Infection control practice questions

Question 1

The nurse is observing a nursing student set up a sterile field to change the dressing on a 60-year-old client's abdominal incision. Which of the following actions by the student would require the nurse to intervene?

Accepted Answer

B: Holds wet sterile forceps with the tips pointing upward while cleaning the incision; C: Drops a sterile gauze pad onto the field about half an inch from its edge; D: Turns away from the field to answer the client's question about pain medication. Surgical asepsis keeps an area free of all microorganisms. A sterile field stays sterile only while it is in view, above waist level, and touched only by sterile items, and its outer inch is considered contaminated because it borders unsterile surfaces.

A gauze pad landing half an inch from the edge is inside that contaminated border and is no longer sterile. Turning away means the field is out of sight and could be contaminated without anyone knowing, so it is treated as contaminated. Wet forceps held tips up let fluid run from the tips to the unsterile handle and back down onto the tips, carrying organisms with it; forceps are held tips down.

Question 2

While the nurse is drawing blood from a client with HIV infection, a specimen tube cracks and a small amount of blood spills onto the bedside table. Which action should the nurse take to clean the spill?

Accepted Answer

B: Wear gloves, absorb the blood and disinfect with a 1:10 bleach solution. Blood is treated as potentially infectious from every client, and this spill comes from a client known to have HIV. The goal is to remove the blood safely and then disinfect the surface.

The nurse puts on gloves, and eye protection if there is any risk of splashing, absorbs the blood with disposable towels, then cleans the area with a freshly made 1:10 dilution of household bleach, about one part bleach to nine parts water, or with an approved hospital disinfectant, and leaves it wet for the contact time on the label. The soaked towels go in a biohazard bag, and the gloves are removed and the hands washed. Any broken glass is picked up with tongs or a dustpan, never by hand.

Question 3

The nurse is caring for a client receiving chemotherapy whose absolute neutrophil count is 400/mm3 and platelet count is 18,000/mm3. For each intervention below, click to specify whether the intervention is intended to prevent infection or to prevent bleeding.

Accepted Answer

Remove fresh flowers and plants from the room: Prevent infection; Use an electric razor for shaving: Prevent bleeding; Avoid intramuscular injections: Prevent bleeding; Screen visitors for colds and other infections: Prevent infection; Give acetaminophen instead of aspirin for pain: Prevent bleeding; Report a temperature of 38.0 C (100.4 F) or higher at once: Prevent infection. The two problems need different protection. Neutropenia leaves the client unable to fight infection, so the measures keep germs away and catch infection early. Flowers and plants carry bacteria and molds, visitors with colds bring viruses, and a fever may be the only sign of a serious infection, because the client cannot form pus.

Thrombocytopenia leaves the client unable to stop bleeding, so the measures prevent injury and avoid anything that impairs clotting. A blade razor can cut the skin, an intramuscular injection can bleed into the muscle, and aspirin blocks platelet function.

Question 4

The charge nurse on an inpatient psychiatric unit is orienting a newly hired nurse who will observe a client on suicide precautions with checks every 15 minutes. Which of the following statements by the newly hired nurse would require follow-up?

Accepted Answer

A: "I will stop the checks overnight once the client has fallen asleep in bed."; E: "I will do the checks at exactly 0900, 0915, 0930, and 0945 so they are evenly spaced.". Checks every 15 minutes are the lowest level of suicide observation. They work only if they are unpredictable, thorough, and continued around the clock, and only if the room stays free of anything the client could use for self-harm.

Checks done at exactly the same minutes every quarter hour teach the client how long the gap is and when the nurse will not be looking. The checks are staggered at irregular times within each 15-minute window. Checks also continue through the night, and a sleeping client is seen well enough to confirm breathing and that the client is in fact asleep, because night hours with fewer staff are a high-risk time.

Question 5

While dropping a used needle into the sharps container after giving an IM injection to a client with HIV infection, the nurse sustains a puncture wound to the finger through the glove. Place the following actions in the order the nurse should perform them.

Accepted Answer

1: Remove the gloves; 2: Wash the puncture site with soap and running water; 3: Report the exposure to the charge nurse and employee health immediately; 4: Begin postexposure prophylaxis as prescribed, ideally within 2 hours of the exposure; 5: Complete an incident report describing how the exposure happened. A needlestick from a client with HIV infection carries a small but real risk of transmission, about 0.3% without treatment, and postexposure prophylaxis cuts that risk sharply when it is started early. The sequence protects the nurse first and then gets the drugs started as fast as possible.

The gloves come off so the wound can be reached, and the site is washed with soap and running water. The nurse then reports the exposure immediately, so employee health or the emergency department can assess the risk, test the nurse and the source client with consent and prescribe prophylaxis. Postexposure prophylaxis, usually a three-drug antiretroviral regimen taken for 28 days, works best when it begins within hours, ideally within 2 hours and no later than 72 hours. The incident report is completed afterward, once treatment has started.

Question 6

The clinic nurse is reviewing the medications of a 70-year-old client who is prescribed ciprofloxacin 500 mg orally every 12 hours for a urinary tract infection. The client also takes a calcium carbonate supplement with breakfast at 0800 and with lunch at 1200 for osteoporosis. Which plan for taking ciprofloxacin should the nurse recommend?

Accepted Answer

A: Take ciprofloxacin at 0600 and 1800, at least 2 hours before or 6 hours after the calcium. Ciprofloxacin is a fluoroquinolone antibiotic. Calcium, magnesium, aluminum, iron, and zinc bind to fluoroquinolones in the gut and form a complex the body cannot absorb, so much less antibiotic reaches the blood and the infection may not clear. The same happens with tetracyclines.

The fix is to separate them. Ciprofloxacin is taken at least 2 hours before or 6 hours after calcium, antacids, iron, zinc, and dairy foods taken on their own. A dose at 0600 is 2 hours before the 0800 calcium, and a dose at 1800 is 6 hours after the 1200 calcium, so both doses are absorbed and the 12-hour spacing stays.

Question 7

The clinic nurse receives a call from a 48-year-old client who has taken isoniazid 300 mg orally daily for latent tuberculosis infection for 2 months. The client reports 4 days of poor appetite, nausea, dark amber urine, and an ache under the right ribs. Which action should the nurse take?

Accepted Answer

D: Instruct the client to hold isoniazid and come in today for liver function tests. Isoniazid can cause hepatitis, and the risk rises with age, daily alcohol use, other liver disease and other drugs that affect the liver. Most cases appear in the first months. Loss of appetite, nausea, dark urine and pain in the right upper abdomen are the warning signs, and jaundice may follow. A client who keeps taking isoniazid with these symptoms can develop liver failure.

That is why every client on isoniazid is taught to stop the drug and call as soon as these symptoms begin, and why the nurse arranges liver function tests the same day. The health care provider decides whether and how treatment can continue. Pyridoxine (vitamin B6) is often given with isoniazid, but it prevents nerve damage, not liver injury.

Question 8

The nurse in the intensive care unit is caring for a 70-year-old client on day 4 of vancomycin 1,250 mg IV every 12 hours for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. The creatinine has risen from 1.0 mg/dL on admission to 1.9 mg/dL, and the trough level drawn 30 minutes ago is 26 mcg/mL (unit protocol target 15 to 20 mcg/mL). The next dose is due now. Which action should the nurse take?

Accepted Answer

A: Hold the dose and report the trough and creatinine to the health care provider. Vancomycin is an antibiotic used to treat serious bacterial infections, including MRSA.

Vancomycin is cleared almost entirely by the kidneys, and at high levels it injures the kidney tubules. The two problems feed each other. As the kidneys fail, the medication builds up, and the higher level damages the kidneys further.

A trough is the lowest level, drawn just before a dose, and it shows how much medication is still in the blood when the next dose would be added. This trough of 26 mcg/mL is above the target, and the creatinine has nearly doubled. Giving the dose now would push the level even higher. The nurse holds it and reports both results so the health care provider and pharmacist can lengthen the interval, lower the dose, or change the antibiotic.

Question 9

The charge nurse needs to place a newly admitted client with HIV infection and an absolute neutrophil count of 450 cells/mm3 in a semi-private room. Which roommate is most appropriate?

Accepted Answer

D: A client recovering from an uncomplicated hernia repair. Human immunodeficiency virus (HIV) is a virus that attacks the immune system's CD4 cells, which help the body fight infection.

A neutrophil count under 500 means this client is severely neutropenic and very vulnerable to infection. Ideally the client would have a private room. When a shared room is the only option, the roommate must be someone with no infection to pass on.

The client recovering from an uncomplicated hernia repair, with no signs of infection, is the only safe choice here.

Question 10

The nurse is making a home visit to a 34-year-old client who is recovering from hepatitis A. The client usually cooks for a spouse and two school-age children. Which instruction should the nurse give to prevent spread of the infection to the family?

Accepted Answer

C: Wash hands with soap and water after using the toilet and before preparing any food. Hepatitis A is a viral infection of the liver that spreads by the fecal-oral route. The virus leaves the body in the stool and reaches the next person on unwashed hands, on food, or in water. A client is most contagious in the 2 weeks before the jaundice appears and stays contagious for about a week after it starts.

For a client who cooks for the family, careful handwashing with soap and water after using the toilet and before touching food is the most important protection. Where possible, someone else does the cooking until the client is past the contagious period. The household contacts should also be offered the hepatitis A vaccine, which prevents illness when it is given within 2 weeks of exposure.

Infection control practice questions.