Which of the following infection control activity should be delegated to an experienced nursing assistant?
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Solution
Disinfecting blood pressure cuffs after clients are discharged.
Nursing assistants can follow agency protocol to disinfect items that come in contact wth intact skin by cleaning with chemicals such as alcohol.
Options A, B, and D: The other options should be carried out by a licensed nurse.
A client with a vancomycin-resistant enterococcus (VRE) infection is admitted to the medical unit. Which action can be delegated to a nursing assistant who is assisting with the client’s care?
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Solution
Implement contact precautions when handling the client.
All hospital personnel who care for the client are responsible for correct implementation of contact precautions.
Options B, C, and D: The other options should be carried out by a licensed nurse.
Malcolm is a newly assigned as a triage nurse, on his first day of work, the following clients arrive at the ED. Which among the client require the most rapid action to protect other clients in the ED from infection?
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Solution
A pregnant woman with a blister-like rash on the face and is possibly having varicella.
Chickenpox (Varicella) is transmitted by airborne and that can be easily transferred to the other clients in the emergency unit. The pregnant woman with the rash should be isolated right away from other clients through placement in a negative-pressure room.
Option A: The client who has been exposed to TB does not place the other clients at risk for infection because there are no symptoms of active TB.
Options B and D: Droplet and contact precautions should be instituted for the clients with pertussis and MRSA infection, but this can be done after isolating the client with possible varicella.
A newly admitted client with streptococcal pharyngitis (tonsillitis) has been placed on droplet precaution. Which of the following statements indicates the best understanding for this type of isolation?
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Solution
Must maintain a spatial distance of 3 feet.
The most common forms of transmission of an organism in a client with tonsillitis are through coughing, sneezing, and talking. Droplets can travel no more than 3ft so precautions should be maintained when there is a possibility of entering this distance.
Option A: Client requires a private room.
Option B: An N95 mask is not required for this client. A face mask instead can be used when dealing with the client.
Option D: Gloves, gowns, face mask and eye protection should be worn in giving direct care.
A 29-year-old client is diagnosed with scarlet fever. Which of the following is the most appropriate type of isolation for this client?
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Solution
Droplet.
Tonsillitis is contagious and is spread by droplet transmission.
You are preparing to care for a 6-year-old who has just undergone allogeneic stem cell transplantation and will need protective environmental isolation. Which nursing tasks will you delegate to a nursing assistant? Select all that apply.
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Solution
Answer: A. Posting the precautions for protective isolation o the door of the client’s room;
B. Stocking the client’s room with the needed PPE items; D. Reminding visitors to wear a respirator mask, gloves, and gown.
Because all staff who care for clients should be familiar with the various type of isolation, the nursing assistant will be able to stock the room and post the precautions on the client’s door. Reminding visitors about previously taught information is a task that can be done by the nursing assistant, although the RN is responsible for the initial teaching.
Options C and E: Client teaching and discussion of the reason for protective isolation fall within the RN-level scope of practice.
You are preparing to change the linens on the bed of a client who has a draining sacral wound infected by MRSA. Which PPE items will you plan to use. Select all that apply
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Solution
Answer: A. Gloves. E. Gown.
A gown and gloves should be used when coming in contact with linens that may be decontaminated by the client’s wound secretions.
Options B, C, and D: The other items are not necessary because transmission by splashes, droplets, or airborne means will not occur when the bed is changed.
You are preparing to leave the room after performing oral suctioning on a client who is on contact and airborne precautions. In which order will you perform the following actions?
1. Take off the gown.
2. Remove N95 respirator.
3. Perform hand hygiene.
4. Take off goggles.
5. Remove gloves.
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Solution
5, 4, 1, 2, 3
The sequence will prevent contact of the contaminated gloves and gowns with areas (such as your hair) that cannot be easily cleaned after client contact and stop transmission of microorganisms to you and your other clients.
As the infection control nurse in an acute care hospital, which action will you take to most effectively reduce the incidence of health-care-associated infections?
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Solution
Ensure that dispensers for alcohol-based hand rubs are readily available in all client care areas of the hospital.
Because the hands of health care workers are the most common means of transmission of infection from one client to another, the most effective method of preventing the spread of infection is to make supplies for hand hygiene readily available for staff to use.
Option A: Although some hospitals have started screening newly admitted clients for MRSA, there is no evidence that this decreases the spread of infection.
Option B: Because administration of antibiotics to individuals who are colonized by bacteria may promote the development of antibiotic resistance, antibiotic use should be restricted to clients who have clinical manifestations of infection.
Option D: Wearing a gown to care for clients who are not on contact precautions is not necessary.
A client has been diagnosed with disseminated herpes zoster. Which personal protective equipment (PPE) will you need to put on when preparing to assess the client? Select all that apply
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Solution
Answer: B. Gown. C. Gloves. E. N95 respirator.
Because herpes zoster is spread through airborne means and by direct contact with the lesions, you should wear an N95 respirator or high-efficiency particulate air filter respirator, a gown, and gloves.
Options A and D: Goggles and shoe covers are not needed for airborne or contact precautions.
Option F: Surgical face mask filters only large particles and will not provide protection from herpes zoster.
A client who states that he may have been contaminated by anthrax arrives at the ED. The following actions are part of the ED protocol for possible anthrax exposure or infection. Which action will you take first?
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Solution
Escort the client to a decontamination room.
To prevent contamination of staff or other clients by anthrax, decontamination of the client by removal and disposal of clothing and showering is the initial action in possible anthrax exposure.
Option B: Assessment of the client for signs of infection should be before decontamination.
Option C: Notification of security personnel is necessary in the case of possible bioterrorism, but this should occur before decontaminating and caring for the client.
Option D: According to the CDC guidelines, antibiotics should be administered only if there are signs of infection or the contaminating substance tests positive for anthrax.
You are the charge nurse on the pediatric unit when a pediatrician calls wanting to admit a child with rubeola (measles). Which of these factors is of most concern in determining whether to admit the child to your unit?
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Solution
No negative-airflow rooms are available on the unit.
Because clients with rubeola require implementation of airborne precautions, which include placement in a negative airflow room, this child cannot be admitted to the pediatric unit.
Options A, B, and C: The other circumstances may require actions such as staff reassignments but would not prevent the admission of a client with rubeola.
Which of the following information about a client who has meningococcal meningitis has the best indicator that you can discontinue droplet precautions?
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Solution
Appropriate antibiotics have been given for 24 hours.
Current CDC evidenced-based guidelines indicate that droplet precautions for clients with meningococcal meningitis can be discontinued when the client has received antibiotic therapy for 24 hours.
Options A, B, and C: The other information may indicate that the client’s condition is improving but does not indicate that droplet precaution should be discontinued.
A hospitalized 88-year-old client who has been receiving antibiotics for 10 days tells you that he is having frequent watery stools. Which action will you take first?
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Solution
Place the client on contact precaution.
The client’s age, history of antibiotic therapy, and watery stools suggest that he may have Clostridium difficile infection. The initial action should be able to place him on contact precautions to prevent the spread of C. difficile to other clients.
Options B, C, and D: The other actions are also needed and should be taken after placing the client on contact precautions.
You are caring for a newly admitted client with increasing dyspnea and dehydration who has possible avian influenza (bird flu). Which of these prescribed actions will you implement first?
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Solution
Provide oxygen using a non-rebreather mask.
Because the respiratory manifestations associated with avian influenza are potentially life-threatening, the nurse’s initial action should be to start oxygen therapy.
Options A, B, and D: The other interventions should be implemented after addressing the client’s respiratory problem.