Safety and Infection Control NCLEX Part #3 (25 Questions)

NCLEX-Question-3-001

While working in a pediatric clinic, you receive a telephone call from the parent of a 10-year-old who is receiving chemotherapy for leukemia. The client’s sibling has chickenpox. Which of these actions will you anticipate taking next?

• A. Administer varicella-zoster immune globulin to the client
• B. Educate the parent about the correct use of acyclovir (Zovirax) 
• C. Prepare the client for admission to a private room in the hospital
• D. Teach the parents regarding contact and airborne precaution

Correct Answer: A. Administer varicella-zoster immune globulin to the client

Varicella-zoster immune globulin administration can prevent the development of chickenpox in high-risk clients and will typically be prescribed. The varicella-zoster immunoglobulin is used to manage patients who are immunocompromised. In addition, a live attenuated vaccine has been available since 1995. There is high seroconversion following the vaccine which is long lasting. Adverse effects of the vaccine are rare.

• Option B: In children, acyclovir decreases symptoms by one day if taken within 24 hours of the start of the rash, but it has no effect on complication rates, and it is not recommended for individuals with normal immune function.
• Option C: Hospitalization may be required if the child develops a varicella-zoster virus infection. For most children who develop chickenpox, the outcome is excellent. However, in immunocompromised individuals, there is increased morbidity and mortality.
• Option D: Contact and airborne precautions will be implemented to prevent the spread of infection to other children if the child develops varicella. It is acquired by inhalation of infected aerosolized droplets. This virus is highly contagious and can spread rapidly. The initial infection is in the mucosa of the upper airways.

NCLEX-Question-3-002

Which action will you take to most effectively reduce the incidence of hospital-associated urinary tract infections?

• A. Ensure that clients have enough adequate fluid intake
• B. Teach assistive personnel how to provide good perineal hygiene
• C. Perform dipstick urinalysis for clients with risk factors for UTI
• D. Limit the use of indwelling foley catheter (IFC)

Correct Answer: D. Limit the use of indwelling foley catheter (IFC)

The most effective way to reduce the incidence of UTIs in the hospital setting is to avoid using retention catheters. Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine.  Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay.  The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter.

• Option A: Adequate fluid intake may improve the symptoms of UTI, however, it can help mildly with the prevention of  hospital-acquired UTI. The DRInK-Up study provides preliminary evidence suggesting that increasing daily fluid intake by small amounts may have a potentially positive effect on the number of UTIs experienced. However, further research is still needed.
• Option B: Routine hygiene of the urethral meatus surface should be performed during daily bathing or showering. Urethral cleaning with povidone-iodine solution or soap and water has not been shown to prevent CA-UTIs. However, there is evidence that frequent urethral cleaning can lead to mucosal irritation and breakdown that may increase the risk of infection.
• Option C: Avoid breaking the collecting system to obtain urine specimens for analysis and bacterial culture. To obtain urine specimens, the sampling port for the urine collection must be used. If this is not available, urine can be aspirated with a sterile needle and syringe from the distal end of the catheter using aseptic technique. 

NCLEX-Question-3-003

You are caring for a client who has been admitted to the hospital with a leg ulcer that is infected with vancomycin-resistant S. aureus (VRSA). Which of these nursing actions can you delegate to an LPN/LVN?

• A. Assess risk for further skin breakdown
• B. Plan ways to improve the client’s oral protein intake
• C. Obtain wound cultures during dressing changes
• D. Educate the client about home care of the leg ulcer

Correct Answer: C. Obtain wound cultures during dressing changes.

LPN/LVN education and scope of practice include performing dressing changes and obtaining specimens for wound culture. It is within the scope of practice of a licensed practical nurse (LPN) to contribute to the initial assessment of wounds through the gathering and recording of assessment data and to perform basic and advanced wound care in collaboration with the RN or licensed independent practitioner (LIP) on an ongoing basis.

• Option A: The scope of practice for the registered nurse will most likely include the legal ability of the registered professional nurse to perform all phases of the nursing process including assessment, nursing diagnosis, planning, implementation and evaluation.
• Option B: Only RNs can develop the care plan and make changes, although LPNs can contribute suggestions. All of these skills are taught in nursing school but are not included in the LPN curriculum, which is focused on bedside tasks.
• Option D: Teaching is a complex action that should be carried out by a licensed nurse. An LPN can reinforce an RN’s patient teaching, but not perform independent patient education or assessments.

NCLEX-Question-3-004

You are the pediatric unit charge nurse today and are working with a new RN. Which action by the new RN requires the most immediate action on your part?

• A. The new RN wears goggles to change linens of a client who has diarrhea caused by C. difficile.
• B. The new RN places a child who has chemotherapy-induced neutropenia into a negative-pressure room.
• C. The new RN admits a new client with respiratory syncytial virus (RSV) infection to a room with another child who has RSV.
• D. The new RN tells the nursing assistant to use an N95 respirator mask when caring for a child who has pertussis.

Correct Answer: B. The new RN places a child who has chemotherapy-induced neutropenia into a negative-pressure room.

Clients who are neutropenic should be placed in positive-airflow rooms; placement of the child in a negative airflow room will increase the likelihood of infection for this client. Clean, filtered air is constantly pumped into the room. This is done to keep contagious diseases out of the room. With this type of isolation room, the client may be able to feel air blowing out of the room under a closed door.

• Option A: Goggles are not needed for changing the linens of clients infected with C. difficile; however, these protections do not increase the risk to the clients. Healthcare providers will put on gloves and wear a gown over their clothing while taking care of clients with C. diff. Visitors may also be asked to wear a gown and gloves. When leaving the room, hospital providers and visitors remove their gown and gloves and clean their hands.
• Option C: Although private rooms are preferred for clients who need droplet precautions, such as clients with RSV infection, they can be placed in rooms with other clients who are infected with the same microorganism.
• Option D: The use of an N95 respirator is not necessary for pertussis. Wearing a surgical mask within 3 feet of the client provides protection from the spread of pertussis. Oftentimes, close household contacts are the source of the child’s infection; therefore, providers should also wear masks when within 3 feet of symptomatic parents or siblings.

NCLEX-Question-3-005

A client comes to the outpatient clinic where you work complaining of abdominal pain, diarrhea, shortness of breath and epistaxis. Which of the following actions would you take first?

• A. Screening clients for upper respiratory tract symptoms
• B. Call an ambulance to take the client immediately to the hospital
• C. Ask the client about any recent travel to Asia or the Middle East
• D. Determine whether the client has had recommended immunizations

Correct Answer: C. Ask the client about any recent travel to Asia or the Middle East.

The client’s clinical manifestation suggests possible avian influenza  (bird flu). If the client has traveled recently in Asia or the Middle East, where outbreaks of bird flu have occurred, you will need to institute airborne and contact precautions immediately. The other actions may also be appropriate but are not the initial action to take for this client, who may transmit the infection to other clients or staff members

• Option A: Most patients present with symptoms consistent with a flu-like viral illness. In these patients, especially during a known avian influenza outbreak, a thorough history is necessary to evaluate for clues that the illness is due to avian influenza.
• Option B: Whenever there is a possible outbreak of avian influenza, the essential way to reduce the severity and population impact are to reduce the spread of the virus. Since human-to-human transmission is uncommon, the focus should be on reinforcing appropriate sanitation habits in the population, especially those that work around birds or that are involved in food preparation.
• Option D: There is currently an FDA-licensed vaccine for the H5N1 strain of avian influenza in the United States. In the case of an H5N1 outbreak in the United States, the CDC and public health officials may decide to vaccinate at-risk populations to reduce spread.

NCLEX-Question-3-006

A client who has recently traveled to China comes to the emergency department (ED) with increasing shortness of breath and is strongly suspected of having a severe acute respiratory syndrome (SARS). Which of these prescribed actions will you take first?

• A. Obtain blood, urine, and sputum for cultures
• B. Infuse normal saline at 100ml/hr
• C. Administer methylprednisolone (Solu-Medrol) 1 gram/IV
• D. Place the client on contact and airborne precautions

Correct Answer: D. Place the client on contact and airborne precautions.

Since SARS is a severe disease with a high mortality rate, the initial action should be to protect other clients and health care workers by placing the client in isolation. If an airborne-agent isolation (negative pressure) room is not available in the ED, droplet precautions should be initiated until the client can be moved to a negative-pressure room.

• Option A: SARS-CoV testing for diagnosis should be done via PCR from samples obtained from at least two sites and as early in the illness as possible and then repeated five to seven days later if symptoms continue.
• Option B: There are potential agents for use against SARS. Lopinavir-ritonavir has shown some activity in vitro only thus far. Additionally, the experimental agent for Ebola, Remdesivir, has shown activity against both SARS and MERS coronaviruses.
• Option C: There is no specific treatment for severe acute respiratory syndrome (SARS), and supportive care is emphasized. To date, no antiviral agents have been found to be beneficial, nor were glucocorticoids shown to have a beneficial effect.

NCLEX-Question-3-007

Four clients with infections arrive at the emergency department with some existing infection, however, only one private room is available. Which of the following clients is the most appropriate to assign to the private room?

• A. A client with toxic shock syndrome and a temperature of 102.4°F (39.1°C).
• B. A client with diarrhea caused by C. difficile.
• C. A client with a wound infected with VRE.
• D. A client with a cough who may have Koch disease

Correct Answer: D. A client with a cough who may have Koch disease.

Clients with infections that require airborne precautions (such as TB) need to be in private rooms. Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source airborne infection isolation (AII) rooms, and cleaning the air by using high-efficiency particulate air (HEPA) filtration, or ultraviolet germicidal irradiation.

• Option A: Standard precautions are required for the client with toxic shock syndrome. At a minimum, standard precautions should be used in the hospital setting to prevent transmission to patients and staff. The CDC has recommended for the first 24 hours of effective antibiotics to have the patient in both contact and droplet isolation.
• Option B: Use contact precautions for patients with known or suspected CDI. Place these patients in private rooms. If private rooms are not available, they can be placed in rooms (cohort) with other CDI patients. Wear gloves and a gown when entering CDI patient rooms and during their care.
• Option C: Clients with infections that require contact precautions (such as C.difficile and VRE infections) should ideally be placed in private rooms; however, they can be placed in rooms with other clients with the same diagnosis. Wear gloves (clean, non-sterile gloves are adequate) when entering the room of a VRE-infected or colonized patient because VRE can extensively contaminate such an environment. When caring for a patient, a change of gloves might be necessary after contact with a material that could contain high concentrations of VRE.

NCLEX-Question-3-008

You are caring for four clients who are receiving IV infusions of normal saline. Which client is at highest risk for bloodstream infections?

• A. A client who has a non-tunneled central line in the left internal jugular vein.
• B. A client with an implanted port in the right subclavian vein.
• C. A client with a peripherally inserted central catheter (PICC) line in the right upper arm.
• D. A client who has a midline IV catheter in the left antecubital fossa.

Correct Answer: A. A client who has a non-tunneled central line in the left internal jugular vein.

Several factors increase the risk for infection for this client: central lines are associated with a higher infection risk, the skin of the neck and chest having a high number of microorganisms, and the line is tunneled. The concern that physicians have with non-tunneled catheters is that they have a short duration of use. Because of this, they should be removed as soon as possible in order to prevent complications like infections or thrombosis.

• Option B: Implanted ports are placed under the skin and so are less likely to be associated with catheter infection than a nontunneled central IV line. For long-term use, implanted ports are preferred as they have better cosmetic results and less infection as compared to non-tunneled catheters and tunneled catheters.
• Option C: PICC lines can remain inserted for weeks to months. They are indicated in situations where the patient needs an intravenous delivery of antibiotics or chemotherapy drugs while preserving the integrity of the peripheral vascular system.
• Option D: Peripherally inserted IV lines such as midline catheters and PICC lines are associated with a lower incidence of infection. A peripherally inserted central catheter or a PICC line is a thin, flexible tube that is inserted into an upper arm vein and then guided into the superior vena cava on the right side of the heart.

NCLEX-Question-3-009

A client who has frequent watery stools and a possible Clostridium difficile infection is hospitalized with dehydration. Which nursing action should the charge nurse delegate to an LPN/LVN?

• A. Assess the client’s hydration status
• B. Explain the purpose of ordered stool cultures to the client and family
• C. Administer metronidazole (Flagyl) 500 mg PO as ordered to the client
• D. Review the client’s medical history for any risk factors for diarrhea

Correct Answer: C. Administer metronidazole (Flagyl) 500 mg PO as ordered to the client

LPN/LVN education and scope of practice and education include the administration of medications. The administration of medications is recognized as the responsibility of the Registered Nurse (RN) and *Licensed Practical Nurses (LPNs). All orders for medications must be legible, complete, and non-ambiguous.

• Option A: The scope of practice for the registered nurse will most likely include the legal ability of the registered professional nurse to perform all phases of the nursing process including assessment, nursing diagnosis, planning, implementation, and evaluation.
• Option B: Teaching is a complex activity that should be carried out by a licensed nurse. An LPN can reinforce an RN’s patient teaching, but not perform independent patient education or assessments.
• Option D: Assessment of risk factors for diarrhea should be done by a licensed nurse. A Licensed Practical Nurse (LPN) may not perform an initial assessment. Initial assessments are to be performed by a Registered Nurse (RN). The initial assessment is to be used to determine a patient’s baseline and develop an initial nursing plan of care.

NCLEX-Question-3-010

You are a school nurse. Which action will you take to have the most impact on the incidence of infectious disease in the school?

• A. Provide written information about infection control to all patients.
• B. Ensure that students are immunized according to national guidelines.
• C. Make soap and water readily available in the classrooms.
• D. Teach students how to cover their mouths when coughing.

Correct Answer: B. Ensure that students are immunized according to national guidelines.

The incidence of once common infectious diseases such as measles, chickenpox, and mumps has been most effectively reduced by immunization of all school-aged children. School immunization requirements exist to protect students and members of their community from serious vaccine-preventable diseases by ensuring high vaccination rates.

• Option A: Relevant studies showed that implementation of health education for school students was conducive for students to consciously adopt healthy behaviors and lifestyle, eliminating or mitigating risk factors that affect spread of infectious diseases, preventing infectious diseases, and promoting health and improving quality of life.
• Option C: Soap and water are also helpful in reducing the incidence of infectious diseases at school. Alcohol-based antiseptics for hand hygiene are an appealing innovation because of their efficacy in reducing hand contamination and their ease of use, especially when sinks and supplies for hand washing are limited.
• Option D: Recommended cough etiquette maneuvers did not block the release and dispersion of a variety of different diameter droplets to the surrounding environment. Droplets smaller than one-micron size dominate the total number of droplets leaked when practicing assessed maneuvers.

NCLEX-Question-3-011

You are caring for a newly admitted client with increasing dyspnea and dehydration who has possible avian influenza (bird flu). Which of these prescribed actions will you implement first?

• A. Provide oxygen using a non-rebreather mask
• B. Infuse 5% dextrose in water at 75ml/hr
• C. Administer the first dose of oseltamivir (Tamiflu)
• D. Obtain blood and sputum specimens for testing

Correct Answer: A. Provide oxygen using a non-rebreather mask.

Because the respiratory manifestations associated with avian influenza are potentially life-threatening, the nurse’s initial action should be to start oxygen therapy. Patients with respiratory compromise should be placed on supplemental oxygen and monitored closely for signs of deterioration as these patients are at high risk of requiring intubation and mechanical ventilation. The other interventions should be implemented after addressing the client’s respiratory problem.

• Option B: Treatment may include hospitalization and supportive care, such as intravenous fluids. Additionally, studies suggest that antiviral drugs help minimize the severity of bird flu in people. However, changes in the virus may limit its effectiveness in the future.
• Option C: The World Health Organization released Rapid Advice Guidelines in 2007, outlining consensus treatment recommendations for H5N1 influenza outbreaks. These recommendations include neuraminidase inhibitors (especially oseltamivir) for strongly suspected or confirmed cases of H5N1.
• Option D: The preferred source of a sample for testing is a nasopharyngeal swab or aspirate, but other body fluids are usable if the nasopharyngeal swab or aspirate is not available. RT-PCR identification of the virus in viral cultures is the standard of care for diagnosis of AIV, and viral detection is typically possible within a few days of disease onset.

NCLEX-Question-3-012

A hospitalized 88-year-old client who has been receiving antibiotics for 10 days tells you that he is having frequent watery stools. Which action will you take first?

• A. Obtain stool specimens for culture
• B. Place the client on contact precaution
• C. Notify the physician about the loose stools
• D. Instruct the client about correct handwashing

Correct Answer: B. Place the client on contact precaution

The client’s age, history of antibiotic therapy, and watery stools suggest that he may have Clostridium difficile infection. The initial action should be able to place him on contact precautions to prevent the spread of C. difficile to other clients. Clostridium difficile is a gram-positive bacterium that is the cause most implicated in antibiotic-associated diarrhea. The other actions are also needed and should be taken after placing the client on contact precautions.

• Option A: Patients with new-onset 3 or more loose or unformed stools in 24 hours with no obvious other etiology should be checked for testing for C. difficile infection. Stool examination for C. difficile toxins or toxigenic C. difficile bacillus is the commonly used diagnostic test used to diagnose C. difficile infection.
• Option C: The management of C. difficile infection includes a multi-step approach of discontinuing the usage of inciting antibiotics, isolating the patient, and administering the antibiotic based on the severity of the infection.
• Option D: General strategies such as early detection of the disease, placing the patient under isolation with a dedicated toilet and contact precautions, promoting hygiene measures such as improved hand hygiene, and environmental cleaning are effective measures in preventing infections from C. difficile infections.

NCLEX-Question-3-013

Which of the following information about a client who has meningococcal meningitis has the best indicator that you can discontinue droplet precautions?

• A. Pupils are equal and reactive to light
• B. Temperature is lower than 100°F (37.8°C)
• C. Appropriate antibiotics have been given for 24 hours
• D. Cough is productive of clear, nonpurulent mucus

Correct Answer: C. Appropriate antibiotics have been given for 24 hours.

Current CDC evidence-based guidelines indicate that droplet precautions for clients with meningococcal meningitis can be discontinued when the client has received antibiotic therapy for 24 hours. Antibiotic dose should be given as soon as meningitis is suspected and should not be delayed awaiting confirmatory studies. The other information may indicate that the client’s condition is improving but does not indicate that droplet precaution should be discontinued.

• Option A: Meningeal irritability can be confirmed by provocative tests like Kernig and Brudzinski sign. A thorough neurologic exam should be performed looking for alteration in mental status, as well as any focal deficits.
• Option B: Older children and adults will present with headaches, fever, photophobia, vomiting, neck stiffness, and altered mental status. Patients can present with abnormal vital signs, including fever, tachypnea, tachycardia, and hypotension. Hypotension with elevated pulse rate is suggestive of early vascular instability.
• Option D: The classic triad of neck stiffness, fever, and altered mental status is a more specific sign for meningitis. Infants can present with a variety of non-specific symptoms, which include lethargy, irritability, and in some cases bulging fontanelles. 

NCLEX-Question-3-014

You are the charge nurse on the pediatric unit when a pediatrician calls wanting to admit a child with rubeola (measles). Which of these factors is of most concern in determining whether to admit the child to your unit?

• A. No negative-airflow rooms are available on the unit
• B. The infection control nurse liaison is not on the unit today
• C. There are several children receiving chemotherapy on the unit
• D. The unit is not staffed with the usual number of RNs

Correct Answer: A. No negative-airflow rooms are available on the unit

Because clients with rubeola require the implementation of airborne precautions, which include placement in a negative airflow room, this child cannot be admitted to the pediatric unit. An airborne isolation room is also known as a negative pressure room. This negative pressure room is usually a single-occupancy patient-care room frequently used to isolated individuals with confirmed or suspected airborne infections. The other circumstances may require actions such as staff reassignments but would not prevent the admission of a client with rubeola.

• Option B: The absence of the infection control nurse liaison should not prevent the admission of the child with rubeola. Before transferring a patient with an airborne infection, one must always communicate with the relevant department first. The earlier the airborne prevention methods are adopted, the lower the risk of transmission to other patients and healthcare staff.
• Option C: The clients receiving therapy can be transferred to a different location far from the isolation room. The door to the room of the isolation area must be kept closed to maintain negative pressure even if the client is not in the room. The windows in the room should remain closed at all times; opening the window may cause the reversal of airflow, which counters the benefits of a negative pressure room.
• Option D: Only healthcare providers immunized to the organism in question should enter a room where airborne precautions are in place for varicella or measles. A respirator is not necessary for immunized individuals but is required for non-immunized workers who provide care.

NCLEX-Question-3-015

A client who states that he may have been contaminated by anthrax arrives at the ED. The following actions are part of the ED protocol for possible anthrax exposure or infection. Which action will you take first?

• A. Assess the client for signs of infection
• B. Notify hospital security personnel about the client
• C. Escort the client to a decontamination room
• D. Administer ciprofloxacin (Cipro) 250 mg PO

Correct Answer: C. Escort the client to a decontamination room

To prevent contamination of staff or other clients by anthrax, decontamination of the client by removal and disposal of clothing and showering is the initial action in possible anthrax exposure. Clients should remove contaminated clothing and store it in labeled, plastic bags. Clothing should be handled as little as possible to avoid agitation. Clients should shower thoroughly with soap and water.

• Option A: Assessment of the client for signs of infection should be done before decontamination. Initial symptoms of inhalation anthrax are mild and nonspecific and may include fever, malaise, fatigue, and a mild cough or chest discomfort; acute symptoms of respiratory distress, fever, and shock follow, with death occurring shortly thereafter.
• Option B: Notification of security personnel is necessary in the case of possible bioterrorism, but this should occur before decontaminating and caring for the client. During the 2001 anthrax outbreak, the New York City Department of Health and Mental Hygiene established the Cutaneous Anthrax Rapid Referral System for rapid referral and early diagnosis of anthrax cases (Redd 2005). This system functioned to efficiently assess patients but also provided a mechanism for rapid centralized reporting, which could be a good surveillance model in the setting of known mass exposure to anthrax.
• Option D: According to the CDC guidelines, antibiotics should be administered only if there are signs of infection or the contaminating substance tests positive for anthrax. Early initiation of appropriate antibiotics is paramount for patient survival of IA. Initial therapy for adults with IA due to a strain with unknown antibiotic susceptibilities should include ciprofloxacin OR doxycycline PLUS one or two additional antibiotics effective against anthrax.

NCLEX-Question-3-016

A client has been diagnosed with disseminated herpes zoster. Which personal protective equipment (PPE) will you need to put on when preparing to assess the client? Select all that apply.

• A. Goggles
• B. Gown
• C. Gloves
• D. Shoe covers
• E. N95 respirator
• F. Surgical face mask

Correct Answer: B, C, & E

Because herpes zoster is spread through airborne means and by direct contact with the lesions, you should wear an N95 respirator or high-efficiency particulate air filter respirator, a gown, and gloves.

• Option A: Goggles are not needed for airborne or contact precautions. Wear a surgical mask and goggles or face shield if there is a reasonable chance that a splash or spray of blood or body fluids may occur to the eyes, mouth, or nose.
• Option B: Wear a gown if skin or clothing is likely to be exposed to blood or body fluids. If PPE or other disposable items are saturated with blood or body fluids such that fluid may be poured, squeezed, or dripped from the item, discard into a biohazard bag. PPE that is not saturated may be placed directly in the trash. 
• Option C: Wear gloves when touching blood, body fluids, non-intact skin, mucous membranes, and contaminated items. Remove PPE immediately after use and wash hands. It is important to remove PPE in the proper order to prevent contamination of skin or clothing. 
• Option D: Wear shoe covers to provide a barrier against possible exposure to airborne organisms or contact with a contaminated environment. Shoe covers should also be worn as part of Full Barrier Precautions. Full Barrier Precautions are the combination of airborne and contact precautions, plus eye protection, in addition to standard precautions.
• Option E: Put on a NIOSH-certified fit-tested N-95 respirator just before entry to an area of shared air space and wear at all times while in the area of shared air space. Remove and discard the respirator just after exiting the area. The respirator may be discarded into the regular trash unless contact precautions must also be followed. In this case, place the respirator in a plastic zip-lock bag, seal and then discard into the trash. 
• Option F: Surgical face mask filters only large particles and will not provide protection from herpes zoster. Airborne and contact precautions until disseminated infection is ruled out. Airborne and contact precautions until lesions are dry and crusted.

NCLEX-Question-3-017

As the infection control nurse in an acute care hospital, which action will you take to most effectively reduce the incidence of health-care-associated infections?

• A. Develop policies that automatically start antibiotic therapy for clients colonized by multidrug resistant organisms.
• B. Screen all newly admitted clients for colonization or infection with MRSA.
• C. Require nursing staff to don gowns to change wound dressings for all clients.
• D. Ensure that dispensers for alcohol-based hand rubs are readily available in all client care areas of the hospital.

Correct Answer: D. Ensure that dispensers for alcohol-based hand rubs are readily available in all client care areas of the hospital.

Because the hands of healthcare workers are the most common means of transmission of infection from one client to another, the most effective method of preventing the spread of infection is to make supplies for hand hygiene readily available for staff to use.

• Option A: Because administration of antibiotics to individuals who are colonized by bacteria may promote the development of antibiotic resistance, antibiotic use should be restricted to clients who have clinical manifestations of infection.
• Option B: Although some hospitals have started screening newly admitted clients for MRSA, there is no evidence that this decreases the spread of infection. Although results of MRSA screening are not intended to guide empirical treatment, they may offer an additional benefit among patients in whom clinical infection with S. aureus develops.
• Option C: Wearing a gown to care for clients who are not on contact precautions is not necessary. They must be worn when undertaking all direct care procedures with patients, when there is a likelihood of contact with blood, secretions, excretions or body fluids (Loveday et al, 2014).

NCLEX-Question-3-018

You are preparing to leave the room after performing oral suctioning on a client who is on contact and airborne precautions. In which order will you perform the following actions?

• 3. Remove gloves
• 4. Take off goggles
• 5. Take off the gown
• 1. Remove N95 respirator
• 2. Perform hand hygiene

Correct Answer: 3, 4, 5, 1, 2

The sequence will prevent contact of the contaminated gloves and gowns with areas (such as your hair) that cannot be easily cleaned after client contact and stop transmission of microorganisms to you and your other clients.

• The outside of the gloves is contaminated, therefore, if the hands are contaminated during glove removal, the nurse should immediately wash their hands or use alcohol-based hand sanitizer. Using the gloved hand, the nurse should grasp the palm area of the other gloved hand, peel off the first glove, and hold the removed glove in the gloved hand. Slide the fingers of the ungloved hand under the remaining glove at wrist and peel off the second glove over the first glove, then discard it in a waste container.
• Goggles or face shields should be removed from the back by lifting headband or ear pieces. If the item is reusable, the nurse may place it in a designated receptacle for reprocessing. Otherwise, it can be discarded in a waste container.
• The nurse should keep in mind that the front of the gown and the sleeves are contaminated. To remove the gown, the nurse should unfasten the gown ties, taking care that the sleeves don’t contact the body when reaching for the ties. The gown should be pulled away from the neck and shoulders, touching the inside of the gown only, then turning it inside out. Finally, the gown should be rolled or folded into a bundle and discarded in a waste container.
• The front of the respirator should never be touched because it is contaminated. To remove the respirator, the nurse should grasp the bottom ties or elastics of the respirator, then the ones at the top, and remove them without touching the front.
• After doffing, it is imperative for the nurse to wash their hands immediately or use an alcohol-based hand sanitizer immediately after removing all of the PPE. Hand hygiene should also be performed in between steps if hands become contaminated.

NCLEX-Question-3-019

You are preparing to change the linens on the bed of a client who has a draining sacral wound infected by MRSA. Which PPE items will you plan to use? Select all that apply

• A. N95 respirator
• B. Surgical Mask
• C. Gloves
• D. Goggles
• E. Gown

Correct Answer: C & E

A gown and gloves should be used when coming in contact with linens that may be decontaminated by the client’s wound secretions. Contact precautions (gloves and gowns) are used during clinical encounters with clients who are colonized or infected with MRSA. The other items are not necessary because transmission by splashes, droplets, or airborne means will not occur when the bed is changed.

• Option A: A surgical N95 (also referred as a medical respirator) is recommended only for use by healthcare personnel (HCP) who need protection from both airborne and fluid hazards (e.g., splashes, sprays). These respirators are not used or needed outside of healthcare settings.
• Option B: Surgical masks are Class II medical devices. These masks meet certain fluid barrier protection standards and flammability requirements (that is, Class I or Class II, per 16 CFR 1610.4). Surgical masks are also tested for particulate and bacterial filtration efficiencies and biocompatibility and are considered personal protective equipment (PPE).
• Option C: Gloves must be worn when contact with blood or body fluids, mucous membranes, non intact skin, or potentially contaminated objects or the environment is anticipated. Since hand contamination may occur due to holes, leaks, tears, or improper removal, gloves are not a substitute for proper hand hygiene. Hand hygiene must be performed following removal of gloves. 
• Option D: Safety goggles are tight-fitting eye protection that completely cover the eyes, eye sockets and the facial area around the eyes and provide protection from impact, dust, mists, and splashes. Safety goggles can be worn over prescription lenses.
• Option E: Gowns must be worn to protect the arms and prevent soiling or contamination of clothing during procedures and direct care activities when caring for patients on Contact Precautions. 

NCLEX-Question-3-020

You are preparing to care for a 6-year-old who has just undergone allogeneic stem cell transplantation and will need protective environment isolation. Which nursing tasks will you delegate to a nursing assistant? Select all that apply.

• A. Teaching the client to perform thorough hand washing after using the bathroom.
• B. Talking to the family members about the reasons for the isolation.
• C. Stocking the client’s room with the needed PPE items.
• D. Reminding visitors to wear a respirator mask, gloves, and gown.
• E. Posting the precautions for protective isolation on the door of the client’s room.

Correct Answer: C, D, & E

Because all staff who care for clients should be familiar with the various types of isolation, the nursing assistant will be able to stock the room and post the precautions on the client’s door. CNAs work directly with clients and nurses, helping with the many physical and complex tasks for client care. 

• Option A: Teaching is a complex action that should be carried out by a licensed nurse. A nursing assistant can reinforce an RN’s patient teaching, but not perform independent patient education or assessments.
• Option B: Client discussion of the reason for protective isolation falls within the RN-level scope of practice. A certified nursing assistant helps clients with direct health care needs, often under the supervision of a nurse.
• Option C: Gathering and stocking medical supplies is a nursing assistant’s responsibility. Different hospitals and facilities will have unique requirements and responsibilities for their CNAs. But in essence, certified nursing assistants help perform critical tasks that ensure the clients are well-cared for and safe during their hospital stay
• Option D: Reminding visitors about previously taught information is a task that can be done by the nursing assistant, although the RN is responsible for the initial teaching. It is within an LPN’s scope of practice to assist the RN with collecting data and monitoring client findings
• Option E: The nursing assistant may post helpful information within the hospital rooms for the benefit of educating the client and others. Furthermore, they can also tidy up the client’s room and change the linens.  It also means getting the chance to have regular, one-on-one contact with clients—the compassionate relationships that can help people make it through times of illness with dignity.

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NCLEX-Question-3-021

A 26-year-old client is diagnosed with scarlet fever. Which of the following is the most appropriate type of isolation for this client?

• A. Airborne
• B. Contact
• C. Droplet
• D. Standard

Correct Answer: Answer: C. Droplet.

Scarlet fever is an infection caused by Group A Streptococcus bacteria. This bacteria lives in the throat and nose and is highly contagious. It is spread by droplet transmission when an infected individual coughs or sneezes. Droplet Precautions are used to prevent the spread of pathogens that are passed through respiratory secretions and do not survive for long in transit. These droplets are relatively large particles that cannot travel through the air very far. 

• Option A: Airborne precautions prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], M. tuberculosis, and possibly SARS-CoV).
• Option B: Contact precautions are intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient’s environment.
• Option D: Standard precautions combine the major features of Universal Precautions (UP) and Body Substance Isolation (BSI) and are based on the principle that all blood, body fluids, secretions, excretions except sweat, non intact skin, and mucous membranes may contain transmissible infectious agents.

NCLEX-Question-3-022

A newly admitted client with streptococcal pharyngitis (tonsillitis) has been placed on droplet precaution. Which of the following statements indicates the best understanding for this type of isolation?

• A. Must maintain a spatial distance of 3 feet
• B. The client can be placed in a room with another client with measles (rubeola)
• C. A special mask (N95) should be worn when working with the client
• D. Gloves should be only worn when giving direct care

Correct Answer: A. Must maintain a spatial distance of 3 feet.

The most common forms of transmission of an organism in a client with tonsillitis are through coughing, sneezing, and talking. Droplets can travel no more than 3ft so precautions should be maintained when there is a possibility of entering this distance.

• Option B: Client requires a private room. Ensure appropriate client placement in a single room if possible. In acute care hospitals, if single rooms are not available, utilize the recommendations for alternative client placement considerations in the Guideline for Isolation Precautions.
• Option C: An N95 mask is not required for this client. A face mask instead can be used when dealing with the client. Don mask upon entry into the patient room or patient space. Instruct clients to follow Respiratory Hygiene/Cough Etiquette recommendations.
• Option D: Gloves, gowns, face masks and eye protection should be worn in giving direct care. A face mask is worn upon entry into the client room. PPE must be removed at the point of exit; do not reuse face masks. 

NCLEX-Question-3-023

Malcolm is newly assigned as a triage nurse, on his first day of work, the following clients arrive at the ED. Which among the clients require the most rapid action to protect other clients in the ED from infection?

• A. An infant with a runny nose and whose older brother has pertussis.
• B. A travel blogger who needs tuberculosis testing after an exposure to a person with TB during his trip.
• C. An elderly woman who has a history of a methicillin-resistant Staphylococcus aureus (MRSA) leg wound infection.
• D. A pregnant woman with a blister-like rash on the face and is possibly having varicella.

Correct Answer: D. A pregnant woman with a blister-like rash on the face and is possibly having varicella.

Chickenpox (Varicella) is transmitted by airborne and that can be easily transferred to the other clients in the emergency unit. The pregnant woman with the rash should be isolated right away from other clients through placement in a negative-pressure room. In pregnant women, antibodies produced as a result of immunization or previous infection are transferred via the placenta to the fetus. Varicella infection in pregnant women could spread via the placenta and infect the fetus.

• Option A: Droplet precautions should be instituted for the client with pertussis, but this can be done after isolating the client with possible varicella. Strict isolation is important while the client remains infectious. Pertussis is contagious throughout the catarrhal phase and for 3 weeks after the onset of the paroxysmal phase. In patients treated with antibiotics, isolation should be continued for at least 5 days after treatment is initiated.
• Option B: The client who has been exposed to TB does not place the other clients at risk for infection because there are no symptoms of active TB. The body’s ability to effectively limit or eliminate the infective inoculum is determined by the immune status of the individual, genetic factors and whether it is a primary or secondary exposure to the organism.
• Option C: Contact precautions should be instituted for the client with MRSA infection. Contact precautions include the use of gowns, gloves, and possibly masks during clinical encounters with clients with MRSA infection. Infection control also may include keeping clients in isolated rooms or the same rooms of other clients who have a MRSA infection.

NCLEX-Question-3-024

A client with a vancomycin-resistant enterococcus (VRE) infection is admitted to the medical unit. Which action can be delegated to a nursing assistant who is assisting with the client’s care?

• A. Monitor the results of the laboratory culture and sensitivity test.
• B. Educate the client and family members on ways to prevent transmission of VRE.
• C. Implement contact precautions when handling the client.
• D. Collaborate with other departments when the client is transported for an ordered test.

Correct Answer: C. Implement contact precautions when handling the client.

All hospital personnel who care for the client are responsible for correct implementation of contact precautions. They are responsible for ensuring that the convenience, hygiene and safety of patients are well-established during their entire stay in the medical facility.

• Option A: Nursing assistants may not monitor the laboratory results of the client. Certified nursing assistants may only check and record a patient’s vital signs daily. The CNA also measures the client’s height and weight, monitors intake and output and collects specimens to test.
• Option B: Teaching is a complex action that should be carried out by a licensed nurse. A nursing assistant can reinforce an RN’s patient teaching, but not perform independent patient education or assessments.
• Option D: Collaboration is not within the scope of the nursing assistant’s practice. When the client must be moved, the assistants also transfer the client between the bed and a wheelchair. If the client is able to stand, the CNA may walk the individual to an appointment or for exercise.

NCLEX-Question-3-025

Which of the following infection control activities should be delegated to an experienced nursing assistant?

• A. Screening clients for upper respiratory tract symptoms
• B. Disinfecting blood pressure cuffs after clients are discharged
• C. Demonstrating correct handwashing techniques to client and family
• D. Asking clients about the duration of antibiotic therapy

Correct Answer: B. Disinfecting blood pressure cuffs after clients are discharged

Nursing assistants can follow agency protocol to disinfect items that come in contact with intact skin by cleaning with chemicals such as alcohol. Depending on daily needs, this can involve changing soiled sheets, cleaning up spills, changing bedpans, setting up equipment, and reducing the spread of germs and infection in the client’s living area.

• Option A: The daily direct contact that the nursing assistant has with a client also gives them the opportunity to identify bruises, blood in urine, and other injuries and report them to medical staff who can initiate care.
• Option C: Teaching is a complex action that should be carried out by a licensed nurse. A nursing assistant can reinforce an RN’s patient teaching, but not perform independent patient education or assessments.
• Option D: Inquiring about medication therapy is the nurse’s responsibility. However, nursing assistants serve as a channel between clients and nurses and physicians so that all client issues are communicated.