4. Identify patients at risk The nurse is caring for a group of hospitalized patients. What should the nurse do first to prevent patient infections? 1. Provide small bedside bags to dispose of used tissues 2. Encourage staff to avoid coughing near patients 3. Administer antibiotics as ordered 4. Id...
NURS 230 EXAM 1 QUESTIONS AND
CORRECT ANSWERS
4. Identify patients at risk ✅The nurse is caring for a group of hospitalized patients.
What should the nurse do first to prevent patient infections?
1. Provide small bedside bags to dispose of used tissues
2. Encourage staff to avoid coughing near patients
3. Administer antibiotics as ordered
4. Identify patients at risk
1. Fever ✅The nurse identifi es that a patient has an infl ammatory response. Which
local patient adaptation supports this conclusion?
1. Fever
2. Erythema
3. Bradypnea
4. Tachycardi
3. Normal saline and apply a wet-to-damp dressing." ✅A patient has a wound that is
healing by secondary intention. To best support healing of the wound, the nurse should
expect the practitioner's order to state, "Clean wound with:
1. Betadine and apply a dry sterile dressing."
2. Normal saline and cover with a gauze dressing."
3. Normal saline and apply a wet-to-damp dressing."
4. Half peroxide and half normal saline and apply a wet to dry dressing."
3. Puncture of the foot by a nail ✅The nurse identifi es that the greatest risk for a
wound infection exists for a patient with a:
1. Surgical creation of a colostomy
2. First-degree burn on the back
3. Puncture of the foot by a nail
4. Paper cut on the finger
1. Cells of the skin are constantly being replaced, thereby eliminating external
pathogens ✅.The nurse understands that the skin protects the body from infections
because the:
1. Cells of the skin are constantly being replaced, thereby eliminating external
pathogens
2. Epithelial cells are loosely compacted on skin, providing a barrier against pathogens
3. Moisture on the skin surface prevents colonization of pathogens
4. Alkalinity of the skin limits the growth of pathogens
1. Stool for ova and parasites ✅The nurse must collect the following specimens. Which
specimen collection does not require the use of surgical aseptic technique?
1. Stool for ova and parasites
,2. Specimen for a throat culture
3. Urine from a retention catheter
4. Exudate from a wound for culture and sensitivity
2. Contact ✅A patient is positive for Clostridium difficile. The nurse should institute the
isolation precaution known as:
1. Droplet
2. Contact
3. Reverse
4. Airborne
1. Hyperthermia ✅Which patient information collected by the nurse reflects a systemic
adaptation to a wound infection?
1. Hyperthermia
2. Exudate
3. Edema
4. Pain
1. Wash the hands before and after providing care to a patient ✅To interrupt the
transmission link in the chain of infection, the nurse should:
1. Wash the hands before and after providing care to a patient
2. Position a commode next to a patient's bed
3. Provide education about a balanced diet
4. Change a dressing when it is soiled
3. Pneumonia ✅The nurse is providing for the nutrition needs of several patients. The
nurse identifies the need for an increase in caloric intake above average requirements
for the patient who has:
1. Nausea
2. Dysphagia
3. Pneumonia
4. Depression
1. Cuts in the skin from a kitchen knife ✅The nurse is caring for patients with a variety
of wounds. The nurse understands that healing by primary intention most likely occurs
with:
1. Cuts in the skin from a kitchen knife
2. Excoriated perianal areas
3. Abrasions of the skin
4. Pressure ulcers
3. Harbor microorganisms ✅The primary reason why the nurse should avoid glued-on
artificial nails is because they:
1. Interfere with dexterity of the fingers
2. Could fall off in a patient's bed
3. Harbor microorganisms
,4. Can scratch a patient
3. Older adults ✅The nurse understands that subclinical infections most commonly
occur in:
1. Infants
2. Adolescents
3. Older adults
4. Children of school age
3. Burns more than twenty percent of the body ✅The nurse understands that the factor
that places a patient at the greatest risk for developing an infection is:
1. Implantation of a prosthetic device
2. Presence of an indwelling urinary catheter
3. Burns more than twenty percent of the body
4. Multiple puncture sites from laparoscopic surgery
4. Immune response ✅The nurse understands that a secondary line of defense
against infection is the:
1. Mucous membranes of the respiratory tract
2. Urinary tract environment
3. Integumentary system
4. Immune response
2. Administering childhood immunizations ✅Which nursing action protects the patient
as a susceptible host in the chain of infection?
1. Wearing personal protective equipment
2. Administering childhood immunizations
3. Recapping a used needle before discarding
4. Disposing of soiled gloves in a waste container
2. Purulent drainage ✅A patient tells the nurse, "I think I have an ear infection." The
nurse should assess this patient for which objective human response to an ear
infection?
1. Throbbing pain
2. Purulent drainage
3. Dizziness when moving
4. Hearing a buzzing sound
2. Neutrophils ✅The nurse is concerned about a patient's ability to withstand exposure
to pathogens. What blood component should the nurse monitor?
1. Platelets
2. Neutrophils
3. Hemoglobin
4. Erythrocytes
, 1. Tears in the eyes ✅The nurse understands which primary (nonspecific) defense
protects the body from infection?
1. Tears in the eyes
2. Alkalinity of gastric secretions
3. Bile in the gastrointestinal system
4. Moist environment of the epidermis
4. Pediculosis ✅When brushing a patient's hair, the nurse notes white oval particles
attached to the hair behind the ears. The nurse should assess the patient further for
signs of:
1. Scabies
2. Dandruff
3. Hirsutism
4. Pediculosis
4. Phagocytic cells release pyrogens that stimulate the hypothalamus ✅The nurse
understands that a rise in body temperature is associated with the presence of infection
because:
1. Pain activates the sympathetic nervous system
2. Erythema increases the flow of blood throughout the body
3. Leukocyte migration precipitates the inflammatory response
4. Phagocytic cells release pyrogens that stimulate the hypothalamus
4. Wound infection caused by unwashed hands of a caregiver ✅. The nurse
understands that an example of an iatrogenic infection is a:
1. Vaginal infection in a postmenopausal woman
2. Respiratory infection contracted from a grandchild
3. Urinary tract infection in a patient who is sedentary
4. Wound infection caused by unwashed hands of a caregiver
2. Facilitate the healing process ✅The physician orders a wound to be packed with a
wet-to-damp gauze dressing. The nurse understands that this is done primarily to:
1. Minimize the loss of protein
2. Facilitate the healing process
3. Increase resistance to infection
4. Prevent the entry of microorganisms
3. Cilia in the respiratory tract ✅The nurse understands that a primary (nonspecific)
defense that protects the body from infection is:
1. Antibiotic therapy
2. The high pH of the skin
3. Cilia in the respiratory tract
4. The alkaline environment of the vagina
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