Kacmarek: Egan's Fundamentals of Respiratory Care, 10th Edition

Chapter 4: Principles of Infection Prevention and Control

Test Bank

MULTIPLE CHOICE

1. About how many people die each year in the United States from hospital-acquired infections
(HAIs)?
a. 5,000
b. 25,000
c. 99,000
d. 250,000

ANS: C
HAIs account for an estimated 1.7 million infections; $4.5 billion in costs, and 99,000 excess
deaths annually.

DIF: Recall REF: p. 62 OBJ: 1

2. Approximately what percent of patients receiving mechanical ventilation develop pneumonia

as a complication?
a. 1%
b. 10%
c. 15%
d. 25%

ANS: D
Approximately 25% of patients undergoing mechanical ventilation develop pneumonia.

DIF: Recall REF: p. 62 OBJ: 1

3. Which of the following is considered the primary source of infection in the health care
setting?
a. medical equipment
b. humans
c. food and water
d. carpet

ANS: B
Humans (patients, personnel, or visitors) are the primary source for infectious agents in the
health care setting

DIF: Recall REF: p. 62 OBJ: 1

4. How do endotracheal tubes increase the risk of infection?

a. impeding local host defenses
b. providing surfaces for biofilms to develop
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c. by reducing neutrophil effectiveness

d. both A and B

ANS: D
Endotracheal tubes allow pathogens to increase the risk of infection by impeding local host
defenses and providing biofilms that may facilitate adherence of pathogens.

DIF: Application REF: p. 62 OBJ: 5

5. All of the following factors increase the risk of surgical patients for developing postoperative
pneumonia except:
a. obesity
b. prolonged intubation
c. history of smoking
d. strong cough

ANS: D
Patients at highest risk include elderly persons, the severely obese, those with chronic
obstructive pulmonary disease (COPD) or a history of smoking, and those having an artificial
airway in place for long periods. Strong cough mechanism actually helps to prevent atelectasis
and pneumonia

DIF: Recall REF: p. 63 OBJ: 4

6. What is the most common route of pathogen transmission in the hospital setting?
a. indirect contact
b. droplet transmission
c. airborne transmission
d. surgical transmission

ANS: A
Indirect contact transmission is the most frequent mode of transmission in the health care
environment

DIF: Recall REF: p. 63 OBJ: 3

7. Which of the following is an example of indirect contact transmission involving fomites?

a. use of a sterile needle on a pneumonia patient
b. use of a dirty nebulizer on another patient
c. drinking tap water
d. inhaling tuberculosis pathogens in the emergency department

ANS: B
Instruments that have been inadequately cleaned between patients before disinfection or
sterilization are an example of indirect contact transmission involving fomites.

DIF: Application REF: p. 63 OBJ: 3

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8. If you are caring for a patient who is suspected of having SARS, at what distance from the
patient is it recommended to wear an effective filtration mask?
a. 6 feet
b. 10 feet
c. 12 feet
d. 15 feet

ANS: A
Current HICPAC guidelines state it may be prudent to don a mask when within 6 feet of the
patient or upon entry into the room of a patient who is on droplet isolation.

DIF: Application REF: p. 63 OBJ: 9

9. Which of the following diseases is transmitted primarily by airborne transmission?

a. tuberculosis
b. measles
c. smallpox
d. all the above

ANS: D
The pathogens transmitted by the airborne route include Mycobacterium tuberculosis,
varicella-zoster virus (chickenpox), and rubeola virus (measles). Airborne transmission of
variola (smallpox) has been documented and airborne transmission of SARS, monkeypox, and
the viral hemorrhagic fever virus has been reported, although not proved conclusively.

DIF: Recall REF: p. 64 OBJ: 3

10. What techniques are used by most hospitals to reduce host susceptibility to infection?
a. immunization
b. chemoprophylaxis
c. surveillance
d. both A and B

ANS: D
Hospital efforts to decrease host susceptibility focus mainly on employee immunization and
chemoprophylaxis.

DIF: Recall REF: p. 64 OBJ: 6

11. What vaccination does OSHA require hospital employers to provide?

a. tuberculosis
b. smallpox
c. hepatitis B
d. Streptococcus pneumoniae

ANS: C
OSHA mandates that employers offer hepatitis B vaccination.

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DIF: Recall REF: p. 64 OBJ: 6

12. Exposure to which of the following organisms calls for postexposure chemoprophylaxis?
a. N. meningitides
b. B. pertussis
c. B. anthracis
d. All of the above

ANS: D
Post exposure chemoprophylaxis is recommended under defined circumstances for B.
pertussis (whooping cough), N. meningitides (meningococcal meningitis), B. anthracis
(anthrax), influenza virus, human immunodeficiency virus, and group A streptococci.

DIF: Recall REF: p. 64-65 OBJ: 9

13. What is the first step in equipment processing for reuse on another patient?
a. drying the equipment
b. cleaning the equipment
c. disinfecting the equipment
d. sterilizing the equipment

ANS: B
Cleaning is the first step in all equipment processing.

DIF: Recall REF: p. 72 OBJ: 8

14. Which of the following statements is NOT true regarding the use of soaps to clean equipment?
a. Soaps act by lowering the surface tension.
b. Soaps work poorly in hard water.
c. Soaps have good bactericidal activity.
d. Soaps can help remove organic material.

ANS: C
Soaps act by lowering surface tension and forming an emulsion with organic matter.
Unfortunately, soaps have little bactericidal activity and work poorly in hard water. A
detergent refers to a substance (usually a chemical agent but sometimes a physical one)
applied to inanimate objects that destroys disease-causing pathogens but not spores.

DIF: Application REF: p. 72-73 OBJ: 7

15. What should be used to wipe down the surface of devices that cannot be immersed in water?
a. 70% ethyl alcohol
b. warm soapy water
c. strong detergent
d. bleach

ANS: A

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The surface of the device should be disinfected using a 70% ethyl alcohol solution or the
equivalent.

DIF: Recall REF: p. 79 OBJ: 7

16. Which of the following organisms is NOT destroyed by a disinfection agent?

a. gram-negative cocci
b. bacterial spores
c. gram-positive rods
d. viruses

ANS: B
Disinfection describes a process that destroys the vegetative form of all pathogenic organisms
on an inanimate object except bacterial spores.

DIF: Recall REF: p. 73 OBJ: 7

17. What solution should be used to disinfect the surfaces of the room of a patient who was
infected with C. difficile?
a. 70% ethyl alcohol
b. 5.25% sodium hypochlorite
c. 1% sodium benzoate
d. 5% iodine solution

ANS: B
Because C. difficile may form spores that are resistant to commonly used surface
disinfectants, the CDC recommends the use of 1:10 dilution of 5.25% sodium hypochlorite
(household bleach) and water for routine environmental disinfection in the rooms of patients
with C. difficile.

DIF: Recall REF: p. 73 OBJ: 7

18. Which of the following statements is NOT true regarding the use of alcohol disinfectants?
a. Their activity drops when diluted below 50% concentration.
b. Alcohols are good for surface cleaning of stethoscope bells and diaphragms.
c. They can damage rubber tubing.
d. They are considered sporicidal.

ANS: D
Alcohol disinfectants in the health care setting refer to either ethyl alcohol or isopropyl
alcohol. Neither is considered a high-level disinfectant as a single agent, they are not
sporicidal, and they do not penetrate protein-rich materials. Their activity drops when diluted
below 50% concentration. Alcohols are inactivated by protein and can damage rubber,
plastics, and the shellac mounting of lensed instruments. Alcohol wipes are a good choice for
disinfecting small surfaces, such as medication vial tops. Alcohols are also useful as surface
disinfectants for stethoscopes, ventilators, and manual ventilation bags.

DIF: Recall REF: p. 73 OBJ: 7

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19. Which of the following statements is NOT true regarding the use of phenolics as a
disinfectant?
a. They are bactericidal.
b. They are fungicidal.
c. They are ineffective on surfaces shortly after application.
d. They cause tissue irritation.

ANS: C
Phenolics are not sporicidal but are bactericidal, fungicidal, and tuberculocidal at their
recommended use dilution (see Table 4-3). Phenolics retain their activity in the presence of
organic matter and can remain effective on surfaces long after application.

DIF: Recall REF: p. 73 OBJ: 7

20. Which of the following characteristics is true for iodophors as disinfectants?

a. water soluble
b. nonstaining
c. less irritating to tissue
d. all of the above

ANS: D
Unlike iodine tinctures, iodophors are water soluble, nonstaining, and less irritating to tissue.
Iodophors are bactericidal, virucidal, and tuberculocidal.

DIF: Recall REF: p. 73 OBJ: 7

21. Which of the following statements is NOT true regarding the use of glutaraldehyde?
a. It is a true sterilizing agent when used properly.
b. It can retain activity up to 90 days once activated.
c. It is not used for disinfection on surfaces due to cost.
d. It can cause significant tissue inflammation in workers who use it.

ANS: B
Glutaraldehyde (saturated dialdehyde) is a commonly used high-level disinfectant/sterilant.
When aqueous solutions of 2% glutaraldehyde are alkalized (“activated”) to a pH between 7.5
and 8.5, glutaraldehyde can kill vegetative bacteria, M. tuberculosis, fungi, viruses, and spores
in less than 10 minutes (see Table 4-3). This sporicidal activity qualifies glutaraldehyde as a
true sterilizing agent.

DIF: Recall REF: p. 74 OBJ: 7

22. What is the recommended dilution level of bleach according to the CDC for cleaning up blood
spills?
a. 1:1
b. 1:5
c. 1:10
d. 1:20
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ANS: C
The CDC recommends a 1:10 dilution of bleach (or an Environmental Protection Agency
[EPA]-registered disinfectant) to disinfect blood spills.

DIF: Recall REF: p. 77-78 OBJ: 7

23. What is the most common, efficient, and easiest sterilization method?
a. ETO
b. flash sterilization
c. steam sterilization
d. use of hydrochlorofluorcarbon

ANS: C
Moist heat in the form of steam under pressure is the most common, efficient, and easiest
sterilization method.

DIF: Recall REF: p. 74 OBJ: 7

24. Which of the following statements is NOT true regarding the use of ETO for sterilization?
a. It is harmless to rubber and plastics.
b. It will penetrate prewrapping.
c. Acute exposure is of little consequence.
d. It is useful for equipment that cannot be autoclaved.

ANS: C
Unfortunately, acute exposure to ETO gas can cause airway inflammation, nausea, diarrhea,
headache, dizziness, and even convulsions.

DIF: Recall REF: p. 75 OBJ: 7

25. Which of the following is the most common source of patient infections?
a. large-volume nebulizers
b. small-volume nebulizers
c. internal circuits of a ventilator
d. oxygen therapy devices

ANS: A
Large-volume nebulizers are the worst offenders.

DIF: Recall REF: p. 76 OBJ: 4

26. Which of the following steps for disinfection of a bronchoscope is NOT true?
a. The first step is cleaning the scope.
b. Disinfection is done by immersion in a liquid disinfectant.
c. The device is stored lying flat to promote drying.
d. Drying techniques can include forced air.

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ANS: C
Store in a manner so that the bronchoscope is vertical to prevent recontamination and
facilitate drying.

DIF: Recall REF: p. 72 OBJ: 7

27. Which of the following organisms has been associated with health care–associated infections
in patients using a poorly disinfected bronchoscope?
a. M. tuberculosis
b. Pseudomonas aeruginosa
c. Klebsiella
d. both A and B

ANS: D
Health care–associated infections associated with bronchoscopes have been most commonly
reported with M. tuberculosis, nontuberculosis mycobacterium, and P. aeruginosa.

DIF: Recall REF: p. 79 OBJ: 4, 5

28. Which of the following statements is/are true regarding the use of disposable respiratory care
equipment?
a. Recent research supports their use as a cost-effective measure.
b. Many quality issues exist.
c. Reusing the equipment is often done.
d. All of the above are true.

ANS: D
Three major issues are involved in using disposables: cost, quality, and reuse.

DIF: Recall REF: p. 80 OBJ: 8

29. Which of the following is NOT a category under Expanded Precautions?

a. Contact Precautions
b. Droplet Precautions
c. Standard Precautions
d. Airborne Infection Isolation

ANS: C
There are four categories of Expanded Precautions: Contact Precautions, Droplet Precautions,
Airborne Infection Isolation, and Protective Environment.

DIF: Recall REF: p. 69 OBJ: 8

30. What is the minimum recommended time for handwashing in the health care environment?
a. 5 seconds
b. 15 seconds
c. 30 seconds
d. 60 seconds
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ANS: B
Hand hygiene includes handwashing with both plain or antiseptic-containing soap and water
for at least 15 seconds.

DIF: Recall REF: p. 65 OBJ: 6

31. Which of the following statements is NOT true regarding the use of sterile gloves in the
hospital setting?
a. They should be worn for all invasive procedures.
b. They should not be used as a substitute for handwashing.
c. The same pair can be used on numerous patients if noninvasive procedures are
done.
d. They may have small invisible defects that cause contamination of the user’s
hands.

ANS: C
Gloves should be changed, regardless of use, between each patient contact.

DIF: Recall REF: p. 66 OBJ: 6

32. Which of the following is NOT one of the five key recommended components of an infection
control program in the hospital setting?
a. development
b. surveillance
c. investigation
d. reporting

ANS: A
The five key recommended components of an infection control program are surveillance,
investigation, prevention, control, and reporting.

DIF: Recall REF: p. 81 OBJ: 6

33. Which of the following diseases is transmitted through direct contact?

a. HIV
b. pertussis
c. hepatitis B
d. hepatitis C

ANS: A
The only one of those diseases that is transmitted through direct contact is HIV. Hepatitis B
and C and both indirect contact, and pertussis is through droplet transmission.

DIF: Recall REF: p. 63 OBJ: 4

34. Which of the following diseases travels through droplet mode?

a. influenza
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b. small pox
c. pertussis
d. both A and C

ANS: D
Influenza and Pertussis BOTH travel through droplet mode. Small pox travels airborne
thorugh droplet nuclei.

DIF: Recall REF: p. 63 OBJ: 4

35. What is a Prevention Bundle?

a. The use of multiple evidence based best practices to prevent device related
infection
b. Recent research supports the use of cost-effective measurements.
c. An ongoing process of monitoring patients and personnel for the acquisition of
infection in the healthcare setting
d. All of the above

ANS: A
Prevention Bundle is the use of multiple evidence-based best practices to prevent device
related infection.

DIF: Recall REF: p. 69 OBJ: 6

36. Besides humans, what is another source of infectious agents in a health care setting?
a. ventilator-associated pneumonia (VAP)
b. catheter-related bloodstream infections
c. catheter-associated urinary tract infections (UTI)
d. all of the above

ANS: D
All of the above can be infectious agents in a health care setting. This is why it is important to
use medical devices for the least amount of time necessary.

DIF: Application REF: p. 81 OBJ: 5

37. Small volume nebulizers produce bacterial aerosols that have been commonly associated with
which of the following diseases?
a. Pseudomonas aeruginosa
b. measles
c. small pox
d. nosocomial pneumonia

ANS: D
Small volume nebulizers produce bacterial aerosols that have been associated with
nosocomial pneumonia.

DIF: Application REF: p. 70 OBJ: 5

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38. What is the purpose of an inspiratory HEPA filter in a ventilator circuit?

a. The purpose is to serve as a heated thermistor that prevents condensation from
forming in the circuits.
b. It prevents pathogens from being expelled into the surroundings.
c. When placed between the ventilator and the circuit, it can eliminate bacteria
d. None of the above

ANS: C
The purpose of an inspiratory HEPA filter, when it is placed between the ventilator and the
external circuit, is to eliminate bacteria from the driving gas and prevent retrograde
contamination back into the ventilator.

DIF: Application REF: p. 70 OBJ: 8

39. The unit residence asked you to reduce the risk of contamination caused by condensation in
the circuit of a mechanically ventilated patient. Which of the following would help to reduce
or eliminate condensation in this patient’s circuit?
a. using a heat and moisture exchange (HME)
b. by draining the circuit on a daily basis
c. by not using any form of heater at all
d. by lowering the temperature in the heater

ANS: A
By replacing an active humidification system by a passive humidification one (HME), there
will be less condensation in the circuit because no water is being used to heat and moisten the
air, but instead the patient’s own body heat is used. Draining the circuit daily, not using heat,
or lowering the heater temperature are not acceptable and may place the patient at risk of
infection caused by inspisated secretions among other consequences.

DIF: Analysis REF: p. 76 OBJ: 6

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