SAN PEDRO COLLEGE COMPETENCY APPRAISAL - OXYGENATION

Name: __________________________ Date: _____________

1. The first step in processing reusable equipment is:

A) pasteurization

B) cleaning

C) disinfection

D) sterilization

Ans: B

Response:
The first step in equipment processing is cleaning. Equipment is cleaned by removing dirt and
organic material from its surfaces, usually by washing. If equipment is improperly cleaned,
subsequent processing efforts may be ineffective.

2. The label of a disinfectant indicates that it does NOT inactivate or kill either Mycobacterium
tuberculosis or bacterial spores. What class of disinfectant is this?
A) surface active

B) low-level

C) intermediate-level

D) high-level

Ans: B

Response:
A low-level disinfectant inactivates most bacteria, some viruses, and fungi but cannot destroy
resistant microorganisms such as Mycobacterium tuberculosis or bacterial spores.

3. A patient with pneumonia has her noninvasive ventilatory support discontinued. Which of the
following should be used to disinfect the device's nondisposable breathing circuit before it is
placed back into service?
A) pasteurization

B) isopropyl alcohol

C) acetic acid

D) hydrogen peroxide

Ans: A

Response:
Reusable breathing circuits are semicritical items. According to CDC recommendations,
reusable semicritical equipment should be sterilized or undergo high-level disinfection. Of the
available options, only pasteurization meets this standard.

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4. For patients receiving bronchodilator therapy via small-volume nebulizer (SVN), which of the
following precautions would be beneficial in preventing nosocomial infection?

I. use a different SVN for each patient

II. change the nebulizer and tubing every 24 hours
III. perform thorough hand hygiene before each patient contact
A) I only

B) II only

C) I and III only

D) I, II, and III

Ans: D

Response:
To minimize the likelihood of infection in patients receiving bronchodilator therapy via SVN,
you should (1) use a different SVN for each patient, (2) change the SVN and tubing every 24
hours, and (3) perform thorough handwashing prior to each therapy session. It is also
recommended that the nebulizer not be rinsed with tap water but rather rinsed with sterile
water and blown dry between uses.

5. A patient who was hospitalized with ARDS of unknown etiology recently traveled to an area
with a documented outbreak of severe acute respiratory syndrome (SARS). Which of the
following infection control precautions should you recommend for this patient?

I. airborne precautions
II. contact precautions
III. droplet precautions
A) I and II only

B) I, II, and III

C) I and III only

D) II and III only

Ans: B

Response:
If either the suspicion of SARS is strong or laboratory evidence confirms a SARS-CoV
infection, the CDC recommends a combination of standard, contact, and strict airborne
precautions to manage these patients.

6. ALL of the following help minimize the risk of cross-contamination during suctioning except:
A) using a fresh sterile single-use catheter on each patient

B) using only sterile fluid to remove secretions from the catheter

C) instilling 10 mL sterile saline before the suctioning attempt

D) performing proper handwashing and gloving before suctioning

Ans: C

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Response:
To decrease the risk of patient contamination during suctioning, you should use a fresh sterile
single-use catheter on each patient and use only sterile water or saline to clear the catheter. In
addition, both the suction collection tubing and collection canister should be changed between
patients, except in short-term care units (where only the collection tubing should be changed).

7. If sterilization is not feasible, which of the following are acceptable alternatives for processing
a specialized reusable plastic airway?

I. exposure to a high-level chemical disinfectant

II. surface disinfection with 70% ethyl alcohol
III. pasteurization at 63° C for 30 minutes
A) I and II only

B) II and III only

C) I and III only

D) I, II, and III

Ans: C

Response:
Because it directly comes in contact with mucous membranes, a reusable airway is
categorized as semicritical equipment. If sterilization of a semicritical item is not feasible, the
alternatives are high-level disinfection or pasteurization.

8. What is the primary reason for using chemical indicators in equipment sterilization
processing?
A) to warn the user about the presence of toxic residues

B) to show that a package has been through a sterilizing process

C) to indicate the remaining safe shelf-life of the equipment

D) to verify that the sterilization process has worked

Ans: B

Response:
Chemical indicators are usually impregnated on packaging tape. These indicators change color
when exposed to specific conditions, telling the user that the package has been processed via
an appropriate sterilizer cycle. Chemical indicators cannot ensure that the contents are actually
sterile. Only biological indicators can provide that information.

9. Cultures taken from a respirometer that has been used in the surgical intensive care unit to
monitor several patients indicate that it is contaminated. The most practical way to prevent
cross-contamination is to:
A) provide a new respirometer for each patient

B) sterilize the respirometer after each use

C) replace the respirometer with a water-sealed spirometer

D) use a disposable HEPA filter and one-way valve for each patient

Ans: D

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Response:
The best way to prevent the contamination of a Wright respirometer used on several different
patients is to use a one-way valving system, preferably with an in-line HEPA filter. Such an
approach can ensure that patients only breathe out through the device, thus preventing cross-
contamination.

10. ALL of the following will reduce the incidence of ventilator-acquired pneumonia (VAP) on
your patients except:
A) elevating the head of the bed at least 30°

B) implementing daily spontaneous breathing trials

C) continuously aspirating subglottic secretions

D) changing ventilator circuits every 48 hours

Ans: D

Response:
The CDC VAP 'bundle' includes elevating the head of the bed at least 30°, implementing a
daily “sedation vacation” and spontaneous breathing trial, and providing peptic ulcer and deep
venous thrombosis disease prophylaxis. Airway management techniques that can help
decrease the incidence of VAP include: (1) avoiding intubation when possible (using NPPV
instead); (2) intubating orally (as opposed to nasal) route; (3) maintaining proper ET cuff
pressures; (4) aspirating subglottic secretions; and (5) using only sterile water or saline to
flush suction catheters. Ventilator circuits should be changed only when visibly soiled or
malfunctioning.

11. The label of a disinfectant indicates that it destroys vegetative bacteria, mycobacteria, fungi
and viruses, and can inactivate bacterial spores if the contact time is adequate. What class of
disinfectant is this?
A) surface active

B) low-level

C) intermediate-level

D) high-level

Ans: D

Response:
A high-level disinfectant kills vegetative bacteria, mycobacteria, fungi and viruses, but not
necessarily bacterial spores. Some high-level disinfectant chemicals ("chemical sterilants") are
be capable of sterilization with adequate contact time.

12. After a bronchoscopic biopsy, the physician asks that your properly process the metal forceps
used to obtain the tissue sample. Which of the following processing methods should you use?
A) steam autoclaving

B) immersion in acetic acid

C) pasteurization at 63 °C

D) washing in a detergent

Ans: A

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Response:
Because they are introduced into the body, bronchoscope forceps/brushes are considered
critical items that must be sterilized before reuse. Because this equipment is heat tolerant, the
best processing method to ensure sterilization would be steam autoclaving.

13. During a procedure, a glass suction collection bottle fills with fluid, interrupting the vacuum
pressure. Which of the following would be the proper way to dispose of the contents and
restore vacuum?
A) pour the bottle contents into a biohazard bag

B) seal the bottle with a stopper and replace it

C) pour the bottle contents down a utility sink or toilet

D) send the full bottle to central supply for sterilization

Ans: C

Response:
The collection bottle needs to be emptied in order to restore vacuum. Most liquid wastes (e.g.,
blood, suction fluids, etc.) can be carefully poured down a utility sink drain or toilet. If
transported, liquid wastes should be placed in capped or tightly-stoppered bottles or flasks.
Large quantities of liquid wastes may be placed in containment tanks.

14. During a procedure in ICU, blood spills onto the outer metal casing of an in-use ventilator.
After cleaning the surface using gloves and disposable gauze pads, how would to
decontaminate it?
A) spray the area with a concentrated isopropyl alcohol solution

B) swab the area with a tuberculocidal disinfectant or bleach solution

C) take the ventilator out of service and have it sterilized

D) wash the surface with a detergent and rinse with sterile water

Ans: B

Response:
Should a spill of blood or body fluids occur, you should first use don gloves and other
protective equipment and clean area with disposable absorbent material, which should be
discarded as infectious waste. You should then swab the area with a cloth or paper towels
wetted with an EPA-registered hospital disinfectants labeled tuberculocidal solution.
Alternatively, you can use either a registered germicide that is active against HIV or hepatitis
B or a 1:100 bleach solution. More concentrated bleach solutions (1:10) should be used for
spills involves large amounts of blood or body fluids.

15. Hand hygiene should be performed:

I. after touching blood/body fluids

II. immediately after removing gloves
III. between patient contacts
A) I and II only

B) II and III only

C) I and III only

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D) I, II and III

Ans: D

Response:
Hand hygiene should be performed (1) after touching blood, body fluids, secretions,
excretions, contaminated items; (2) immediately after removing gloves; and (3) between all
patient contacts.

16. In preparing for a bronchoscopy on a patient suspected of having severe acute respiratory
syndrome (SARS), which of the following equipment would provide inadequate protection?
A) eye shield

B) disposable gloves

C) disposable gown

D) surgical mask

Ans: D

Response:
During aerosol-generating procedures on patients with suspected or proven infections
transmitted by respiratory aerosols (e.g., SARS), in addition to gloves, gown, and face/eye
protection, you should wear a fit-tested N95 respirator. A standard surgical mask provides
inadequate protection.

17. While assessing a post-operative patient for atelectasis, you note that his visitors are sneezing
and coughing. You should instruct them to:

I. wash their hands after soiling with respiratory secretions

II. cover their mouth and nose when sneezing/coughing
III. use tissues and dispose of them in a no-touch receptacle
A) I and II only

B) II and III only

C) I and III only

D) I, II and III

Ans: D

Response:
The CDC recommends respiratory hygiene/cough etiquette to help prevent the spread of
respiratory infections. Under this protocol, patients and visitors who are sneezing or coughing
should be instructed to: (1) cover the mouth/nose when sneezing/coughing; (2) use tissues and
dispose in no-touch receptacle; and (3) observe hand hygiene after soiling of hands with
respiratory secretions. In addition, in common waiting those who are who are sneezing or
coughing should wear surgical masks. If masks are not tolerated, efforts should be made to
separate individuals from each other by at least 3 feet..

18. In addition to standard precautions, which of the following transmission-based precautions

would you recommend for an elderly patient admitted to a medical unit with severe viral
influenza?
A) contact precautions

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B) droplet precautions

C) airborne precautions

D) universal precautions

Ans: B

Response:
Influenza is one of several common infections spread by the transmission of large droplets
(greater than 5µm) in the air. Droplet precautions are designed to thwart this route of
transmission and include (1) placing the patient in a private room; (2) wearing a surgical mask
when within 3 feet of the patient; (3) using eye/face protection if aerosol-generating procedure
performed or contact with respiratory secretions anticipated; and (4) having the patient wear a
mask and follow respiratory hygiene/cough etiquette when being transported outside their
rooms.

19. Airway management techniques can help decrease the incidence of ventilator-acquired
pneumonia (VAP) except:
A) using the nasal route for intubation

B) aspirating subglottic secretions

C) maintaining proper ET tube cuff pressures

D) only sterile fluids to flush suction catheters

Ans: A

Response:
Airway management techniques that can help decrease the incidence of VAP include: (1)
avoiding intubation when possible (using noninvasive ventilation instead); (2) intubating via
the oral (as opposed to nasal) route; (3) maintaining proper ET tube cuff pressures; (4)
aspirating subglottic secretions; and (5) using only sterile water or saline to flush suction
catheters. Ventilator circuits should be changed only when visibly soiled or malfunctioning.

20. In which of the following clinical circumstances should you wear a gown?

I. when one's clothing can be soiled with infective material

II. when in the room of a patient with a highly contagious disease
III. whenever assisting in a noninvasive procedure
IV. whenever assigned to emergency care settings
A) I and II only

B) I and III only

C) I, II and IV only

D) I, II, III and IV

Ans: A

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Response:
Gowns protect clothing from contamination that can occur in patient care activities. Because
such soiling is uncommon, gowns are not necessary for most activities. Gowns are indicated
when there is likely contact with blood or body fluids or clothes are likely to be soiled
infective secretions or excretions of a patient in isolation. Gowns also are indicated for
persons entering the room of patients who have highly contagious disorders such as varicella
(chickenpox) or disseminated zoster.

21. Which of the following conform to the CDC standards for standard precautions?

I. extreme care with sharp instruments

II. gowns for touching blood/body fluids
III. gloves for touching blood/body fluids
IV. masks/protective eyewear for invasive procedures
V. immediate skin/handwashing if contamination occurs
A) I and III only

B) II, IV and V

C) II, III, IV and V

D) I, II, III, IV and V

Ans: D

Response:
CDC standards for standard precautions include: 1) gloves and gowns for touching
blood/body fluids: 2) masks and protective eyewear for procedures resulting in splashing of
blood/body fluids; 3) discarding or bagging/labeling contaminated articles before removal; 4)
taking extreme care with sharp instruments; and 5) immediate skin/handwashing if
contamination occurs.

22. You are gathering a sputum specimen from a patient in isolation. Which of the following
procedures should be followed in gathering, removing and transporting this specimen?

I. disinfect outside of specimen container if contaminated

II. placed specimen in a sturdy container with a secure lid
III. place specimen container in an impervious, labeled bag
A) III only

B) I, II and III

C) I and III only

D) I and II only

Ans: B

Response:
When gathering a laboratory specimen, great care should be taken to prevent external
contamination of the container. If the outside of the container gets contaminated, it must be
disinfected or placed in an bag. To minimize leakage during transport, specimens should
always be placed in a sturdy container with a secure lid. When a specimen comes from a
patient in isolation, the container should be placed in an impervious bag and labeled before
removal from the room.

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23. You are assisting a physician who is inserting a catheter into the radial artery of an HIV
positive patient. Which of the following barrier precautions should you employ?

I. don gloves and a surgical mask

II. wear protective eyewear
III. wear a gown or apron
A) I and II only

B) I, II and III

C) I and III only

D) I only

Ans: B

Response:
Gloves and masks are required for all invasive procedures. Protective eyewear and gowns or
aprons are recommended for any procedure that could result in the generation of droplets or
the splashing of blood or other body fluids. If hands or other skin areas become contaminated
during an invasive procedure, the gloves should be removed, and the affected area thoroughly
washed.

24. Which of the following measures can reduce the incidence of infection associated with large
volume heated humidifier systems?

I. using prepackaged sterile disposables or wick humidifiers

II. using closed-feed sterile water reservoir systems
III. carefully draining condensate back into the humidifier
IV. changing the humidifier/circuitry every 24 hours
A) I and IV only

B) I, II, III, and IV

C) III and IV only

D) I and II only

Ans: D

Response:
The incidence of infection due to humidifier contamination can be reduced by: 1) using
prepackaged sterile disposables or wick humidifiers, 2) using closed feed reservoir systems
with sterile water, and 3) carefully draining condensate AWAY from the humidifier and
patient. Changing components every 24 hrs has not been shown to reduce the incidence of
nosocomial infection associated with heated water humidifiers.

25. The proper infection control procedures to be used when drawing an arterial blood gas are:
A) hand washing and gloves only

B) apron and protective eyewear

C) mask and protective eyewear

D) all CDC standard precautions

Ans: D

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Response:
Standard blood and body fluid precautions should be implemented in the care of all patients.
In particular, blood samples from all patients must be treated with full CDC standard
precautions, as if they were known to be contaminated. This requires diligent hand washing,
gloves, masks and protective eyewear and aprons or gowns if blood is likely to be splashed.

26. An increase in the number of staphylococcal infections is noted among hospitalized patients
receiving respiratory therapy. The most likely source of the infections is
A) the ventilators

B) the medications

C) the personnel

D) distilled water

Ans: C

Response:
Staphylococcal infections are most commonly transmitted via direct contact. Consequently,
health care personnel who fail to adequately wash their hands before caring for each patient
are often implicated in the spread of such infections.

27. Airborne precautions are indicated for which of the following?

A) tuberculosis patient

B) hepatitis patient

C) patient with an open wound

D) cancer patient

Ans: A

Response:
Airborne precautions help reduce airborne transmission of infectious agents. Common
examples of diseases transmitted via this route include legionellosis, tuberculosis, varicella,
measles and histoplasmosis. Organisms transmitted via this route can be dispersed over long
distances by air currents. For this reason, special air handling and ventilation are required to
prevent airborne transmission.

28. You have only one mainstream capnometer available in ICU, but the attending doctor has
asked that you make end-tidal CO2 (PETCO2) measurements on several different patients
before morning rounds. In order to obtain these measurement while minimizing the risk of
cross infection to you patients, which of the following actions would be most appropriate?
A) gas sterilize the sensor between patient

B) provide an individual airway adapter for each patient

C) sterilize the capnometer between patient uses

D) substitute arterial blood gas analysis for infected patients

Ans: B

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Response:
Whenever a nondisposable device (respirometer, capnometer, pressure manometer) is used to
monitor ventilatory parameters on multiple patients, the best way to minimize the risk of cross
infection is to use a single-use disposable adapter for each patient.

29. The most frequent route for transmission of nosocomial infections is:
A) contact transmission

B) vehicle transmission

C) airborne transmission

D) vectorborne transmission

Ans: A

Response:
Contact transmission is the most important and most frequent route for transmission of
nosocomial infections.

30. A patient has been receiving nebulized albuterol (Proventil) via SVN for the last 24 hours.
Which of the following would you recommend to minimize the risk of her getting a
nosocomial infection?

I. add an antibiotic to the SVN for every other treatment

II. rinse the SVN with sterile water and dry between treatments
III. use only sterile fluids for nebulization
IV. perform handwashing before giving her a treatment
A) I, II only

B) II, III, IV only

C) III, IV only

D) I, II, III, IV only

Ans: B

Response:
Measures that can be taken to minimize the likelihood of getting a hospital-acquired infection
from a small volume nebulizer (SVN) include: proper handwashing before and after handling
such equipment, rinsing out the SVN with sterile water and air-drying it between treatments
and storing, handling and dispensing multidose medications according to manufacturers'
instructions.

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