ATI LPN
Fundamentals of Nursing: The Art and Science of Person-Centered Care Tenth, North American Edition
Chapter 25 Questions
Question 1 of 5
Nursing students enrolled in a medical-surgical nursing course are learning about infection control measures. They have learned that nurses use droplet precautions for patients with which infections? Select all that apply.
Correct Answer: A,F
Rationale: Rubella, diphtheria, and adenovirus infection are illnesses transmitted by large-droplet particles; droplet precautions and standard precautions are indicated. Airborne precautions refer to small, infectious particles spread through the air; for example, tuberculosis, varicella, and rubeola. Contact precautions are used for patients who are infected or colonized by a multidrug-resistant organism (MDRO), such as MRSA.
Question 2 of 5
When performing a dressing change requiring surgical asepsis, a nurse opens sterile supplies and dons sterile gloves. What additional action by the nurse is appropriate?
Correct Answer: A
Rationale: Avoiding splashing while pouring irrigant onto the sterile field is appropriate as moisture can contaminate the sterile field. Covering the nose and mouth with gloved hands during a sneeze would contaminate the gloves. Forceps soaked in disinfectant are not sterile. The outer 1 inch of the sterile field is considered contaminated, not sterile.
Question 3 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 4 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.
Question 5 of 5
A nursing student is performing hand hygiene after providing care to a patient who is in isolation for C. diff related to antibiotic therapy. Which actions by the nursing student will the primary nurse need to correct? Select all that apply.
Correct Answer: B,D
Rationale: After caring for patients with C. diff infection, proper handwashing includes using soap and water, then rinsing thoroughly with water flowing toward fingertips. Proper hand hygiene permits a plain wedding band to be worn; other jewelry is removed. The nurse uses about 1 teaspoon (5 mL) of liquid soap, using friction motion for at least 20 seconds, washing to 1 inch above the wrists using friction. Keeping hands higher than elbows is incorrect as it allows water to run from less clean to more clean areas.