Rationales Sept 2 - Test 8: Safety & Infection Control: Key Principles and Precautions

What principle should guide restraint selection?

Use the least restrictive restraint that allows as much safe movement as possible.

What home-safety modification improves visibility of stairs and doorways for older adults?

Line the edges with a bright contrasting color, such as paint or tape.

What footwear is recommended for older adults to reduce fall risk?

Shoes or non-skid socks; avoid throw rugs.

What bathroom modifications can improve home safety?

Use a raised toilet seat and install grab bars.

How should household cleaning solutions be stored?

Properly labeled and stored separately from food or meal-preparation areas.

How many client identifiers should be verified before an intervention that could cause harm?

Two identifiers, such as name, date of birth, or medical record number.

Is barcode scanning a substitute for verifying two client identifiers?

No. Always verify two identifiers even when barcode scanning is used.

What precautions are required for influenza?

Droplet precautions.

When should eye protection be worn during client care?

When there is potential for spraying or splashing of bodily fluids.

What foods may cross-react with a latex allergy?

Foods such as bananas and kiwi because they contain proteins similar to latex.

Why is identifying a latex allergy before surgery important?

Many surgical items may contain latex, and exposure can cause reactions ranging from hives to anaphylaxis.

What PPE is required for contact precautions?

A gown and gloves.

What types of infections commonly require contact precautions?

Infections spread by contact with body fluids/environment, multidrug-resistant organisms such as MRSA or C. difficile, and wounds with copious or purulent drainage.

What is the PPE removal order in these Test 8 rationales?

Gloves, goggles, gown, mask.

Which PPE surfaces are considered contaminated?

The front and anterior surfaces of PPE.

When should PPE be removed for airborne precautions?

Remove PPE in the anteroom; the respirator is removed after leaving the client's room.

Where should a restraint be secured?

To a non-movable surface such as the bed frame, using a quick-release knot - never to the bed rail.

How frequently should restraints generally be removed when safe?

Usually every 2 hours, with skin/neurovascular assessment and range of motion.

How much space should be allowed under a restraint?

Two fingers for an adult client; the rationale notes one finger for pediatric clients.

What is an important action if a restrained client shows distress?

Assess for the cause of distress and use less restrictive methods when possible; restraints can increase injury and psychological distress.

What precautions are required for rubella (German measles)?

Droplet precautions, including a surgical mask within 3 ft of the client.

What precautions are required for routine care of a client with HIV?

Standard precautions.

When is additional PPE needed when caring for a client with HIV?

When there is potential exposure to body fluids, such as splashing during wound irrigation or childbirth.

What is the correct way to dispose of a used lancet?

Place it directly in a sharps disposal container.

When donning PPE, when are gloves applied?

Last, so they remain clean before client contact.

When doffing PPE, when are gloves removed?

First, or at the same time as the gown, to limit spread of contaminated particles.

What complications can immobilization and restraints increase?

Aspiration, constipation, impaired circulation, pressure injury, and other immobility complications.

How can aspiration risk be reduced in an immobilized client?

Elevate the head of the bed or place the client in a lateral position rather than supine.

Why is constipation risk increased in an immobilized client taking an opioid?

Both immobility and opioids slow gastrointestinal motility.

What may be anticipated for constipation prevention in an immobilized client taking opioids?

Constipation prophylaxis, such as a stool softener as prescribed.

What restraint-related factors can compromise circulation?

Diabetes and overly snug restraint application.

What precautions are required for streptococcal pharyngitis?

Droplet precautions.

What room arrangement is appropriate for a client on droplet precautions?

A private room or a room with a client who has the same pathogen.

What mask should a client on droplet precautions wear during transport?

A surgical mask.

What are the 5 Ps of purposeful hourly rounding?

Pain, Potty, Possessions, Positioning, and Personal needs.

How does purposeful hourly rounding reduce falls?

It proactively addresses pain, toileting, possessions, positioning, and other needs so clients are less likely to get up unsafely.

Where should personal belongings be kept for a client at high fall risk?

Within easy reach.

Should a high-fall-risk client ambulate independently?

No. Encourage supervised ambulation.

How should a wheelchair be positioned for a transfer or ambulation?

Locked and placed appropriately on the exit side of the bed.

How is hepatitis A transmitted?

By the fecal-oral route, often through contaminated food/water or close contact.

What symptoms of hepatitis A are highlighted in these rationales?

Fever, jaundice, anorexia, and abdominal pain.

What precautions are used for hepatitis A in these rationales?

Standard precautions; caregivers should use gloves for diaper changes and disinfect changing areas.

Which hepatitis viruses have vaccines used to prevent infection in children?

Hepatitis A and hepatitis B.

How is hepatitis B commonly transmitted?

Through blood and body fluids, including perinatal transmission from mother to baby.

What precautions are required for varicella (chickenpox) while infectious?

Standard, contact, and airborne precautions.

What room is required for varicella?

A private negative-pressure room with appropriate air handling/HEPA filtration.

Should two clients with airborne infections such as chickenpox share a room?

No. These rationales emphasize private rooms because of ease of spread and reinfection risk.

What precautions are required for C. difficile?

Contact precautions.

What precautions should be maintained for a client with an MDRO such as VRE?

Standard and contact precautions.

What PPE is especially important when caring for an incontinent client with VRE in the urine?

Gown and gloves.

Should an indwelling urinary catheter be inserted solely because a client has VRE in the urine?

No. Indwelling catheters increase CAUTI risk and should be used only when medically necessary.

What type of respirator is used for airborne precautions?

An N95 respirator.

What PPE is described for entering the room of a client on airborne precautions?

Gown, respirator, goggles, and gloves, as indicated in the Test 8 rationale.

When should an N95 respirator be removed?

Outside the client's room with the door closed.

How often should an N95 respirator be fit tested according to these rationales?

Initially and annually, and refitted when the mask model/manufacturer or face shape changes.

Can a surgical mask substitute for an N95 for airborne precautions?

No. Surgical masks are for droplet precautions and do not filter smaller airborne particles like an N95.

Does RSV require an N95 respirator in these rationales?

No. RSV requires contact precautions; it is not treated as an airborne pathogen here.

What less-restrictive alternatives should be tried before restraints?

Examples include diversion activities, scheduled ambulation, removing cues that encourage leaving, and discontinuing unnecessary medical treatments when possible.

What is an appropriate intervention for a confused client repeatedly trying to leave?

Use diversion activities and supervision, such as a trained sitter, before applying restraints.

Why should unnecessary indwelling urinary catheters be avoided in confused clients?

They increase infection risk and may increase fall risk if the client tries to ambulate independently.

What cells does HIV attack?

CD4+ T cells, causing immunosuppression.

How is HIV mainly transmitted?

Through direct exposure to specific bodily fluids such as blood.

Do visitors need to wear a mask simply because a client has HIV?

No. HIV is not transmitted by respiratory droplets; standard precautions are used.

Does a client with HIV require a closed room door solely because of HIV?

No. With standard precautions, the door can remain open based on client preference.