Questão 1
Questão
A nurse is following the principles of medical asepsis when performing patient care in a hospital setting. Which nursing action performed by the nurse follows these recommended guidelines?
Responda
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The nurse carries the patient's soiled bed linens close to the body to prevent spreading microorganisms into the air
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The nurse places soiled bed linens and hospital gowns on the floor when making the bed
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The nurse moves the patient table away from the nurse's body when wiping it off after a meal
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The nurse cleans the most soiled items in the patient's bathroom first and follows with the cleaner items
Questão 2
Questão
A school nurse is performing an assessment of a student who states: I'm too tired to keep my head up in class. The student has a low-grade fever. The nurse would interpret these findings as indicating which stage of infection?
Responda
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Incubation period
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Prodromal stage
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Full stage of illness
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Convalescent period
Questão 3
Questão
A nurse is caring for patients in an isolation ward. In which situations would the nurse appropriately use an alcohol-based handrub to decontaminate the hands?
Responda
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The nurse is providing a bed bath for a patient
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The nurse has visibly soiled hands after changing the bedding of a patient
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The nurse removes gloves when patient care is completed
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The nurse is inserting a urinary catheter for a female patient
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The nurse is assisting with a surgical placement of a cardiac stent
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The nurse removes old magazines from a patient's table
Questão 4
Questão
A nurse is performing hand hygiene after providing patient care. The nurse's hands are not visibly soiled. Which steps in this procedure are performed correctly?
Responda
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The nurse removes all jewelry including a platinum wedding band
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The nurse washes hands to one inch above the wrists
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The nurse uses approximately two teaspoons of liquid soap
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The nurse keeps hands higher than elbows when placing under faucet
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The nurse uses friction motion when washing for at least 15 seconds
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The nurse rinses throroughly with water flowing toward fingertips
Questão 5
Questão
The nurse has opened the sterile supplies and put on two sterile gloves to complete a sterile dressing change, a procedure that requires surgical asepsis. The nurse must
Responda
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Keep splashes on the sterile field to a minimum
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Cover the nose and mouth with gloved hands if a sneeze is imminent
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Use forceps soaked in a disinfectant.
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Consider the outer 1 inch of the sterile field as contaminated
Questão 6
Questão
The nurse caring for patients in a hospital setting institutes CDC standard precaution recommendations for which category of patients?
Responda
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Only patients with diagnosed infections
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Only patients with visible blood, body fluids or sweat
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Only patients with nonintact sking
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All patients receiving care in hospitals
Questão 7
Questão
In addition to standard precautions, the nurse would initiate droplet precautions for which patients?
Responda
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A patient diagnosed with rubella
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A patient diagnosed with diptheria
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A patient diagnosed varicella
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A patient diagnosed with tuberculosis
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A patient diagnosed with MRSA
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An infant diagnosed with adenovirus infection
Questão 8
Questão
A nurse is preparing a sterile field using a packaged sterile drape for a confused patient who is scheduled for a surgical procedure. When setting up the field, the patient accidentally touches an instrument in the sterile field. What is the appropriate nursing action in this situation?
Responda
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Ask another nurse to hold the hand of the patient and continue setting up the field
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Remove the instrument that was touched by the patient and continue setting up the sterile field
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Discard the supplies and prepare a new sterile field with another person holding the patient's hand
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No action is necessary since the patient has touched his or her own sterile field
Questão 9
Questão
A nurse who created a sterile field for a patient is adding a sterile solution to the field. What is an appropriate action when performing this task?
Responda
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Place the bottle cap on the table with the edges down
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Hold the bottle inside the edge of the sterile field
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Hold the bottle with the label side opposite the palm of the hand
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Pour the solution from a height of 4-6 inches
Questão 10
Questão
A nurse is finished with patient care. How would the nurse remove PPE when leaving the room?
Responda
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Remove gown, goggles, mask, gloves, and exit the room
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Remove gloves, perform hand hygiene, then remove gown, mask and goggles
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Untie gown waistrings, remove gloves, goggles, gown, mask; perform hand hygiene
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Remove goggles, mask, gloves, gown and perform hand hygiene
Questão 11
Questão
A nurse who is caring for a patient diagnosed with HIV/AIDS incurs a needlestick injury when administering the patient's medications. What would be the priority action of the nurse following the exposure?
Responda
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Report the incident to the appropriate person and file an incident report
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Wash the exposed area with warm water and soap
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Consent to postexposure prophylaxis at appropriate time
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Set up counseling sessions regarding safe practice to protect self
Questão 12
Questão
The nurse assesses patients to determine their risk for health care-associated infections. Which hospitalized patient is most at risk for developing this type of infection?
Responda
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A 60 year old patient who smokes two packs of cigarettes daily
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A 40 year old patient who has a white blood cell count of 6,000mm
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A 65 year old patient who has an indwelling urinary catheter in place
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A 60 year old patient who is a vegetarian and slightly underweight
Questão 13
Questão
A nurse is caring for an obese 62 year old patient with arthritis who has developed an open reddened are over his sacrum. What is a priority nursing diagnosis for this patient?
Responda
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Imbalanced Nutrition: More Than Body Requirements related to immobility
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Impaired Physical Mobility related to pain and discomfort
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Chronic pain related to immobility
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Risk for infection related to altered skin integrity
Questão 14
Questão
A nurse teaches a patient at home to use clean technique when changing a wound dressing. This practice is considered:
Questão 15
Questão
A nurse is using personal protective equipment when bathing a patient diagnosed with C. difficile infection. Which nursing action related to this activity promotes safe, effective patient care?
Responda
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The nurse puts on PPE after entering the patient room
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The nurse works from clean ares to dirty areas during bath
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The nurse personalizes the care by substituting glasses for goggles
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The nurse removes PPE prior to leaving eh patient room.
Questão 16
Questão
Routine and nasal swabbing of a newly admitted hospital client has come back positive for methicillin-resistant Staphylococcus aureus (MRSA), indicating that the client is colonized by MRSA. The client is surprised at this finding, since he enjoys generally robust health. What should the client nurse teach him about this diagnostic finding?
Responda
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This finding becomes part of your medical record, but it is not a threat to yourself or others
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You may not develop any systems, but you may be given a round of antibiotics to eliminate this bacteria
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This means that this organism is present on your skin, but it doesn't necessarily mean that you will become sick
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It's very fortunate that this was detected early, since this had the potential to make you very sick
Questão 17
Questão
Which of the following are basic principles of surgical asepsis?
Responda
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Avoid talking, coughing, sneezing, or reaching over a sterile field
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Hold sterile objects at hip level or above
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Never turn your back on a sterile field
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Only a sterile object can touch another sterile object
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Forceps soaked in disinfectant can be used to place items on sterile fields
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Consider the outer one inch of a sterile field to be contaminated
Questão 18
Questão
Which of the following is an accurate guideline for the use of PPE?
Responda
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Put on PPE after entering the client's room
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When wearing gloves work from dirty areas to clean ones
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Substitute personal glasses for protective eyewear if desired
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Replace gloves if they are visibly soiled
Questão 19
Questão
A client on the surgical unit has developed an infection at the site of a laparoscopy. This type of infection is best termed as which of the following?
Responda
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Endogenous
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Antibiotic resistant
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Latrogenic
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Exogenous
Questão 20
Questão
The nurse is caring for a client who has active tuberculosis (TB) and is in Airborne Precautions. The primary care provider orders a computed tomography (CT) examination of the chest. Which of the following actions by the nurse is appropriate?
Responda
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Place a surgical mask on the client and transport to the CT department at the specified time
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Question the need of the examination because the client must remain in Airborne Precautions
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Request that the examination be done at the bedside
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Notify the CT department in advance so other clients and staff can be removed from the area
Questão 21
Questão
A nurse is caring for a client with urinary incontinence and acute diarrhea. What is the highest priority diagnosis for this client?
Responda
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Impaired walking
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Risk of loneliness
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Risk of infection
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Social isolation
Questão 22
Questão
When is hand hygiene with an alcohol based rub appropriate, as opposed to using handwashing?
Responda
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When hands have been in contact with blood or bodily fluids
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When hands have been in contact with blood or bodily fluids, but there is no visible soiling
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When hands are not visibly soiled
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Before eating and after using the restroom
Questão 23
Questão
Which of the following pieces of PPE should be removed first?
Responda
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goggles
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gloves
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gown
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respirator
Questão 24
Questão
A nurse is performing a venipuncture on a client and notices that there is a hole on one of the sterile gloves. What would be the appropriate action to take to maintain a sterile field?
Responda
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Stop the procedure, remove damaged gloves, perform handwashing, and open new sterile gloves
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Finish the procedure and perform hand washing immediately afterward
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Finish the procedure, remove damaged gloves, and open new sterile gloves
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Stop the procedure, remove damaged gloves, and open new sterile gloves
Questão 25
Questão
A nurse is caring for a child who is hospitalize for diptheria. Which one of the following guidelines would be appropriate when caring for this patient?
Responda
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use a private room with the door closed
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use respiratory protection when entering the room of client with known or suspected diptheria
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place client in private room that has monitored negative air pressure
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wear PPE when entering the room for all interactions that may involve contact with the client
Questão 26
Questão
An infection control nurse is discussing needle stick injuries with a group of newly hired nurses. The infection control nurse informs the group that most needlestick injuries result from which of the following?
Questão 27
Questão
An acute medical unit of a hospital currently has a number of clients who have tested positive for MRSA. Which of the following measures should the nursing staff prioritize in preventing the spread of MRSA to clients who are currently MRSA-negative?
Responda
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Diligent hand washing practices
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Reduce length of stay for MRSA-positive clients
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Constant use of gloves when on the unit
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Prophylactic antibiotic therapy for MRSA-negative clients
Questão 28
Questão
Which of the following is an accurate guideline for removing soiled gloves after client care?
Responda
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Use the non-dominant hand to grasp the opposite glove, near the cuffed end, on the outside exposed area
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Remove the glove on the non-dominant hand by pulling it straight off, keeping the contaminated area on the outside
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After removing the first glove, slide the fingers of the ungloved hand, between the remaining glove and the wrist and pull the glove straight off with the contaminated area on the outside
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After removing the glove, on the non-dominant hand, hold the removed glove in the remaining gloved hand
Questão 29
Questão
Unbeknown to him, a nursing student has inhaled droplets containing common cold viruses and is soon to develop a cold himself. Place the following stage of infection in the sequence in which they will occur.
1. [blank_start]Incubation period[blank_end]
2. [blank_start]Prodromal stage[blank_end]
3. [blank_start]Full stage of illness[blank_end]
4. [blank_start]Convalescent stage[blank_end]
Responda
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Incubation period
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Prodromal stage
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Full stage of illness
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Convalescent stage
Questão 30
Questão
Upon review of a client's microbiology culture results, the nurse recognizes which organisms as indicative of normal flora?
Responda
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Eschiricia coli in the intestinal tract
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Shigella in the urinary tract
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Shigella in the intestinal tract
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Eschiricia coli in the urinary tract
Questão 31
Questão
For which of the following clients, would the use of Standard Precautions alone be appropriate?
Responda
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A client with TB who needs medications administered
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A child with chickenpox who is treated in the ER
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A client with diptherea who needs pm care
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An incontinent client who lives in a nursing home who has diarrhea
Questão 32
Questão
A nurse follows surgical asepsis techniques for inserting an indwelling urinary catheter in a client. Which of the following is an accurate guideline for using this technique?
Responda
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Consider the outer 3 inch edge of a sterile field to be contaminated
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Open sterile packages so the first edge of the wrapper is directed toward you
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Consider the outside of the sterile package to be sterile
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Hold sterile objects above waist level to prevent accidental contamination
Questão 33
Questão
When caring for clients at the health care facility, the nurse knows that clients are susceptible to infections. Which of the following clients are at a greater risk for infection?
Responda
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Client with an IV catheter
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Client with an indwelling catheter
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Client with hypertension
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Client with gastric tube feeding
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Client with fever and chills
Questão 34
Questão
A nurse is taking care of a client with TB who has developed resistance to the ordered antibiotic. Which type of client is most likely at increase risk for infection?
Responda
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Older adult
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Pregnant
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Adult
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Child
Questão 35
Questão
Transit and residential bacterial flora can reside on the hands, so strict handwashing techniques are important. Where are resident bacteria most likely to reside?