Chapter 34: Infection Prevention and Control Nursing School Test Banks Potter & Perry: Fundamentals of Nursing, 7th Edition Test Bank MULTIPLE CHOICE

The client has a 6-inch laceration on his right forearm. The arm develops an infection. Which of the following is a sign of an acute inflammatory process? 1. A blanching of the skin 2. A decrease in temperature at the site 3. A decrease in the number of white blood cells 4. A release of histamine that adds to the pain response ANS: 4 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. The skin is not blanched; but rather, with the increase in local blood flow; it is reddened. The symptom of localized warmth results from a greater volume of blood at the inflammatory site. The cellular response of acute inflammation involves WBCs arriving at the site. There is an increase in WBCs, rather than a decrease. 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. Upon reviewing the results, the nurse will report which of the following findings to the physician, which is abnormal? 1. Erythrocyte sedimentation rate (ESR) 35 mm/hr 2. White blood cell (WBC) count 8000/mm3 3. Neutrophils 65% 4. Iron 75 g/100 mL ANS: 1 The normal erythrocyte sedimentation rate for women is 20 mm/hr. The client’s ESR is 35 mm/hr., indicating the presence of the inflammatory process. The normal WBC count is 5000-10,000/mm3. The client is within normal limits at 8000/mm3. The normal neutrophil count is 55-70%. The client is within normal limits at 65%. The normal iron level is 60-90 g/100 mL. The client is within normal limits at 75 g/100 mL. 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? 1. Washing hands before applying a dressing 2. Taping a plastic bag to the bed rail for tissue disposal 3. Placing a Foley catheter bag on the bed when transferring a client 4. Using alcohol to cleanse the skin before starting an intravenous line ANS: 3 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). Washing hands before applying a dressing is a correct action to help prevent a nosocomial infection. Taping a plastic bag to the bed rail for tissue disposal is a correct action to aid the client in proper disposal of secretions. Using alcohol to cleanse the skin before starting an intravenous line is a correct action to prevent a nosocomial infection of the bloodstream. 4. Droplet precautions will be instituted for the client admitted to the infectious disease unit with: 1. Streptococcal pharyngitis 2. Herpes simplex 3. Pertussis 4. Measles ANS: 1 Droplet precautions are instituted when droplets are larger than 5 micrometers, such as in the case of streptococcal pharyngitis. Contact precautions are instituted for herpes simplex. Airborne precautions are instituted with pulmonary TB. Airborne precautions are instituted with measles. 5. In a small rural hospital they work with a wide variety of clients. Of this afternoon clients admitted, the nurse acknowledges the client with the highest susceptibility to infection is the individual with: 1. Burns 2. Diabetes 3. Pulmonary emphysema 4. Peripheral vascular disease ANS: 1 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. Victims of chronic diseases such as diabetes mellitus and multiple sclerosis are susceptible to infection because of general debilitation and nutritional impairment. Diseases that impair body system defenses, such as emphysema and bronchitis (which impair ciliary action and thicken mucus), increase susceptibility to infection. Diseases that impair body system defenses, such as peripheral vascular disease (which reduces blood flow to injured tissues), increase susceptibility to infection. 6. A nurse must display understanding of the mental implications of a client on isolation precautions when planning care to control the risk of: 1. Denial 2. Aggression 3. Regression 4. Isolation ANS: 4 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. Denial is not a risk related to isolation. Aggression is not a risk for the client on isolation precautions. Regression is not a risk related to isolation. 7. Surgical aseptic techniques are employed by a nurse when: 1. Inserting an intravenous catheter 2. Placing soiled linen in moisture-resistant bags 3. Disposing of syringes in puncture-proof containers 4. Washing hands before changing a dressing ANS: 1 Surgical asepsis should be used during procedures that require intentional perforation of the client’s skin, such as with the insertion of IV catheters. The nurse is employing medical aseptic technique when placing soiled linen in moisture-resistant bags. The nurse is employing medical aseptic technique when disposing of syringes in puncture-proof containers. The nurse is employing medical aseptic technique when washing hands before changing a dressing. 8. A nurse is changing the dressing and accidentally drops the packing onto the client’s abdomen. The client has a large, deep abdominal incision that is packed with sterile half-inch packing and covered with a dry 4 x 4 gauze. The nurse should: 1. Add alcohol to the packing and insert it into the incision 2. Throw the packing away, and prepare a new one 3. Pick up the packing with sterile forceps, and gently place it into the incision 4. Rinse the packing with sterile water, and put the packing into the incision with sterile gloves ANS: 2 A sterile object (the packing) remains sterile only when touched by another sterile object. The client’s abdomen is not sterile; therefore, the nurse should throw the packing away and prepare a new one. The nurse should not add alcohol to the packing and insert it into the incision. The packing is considered contaminated as it touched a nonsterile surface and should be discarded. 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. 9. A client has a viral infection. Which of the following is typical of the illness stage of the course of her infection? 1. There are no longer any acute symptoms. 2. An oral temperature reveals a febrile state. 3. The client was first exposed to the infection 2 days ago but has no symptoms. 4. The client feels sick but is able to continue her normal activities. ANS: 2 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. There are no longer any acute symptoms during the convalescent period. 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. The client who feels sick but is able to continue normal activities is in the prodromal stage of a course of infection. 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? 1. Blood 2. Feces 3. Saliva 4. Vaginal secretions ANS: 2 To prevent the transmission of hepatitis A, the nurse needs to take special care when handling feces. Hepatitis B and C may be found in blood. Hepatitis A is not found in saliva. Hepatitis A is not found in vaginal secretions. 11. The parent of a preschool child asks the nurse how chickenpox (varicella zoster) is transmitted. The nurse identifies that the virus is: 1. Carried by a vector organism 2. Carried through the air in droplets after sneezing or coughing 3. Transmitted through person-to-person contact 4. Acquired through contact with contaminated objects ANS: 2 Varicella zoster virus (chickenpox) is transmitted by droplets carried through the air after sneezing or coughing. Varicella zoster virus (chickenpox) is not transmitted by a vector. Person-to-person contact is not responsible for varicella zoster virus (chickenpox) transmission. The transmission of varicella zoster virus (chickenpox) does not occur by contact with contaminated objects. 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? 1. Iron 80 g/100 mL 2. Neutrophils 65% 3. White blood cells (WBC) 18,000/mm3 4. Erythrocyte sedimentation rate (ESR) 15 mm/hr ANS: 3 An elevated WBC count is indicative of an acute infection. The normal WBC count is 5000 to 10,000/mm3. The normal neutrophil count is 55%-70%. The client is within normal limits at 65%. The normal iron level is 60-90 g/100 mL. The client is within normal limits at 80 g/100 mL. 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. 13. Which of the following is an example of a nursing intervention that is implemented to reduce a reservoir of infection for a client? 1. Covering the mouth and nose when sneezing 2. Wearing disposable gloves 3. Isolating client’s articles 4. Changing soiled dressings ANS: 4 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. Covering the mouth and nose when sneezing is an intervention to control a portal of exit. Wearing disposable gloves helps protect the susceptible host. Isolating client’s articles is an intervention to control transmission. 14. In preventing and controlling the transmission of infections, the single most important technique is: 1. Hand hygiene 2. The use of disposable gloves 3. The use of isolation precautions 4. Sterilization of equipment ANS: 1 The most important and most basic technique in preventing and controlling transmission of infections is hand hygiene. Use of disposable gloves may help reduce the transmission of infections, but is not the single most important technique to prevent and control the transmission of infections. The use of isolation precautions is not the single most important technique to prevent and control the transmission of infections. Sterilization of equipment is not the single most important technique to prevent and control the transmission of infections. 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: 1. Airborne precautions 2. Droplet precautions 3. Contact precautions 4. Reverse isolation ANS: 1 A client with active tuberculosis requires airborne precautions. A client with active tuberculosis does not require droplet precautions, as the droplet nuclei of tuberculosis are smaller than 5 micrometers. Contact precautions are not necessary for the client with active tuberculosis. Reverse isolation is not required for the client with active tuberculosis