ATI LPN
Fundamentals of Nursing: The Art and Science of Person-Centered Care Tenth, North American Edition
Chapter 25 : Asepsis and Infection Control Questions
Question 1 of 5
When performing sterile wound irrigation and dressing change for a postoperative patient, a new graduate nurse creates a sterile field. Which actions require correction by the preceptor? Select all that apply.
Correct Answer: B,C
Rationale:
To add a sterile solution to a sterile field, the nurse opens the solution container according to directions and places the cap on the table away from the field with the edges up. The nurse then holds the bottle outside the edge of the sterile field with the label side facing the palm of the hand and pours from a height of 4 to 6 inches (10 to 15 cm) to prevent splashing. When donning sterile gloves, the thumb should not be held away from the glove to avoid contamination.
Question 2 of 5
A nurse has finished providing care for a patient in contact isolation for a MRSA infection. Place the steps the nurse should follow to remove PPE in the correct order.
Correct Answer: A,C,E,D,B
Rationale: If an impervious gown has been tied in front of the body at the waist, the nurse should untie the waist strings before removing gloves. Gloves are removed first because they are most likely to be contaminated, followed by the goggles, gown, and mask. Hands should be washed thoroughly after the equipment has been removed and before leaving the room.
Question 3 of 5
A nurse administering an injection to a patient who tested positive for HIV sustains a needlestick. What action should the nurse take first?
Correct Answer: B
Rationale: When a needlestick injury occurs, the nurse should wash the affected area immediately with warm water and soap, report the incident to the nurse manager or appropriate person and complete an injury report, consent to and await the results of blood tests, consent to PEP, and attend counseling sessions regarding safe practice to protect self and others.
Question 4 of 5
During morning huddle, a nurse manager and some nurses are identifying patients on the unit who are at risk for hospital-acquired infections (HAIs). Which patients will the nurses identify? Select all that apply.
Correct Answer: B,C,E,F
Rationale: Leukopenia (low white blood cell count), indwelling urinary catheters, central venous catheters, and surgeries in which the wound is classified as dirty have been implicated in most HAIs. Cigarette smoking and a vegetarian diet have not been implicated as risk factors for HAIs.
Question 5 of 5
A nurse is caring for a patient who is incontinent of stool and has developed a stage 3 pressure wound on the buttocks. What intervention will the nurse set as the priority of care?
Correct Answer: D
Rationale: The priority in this situation is to prevent infection through contamination of the wound by stool. The other actions may be taken as needed, after infection prevention is addressed.