NCLEX-PN infection control practice questions

Question 1

Four days after admission to an airborne infection isolation room, a 39-year-old client whose sputum smears are positive for acid-fast bacilli paces the room, says, "I can't stand being locked in here. I'm going home today," and begins packing a bag. Which of the following actions should the nurse take?

Accepted Answer

B: Stay with the client and ask what has been the hardest part of being in the room. Airborne isolation for tuberculosis means days to weeks in a single closed room, often far from family and work. Anxiety, boredom, anger, and a wish to leave are common. A client who walks out while still infectious is a risk to the public, and in most places the health department can legally require isolation, but a calm conversation is far more likely to keep the client in the room than a threat.

The nurse stays, uses a calm tone, and asks an open question about what has been hardest. That lets the client vent and tells the nurse what is driving the distress, whether it is boredom, worry about a job or children, cost, or fear. The nurse can then work with the client on what can change, such as a phone, a laptop, visits from family members already exposed, or a daily schedule, and report the client's distress to the registered nurse (RN) so a social work referral can follow.

Question 2

At a community HIV clinic, a client who was newly diagnosed with HIV infection started antiretroviral therapy (ART) 2 weeks ago. At a follow-up visit, the nurse collects data on how the client is coping with the diagnosis and the daily medication. Which statement by the client requires follow-up?

Accepted Answer

C: "I'd rather not see my friends right now, and the pills can wait until I feel better.". A new HIV diagnosis brings a period of shock, anger and grief, and those feelings are expected. What the nurse watches for is the move from distress into hopelessness and withdrawal, because that signals ineffective coping and possible depression.

This client describes two warning signs in one statement: withdrawing from friends and putting off the medication until some later point. The missed doses add a physical danger, because antiretroviral drugs only work when blood levels stay steady, and repeated gaps let the virus multiply and develop resistance. The nurse explores the statement further, asks directly about thoughts of self-harm, and reports it to the registered nurse (RN) and health care provider so that mental health support and adherence help can be arranged.

Question 3

The nurse on a medical unit is reviewing the transmission precautions for five clients with varicella-zoster virus infections. For each client, click to specify if the client requires standard precautions or airborne and contact precautions.

Accepted Answer

Shingles across several dermatomes on both sides of the trunk after a kidney transplant: Airborne and contact precautions; Shingles in one dermatome on the left side of the chest of a healthy 70-year-old: Standard precautions; Shingles in one dermatome of the face in a client taking high-dose corticosteroids: Airborne and contact precautions; Shingles on the back of a healthy adult with every lesion dried and crusted: Standard precautions; New chickenpox vesicles on the trunk and face of a 30-year-old: Airborne and contact precautions. Chickenpox and shingles are caused by the same virus, varicella-zoster. Chickenpox spreads through the air and through contact with fluid from the blisters. Shingles is the same virus reactivating along a nerve, and how far it can spread depends on how widely the rash is spread and on the client's immune system.

Chickenpox, and shingles that has spread across several dermatomes, called disseminated zoster, both release virus into the air. They need an airborne infection isolation room, an N95 respirator and gown and gloves until every lesion is dry and crusted. A client whose immune system is suppressed, such as a client taking high-dose corticosteroids, is placed on airborne and contact precautions even with a rash in one dermatome, until the health care provider has ruled out spread, because these clients can have virus in the blood and lungs before new lesions appear.

Question 4

A client with a systemic fungal infection is receiving conventional amphotericin B by intravenous infusion once daily. Before the next dose, the nurse reviews the morning laboratory results. Which result is most important for the nurse to report to the registered nurse (RN)?

Accepted Answer

C: Serum potassium of 3.0 mEq/L. Amphotericin B is a powerful antifungal with serious adverse effects. It damages the kidney tubules, which waste potassium and magnesium, so hypokalemia and hypomagnesemia are common, and the serum creatinine can rise. A potassium of 3.0 mEq/L, below the normal range of 3.5 to 5.0 mEq/L, can cause muscle weakness and dangerous dysrhythmias, so it is reported before the next dose so replacement can be prescribed.

Infusion reactions with fever, chills and rigors are also common, so the client is often premedicated with acetaminophen and diphenhydramine as prescribed, and the infusion runs slowly over several hours. The nurse monitors intake and output, the kidney function tests, the electrolytes and the client's temperature.

Premedicate as prescribed, infuse slowly, monitor creatinine and electrolytes.

Question 5

The registered nurse (RN) has completed the discharge teaching for a 54-year-old client on a medical unit who is going home today after treatment for a kidney infection. Which of the following actions may the nurse take during the client's discharge?

Accepted Answer

A: Remove the client's peripheral IV catheter and check that the catheter tip is intact; B: Reinforce the RN's teaching about taking every dose of the oral antibiotic until the course is finished; D: Check the client's identification band against the name on the discharge papers before handing them over. The nurse takes a full part in discharge, within scope. Removing a peripheral IV catheter is an LPN/VN skill, and checking that the tip is intact makes sure no piece of the catheter is left in the vein. Reinforcing teaching the RN has already given, such as finishing the whole antibiotic course so the infection does not return in a resistant form, is reinforcement, not initial teaching. Checking identity before handing over discharge papers prevents one client from going home with another client's medication list and instructions.

Question 6

A client on a medical unit is prescribed gentamicin. Which of the following infections would the nurse expect this medication to have been prescribed for?

Accepted Answer

D: A wound infection covering most of the body after third degree burns. Gentamicin is a strong antibiotic given intravenously for serious bacterial infections. It can harm the kidneys and hearing, so levels and kidney function are monitored.

Aminoglycosides are the last thing you reach for, not the first. They are reserved for serious, resistant, life-threatening gram-negative infections, because they work when nothing else does and because they are genuinely toxic to the ears and to the kidneys. A large burn colonized with resistant organisms is exactly that kind of infection.

The pattern is that an aminoglycoside is held back for a severe infection. Alongside big burns sit septic peritonitis, fulminating pyelonephritis and septic shock: infections that are killing the client or about to. Streptomycin and amikacin are also used in resistant tuberculosis, which is the one place the class steps outside the gram-negative rule, because the tuberculosis organism is neither gram negative nor gram positive.

Everything ordinary is treated with something else. Otitis media, sinusitis, strep throat, an uncomplicated bladder infection and anything viral are not severe infections, and putting a client's hearing and kidneys at risk for one of them is not a trade anybody would make.

Question 7

Two weeks after starting venlafaxine, a 46-year-old client with major depression has more energy, is attending all groups and asks the nurse to have the suicide precautions stopped. Which action should the nurse take first?

Accepted Answer

A: Ask the client directly about current thoughts of suicide and any plan. Depression is a treatable condition that causes persistent low mood or loss of interest, hopelessness and changes in sleep, appetite or thinking.

Suicide risk can rise during the first weeks of antidepressant treatment, because energy and motivation often return before the low mood and hopelessness lift. A client who once lacked the energy to act on suicidal thoughts may now have it. Before any change in observation, the nurse collects current data by asking directly about suicidal thoughts, intent and plan. The nurse reports the answers to the registered nurse (RN), and the health care provider decides whether the precautions can safely change.

Question 8

In a long-term care facility, a nursing student is setting up a sterile field to pack a deep pressure injury while the nurse observes. Which of the following actions by the student require follow-up?

Accepted Answer

A: Places a package of sterile gauze about 1/2 inch (1 cm) from the edge of the drape; B: Turns away from the sterile field to reach the supply cart; D: Keeps working after saline spills and soaks through the drape to the table. A pressure injury is localized damage to the skin and underlying tissue, usually over a bony prominence, caused by prolonged pressure or pressure plus shear.

The outer 1 inch (2.5 cm) of a sterile drape is considered contaminated, so sterile items must be placed inside that border. A sterile field that leaves the nurse's view can no longer be trusted to be sterile, so the nurse never turns away from it. A drape soaked through to a nonsterile surface lets organisms wick up into the field by strike-through, so the field is contaminated and must be set up again.

Question 9

A 70-year-old client in a skilled nursing facility has an indwelling urinary catheter 5 days after repair of a hip fracture. Which action by the nurse is most effective in reducing the risk of a catheter-associated urinary tract infection (CAUTI)?

Accepted Answer

A: Keep the drainage bag below bladder level and off the floor. A catheter-associated urinary tract infection is an infection of the urinary system caused or encouraged by an indwelling catheter. In older adults it may appear as sudden confusion with few urinary symptoms, and it can progress to more serious infection if untreated.

The urinary tract is the portal of entry, and organisms reach the bladder along the catheter or up the drainage system. Keeping the bag below the bladder stops urine from flowing back, and keeping it off the floor stops the bag and spout from picking up organisms. The CDC also recommends a closed drainage system, daily meatal hygiene with soap and water, and removal of the catheter as soon as it is no longer needed.

Question 10

The nurse is orienting a newly hired licensed practical nurse (LPN) on a surgical unit and watches the newly hired nurse put on sterile gloves before a sterile dressing change. Which of the following actions by the newly hired nurse indicate correct technique?

Accepted Answer

A: Opens the glove package on a clean, dry surface that is above waist level; B: Picks up the first glove by grasping the inside of its folded cuff with the other hand; C: Performs hand hygiene before opening the outer wrapper of the glove package; E: Slides the gloved fingers under the cuff of the second glove to pick it up. Sterile gloving keeps the outside of each glove sterile by letting skin touch only the inside of the glove. Hand hygiene comes first, because gloves can have tiny defects and the hands are contaminated again when the gloves come off. The package is opened on a clean, dry surface above the waist, because anything below the waist is out of sight and is considered contaminated, and a wet surface wicks organisms into the wrapper.

The first glove is lifted by its folded cuff, which is the part that will lie against the skin, so the bare hand touches only the inside. The second glove is lifted by sliding the gloved fingers under its cuff, so sterile touches sterile. Once both gloves are on, the hands stay above the waist and in front of the body. Watching a new staff member perform a skill and confirming it is done safely is part of verifying that staff can carry out the tasks they are given.

NCLEX-PN infection control practice questions.