, Solution manual for Medical Assisting
Administrative & Clinical Competencies, 9th
Edition Michelle Blesi
Notes
1- The file is chapter after chapter.
2- We have shown you 10 or five pages.
3- The file contains all Appendix and Excel
sheet if it exists.
4- We have all what you need, we make
update at every time. There are many
new editions waiting you.
5- If you think you purchased the wrong file
You can contact us at every time, we can
replace it with true one.
Our email:
,
, Solution and Answer Guide:
Solution and Answer Guide
RODRIGUEZ, MICROBIOLOGY FOR SURGICAL TECHNOLOGISTS 2024, 9780357626153
TABLE OF CONTENTS
Under The Microscope................................................................................................................2
Chapter 1...................................................................................................................................2
Chapter 2...................................................................................................................................2
Chapter 3...................................................................................................................................3
Chapter 4...................................................................................................................................3
Chapter 5...................................................................................................................................4
Chapter 6...................................................................................................................................4
Chapter 7...................................................................................................................................5
Chapter 8...................................................................................................................................5
Chapter 9...................................................................................................................................6
Chapter 10.................................................................................................................................6
Chapter 11.................................................................................................................................7
Chapter 12.................................................................................................................................7
Chapter 13.................................................................................................................................7
Chapter 14.................................................................................................................................8
Chapter 15.................................................................................................................................8
Chapter 16.................................................................................................................................9
Chapter 17.................................................................................................................................9
Chapter 18...............................................................................................................................10
Chapter 19...............................................................................................................................10
Chapter 20...............................................................................................................................11
Chapter 21...............................................................................................................................11
Chapter 22...............................................................................................................................12
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1
website, in whole or in part.
, Solution and Answer Guide:
UNDER THE MICROSCOPE
CHAPTER 1
Microbiology research and its application to healthcare have been studied for centuries. The use of
traditional tools of Gram staining and Koch’s Postulates and subsequent advanced tools such as the
electron microscope over the past century have brought the impact of the microbial world on human
health into clear focus. The Centers for Medicare and Medicaid Services (CMS) have initiated revised
policies regarding reimbursement to hospitals for care of patients who suffer health-care-associated
infections (HAIs) such as SSIs. Hospitals must bear the costs of treatment of preventable infections
acquired in the course of their interaction with the medical profession which has the responsibility to
utilize the scientific foundation built by the experimental trials and errors of historical, recent, and current
pioneers in the war against disease and human suffering. Healthcare workers, including surgical team
members, are one critical key in preventing patient injury and protecting hospitals.
1. What are examples of a routine procedures performed by surgical technologists and other
surgical team members prior to entering the sterile field that would be part of aseptic technique?
ANSWER: 1.) Creation and maintenance of the sterile field with use of sterile instruments
and supplies only. 2.) Preparation of the patient’s skin with chemical antiseptic agents that
remove transient microbes and reduce the normal microbial populations to reduce the
potential for surgical site infection (SSI). 3.) Proper skin antisepsis used by all surgical
team members. 4.) Use of appropriate personal protective equipment (PPE) that serve as
2-way barriers that protect patients from contamination from surgical team members and
surgical team members from potential diseases the patient may have. 5.) Following
required vaccination protocols and refraining from exposing others (patients and
personnel) when ill. 6.) Strict adherence to one’s surgical conscience at all times.
2. List components of personal protective equipment (PPE) that serve as barrier protection for
patient and personnel interactions and correlate the various components applicable to the
procedures being performed.
ANSWER: 1.) Surgical masks (regular, N-95 respirator, laser) appropriate for the procedure
or transmissible infectious process the patient may have been diagnosed with previously
and potential inhalation by team members or other personnel. Also a dual protection for
patients from airborne or droplet particles from personnel. 2.) Gloves (unsterile or sterile)
appropriate to the procedure. Unsterile used for unsterile tasks and cleaning while sterile
gloves are used for sterile procedures. Often two pairs of sterile gloves are used for
additional protection or detection of barrier compromise (ex. colored under/indicator
gloves that make perforations more visible). 3.) Gowns (sterile for entry into the sterile
field and unsterile for contact precautions). Other types of body-cover PPE not related to
disease transmission include x-ray aprons (or wrap-around vests or skirts), thyroid
shields, or radiation glasses/goggles when x-ray, fluoroscopy, or other ionizing radiation
is used; or plastic (impermeable) aprons for high-fluid exposure. 4.) Hats, caps, or hoods
contain hair from the head or sideburns or beards to prevent shedding and contamination
of sterile areas. 5.) Eye protection in the form of goggles or face shields prevent exposure
by splash or splatter. 5.) Shoe or lower leg covers for protection of fluid penetration to
team members’ shoes or scrub pants below the level of the sterile surgical gown.
3. Which vaccinations are required for personnel in the operating room and why?
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 2
website, in whole or in part.
, Solution and Answer Guide:
ANSWER: Typically, students and personnel are required to demonstrate positive blood
titers (indicating active immunity) for measles/mumps/rubella, tuberculosis,
tetanus/diphtheria/pertussis, hepatitis B, and more recently annual vaccinations for
seasonal influenza and current COVID-19 vaccination protocols in many healthcare
facilities. Certain exemptions may apply for specific circumstances.
4. Which historical figures in medicine are credited with recognizing the need for aseptic techniques
to reduce wound infections?
ANSWER: Ignaz Semmelweis and Joseph Lister.
5. Which set of measures are used in addition to Standard Precautions when the disease status of a
surgical patient has been determined in advance?
ANSWER: Transmission-based precautions including airborne, droplet, and contact (direct
and indirect)
CHAPTER 2
Dev, a student taking the microbiology course pre-requisite to enter the surgical technology program, was
intrigued by a surgery-related article. As neurosurgery was Dev’s favorite surgical specialty, he chose this
topic for his research paper to discuss the connection between microbiology and his future profession.
The case in the article involved a craniotomy for biopsy in which the neurosurgeon advised the staff that
the patient was being assessed for symptoms of ataxia (loss of muscle coordination) and relatively
sudden onset of dementia. Tumors and any other intracranial lesions had been ruled out by radiographic
studies. The patient had lived in England approximately 10 years ago when there had been an outbreak
of “mad cow” disease.
1. What condition or disease process might the neurosurgeon suspect based on the patient’s history
as given?
ANSWER: Most likely Creutzfeldt-Jakob disease (CJD) or variant CJD (vCJD).
2. Using binomial nomenclature and taxonomy taught in the microbiology course, how would Dev
describe the other groups of organisms affected by this particular type of pathogen and general
category of disease?
ANSWER: Transmissible spongiform encephalopathies affect: Homo sapiens (humans)
from “CJD”; Bos taurus (cows) from “mad cow disease”; Ovis aries (sheep) from
“scrapie” ; large hooved animals (deer, elk, and moose) have other genus and species
names and may be affected by “chronic wasting disease.”
3. What type of infective agent is the cause for this form of transmissible spongiform
encephalopathy?
ANSWER: Prions.
4. Which scientific microbial classification system (if any) would contain this type of pathogen?
ANSWER: Prions would be grouped along with viruses, viroids, transposons, and
plasmids – all non-living pathogens included in the Two Empire System of Cellular and
Virus.
5. How would Dev describe the characteristics of the infective agents in this case as compared to
the other classes of microbes studied in his course?
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 3
website, in whole or in part.
, Solution and Answer Guide:
ANSWER: He would discuss the unique nature of the prions as proteinaceous infectious
particles that have no nucleic acids and no cellular structure. Their mechanism of
infection is an abnormal folding of normal prior proteins found in the central nervous
system (CNS) that cause holes in brain tissue eventually creating a sponge-like
appearance (spongiform encephalopathy). The disease is slow-progressing, but there is
no cure for CJD or vCJD and results are always fatal, unlike bacterial and viral infections
that affect the brain which may be survivable with treatment with antibiotics or antiviral
agents.
CHAPTER 3
During a microlaryngoscopy and bronchoscopy procedure, the surgeon retrieves a small bronchial tissue
specimen with a biopsy brush and a tissue biopsy from the larynx as well as culture swabs from the upper
airway. The surgical technologist assisting the surgeon uses a brush to smear the microscope slide held
by the circulator who sends the specimens and culture swabs to the lab immediately.
1. How would the smear be fixed to the slide?
ANSWER: One method is use of a flamed loop to spread a small bacterial sample
suspended in water or broth onto a slide which is allowed to air dry on the slide. The slide
is then passed over the flame from a Bunsen burner several times, smear side up which
kills the bacteria and fixes them to the glass slide. A second method is similar, but 100%
methanol is used to fix the smear.
2. What staining methods might be used for this smear and tissue biopsy?
ANSWER: 1.) Simple stain to determine shape of bacteria and basic structures. An
additive called a mordant may be used to increase the function of the stain. 2.) Differential
stains include Gram stain to distinguish bacteria from other groups by assessing the
bacterial walls’ ability to retain the specific stains used or not. Acid fast stains are
differential stains used to bind to bacteria with waxy chemical materials in their cell walls
(ex. Mycobacterium). 3.) Special stains are used to stain specific microbial structures
such as spores by negative staining for capsules or flagella staining.
3. Which laboratory personnel would be responsible for performing the preparation of the slides,
staining procedures, and final analysis of the specimen?
ANSWER: Laboratory technicians or technologists are typically the personnel who
perform the laboratory analyses; however, pathologists, histologists, microbiologists, and
other research scientists can also perform various laboratory tests.
4. What types of organisms might be identified by the various staining procedures?
ANSWER: 1.) Simple stains may be used for basic identification of nearly all types of
microbes. 2.) Gram staining will distinguish bacterial cells that retain the purple dye color
including Staphylococcus, Streptococcus, Clostridium, Actinobacteria, and Enterococcus.
Gram-negative bacteria that do not retain the purple dye and appear pink or red include
Neisseria, Treponema, Escherichia, Enterobacter, and Vibrio. 3.) Acid fasts stains are
most commonly used to distinguish waxy cell-walled bacteria such as Mycobacterium
tuberculosis. 4.) Capsule staining is used to identify spore-forming bacterial species
including Bacillus and flagella staining is typically used for Gram-positive rods including
Listeria and Gram-negative bacilli species.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 4
website, in whole or in part.
, Solution and Answer Guide:
5. What type of microscope would be necessary to visualize the organisms found in the smear and
tissue biopsies?
ANSWER: There are several types of microscopes that could be used, depending on the
specific laboratory studies that are appropriate to the tests ordered and include: 1)
compound light, 2) dark-field, 3) phase-contrast, 4) fluorescence, 5) electron, 6)
transmission electron (TEM), 7) scanning electron (SEM).
6. How would the culture swabs be prepared for incubation?
ANSWER: The culture swab will be transferred to appropriate culture media that meet
criteria including 1) contains species-specific nutrients that encourage growth of the
microbial colony present, 2) contains adequate moisture levels and pH, 3) oxygen amount
exposure or prevention, appropriate to microbial needs (aerobic or anaerobic), 4) sterile
media to prevent contamination from other sources, 5) optimal temperatures for microbial
growth.
Types of culture media agars that could be utilized include 1) enriched (blood or chocolate
agar); 2) selective (MacConkey, phenylethyl alcohol, Thayer-Martin, mannitol, colistin-
nalidixic acid, eosin methylene blue); 3) differential; 4) reducing media.
7. Which other types of serological or specialized analysis tests might also be performed to provide
a full diagnosis for this patient?
ANSWER: Serological studies include tests for antibodies by exposure to antisera
including enzyme-linked immunosorbent assay (ELISA) and the slide agglutination test.
Rapid identification testing is another method of microbial identification.
Specialized analyses might include: 1) catalase test, 2) coagulase test, 3) amino acid
sequencing, 4) phage typing, 5) flow cytometry, 6) nucleic acid hybridization, 7) nucleic
acid-base composition, 8) alternative biosensor technology, 9) hanging drop technique,
10) numerical taxonomy.
CHAPTER 4
A surgical technologist working in the Central Sterile Processing Department (CSPD) is asked to run the
steam sterilizer (autoclave) with a biological monitor for the first load of the day without any instrument
trays or items.
1. Which type of bacteria would most likely be used to test the autoclave?
ANSWER: Bacteria that are able to withstand high temperatures and moisture –
Geobacillus stearothermophilus.
2. Which bacterial characteristic demonstrates the required capability for lethality and whether
sterility was achieved when autoclaved?
ANSWER: The bacterial samples used are killed by the temperature achieved by the
autoclave that exceeds the bacteria’s optimal growth temperature.
3. In which domain would this type of microorganism be included?
ANSWER: Empire: cellular and Domain: prokaryotes/bacteria.
4. What are the characteristic morphological features of the biological indicator microbes?
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 5
website, in whole or in part.
, Solution and Answer Guide:
ANSWER: Spore formation or sporulation in which the genetic material is enclosed in a
capsule of several protein coats.
5. Discuss the morphological features of the prokaryotic bacterial cells and their pathogenicity in
humans.
ANSWER: Pathogenicity of bacteria is influenced by 1) opportunistic access to or
invasion of susceptible tissues, 2) secretion of exotoxins, 3) spore or capsule formation, 4)
antibiotic resistance 5) motility by flagella or pili, and potentially 6) biofilm formation.
CHAPTER 5
During certain surgical procedures, such as those for malignancy, the surgeon may request that sterile
water be used for irrigation instead of normal saline following excision of the cancerous mass.
1. How is water different from saline in terms of its tonicity?
ANSWER: Water is the primary solvent in living things and is hypotonic which means the
concentration of solutes outside the cell is lower than inside the cell. This means that
water will cross weak cell walls to cause rupture (lysis) or bursting of the cell due to the
excessive water intake. Saline is isotonic to human tissues which means the
concentration of solutes equals the number found inside a cell so water exits and enters
the cell at the same rate.
2. In this scenario, what effect on the residual malignant cells is the surgeon trying to achieve by use
of the sterile water?
ANSWER: The surgeon is attempting to cause lysis of any residual malignant cells by
subjecting them to the hypotonic water.
3. Compare and contrast the osmotic reactions that occur between eukaryotic and prokaryotic cells
when placed in hypertonic or hypotonic solutions.
ANSWER: Most bacteria live in hypotonic solutions and survive because the swelling
created by the imbalance between extracellular fluid and solutes within the bacterial cells
is managed by the presence of the bacterial cell wall not found in most eukaryotic cells
(except in algae, fungi, and plants).
Hypertonic solutions cause cellular water to exit the cell and enter the extracellular matrix
where the concentration of solutes is higher, causing cell shrinkage and death. The
plasma membrane of eukaryotic cells is covered by a glycocalyx that strengthens the
cell’s surface and helps it to attach cells together for protection.
4. Discuss the other differences between eukaryotic cells and prokaryotic cells.
ANSWER: Eukaryotic cells are more complex and typically much larger than prokaryotes;
they have a true nucleus that is enclosed within a membrane that prokaryotes do not have;
they have specialized structures called organelles found within the cytoplasm that are
membrane bound and not found in prokaryotes; and the cell walls or membranes are
relatively simple in chemical composition as compared to the complex PGN cell wall
structures.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 6
website, in whole or in part.
, Solution and Answer Guide:
CHAPTER 6
Dr. Mehta ordered an exchange of Foley catheter for her patient who was on high doses of
corticosteroids after kidney transplantation. She ordered a urine culture, then the replacement of the
catheter with a coated Foley to resist microbial invasion and prevent urinary tract infection (UTI).
1. What type of coating should make the urinary catheter be a safer choice for this patient?
ANSWER: Antimicrobial coating to prevent biofilm formation.
2. Which type of bacterial counts would most likely demonstrate the extent of the UTI?
ANSWER: The direct measurement, plate count method would provide the most accurate
extent of pathogenic microbes obtained from urine cultures. The disadvantage is the need
for 24 hours of incubation time.
3. Which types of physical or chemical requirements provided by the patient’s body would be
optimal and increase their population growth?
ANSWER: Optimal temperature; pH level; osmotic pressure; carbon, nitrogen, sulfur,
phosphorus, trace element, oxygen, and growth factors contribute to bacterial population
viability and growth.
4. What type of resistant bacterial contamination or colonization is common on implantable devices?
ANSWER: Biofilm formation of varied types of bacteria that congregate as communities
into a slimy, adherent, or almost solid mass resistant to removal or destruction.
5. Why would the prolonged time the catheter is left in place contribute to the risk of serious UTI in
this immunosuppressed patient?
ANSWER: The ability for the bacteria present on the indwelling catheter to utilize quorum-
sensing signals to amass into a biofilm colony that can adhere to both organic and
inorganic surfaces, spread to other areas when resources are depleted, and mutate to
become resistant to antibiotics given. Any reduction in normal immune response will pose
greater risk to a patient with need for long-term indwelling catheters to become
contaminated and override the natural inflammatory response protections of the body.
CHAPTER 7
Gabriela is a surgical technologist who often scrubs in orthopedic procedures. She recently found out she
is 10 weeks pregnant and is thrilled because she has been trying for some time. She has informed her
supervisor but finds herself scheduled to do a total hip replacement procedure with a surgeon who uses
UV light for control of microbial contamination in the operating room, PMMA (bone cement) for
stabilization of the joint prosthesis, and fluoroscopy to check the prosthetic implant placement.
1. Is Gabriela or the fetus at risk by scrubbing in on this type of procedure?
ANSWER: Yes, she is.
2. Which factors represent potential at risk for her and why?
ANSWER: The ionizing radiation from use of intraoperative fluoroscopy poses the
potential risk to her developing fetus as it is a mutagen that forms ions and free radicals
that can cause chromosomal damage, especially so early in fetal development. PMMA has
not been proven to have teratogenic effects, however, it is still an airway irritant from
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 7
website, in whole or in part.
Administrative & Clinical Competencies, 9th
Edition Michelle Blesi
Notes
1- The file is chapter after chapter.
2- We have shown you 10 or five pages.
3- The file contains all Appendix and Excel
sheet if it exists.
4- We have all what you need, we make
update at every time. There are many
new editions waiting you.
5- If you think you purchased the wrong file
You can contact us at every time, we can
replace it with true one.
Our email:
,
, Solution and Answer Guide:
Solution and Answer Guide
RODRIGUEZ, MICROBIOLOGY FOR SURGICAL TECHNOLOGISTS 2024, 9780357626153
TABLE OF CONTENTS
Under The Microscope................................................................................................................2
Chapter 1...................................................................................................................................2
Chapter 2...................................................................................................................................2
Chapter 3...................................................................................................................................3
Chapter 4...................................................................................................................................3
Chapter 5...................................................................................................................................4
Chapter 6...................................................................................................................................4
Chapter 7...................................................................................................................................5
Chapter 8...................................................................................................................................5
Chapter 9...................................................................................................................................6
Chapter 10.................................................................................................................................6
Chapter 11.................................................................................................................................7
Chapter 12.................................................................................................................................7
Chapter 13.................................................................................................................................7
Chapter 14.................................................................................................................................8
Chapter 15.................................................................................................................................8
Chapter 16.................................................................................................................................9
Chapter 17.................................................................................................................................9
Chapter 18...............................................................................................................................10
Chapter 19...............................................................................................................................10
Chapter 20...............................................................................................................................11
Chapter 21...............................................................................................................................11
Chapter 22...............................................................................................................................12
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1
website, in whole or in part.
, Solution and Answer Guide:
UNDER THE MICROSCOPE
CHAPTER 1
Microbiology research and its application to healthcare have been studied for centuries. The use of
traditional tools of Gram staining and Koch’s Postulates and subsequent advanced tools such as the
electron microscope over the past century have brought the impact of the microbial world on human
health into clear focus. The Centers for Medicare and Medicaid Services (CMS) have initiated revised
policies regarding reimbursement to hospitals for care of patients who suffer health-care-associated
infections (HAIs) such as SSIs. Hospitals must bear the costs of treatment of preventable infections
acquired in the course of their interaction with the medical profession which has the responsibility to
utilize the scientific foundation built by the experimental trials and errors of historical, recent, and current
pioneers in the war against disease and human suffering. Healthcare workers, including surgical team
members, are one critical key in preventing patient injury and protecting hospitals.
1. What are examples of a routine procedures performed by surgical technologists and other
surgical team members prior to entering the sterile field that would be part of aseptic technique?
ANSWER: 1.) Creation and maintenance of the sterile field with use of sterile instruments
and supplies only. 2.) Preparation of the patient’s skin with chemical antiseptic agents that
remove transient microbes and reduce the normal microbial populations to reduce the
potential for surgical site infection (SSI). 3.) Proper skin antisepsis used by all surgical
team members. 4.) Use of appropriate personal protective equipment (PPE) that serve as
2-way barriers that protect patients from contamination from surgical team members and
surgical team members from potential diseases the patient may have. 5.) Following
required vaccination protocols and refraining from exposing others (patients and
personnel) when ill. 6.) Strict adherence to one’s surgical conscience at all times.
2. List components of personal protective equipment (PPE) that serve as barrier protection for
patient and personnel interactions and correlate the various components applicable to the
procedures being performed.
ANSWER: 1.) Surgical masks (regular, N-95 respirator, laser) appropriate for the procedure
or transmissible infectious process the patient may have been diagnosed with previously
and potential inhalation by team members or other personnel. Also a dual protection for
patients from airborne or droplet particles from personnel. 2.) Gloves (unsterile or sterile)
appropriate to the procedure. Unsterile used for unsterile tasks and cleaning while sterile
gloves are used for sterile procedures. Often two pairs of sterile gloves are used for
additional protection or detection of barrier compromise (ex. colored under/indicator
gloves that make perforations more visible). 3.) Gowns (sterile for entry into the sterile
field and unsterile for contact precautions). Other types of body-cover PPE not related to
disease transmission include x-ray aprons (or wrap-around vests or skirts), thyroid
shields, or radiation glasses/goggles when x-ray, fluoroscopy, or other ionizing radiation
is used; or plastic (impermeable) aprons for high-fluid exposure. 4.) Hats, caps, or hoods
contain hair from the head or sideburns or beards to prevent shedding and contamination
of sterile areas. 5.) Eye protection in the form of goggles or face shields prevent exposure
by splash or splatter. 5.) Shoe or lower leg covers for protection of fluid penetration to
team members’ shoes or scrub pants below the level of the sterile surgical gown.
3. Which vaccinations are required for personnel in the operating room and why?
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 2
website, in whole or in part.
, Solution and Answer Guide:
ANSWER: Typically, students and personnel are required to demonstrate positive blood
titers (indicating active immunity) for measles/mumps/rubella, tuberculosis,
tetanus/diphtheria/pertussis, hepatitis B, and more recently annual vaccinations for
seasonal influenza and current COVID-19 vaccination protocols in many healthcare
facilities. Certain exemptions may apply for specific circumstances.
4. Which historical figures in medicine are credited with recognizing the need for aseptic techniques
to reduce wound infections?
ANSWER: Ignaz Semmelweis and Joseph Lister.
5. Which set of measures are used in addition to Standard Precautions when the disease status of a
surgical patient has been determined in advance?
ANSWER: Transmission-based precautions including airborne, droplet, and contact (direct
and indirect)
CHAPTER 2
Dev, a student taking the microbiology course pre-requisite to enter the surgical technology program, was
intrigued by a surgery-related article. As neurosurgery was Dev’s favorite surgical specialty, he chose this
topic for his research paper to discuss the connection between microbiology and his future profession.
The case in the article involved a craniotomy for biopsy in which the neurosurgeon advised the staff that
the patient was being assessed for symptoms of ataxia (loss of muscle coordination) and relatively
sudden onset of dementia. Tumors and any other intracranial lesions had been ruled out by radiographic
studies. The patient had lived in England approximately 10 years ago when there had been an outbreak
of “mad cow” disease.
1. What condition or disease process might the neurosurgeon suspect based on the patient’s history
as given?
ANSWER: Most likely Creutzfeldt-Jakob disease (CJD) or variant CJD (vCJD).
2. Using binomial nomenclature and taxonomy taught in the microbiology course, how would Dev
describe the other groups of organisms affected by this particular type of pathogen and general
category of disease?
ANSWER: Transmissible spongiform encephalopathies affect: Homo sapiens (humans)
from “CJD”; Bos taurus (cows) from “mad cow disease”; Ovis aries (sheep) from
“scrapie” ; large hooved animals (deer, elk, and moose) have other genus and species
names and may be affected by “chronic wasting disease.”
3. What type of infective agent is the cause for this form of transmissible spongiform
encephalopathy?
ANSWER: Prions.
4. Which scientific microbial classification system (if any) would contain this type of pathogen?
ANSWER: Prions would be grouped along with viruses, viroids, transposons, and
plasmids – all non-living pathogens included in the Two Empire System of Cellular and
Virus.
5. How would Dev describe the characteristics of the infective agents in this case as compared to
the other classes of microbes studied in his course?
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 3
website, in whole or in part.
, Solution and Answer Guide:
ANSWER: He would discuss the unique nature of the prions as proteinaceous infectious
particles that have no nucleic acids and no cellular structure. Their mechanism of
infection is an abnormal folding of normal prior proteins found in the central nervous
system (CNS) that cause holes in brain tissue eventually creating a sponge-like
appearance (spongiform encephalopathy). The disease is slow-progressing, but there is
no cure for CJD or vCJD and results are always fatal, unlike bacterial and viral infections
that affect the brain which may be survivable with treatment with antibiotics or antiviral
agents.
CHAPTER 3
During a microlaryngoscopy and bronchoscopy procedure, the surgeon retrieves a small bronchial tissue
specimen with a biopsy brush and a tissue biopsy from the larynx as well as culture swabs from the upper
airway. The surgical technologist assisting the surgeon uses a brush to smear the microscope slide held
by the circulator who sends the specimens and culture swabs to the lab immediately.
1. How would the smear be fixed to the slide?
ANSWER: One method is use of a flamed loop to spread a small bacterial sample
suspended in water or broth onto a slide which is allowed to air dry on the slide. The slide
is then passed over the flame from a Bunsen burner several times, smear side up which
kills the bacteria and fixes them to the glass slide. A second method is similar, but 100%
methanol is used to fix the smear.
2. What staining methods might be used for this smear and tissue biopsy?
ANSWER: 1.) Simple stain to determine shape of bacteria and basic structures. An
additive called a mordant may be used to increase the function of the stain. 2.) Differential
stains include Gram stain to distinguish bacteria from other groups by assessing the
bacterial walls’ ability to retain the specific stains used or not. Acid fast stains are
differential stains used to bind to bacteria with waxy chemical materials in their cell walls
(ex. Mycobacterium). 3.) Special stains are used to stain specific microbial structures
such as spores by negative staining for capsules or flagella staining.
3. Which laboratory personnel would be responsible for performing the preparation of the slides,
staining procedures, and final analysis of the specimen?
ANSWER: Laboratory technicians or technologists are typically the personnel who
perform the laboratory analyses; however, pathologists, histologists, microbiologists, and
other research scientists can also perform various laboratory tests.
4. What types of organisms might be identified by the various staining procedures?
ANSWER: 1.) Simple stains may be used for basic identification of nearly all types of
microbes. 2.) Gram staining will distinguish bacterial cells that retain the purple dye color
including Staphylococcus, Streptococcus, Clostridium, Actinobacteria, and Enterococcus.
Gram-negative bacteria that do not retain the purple dye and appear pink or red include
Neisseria, Treponema, Escherichia, Enterobacter, and Vibrio. 3.) Acid fasts stains are
most commonly used to distinguish waxy cell-walled bacteria such as Mycobacterium
tuberculosis. 4.) Capsule staining is used to identify spore-forming bacterial species
including Bacillus and flagella staining is typically used for Gram-positive rods including
Listeria and Gram-negative bacilli species.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 4
website, in whole or in part.
, Solution and Answer Guide:
5. What type of microscope would be necessary to visualize the organisms found in the smear and
tissue biopsies?
ANSWER: There are several types of microscopes that could be used, depending on the
specific laboratory studies that are appropriate to the tests ordered and include: 1)
compound light, 2) dark-field, 3) phase-contrast, 4) fluorescence, 5) electron, 6)
transmission electron (TEM), 7) scanning electron (SEM).
6. How would the culture swabs be prepared for incubation?
ANSWER: The culture swab will be transferred to appropriate culture media that meet
criteria including 1) contains species-specific nutrients that encourage growth of the
microbial colony present, 2) contains adequate moisture levels and pH, 3) oxygen amount
exposure or prevention, appropriate to microbial needs (aerobic or anaerobic), 4) sterile
media to prevent contamination from other sources, 5) optimal temperatures for microbial
growth.
Types of culture media agars that could be utilized include 1) enriched (blood or chocolate
agar); 2) selective (MacConkey, phenylethyl alcohol, Thayer-Martin, mannitol, colistin-
nalidixic acid, eosin methylene blue); 3) differential; 4) reducing media.
7. Which other types of serological or specialized analysis tests might also be performed to provide
a full diagnosis for this patient?
ANSWER: Serological studies include tests for antibodies by exposure to antisera
including enzyme-linked immunosorbent assay (ELISA) and the slide agglutination test.
Rapid identification testing is another method of microbial identification.
Specialized analyses might include: 1) catalase test, 2) coagulase test, 3) amino acid
sequencing, 4) phage typing, 5) flow cytometry, 6) nucleic acid hybridization, 7) nucleic
acid-base composition, 8) alternative biosensor technology, 9) hanging drop technique,
10) numerical taxonomy.
CHAPTER 4
A surgical technologist working in the Central Sterile Processing Department (CSPD) is asked to run the
steam sterilizer (autoclave) with a biological monitor for the first load of the day without any instrument
trays or items.
1. Which type of bacteria would most likely be used to test the autoclave?
ANSWER: Bacteria that are able to withstand high temperatures and moisture –
Geobacillus stearothermophilus.
2. Which bacterial characteristic demonstrates the required capability for lethality and whether
sterility was achieved when autoclaved?
ANSWER: The bacterial samples used are killed by the temperature achieved by the
autoclave that exceeds the bacteria’s optimal growth temperature.
3. In which domain would this type of microorganism be included?
ANSWER: Empire: cellular and Domain: prokaryotes/bacteria.
4. What are the characteristic morphological features of the biological indicator microbes?
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 5
website, in whole or in part.
, Solution and Answer Guide:
ANSWER: Spore formation or sporulation in which the genetic material is enclosed in a
capsule of several protein coats.
5. Discuss the morphological features of the prokaryotic bacterial cells and their pathogenicity in
humans.
ANSWER: Pathogenicity of bacteria is influenced by 1) opportunistic access to or
invasion of susceptible tissues, 2) secretion of exotoxins, 3) spore or capsule formation, 4)
antibiotic resistance 5) motility by flagella or pili, and potentially 6) biofilm formation.
CHAPTER 5
During certain surgical procedures, such as those for malignancy, the surgeon may request that sterile
water be used for irrigation instead of normal saline following excision of the cancerous mass.
1. How is water different from saline in terms of its tonicity?
ANSWER: Water is the primary solvent in living things and is hypotonic which means the
concentration of solutes outside the cell is lower than inside the cell. This means that
water will cross weak cell walls to cause rupture (lysis) or bursting of the cell due to the
excessive water intake. Saline is isotonic to human tissues which means the
concentration of solutes equals the number found inside a cell so water exits and enters
the cell at the same rate.
2. In this scenario, what effect on the residual malignant cells is the surgeon trying to achieve by use
of the sterile water?
ANSWER: The surgeon is attempting to cause lysis of any residual malignant cells by
subjecting them to the hypotonic water.
3. Compare and contrast the osmotic reactions that occur between eukaryotic and prokaryotic cells
when placed in hypertonic or hypotonic solutions.
ANSWER: Most bacteria live in hypotonic solutions and survive because the swelling
created by the imbalance between extracellular fluid and solutes within the bacterial cells
is managed by the presence of the bacterial cell wall not found in most eukaryotic cells
(except in algae, fungi, and plants).
Hypertonic solutions cause cellular water to exit the cell and enter the extracellular matrix
where the concentration of solutes is higher, causing cell shrinkage and death. The
plasma membrane of eukaryotic cells is covered by a glycocalyx that strengthens the
cell’s surface and helps it to attach cells together for protection.
4. Discuss the other differences between eukaryotic cells and prokaryotic cells.
ANSWER: Eukaryotic cells are more complex and typically much larger than prokaryotes;
they have a true nucleus that is enclosed within a membrane that prokaryotes do not have;
they have specialized structures called organelles found within the cytoplasm that are
membrane bound and not found in prokaryotes; and the cell walls or membranes are
relatively simple in chemical composition as compared to the complex PGN cell wall
structures.
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 6
website, in whole or in part.
, Solution and Answer Guide:
CHAPTER 6
Dr. Mehta ordered an exchange of Foley catheter for her patient who was on high doses of
corticosteroids after kidney transplantation. She ordered a urine culture, then the replacement of the
catheter with a coated Foley to resist microbial invasion and prevent urinary tract infection (UTI).
1. What type of coating should make the urinary catheter be a safer choice for this patient?
ANSWER: Antimicrobial coating to prevent biofilm formation.
2. Which type of bacterial counts would most likely demonstrate the extent of the UTI?
ANSWER: The direct measurement, plate count method would provide the most accurate
extent of pathogenic microbes obtained from urine cultures. The disadvantage is the need
for 24 hours of incubation time.
3. Which types of physical or chemical requirements provided by the patient’s body would be
optimal and increase their population growth?
ANSWER: Optimal temperature; pH level; osmotic pressure; carbon, nitrogen, sulfur,
phosphorus, trace element, oxygen, and growth factors contribute to bacterial population
viability and growth.
4. What type of resistant bacterial contamination or colonization is common on implantable devices?
ANSWER: Biofilm formation of varied types of bacteria that congregate as communities
into a slimy, adherent, or almost solid mass resistant to removal or destruction.
5. Why would the prolonged time the catheter is left in place contribute to the risk of serious UTI in
this immunosuppressed patient?
ANSWER: The ability for the bacteria present on the indwelling catheter to utilize quorum-
sensing signals to amass into a biofilm colony that can adhere to both organic and
inorganic surfaces, spread to other areas when resources are depleted, and mutate to
become resistant to antibiotics given. Any reduction in normal immune response will pose
greater risk to a patient with need for long-term indwelling catheters to become
contaminated and override the natural inflammatory response protections of the body.
CHAPTER 7
Gabriela is a surgical technologist who often scrubs in orthopedic procedures. She recently found out she
is 10 weeks pregnant and is thrilled because she has been trying for some time. She has informed her
supervisor but finds herself scheduled to do a total hip replacement procedure with a surgeon who uses
UV light for control of microbial contamination in the operating room, PMMA (bone cement) for
stabilization of the joint prosthesis, and fluoroscopy to check the prosthetic implant placement.
1. Is Gabriela or the fetus at risk by scrubbing in on this type of procedure?
ANSWER: Yes, she is.
2. Which factors represent potential at risk for her and why?
ANSWER: The ionizing radiation from use of intraoperative fluoroscopy poses the
potential risk to her developing fetus as it is a mutagen that forms ions and free radicals
that can cause chromosomal damage, especially so early in fetal development. PMMA has
not been proven to have teratogenic effects, however, it is still an airway irritant from
© 2022 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 7
website, in whole or in part.
