Infection Control (23 Questions)

1. You are working on a general medicine unit. Mrs. Leblanc, an 82-year-old patient, has been receiving Clindamycin for aspiration pneumonia. She has developed profuse, watery, foul-smelling diarrhea (6 episodes in the last 12 hours) and abdominal cramping. A stool sample has confirmed Clostridioides difficile (C. diff). You have just finished changing her soiled linens and performing perineal care.

Question:
Regarding hand hygiene and infection control for this specific pathogen, what is the mandatory nursing action before leaving the room? *

Use an alcohol-based hand rub (ABHR) vigorously for 20 seconds.

Wash hands with soap and warm water for at least 20 seconds.

Double-glove for the procedure, so hand hygiene is not required upon exit.

Use a chlorhexidine-impregnated wipe to cleanse the hands.

2. Mr. Singh, a 45-year-old male, presents to the Emergency Department with a 3-week history of productive cough, night sweats, fatigue, and hemoptysis (coughing up blood). A chest X-ray suggests active pulmonary tuberculosis (TB). You are preparing to transport him from the negative-pressure isolation room to the radiology department for a CT scan.

Question:
To preventing the transmission of airborne droplet nuclei during transport, which measure is essential? *

The nurse and the porter must wear N95 respirators, but the patient does not need a mask.

The patient must wear an N95 respirator during the transport.

The patient must wear a surgical procedure mask, and the staff do not need N95s if the patient is masked.

The hallways must be cleared of all visitors before the transport begins.

3. You are working in the pediatric triage area. A mother brings in her 6-year-old son, who has a high fever, a runny nose, red watery eyes, and a blotchy red rash spreading from his hairline down to his neck. You suspect Measles (Rubeola). The unit is short-staffed, and you need to assign a nurse to care for this child.

Question:
Which staff member is the safest choice to assign to this patient? *

A 28-year-old male nurse who has never been vaccinated against measles.

A 32-year-old female nurse who is currently 12 weeks pregnant and has unknown immunity.

A 55-year-old nurse who had measles as a child.

A 24-year-old new graduate who received only one dose of the MMR vaccine.

4. You are exiting the room of a patient on Contact and Droplet Precautions for Influenza A and MRSA. You are wearing a gown, gloves, a procedure mask with a visor (eye protection).

Question:
To minimize the risk of self-contamination, what is the correct sequence for doffing (removing) your PPE? *

Mask/Visor → Gown → Gloves → Hand Hygiene.

Hand Hygiene → Mask/Visor → Gown → Gloves.

Gown and Gloves together → Mask/Visor → Hand Hygiene.

Gloves → Gown → Hand Hygiene → Mask/Visor → Hand Hygiene.

5. A 17-year-old female is admitted with a sudden onset of high fever, severe headache, projectile vomiting, and nuchal rigidity (stiff neck). The physician suspects bacterial meningitis and is preparing for a lumbar puncture.

Question:
What type of isolation precautions must be initiated immediately upon her arrival to the unit? *

Routine Practices only until the organism is identified.

Airborne Precautions (Negative pressure room and N95).

Droplet Precautions (Private room and surgical mask/visor).

Contact Precautions (Gown and gloves).

6. You are working in a long-term care facility. Mr. Gagnon, a resident, is diagnosed with crusted (Norwegian) scabies, a severe infestation. The physician orders the application of Permethrin 5% cream from head to toe.

Question:
Regarding the duration of precautions, when can Mr. Gagnon be safely taken off Contact Precautions? *

Immediately after the cream is applied to the skin.

24 hours after the treatment has been completed/washed off.

Only after a skin scraping comes back negative for mites.

He must remain in isolation for 14 days.

7. You are the infection control nurse. A nurse on the surgical unit reports a percutaneous injury (needle stick) from a used syringe that had been sitting on a bedside table. The source patient is known to be Hepatitis B positive.

Question:
What is the immediate first aid action the nurse must take? *

Squeeze the puncture site vigorously to promote bleeding and expel the virus.

Apply bleach or alcohol directly to the open wound to disinfect it.

Go immediately to the Emergency Department without washing the wound to preserve evidence.

Wash the area with soap and water and allow it to bleed freely; do not squeeze.

8. Mr. Tremblay, a patient receiving chemotherapy for lymphoma, develops a vesicular rash that spreads across three dermatomes (disseminated Herpes Zoster/Shingles). He is coughing occasionally.

Question:
Considering his immunocompromised state and the presentation of the rash, which isolation category is required? *

Contact Precautions only.

Droplet Precautions only.

Airborne and Contact Precautions.

Protective (Reverse) Isolation only.

9. It is peak influenza season. The Emergency Department is at 150% capacity, and there are no private rooms available. You have two patients requiring admission: Mrs. A (Confirmed Influenza A) and Mrs. B (Suspected Influenza, pending swab).

Question:
In the absence of private rooms, what is the most appropriate bed placement strategy (cohorting)? *

Place Mrs. A in a room with a patient who has a non-infectious condition (e.g., heart failure) and keep curtains drawn.

Place Mrs. A and Mrs. B in the same room because they likely have the same virus.

Keep Mrs. A in the hallway and put Mrs. B in a room with a surgical patient.

Ideally, place Mrs. A with another patient who has confirmed Influenza A; keep Mrs. B isolated until results are back.

10. Ms. Paquette, a 30-year-old patient, has been admitted for severe neutropenia (ANC < 0.5) following a bone marrow transplant. She is placed in a Protective Environment (positive pressure room). Her family arrives to visit and brings several gifts.

Question:
Which item brought by the family poses a safety risk and must be removed from the room immediately? *

A sealed box of chocolates.

A new, hardcover book.

A vase of fresh tulips and a potted plant.

A clean, knitted blanket from home.

11. You are caring for Mr. Tremblay, a patient admitted with active pulmonary tuberculosis (TB). He is housed in a negative-pressure isolation room with an anteroom (a small transition room between the hallway and the patient’s room). You have completed your morning assessment and medication administration. You are currently standing at the patient's bedside wearing a gown, gloves, face shield, and a fit-tested N95 respirator.

Question:
To ensure the safety of the environment outside the room, where must you remove your PPE? *

Remove the gown, gloves, and face shield inside the patient's room near the door; remove the N95 respirator in the anteroom.

Remove all PPE (gown, gloves, face shield, and N95) inside the patient's room before opening the door to the anteroom.

Leave the patient's room wearing all PPE, then remove everything in the anteroom to avoid inhaling the bacteria inside the room.

Remove the gown and gloves inside the room, but keep the face shield and N95 on until you are in the hallway nurses' station.

12. You are the nurse in a pediatric clinic. A mother brings in her 4-year-old daughter who presents with violent coughing spells that end with a high-pitched inspiratory "whoop" sound. The child appears cyanotic during the coughing episodes. You suspect Pertussis (Whooping Cough).

Question:
While waiting for the transfer to the hospital, what is the correct isolation precaution to implement immediately in the waiting room? *

Place the child in a negative-pressure room immediately; this is an airborne pathogen.

Place a surgical mask on the child and maintain a distance of 2 meters.

Wear a gown and gloves only; this is transmitted via direct contact with secretions.

No specific isolation is needed as long as the child covers her mouth when coughing.

13. You are preparing a sterile field to insert a urinary catheter for Mrs. Gagnon. You have opened the sterile kit and donned sterile gloves. While reaching for the lubricant syringe, you accidentally drop your hand below the level of your waist for a brief second. You did not touch anything with the glove.

Question:
According to the principles of surgical asepsis, what is your immediate action? *

Continue the procedure since you did not touch any unsterile object.

Ask a colleague to pour sterile alcohol over your gloves to re-sterilize them.

Remove the gloves, perform hand hygiene, and don a new pair of sterile gloves.

Wipe the glove with a sterile gauze pad soaked in iodine.

14. You are caring for Mr. Roy, a patient with a large, infected abdominal wound that is draining purulent fluid. The wound culture is positive for Vancomycin-Resistant Enterococci (VRE). You need to check his blood pressure and temperature.

Question:
To prevent the spread of this multidrug-resistant organism (MDRO) to other patients, which equipment management strategy is required? *

Use the standard unit blood pressure cuff and thermometer, but wipe them down with alcohol immediately after use.

Use a dedicated disposable stethoscope, blood pressure cuff, and thermometer that remain in the patient's room.

Transport the patient to the nursing station to use the wall-mounted vital signs monitor.

Wear double gloves so you can handle the common equipment without contaminating it.

15. You are working in the Operating Room. During an orthopedic surgery, the surgeon asks for a specific implant. You open the sterile package and carefully flip the item onto the sterile field. However, the outer edge of the package wrapper brushes against the sterile drape covering the instrument table.

Question:
How must the team proceed? *

The entire sterile field is considered contaminated and must be broken down and set up again.

The area of the drape that was touched is covered with a sterile towel, and the surgery proceeds.

The implant is discarded, but the rest of the field is considered safe.

No action is needed as the wrapper was sterilized at the factory.

16. You are caring for a patient confirmed to have COVID-19. The patient is currently on Droplet and Contact Precautions. The respiratory status deteriorates, and the physician decides to intubate the patient urgently.

Question:
Because intubation is considered an Aerosol-Generating Medical Procedure (AGMP), how must the safety precautions change? *

No change is necessary; Droplet precautions are sufficient for intubation.

All staff in the room must upgrade their PPE to include an N95 respirator and the procedure should ideally be done in a negative-pressure room.

The staff must wear double gowns and sterile gloves.

The patient must be transported to the Operating Room for the procedure.

17. A 30-year-old female patient is admitted with Rubella (German Measles). You are the charge nurse making assignments for the shift. One of your nurses, Mrs. Cote, is 10 weeks pregnant.

Question:
What is the correct administrative decision regarding this assignment? *

Mrs. Cote can care for the patient as long as she wears an N95 respirator.

Mrs. Cote can care for the patient if she received the MMR vaccine as a child.

Mrs. Cote must not be assigned to this patient due to the risk of teratogenic effects on the fetus.

Mrs. Cote can care for the patient but must limit her time in the room to 15 minutes per hour.

18. You are about to enter the room of a patient with suspected chickenpox (Varicella). You don your N95 respirator.

Question:
Before entering the room, what step is mandatory to verify that the N95 is functioning correctly? *

Pinch the nose piece tightly and tape the edges of the mask to your face.

Perform a user seal check (fit check) by exhaling sharply to feel for air leakage around the edges.

Ask a colleague to visually inspect if the mask looks straight.

Change the mask if you have been wearing it for more than 30 minutes.

19. You are changing the dressing on a patient's leg ulcer. The gauze you remove is saturated with blood and purulent discharge, and it is dripping.

Question:
According to standard waste management protocols, where should this specific dressing be disposed of? *

In the regular garbage bin at the bedside.

In the yellow biohazard bag/container.

In the sharp's container.

Flush it down the toilet to prevent odor.

20. You are working in the emergency department. A patient arrives complaining of fever, malaise, and jaundice. He mentions he recently returned from a trip where he ate "a lot of street food" and shellfish. You suspect Hepatitis A. The patient asks, "How can I stop my wife from getting this?"

Question:
What is the most accurate information regarding the transmission and prevention of Hepatitis A? *

"It is transmitted through blood; avoid sharing razors or toothbrushes."

"It is transmitted through coughing; you need to wear a mask at home."

"It is transmitted through the fecal-oral route; meticulous hand hygiene after using the toilet is essential."

"It is transmitted sexually only; you must abstain from intercourse for 6 months."

21. You are working as a nurse in a long-term care facility (CHSLD). Mrs. Tremblay, an 82-year-old resident, was diagnosed this morning with Herpes Zoster (Shingles). She has a cluster of fluid-filled vesicles on a red base located on her left trunk (thoracic dermatome). She has been placed on Contact Precautions.

Later that afternoon, Mrs. Tremblay’s daughter, Sophie, calls the nursing station. Sophie states that she is 24 weeks pregnant and plans to visit her mother this evening to bring her some comfort items. She sounds anxious and asks, "I know my mother has shingles. Is it dangerous for my baby if I come to see her?"

Question:
Before providing a recommendation regarding the visit, what is the priority question you must ask Sophie? *

"How close are you to your delivery date?"

"Have you ever had chickenpox or the varicella vaccine in the past?"

"Do you have a fever or any current symptoms of a cold?"

"Are you planning to touch your mother or sit on her bed during the visit?"

22. You are working on a pediatric unit. You have just finished assessing a 3-year-old child admitted with Pertussis (Whooping Cough). The child is placed on Droplet Precautions. You exit the room, remove your PPE, and perform hand hygiene. As you stand at the door documenting, you look through the window and realize you forgot to raise the crib side rails. The child is awake and rolling rapidly toward the open edge of the crib. You have a box of surgical masks mounted on the wall next to you, but the isolation cart with gowns and gloves is located down the hall.

Question:
To ensure the physical safety of the child while adhering to the minimum necessary infection control principles for this specific transmission route, what is your immediate action? *

Run to the isolation cart to retrieve a gown and gloves before entering.

Enter the room immediately without any PPE to catch the child; the risk of a fall outweighs the risk of infection.

Don a surgical mask from the box next to you and immediately enter the room to secure the side rails.

Shout loudly to startle the child to stop them from rolling while you put on full PPE.

23. You are working on a surgical unit. Mr. Gagnon, 65, is recovering from abdominal surgery but has developed a wound infection confirmed to be Methicillin-Resistant Staphylococcus Aureus (MRSA). He is placed on Contact Precautions. You enter the room to administer medication and observe his wife, Mrs. Gagnon, visiting. She has correctly donned a yellow isolation gown and gloves. She is currently sitting on the edge of Mr. Gagnon's bed, holding his hand, and her purse is hanging on the back of the visitor's chair.

Question:
Which specific action by the visitor constitutes a breach of infection control principles and requires immediate intervention and teaching? *

She is holding the patient's hand while wearing gloves.

She is sitting directly on the patient's bed linens.

She is not wearing a procedure mask while talking to the patient.

She left her purse on the chair instead of the windowsill.