Chapter 33: Infection Control Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. The client has a 6-inch laceration on his right forearm and an infection develops. Which of the following is a sign of an acute inflammatory process?

a.

A blanching of the skin

b.

A decrease in temperature at the site

c.

A decrease in the number of white blood cells

d.

A release of histamine that adds to the pain response

ANS: d

d. A sign of an acute inflammatory process is pain. The swelling of inflamed tissues increases pressure on nerve endings, causing pain. Chemical substances such as histamine also stimulate nerve endings, adding to the pain response.

a. The skin is not blanched, but rather with the increase in local blood flow, it is reddened.

b. The symptom of localized warmth results from a greater volume of blood at the inflammatory site.

c. The cellular response of acute inflammation involves WBCs arriving at the site, with an increase in WBCs, rather than a decrease.

REF: Text Reference: p. 778

2. A female client has been undergoing diagnostic testing since admission to the medical unit in the hospital. The results of blood testing are sent back to the unit. On reviewing the results, the nurse will report the following abnormal finding to the physician:

a.

Erythrocyte sedimentation rate (ESR), 35 mm/hr

b.

White blood cells (WBCs), 8,000/mm3

c.

Neutrophils, 65%

d.

Iron, 75 g/100 ml

ANS: a

a. The normal erythrocyte sedimentation rate for women is 20 mm/hr. The clients ESR is 35 mm/hr, indicating the presence of the inflammatory process.

b. The normal WBC count is 5,000 to 10,000/mm3. The client is within normal limits at 8,000/mm3.

c. The normal neutrophil count is 55% to 70%. The client is within normal limits at 65%.

d. The normal iron level is 60 to 90 g/100 ml. The client is within normal limits at 75 g/100 ml.

REF: Text Reference: p. 783

3. The nurse is observing the new staff member work with the client. Of the following activities, which one has the greatest possibility of contributing to a nosocomial infection and requires correction?

a.

Washing hands before applying a dressing

b.

Taping a plastic bag to the bed rail for tissue disposal

c.

Placing a Foley catheter bag on the bed when transferring a client

d.

Using alcohol to cleanse the skin before starting an intravenous line

ANS: c

c. The staff member who places the Foley catheter bag on the bed when transferring the client is placing the client at risk for a nosocomial infection because urine in the catheter or drainage tube may reenter the bladder (reflux).

a. Washing hands before applying a dressing is a correct action to help prevent a nosocomial infection.

b. Taping a plastic bag to the bed rail for tissue disposal is a correct action to aid the client in proper disposal of secretions.

d. Using alcohol to cleanse the skin before starting an intravenous line is a correct action to prevent a nosocomial infection of the bloodstream.

REF: Text Reference: p. 780

4. Droplet precautions will be instituted for the client admitted to the infectious disease unit with:

a.

Streptococcal pharyngitis

b.

Herpes simplex

c.

Pulmonary TB

d.

Measles

ANS: a

a. Droplet precautions are instituted when droplets are larger than 5 mm, such as in the case of streptococcal pharyngitis.

b. Contact precautions are instituted for herpes simplex.

c. Airborne precautions are instituted with pulmonary TB.

d. Airborne precautions are instituted with measles.

REF: Text Reference: p. 797

5. The nurse works in a small rural hospital with a wide variety of clients. Of the clients admitted this afternoon, the nurse recognizes that the individual with the highest susceptibility to infection is the individual with:

a.

Burns

b.

Diabetes

c.

Pulmonary emphysema

d.

Peripheral vascular disease

ANS: a

a. Burn clients have a very high susceptibility to infection because of the damage to skin surfaces. This would be the individual with the highest risk for infection.

b. Victims of chronic diseases, such as diabetes mellitus and multiple sclerosis, are susceptible to infection because of general debilitation and nutritional impairment.

c. Diseases that impair body-system defenses, such as emphysema and bronchitis (which impair ciliary action and thicken mucus), increase susceptibility to infection.

d. Diseases that impair body-system defenses, such as peripheral vascular disease (which reduces blood flow to injured tissues), increase susceptibility to infection.

REF: Text Reference: p. 781

6. The nurse shows an understanding of the psychological implications for a client on isolation when planning care to control the risk of:

a.

Denial

b.

Aggression

c.

Regression

d.

Isolation

ANS: d

d. A sense of loneliness may develop because normal social relationships become disrupted. The nurse should plan care to control the risk of the client feeling isolated.

a. Denial is not a risk related to isolation.

b. Aggression is not a risk for the client on isolation precautions.

c. Regression is not a risk related to isolation.

REF: Text Reference: p. 797, Text Reference: p. 798

7. The nurse uses surgical aseptic technique when:

a.

Inserting an intravenous catheter

b.

Placing soiled linen in moisture-resistant bags

c.

Disposing of syringes in puncture-proof containers

d.

Washing hands before changing a dressing

ANS: a

a. Surgical asepsis should be used during procedures that require intentional perforation of the clients skin, such as with the insertion of IV catheters.

b. The nurse is using medical aseptic technique when placing soiled linen in moisture-resistant bags.

c. The nurse is using medical aseptic technique when disposing of syringes in puncture-proof containers.

d. The nurse is using medical aseptic technique when washing hands before changing a dressing.

REF: Text Reference: p. 802

8. The client has a large, deep abdominal incision that requires a dressing. The incision is packed with sterile half-inch packing and covered with a dry 4 4 inch gauze. When changing the dressing, the nurse accidentally drops the packing onto the clients abdomen. The nurse should:

a.

Add alcohol to the packing and insert it into the incision

b.

Throw the packing away, and prepare a new one

c.

Pick up the packing with sterile forceps, and gently place it into the incision

d.

Rinse the packing with sterile water, and put the packing into the incision with sterile gloves

ANS: b

b. A sterile object (the packing) remains sterile only when touched by another sterile object. The clients abdomen is not sterile; therefore the nurse should throw the packing away and prepare a new one.

a. The nurse should not add alcohol to the packing and insert it into the incision.

c. The packing is considered contaminated, as it touched a nonsterile surface, and therefore should be discarded.

d. The nurse should not rinse the packing with sterile water and put the packing into the incision, as it is considered contaminated. It touched a nonsterile surface. The nurse should throw the packing away and prepare a new one.

REF: Text Reference: p. 802

9. A client has a viral infection. Which of the following is typical of the illness stage of the course of her infection?

a.

No longer are any acute symptoms observed.

b.

An oral temperature reveals a febrile state.

c.

The client was first exposed to the infection 2 days ago but has no symptoms.

d.

The client feels sick but is able to continue her normal activities. 

ANS: b

b. During the illness stage, the client manifests signs and symptoms specific to the type of infection. The client with a viral infection would likely exhibit a fever.

a. No acute symptoms appear during the convalescent period.

c. An example of a client in the incubation period is when the client was first exposed to the infection 2 days ago, but has no symptoms.

d. The client who feels sick but is able to continue normal activities is in the prodromal stage of a course of infection.

REF: Text Reference: p. 777

10. The nurse recognizes that special care must be taken in the handling of which of the following to prevent the transmission of hepatitis A?

a.

Blood

b.

Feces

c.

Saliva

d.

Vaginal secretions

ANS: b

b. To prevent the transmission of hepatitis A, the nurse must take special care when handling feces.

a. Hepatitis B and C may be found in blood.

c. Hepatitis A is not found in saliva.

d. Hepatitis A is not found in vaginal secretions.

REF: Text Reference: p. 775

11. The parent of a preschool child asks the nurse how chickenpox (varicella zoster) is transmitted. The nurse identifies that the virus is:

a.

Carried by a vector organism

b.

Carried though the air in droplets after sneezing or coughing

c.

Transmitted through person-to-person contact

d.

Acquired through contact with contaminated objects

ANS: b

b. Varicella zoster virus (chickenpox) is transmitted by droplets carried through the air after sneezing or coughing.

a. Varicella zoster virus (chickenpox) is not transmitted by a vector.

c. Person-to-person contact is not responsible for varicella zoster virus (chickenpox) transmission.

d. The transmission of varicella zoster virus (chickenpox) does not occur by contact with contaminated objects.

REF: Text Reference: p. 776

12. While working with clients in the postoperative period, the nurse is very alert to the results of laboratory tests. Which one of the following results is indicative of an infectious process?

a.

Iron 80g/100ml

b.

Neutrophils65%

c.

White Blood Cells (WBC) 18,000/mm3

d.

Erythrocyte sedimentation rate (ESR)15 mm/hr

ANS: c

c. An elevated WBC is indicative of an acute infection. The normal WBC count is 5000 to 10,000/mm3.

a. The normal neutrophil count is 55% to 70%. The client is within normal limits at 65%.

b. The normal iron level is 60 to 90g/100 ml. The client is within normal limits at 80 g/100 ml.

d. The normal erythrocyte sedimentation rate (ESR) is up to 15 mm/hr for men and up to 20 mm/hr for women. The client is within normal limits at 15 mm/hr.

REF: Text Reference: p. 783

13. The nurse is aware that it is important to break the chain of infection. An example of a nursing intervention that is implemented to reduce a reservoir of infection for a client is:

a.

Covering the mouth and nose when sneezing.

b.

Wearing disposable gloves.

c.

Isolating clients articles.

d.

Changing soiled dressings.

ANS: d

d. To control or eliminate reservoir sites for infection, the nurse eliminates or controls sources of body fluids, drainage, or solutions that might harbor microorganisms. The nurse also carefully discards articles that become contaminated with infectious material such as in changing soiled dressings.

a. Covering the mouth and nose when sneezing is an intervention to control a portal of exit.

b. Wearing disposable gloves helps protect the susceptible host.

c. Isolating clients articles is an intervention to control transmission.

REF: Text Reference: p. 788

14. The single most important technique to prevent and control the transmission of infections is:

a.

Hand hygiene

b.

The use of disposable gloves

c.

The use of isolation precautions

d.

Sterilization of equipment

ANS: a

a. The most important and most basic technique in preventing and controlling transmission of infections is hand hygiene.

b. Use of disposable gloves may help reduce transmission of infections, but is not the single most important technique to prevent and control the transmission of infections.

c. The use of isolation precautions is not the single most important technique to prevent and control the transmission of infections.

d. Sterilization of equipment is not the single most important technique to prevent and control the transmission of infections.

REF: Text Reference: p. 789

15. A client with active tuberculosis is admitted to the medical center. The nurse recognizes that admission of this client to the unit will require the implementation by the staff of:

a.

Airborne precautions

b.

Droplet precautions

c.

Contact precautions

d.

Reverse isolation

ANS: a

a. A client with active tuberculosis requires airborne precautions.

b. A client with active tuberculosis does not require droplet precautions, as the droplet nuclei of tuberculosis are smaller than 5 mm.

c. Contact precautions are not necessary for the client with active tuberculosis.

d. Reverse isolation is not required for the client with active tuberculosis.

REF: Text Reference: p. 797

16. The nurse recognizes the appropriate procedures for sterile asepsis. Of the following, which action is consistent with sterile asepsis?

a.

Clean forceps may be used to move items on the sterile field.

b.

Sterile fields may be prepared well in advance of the procedures.

c.

The first small amount of sterile solution should be poured and discarded.

d.

Wrapped sterile packages should be opened starting with the flap closest to the nurse.

ANS: c

c. Before pouring the solution into the container, the nurse pours a small amount (1 to 2 ml) into a disposable cap or plastic-lined waste receptacle. The discarded solution cleans the lip of the bottle. This action is consistent with sterile asepsis.

a. Sterile forceps should be used to move items on a sterile field when using sterile asepsis.

b. Sterile fields should not be prepared well in advance of a sterile procedure. A sterile object or field becomes contaminated by prolonged exposure to air.

d. Wrapped sterile packages should be opened starting with the flap farthest away from the nurse (i.e., the top flap).

REF: Text Reference: p. 805

17. The nurse suspects that an older adult client may be experiencing hypostatic pneumonia. Older adult clients may react differently to infectious processes, so the nurse is alert to atypical signs and symptoms, such as:

a.

Hypotension

b.

Confusion

c.

Erythema

d.

Chills

ANS: b

b. An infection in older adults may not demonstrate typical signs and symptoms. Atypical symptoms such as confusion, incontinence, or agitation may be the only symptoms of an infectious illness. An unexplained increased heart rate, confusion, or generalized fatigue may be the only symptoms of pneumonia in the older adult.

a. Hypotension is not one of the atypical symptoms of an older adult experiencing infection. It may be a symptom of a systemic infection related to an elevation in body temperature (regardless of age).

c. Erythema is a typical symptom of a localized infection.

d. Chills are a typical symptom of a systemic infection.

REF: Text Reference: p. 783

18. A nursing assistant is learning how to use protective equipment when caring for a client in isolation. The nursing assistant is instructed in the correct sequence for putting on the protective equipment that is to:

a.

Wash her hands, apply the mask and eyewear, put on the gown, and then apply gloves

b.

Apply the mask and eyewear, put on the gown, wash her hands, and then apply gloves

c.

Wash her hands, put on the gown, apply the mask and eyewear, then apply the gloves

d.

Put on the gown, apply the mask and eyewear, wash her hands, and then apply gloves

ANS: a

a. The correct sequence for putting on protective equipment is to perform hand hygiene, apply the mask and eyewear, apply gown, and then apply gloves.

b. This is not the correct sequence for putting on protective equipment.

c. This is not the correct sequence for putting on protective equipment.

d. This is not the correct sequence for putting on protective equipment.

REF: Text Reference: p. 795

19. A client requires a sterile dressing change for a mid-abdominal surgical incision. An appropriate intervention for the nurse to implement in maintaining sterile asepsis is to:

a.

Put sterile gloves on before opening sterile packages

b.

Discard packages that may have been in contact with the area below waist level

c.

Place the cap of the sterile solution well within the sterile field

d.

Place sterile items on the very edge of the sterile drape

ANS: b

b. A sterile object held below a persons waist is considered contaminated. To maintain sterile asepsis, discard packages that may have been in contact with the area below waist level.

a. Sterile gloves are not put on before opening sterile packages, as the outside of the packages are not sterile. The nurse uses hand hygiene and opens sterile packages being careful to keep the inner contents sterile.

c. After a cap or lid is removed, it is held in the hand or placed sterile side (inside) up on a clean surface. A bottle cap or lid should never rest on a sterile surface, even though the inside of the cap is sterile.

d. The edges of a sterile field are considered to be contaminated. Sterile items should be placed in the middle of the sterile field to maintain sterile asepsis.

REF: Text Reference: p. 802

20. The nurse is preparing to assist with a sterile procedure in the surgical suite. An appropriate technique that the nurse includes in the surgical scrub is to:

a.

Keep the hands below the elbows throughout the scrub

b.

Use a brush on the palms and dorsal surface of the hands

c.

Maintain the scrub for at least 2 to 5 minutes

d.

Wash well around all jewelry

ANS: c

c. A surgical scrub should be maintained for at least 2 to 5 minutes.

a. To avoid contamination during a surgical hand scrub, the nurse holds the hands above the elbows.

b. Several studies suggest that neither a brush nor a sponge is necessary to reduce bacterial counts on the hands, especially when an alcohol-based product is used.

d. For maximal elimination of bacteria, remove all jewelry.

REF: Text Reference: p. 805

21. A client is found to have methicillin-resistant Staphylococcus aureus (MRSA). An appropriate isolation procedure for the nurse to implement when working with this client is to:

a.

Leave all linen in the clients room

b.

Place specimen containers in plastic bags for transport

c.

Wipe the stethoscope before removing it from the room

d.

Remove the mask and goggles first when leaving the clients room

ANS: b

b. Specimen containers should be placed in plastic bags for transport with a label on the outside of the bag.

a. Linen should be placed in an impervious linen bag and may be removed from the clients room. Bags should be tied securely at the top with a knot.

c. For the person infected with MRSA, equipment remains in the room. After discharge or with the discontinuation of isolation, client care equipment is properly cleaned and reprocessed, and single-use items are discarded.

d. Gloves should be removed first when leaving the clients room.

REF: Text Reference: p. 796

22. A client is found to have a bacterial infection of Escherichia coli. The nurse, recognizing the effects of these bacteria, anticipates that the client will demonstrate:

a.

Diarrhea

b.

Coughing

c.

Cold sores around the mouth

d.

Discharge from the eyes

ANS: a

a. Escherichia coli causes gastroenteritis and urinary tract infections. The client with E. coli infection is likely to demonstrate diarrhea.

b. E. coli is found in the colon, not the respiratory tract.

c. Cold sores are seen with herpes simplex virus (type I), not with E. coli.

d. Discharge from the eyes is not seen with E. coli infection. It may be seen with Neisseria gonorrhea.

REF: Text Reference: p. 775

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