer antipyretics around the clock.
b. Change the clients gown and linens when damp.
c. Offer cool fluids to the client frequently.
d. Place ice bags in the armpits and groin.
e. Provide a fan to help cool the client.
ANS: B, C
Comfort measures appropriate for this client include offering frequent cool drinks, and changing linens or the gown when damp. Fever is a defense mechanism, and antipyretics should be administered only when the client is uncomfortable. Ice bags can help cool the client quickly but are not comfort measures. Fans are discouraged because they can disperse microbes.

DIF: Applying/Application REF: 409
KEY: Infection| infection control| comfort measures
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

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