The nurse uses the Standard Precautions, as outlined by the Centers for Disease Control and Prevention (CDC), when:

Caring for patients who have wounds draining body fluids.

Preventing transmission of respiratory and wound infections.

Caring for all patients.

There is a suspicion of or risk of infection.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While it is true that Standard Precautions apply to patients with draining wounds, these precautions are not limited to such scenarios. They are a broader set of practices.

Choice B rationale

Standard Precautions do help prevent the transmission of respiratory and wound infections, but their application is universal, not limited to these conditions.

Choice C rationale

Standard Precautions are designed to be used when caring for all patients, regardless of their diagnosis or infection status, to prevent the spread of infections.

Choice D rationale

Standard Precautions are used routinely with all patients, not only when there is a suspicion or risk of infection. This universal approach helps ensure a high level of infection control.

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Correct Answer is C

Explanation

Choice A rationale

While disposable and clean equipment reduce the risk of infection, sterile technique requires that all organisms are killed or removed from materials to achieve an aseptic environment.

Choice B rationale

Sterile gown, mask, and eye shields are required for surgical procedures, but not necessarily for all sterile techniques, such as catheter insertions or dressing changes.

Choice C rationale

Sterile technique ensures that all organisms are killed or removed, creating an aseptic field and preventing infection.

Choice D rationale

A 10-minute surgical scrub is part of pre-surgical preparation but is not required for all sterile procedures.

A. 45-year-old in traction for a fractured femur. B. 56-year-old with pneumonia who is receiving oxygen by mask. C. 70-year-old with congestive heart failure attached to a monitor. D. 65-year-old with a Foley catheter.

Correct Answer is D

Explanation

Choice A rationale

A 45-year-old in traction for a fractured femur is at risk for infection due to immobility and potential surgical wounds, but not as high as someone with a Foley catheter.

Choice B rationale

A 56-year-old with pneumonia receiving oxygen is at risk for respiratory infections, but the presence of a Foley catheter significantly increases the risk of healthcare-associated infections.

Choice C rationale

A 70-year-old with congestive heart failure attached to a monitor has a risk of infection due to potential breaks in skin integrity, but not as high as someone with a Foley catheter.

Choice D rationale

A 65-year-old with a Foley catheter is at the highest risk for health care-associated infections because the catheter provides a direct pathway for pathogens into the urinary tract, increasing infection risk.

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The nurse uses the Standard Precautions, as outlined by the Centers for Disease Control and Prevention (CDC), when:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When the nurse performs a procedure using sterile technique in the patient's unit, it means that:

Correct Answer is C

Explanation

The nurse is aware that the patient most at risk for a health care-associated infection (HAI) would be the:

Correct Answer is D

Explanation

A nurse caring for a client who requires isolation has just finished a care procedure. Which of the following pieces of personal protective equipment (PPE) should the nurse remove last?

A nurse is caring for a client who is in contact isolation. When exiting the client's room, in what order should the nurse take the following steps when removing her personal protective equipment?

When the nurse is using a syringe and needle to give a patient an injection, he or she should:

Fecal matter has contaminated the patient's bed sheet. The nurse should:

The nurse explains that the immunizations against hepatitis B will:

A nurse is reinforcing teaching with a client about hand hygiene. Which of the following client statements indicates a need for further teaching?

A nurse on a medical unit is reinforcing teaching with a group of assistive personnel about handling clients' bed linens safely. Which of the following instructions should the nurse include?

A patient has a nursing diagnosis of infection, related to inadequate primary defenses, as evidenced by surgical incision and intravenous (IV) line access. An appropriate nursing intervention for this patient is to: