Practice Infection Control Questions

I have completed an update on my infection control seminar. See if you can answer these questions.
If you want all the entire infection control quiz Click here.

6. The proper sequence of precautions for taking care of a pt on Infection Control Precautions are as follows : 1) Wash hands upon completion 2). Care for pt 3). Don mask/gown/gloves 4). Enter Room 5). Remove mask/gown/gloves 7. What type of precaution is used with persons that have Cytomegalovirus infection? A. Standard precautions B. Contact precautions C. Droplet precautions D. Airborne precautions 8. What illness/disease process requires the use of disposable dishware according to the center for disease control guidelines? Choose all that apply:

A. Tuberculosis B. MRSA (methicillin-resistant Staphylococcus aureus). C. Meningitis D. Chicken pox 9. What are the symptoms of Acinetobacter infection caused by pneumonia? Check all that apply: A. Fever B. Chills C. Sneezing D. Congestion E. Cough F. Runny Nose 10. When caring for someone on Contact Isolation. The following is true. 2 part answers must be entirely correct. Check all that apply: 1. Wear gloves for all contact with the patient, the patient's bedside equipment, and the patient's environment. a. Change gloves between distinctive tasks (e.g. wound care, perineal care, suctioning). b. Gloves must always be removed before leaving the room. 2. Wear a disposable gown for direct contact with the patient or the environment if the patient is incontinent, or has diarrhea or a draining wound.

a. Gowns are removed and placed in a special container for next use. b. Cloth gowns may be substituted if there is no risk of splash 3. As per Standard Precautions, wear a mask and protective eyewear when performing procedures that generate aerosols (Standard Precautions)

annelieseRN said... 6. 3,4,2,5 and 1, Everything you need to take care of your pt will be on a cart rightoutside the room. You put on the mask/gown/gloves before entering the room. You enterthe room and care for your pt. Before leaving, you remove mask/gown/gloves and washyour hands.7. A. Cytomegalovirus (CMV) (from the Greek cyto-, "cell", and -megalo-, "large") is aviral genus of the Herpesviruses group: in humans it is commonly known as HCMV orHuman Herpesvirus 5 (HHVTransmission of HCMV occurs from person to personthrough bodily fluids. Infection requires close, intimate contact with a person excretingthe virus in their saliva, urine, or other bodily fluids. CMV can be sexually transmittedand can also be transmitted via breast milk, transplanted organs, and rarelyfrom bloodtransfusions. Standards precautions are recommended by the CDC.8. A, and D. The general rule of thumb is any illness/disease that is airborne. Both TBand chickenpox are transmitted through the air. Meningitus is transmitted by largeparticle droplets. MRSA is transmitted via contact.9. A, B and E. According to the CDC, Acinetobacter causes a variety of diseases,ranging from pneumonia to serious blood or wound infections and the symptoms varydepending on the disease. Typical symptoms of pneumonia could include fever, chills, orcough. Acinetobacter may also colonize or live in a patient without causing infection orsymptoms, especially in tracheostomy sites or open wounds.10.1 and 3. Part A in answer number 2 is incorrect. Should read, Gowns may be wornone time only,

then disposed of in the regular (non-biohazardous) waste. Everything elsein this answer is correct.

How to Choose the Right Answer Decide What Dealing With: the Question is

Which part of the Nursing Process: Assessment; Analysis; Planning; Implementation or Evaluation? Next, Decide the Order of Priority First you must decide what part of the nursing process the question is connected with: ANALYSIS--is the process of identifying potential and actual health problems. Most identify pertinent assessment information and assimilate it into the nursing diagnosis. Prioritize the needs that have been identified during analysis. Some common words that are associated with ANALYSIS questions: diagnose; contrast; compare; analyze; order; prioritize; define; classify; catagorize; synthesize; sort; arrange; ASSESSMENT--consists of a collection of data. Baseline information for pre and post procedures is included. Also included the recognition of pertinent signs and symptoms of health problems both present and potential. Verification of data and confirmation of findings are also included. Assess a situation before doing an intervention.

Some common words that are associated with ASSESSMENT questions: observe; gather; collect; differentiate; assess; recognize; detect; distinguish; identify; display; indicate; describe; PLANNING--Involves formulating goals and outcomes. It also involves various members of the health care team and the patient's family. All outcome criteria must be able to be evaluated with a specific time frame. Be sure to establish priorities and modify according to question. Some common words that are associated with PLANNING questions: rearrange; reconstruct; determine; outcomes; formulate; include; expected; designate; plan; generate; short/long term goal; develop; IMPLEMENTATION--Addresses the actual/direct care of a patient. Direct care entails pre, intra and postoperative management, preforming procedures, treatments, activities of daily living. Also includes the coordination of care and referral on discharge. It involves documentation and therapeutic response to intervention and patient teaching for health promotion and helping the patient maintain proper health. Some common words that are associated with IMPLEMENTATION questions: document; explain; give; inform; administer; implement; encourage; advise; provide; perform; EVALUATION--Determines if the interventions were effective. Were goals met? Was the care delivered properly? Are modification plans needed. Addresses the effectiveness of patient teaching and understands and determines in proper care was

offered. Evaluation can involve documentation, reporting issues, evaluates care given and determine the appropriateness of delegating to others. Most significantly, it finds out the response of the patient to care and the extent to which the goals we met. Some common words that are associated with EVALUATION questions: monitor; expand; evaluate; synthesize; determine; consider; question; repeat; outcomes; demonstrate; reestablish; After determining what part of the nursing process the question is concerned with, next focus your attention on determining the category of priority: Safe and effective care environment is always first. Patient safety is related to the proper preparation and delivery of nursing techniques and procedures as part of the nursing practice. It relates to every aspect of the delivery of care. Physiologic integrity is the ability to provide competent care Information that may be described as traditionally medical- surgical and pediatric nursing falls into this category. Specific questions in this area can be related to many direct-care aspects of nursing practice. The importance of this area is highlighted because it is one in which planning, implementation and evaluation of care needs can easily be identified and tested. Physiologic integrity is always a slight lower priority than safety unless it involves airway, breathing and circulation. "ABC's" always comes first! Psychosocial integrity tests the knowledge about a patients response to a disease or disorder. An understanding of stress, anxiety and ways to cope

are essential. This is a lower priority the physiological integrity. Health maintenance deals with health promotion, health teaching, disease prevention and assessment of risk factors for health problems. Normal growth and development is a major theme in this category. This however, is a low priority. In Summary, when choosing the right answer for you NCLEX exam question 1) ask yourself, "what part of the nursing process is this question dealing with: analysis, assessment, planning, implantation or evaluation? and 2) Remember to prioritize your choices: safety always being first, 2)physiological integrity, 3)psychosocial integrity and health maintenance always has the lowest priority when choosing an answer. Other tidbits: avoid choices with the answers "all" "always" "never" or "none". Nothing is ever a definite in Science. look for answers that are different. If three answers say the same thing but in different words, choose the answer that is different. when given choices that are pharmacologically based or non pharmacologically based, choose the non pharmacological intervention. It is more often then not, the correct answer.

Prioritizing and Delegating in a Disaster

Okay, this is a much needed informational site that I put together to explain the difference between internal, natural and external disasters. The NCLEX is focusing a lot on this due to the advent of 9/11/2001 and the changing times we live in. What is meant by Internal Disaster was when the buildings actually started emploding [collapsing upon themselves] killing and/or trapping thousands of people inside. This is your INTERNAL DISASTER. You know more than you can handle will be hurt and or dead. What do you do? You are the head of the INTERNAL DISASTER MANAGEMENT TEAM. When a disaster happens INSIDE and enclosed place with lots of people, you help the people that are least hurt first. The reason being, so that they can possible help you, with the other survivors or you have very little time and you know you can move the victim and they have a chance to survive. In an INTERNAL DISASTER help and survival are KEY. How does this differ from a disaster from which they are now coming to your hospital? Now, we take all the people from the World Trade Center and now, they are start coming to your hospital. Of course, now you are over loaded. It is up to you as the triage nurse NOW to see the most traumatized person FIRST. The rest can wait. Once they are at their destination of medical care, the gear shifts, you help the more tramatized patient first to ensure their chances of survival. An EXTERNAL DISASTER can also be known as a

NATURAL DISASTER in some cases. This involves a disaster that occurs outside the hospital as well such as a plane crash, or a train wreck ect. To summarize the three types of disasters: an INTERNAL DISASTER is a large number of people wounded/hurt/dead in an enclosed place be it inside or outside. [ie: 9/11 with the explosion of the twin towers in New York or the Pentagon in Washington]. An EXTERNAL DISASTER is a disaster away from a medical center and it is "man made". [ie: Plan crash, train wreck or casualties of war]. In a NATURAL DISASTER, say the San Diago Bridge collapses or there is a giant volcano ect. Still use the same rule as in the 2001 ect above. Help the people off the bridge [the least wounded] before the bridge collapses. The goal here is to save lives. You can not do anything about the people whose cars have already fallen into the ocean or for the people to whom the fire has already engulfed. Once, you get the people into a save distance, then you do the whole triage thing helping the most wounded. Does that make it any clearer? Please continue to ask your questions. This is an important area of discussion. My goal personally, is not to answer the actual questions. You will never pass the nclex memorizing questions. We must understand CONCEPTS to pass the NCLEX. Now, let us move on to delegating in terms of

triage: How do you prioritize in a disaster? Remember the word T-R-I-A-G-E. Trauma, R=respiratory, Intracranial pressure & mental status, An infection, GI-upper, Elimination-lower. In that order. Prioritizing, starting with trauma first and lower GI injuries last. You will not need to know how to tag for the nclex but I place this here so that you can understand the concept.

Triage is a French verb that means "to sort". The goal of triage is to do the greatest good for the greatest numbers of individuals. This is accomplished by having a system to quickly assess each patient, categorize and prioritize them according to their needs. Be sure to evaluate the hazards before entering an area to perform triage. Triage should be initiated whenever there are more injured persons than rescuers. The four (4) triage categories and a description of their meanings are: Green is the lowest priority and is used for walking wounded or patients who may not need to go to the hospital. Patients in this category may have minor musculoskeletal or soft tissue injures. They can wait for treatment and/or transport until all other

patients have been removed from the scene. Moving up the tag, yellow is the next category and is used for patients who definitely need to go to a hospital, but not immediately. These patients have injuries that are serious but not life-threatening, such as burns without airway problems, major or multiple bone or joint injuries, and back injuries without spinal cord damage. These patients will be treated and transported after the critical (or red-tagged) patients have been taken to trauma centers or hospitals. The highest priority is red, and it is used for critically-injured patients with treatable life-threatening injuries or illnesses. This might include airway and breathing difficulties, decreased mental status, and uncontrolled bleeding. These patients will be treated and transported from the scene first. The final category is black and it is used for dead and unsalvageable patients such as someone in cardiac arrest. These victims will be removed from the scene, but only after all of the living/salvageable patients.

START Now METTAGs

in hand, you now begin the tremendous responsibility of organizing the chaos. Simple Triage And Rapid Treatment, or START, is a triage system that

was developed in California in the early 1980s. It is simple and fast, requiring less than sixty seconds for each patient. It does not require any special assessment or diagnostic tools. EMTs do not need a blood pressure cuff, a stethoscope or even a penlight. The system provides for rapid life saving stabilization such as airway control and bleeding control, but excludes CPR. A word here about cardiopulmonary resuscitation: CPR is not performed in these situations because two or three rescuers would be required to treat a single patient whose probability of survival (in the chaos) is zero-to-none. On the other hand, those same two or three rescuers could play an important role in treating five, ten, or maybe even more patients.

How to Start The

first (and easiest) thing you must do is separate the walking wounded from the other victims with more severe injuries. This can be done by shouting slowly and clearly or using a bullhorn. Designate an area for walking wounded and instruct anyone who can walk to get up and move to that area. (Note: Some victims may be unwilling to leave their friends or family members who are ill or injured; permit them to stay as they can help you with managing the patient.) The theory here is that if a person can walk, he does not need immediate medical care. Greentagged patients will not be ignored. Rather, they will be further assessed and treated

when all of the red and yellow patients have been treated and/or transported and resources become available to take care of them. All of the patients in this area are considered to be "green tags." Later you will return to the "green" area and "officially" tag them but only after you have triaged the red and yellow victims. With this green group in a separate (safe) location, you are well on the way to being organized.

Evaluating the Remaining Victims The

next step is to triage the remaining victims. By evaluating respiration, perfusion and mental status, you sort and separate them into three categories which give the greatest priority to those victims who are most critically injured, and have the greatest chance of survival. Let's quickly review our color-coded tags: Red Tag: those victims whose injuries are life-threatening and must be immediately treated and transported. Yellow Tag: those whose injuries will allow for delayed treatment and transport. Black Tag: those who are dead or unsalvageable.

How do we make that determination?

RPM.
R = Respirations The first assessment is for presence and rate of respiration (RPM). Is the victim breathing? If there is no respiratory effort, reposition his head and reassess. If there is still no respiratory effort, the victim is considered "dead/non-salvageable." Apply a black tag and move on to the next victim. What if he is breathing? Assess the rate. If the rate is above 30 breaths-per-minute, the patient is critical and requires immediate care. (Remember from your EMT-B class that a respiratory rate above 30 and below eight breaths-per-minute (BPM) is not adequate to meet the body's needs and may quickly progress to cellular death.) As triage officer, however, you do not stop to ventilate this patient! He is given a red tag and you move on to the next victim. You do not need to complete any other components of the START assessment on this patient. If the patient requires simple airway maintenance (e.g. manual head positioning), you will need to assign someone to this task. If no emergency service personnel are available, remember that you have a pool of human resources in the green tag area. If no one there is available, you will need to improvise by placing something under the

patient's head/neck to keep the airway open. It should also be noted here that airway maintenance might need to be done without standard cervical spine precautions. If the respiratory rate is less than 30 breathsper-minute, move on to the next part of the assessment process. P = Perfusion The next step is to assess for Perfusion (RPM). As you may remember from your EMT-B course or core refresher, perfusion is the circulation of blood within an organ or tissue in adequate amounts to meet the cells' current needs. If the body lacks adequate perfusion or circulation, cells, tissues, and organs will die. How do we assess perfusion in victims at an MCS? Check for the presence of radial pulses. However, note that we are not concerned with a pulse rate at this time. If the patient has no radial pulses, he is critical and in immediate need of care. You apply a red tag to the patient and move on to the next patient. If there are no radial pulses, there is no need to check for carotid pulses. Why not? If the patient does not have a carotid pulse, then he will also have no respiratory effort, and therefore, would have been triaged as dead/non-salvageable in the previous step. Recall also that the presence

of a radial pulse correlates to a systolic blood pressure of at least 80 to 90 mmHg. If radial pulses are present, move onto the next assessment. There is one other assessment-finding related to perfusion status which must be mentioned here: severe bleeding. Uncontrolled bleeding is potentially life threatening and must be treated when found. Again, you may have to improvise by using the cleanest piece of cloth around which may not be sterile. Do not forget your human resources available in the green area. Delegate someone to maintain direct pressure on the wound and move on to the next victim. Your job remains triage. M = Mentation The third and final assessment is for Mentation (RPM) or mental status. A patient who is either unconscious, or conscious but unable to follow directions, is critical and requires immediate care. You will apply a red tag to this patient and move on to the next victim. If the patient has a normal level of consciousness and can follow directions, he is not in immediate need of care and is triaged as yellow. As soon as a patient meets any one of the criteria for triage as critical/immediate,

you should apply a red tag, delegate someone to provide rapid treatment (e.g. maintain an airway or control bleeding), stop any further assessment and move on to the next victim. Any patient who makes it through all three assessments, without any findings that would result in triaging as critical/immediate, is given a yellow tag. No triage system is 100% fail safe. It is, however, reasonable to assume, that a patient who cannot walk, but is maintaining his own airway, breathing at a rate less than 30 breaths- per-minute, perfusing radial pulses, has no sign of uncontrolled bleeding and follows commands, is in need of medical attention at the hospital, but can wait until all of the critical/immediate (red tags) are removed from the scene. Secondary Triage Let's quickly review how START integrates with the METTAG system. Anyone who gets up and walks to the designated area is given a green tag (may not even require hospital care). Anyone who is not breathing is given a black tag (dead/non- salvageable). Anyone who fails one of the RPM assessments is given a red tag (critical/immediate). Anyone who cannot walk but passes all of the assessments is given a yellow tag (delayed).