CIC Practice Test 2 In-class activity

CIC Practice Test 2 In-class activity 1. The infection preventionist (IP) on the Antimicrobial Stewardship Team is thinking of ways that he can support efforts and add to the success of the team in decreasing antimicrobial resistance. Some of the activities that he can do to help with the mission of the team include: 1) Calculate multidrug-resistant organism (MDRO) infection rates 2) Detect asymptomatic carriers using active surveillance cultures 3) Use molecular typing for investigating outbreaks 4) Collect environmental cultures of isolation rooms a. 2, 3, 4 b. 1, 3, 4 c. 1, 2, 4 d. 1, 2, 3 - 1. D 1, 2, 3 Rationale: Surveillance of MDROs is critical to an antimicrobial stewardship program. IPs monitoring microbiology isolates to detect prevalence and emergence of MDROs. IPs may also support antimicrobial stewardship efforts in the following ways:• Calculate MDRO incidence on the basis of clinical culture results• Calculate MDRO infection rates• Use molecular typing for investigating outbreaks• Detect asymptomatic carriers using active surveillance cultures 2. A classic sign of measles is: a. Kaposi sarcoma b. Stiff neck c. Koplik spots d. Bull's-eye rash - C Koplik spots Rationale: Measles is a highly communicable viral illness with prodromal fever, conjunctivitis, coryza, cough, and small spots with white or bluish-white centers on an erythematous base on the buccal mucosa. These small spots are called Koplik spots. The IP has been notified that three patients with possible pneumonic plague have been admitted to the Emergency Department. The IP recommends which of the following strategies?a. A surgical mask worn within 3 feet of patient, door may be open b. Negative pressure isolation room with use of N95 respirators c. Normal ventilation, but door must remain closed and N95 respirator mask worn d. No masks are required, but patient must be placed in private room and contacts should be treated for exposure - A A surgical mask worn within 3 feet of patient, door may be open Rationale: Pneumonic plague is the least common form of naturally occurring disease and also the most severe. The mortality rate is nearly 100 percent in untreated cases and almost 60 percent even when treated. In a bioterrorism event, primary pneumonic plague is most likely to occur because it results from the inhalation of aerosolized bacterial particles. The incubation period for pneumonic plague is 1 to 6 days, but most commonly occurs 2 to 4 days after exposure. Clinical features for pneumonic plague are similar to symptoms for the other forms of plague: nonspecific influenza-le symptoms such as fever, chills, body aches, malaise, headache, and gastrointestinal distress such as nausea, vomiting, diarrhea, and abdominal pain. Patients typically progress from feeling well to having severe pneumonia with cough, chest pain, shortness of breath, and stridor within 24 hours. Pneumonic plague can be spread from person to person. Transmission occurs by respiratory droplets. Patients with pneumonic plague require Droplet Precautions. Special air handling or negative pressure rooms are not indicated. Droplet Precautions (in addition to Standard Precautions) require that patients be placed in private rooms or cohorted, wearing a mask when working within 3 feet of the patient (logistically, some hospitals may want to implement the wearing of a mask to enter the room). Patient transport should be minimized to essential purposes only, and if movement is necessary, the patient should wear a surgical mask to minimize dispersal of droplets. Isolation generally can be discontinued after 48 hours of appropriate antimicrobial therapy. However, isolation should never be discontinued if the patient is not clinically improving. It is possible that the terrorists will gen 4. Using the surgical risk index to stratify the identified infections for the previous quarter, an IP would report which of the following case(s) as having a higher risk for developing a surgical site infection (SSI)? 1) An 80-year-old male with poor circulation who develops a donor site infection after a coronary artery bypass graft surgery that took 4 hours to perform 2) A 30-year-old female who has knee surgery to repair a torn anterior cruciate ligament (ACL) after a skiing accident 3) A 90-year-old female with insulin-dependent diabetes who has hip replacement surgery that takes 2.5 hours to per 4) A 27-year-old male with Crohn's disease who has colon resection that takes more than 4 hours to perform due to adhesions a. 1, 2 b. 2, 3 c. 3, 4 d. 1, 4 - C 3, 4 Rationale: A surgical risk index is a score used to predict a surgical patient's risk of acquiring an SSI. The risk index score, ranging from 0 to 3, is the sum of the number of risk factors present among the following: • A patient with an ASA physical status classification score of 3, 4, or 5 • An operation classified as contaminated or dirty/infected • An operation lasting longer than the duration cut point in minutes, where the duration cut point varies by the type of operative procedure performed The higher the score by this index, the greater is the risk for subsequent SSI (see Table PE2-1).Patient 1 has a risk index of 1 and an ASA score of 3. Patient 2 has a risk index of 0. Patient 3 has an ASA score of 3 and an operation lasting longer than the duration cut point in minutes; her risk index would be 2. Patient 4 has a Class II procedure (contaminated) and an operation lasting longer than the duration cut point in minutes; his risk index is 2. 5. A 47-year-old female bus driver is brought to the Emergency Department (ED) with a two-day history of fever, shortness of breath, and chest pain. She is diaphoretic and appears acutely ill. She is confused as to place and time. Temperature is 38°C (100.4°F), blood pressure is 88/60 mm Hg, pulse rate is 110/min, and respiration rate is 28/min. Coarse bronchial breath sounds are heard. She has had no recent known contact with ill persons. The leukocyte count is 15,000/μL (15 × 109/L). A chest radiograph shows a widened mediastinum and bilateral pleural effusions. Gram stain of a peripheral blood smear shows box car-shaped Gram-positive bacilli. A bioterrorism agent is suspected. Which of the following agents is most likely? a. Typhus fever b. Smallpox c. Tularemia d. Anthrax - D Anthrax Rationale: A biological attack, or bioterrorism, is the intentional release of viruses, bacteria, or other germs that can sicken or kill people, livestock, or crops. Bacillus anthracis, the bacteria that causes anthrax, is one of the most likely agents to be used in a biological attack because:• Anthrax spores are easily found in nature, can be produced in a lab, and can last for a long time in the environment• Anthrax makes a good weapon because it can be released quietly and without anyone knowing. The microscopic spores could be put into powders, sprays, food, and water. Because they are so small, individuals may not be able to see, smell, or taste them.• Anthrax has been used as a weapon before.There are three types of anthrax: cutaneous, gastrointestinal, and inhalational. Symptoms of inhalation anthrax include:• Fever and chills• Chest discomfort• Shortness of breath• Confusion or dizziness• Cough• Nausea, vomiting, or stomach pains• Headache• Sweats (often drenching)• Extreme tiredness• Body aches If inhalation anthrax is suspected, chest X-rays or computed tomography scans can confirm if the patient has mediastinal widening or pleural effusion, which are X-ray findings typically seen in patients with inhalation anthrax. The only way to confirm a diagnosis of anthrax is to either test directly for B. anthracis in a sample (blood, skin lesion swab, spinal fluid, or respiratory secretions) or measure antibodies or toxin in blood. Samples must be taken before the patient begins taking antibiotics. 6. Phlebotomists within an organization are complaining that the new blood collection device introduced 6 months ago is difficult o use for blood draws and has resulted in an increase in needlestick injuries (NSIs). The IP is working with Occupational Health to evaluate the problem and would like to compare NSI rates before and after implementation of the device. Which of the following would be the most useful denominator in order to calculate useful data? a. Phlebotomist employee hours at work (full-time equivalents) b. Number of occupied beds (or licensed beds) c. Number of patients (average daily census) d. Number of blood collection devices used or purchased - 6. D Number of blood collection devices used or purchased Rationale: The denominator should represent the potential for exposure to sharps. There are many possible denominators that may be used, and each will provide a different view of the sharps injury situation in the facility. A device-based rate can be used to compare needlestick risk from different devices and to evaluate the effectiveness of the product design. Because blood draws may be performed by nurses, phlebotomists, or physicians, total device-associated needlestick injuries since implementation of the new product will provide the most useful data. 7. Which of the following processes should be used for contaminated endotracheal blades? a. Cleaning followed by high-level disinfection b. Cleaning with chlorhexidine followed by soaking in an enzymatic solution for 20 minutes c. Cleaning followed by ultrasonic washer d. Cleaning followed by alcohol disinfection - 7. A Cleaning followed by high-level disinfection Rationale: Semicritical items are those items that will contact mucous membranes or nonintact skin. Respiratory therapy and anesthesia equipment, some endoscopes, laryngoscope blades, esophageal manometry probes, anorectal manometry catheters, and diaphragm fitting rings ae included in this category. These medical devices should be free of all vegetative microorganisms (i.e., mycobacteria, fungi, viruses, bacteria), though small numbers of bacterial spores may be present. Intact mucous membranes, such as those of the lungs or the gastrointestinal tract, generally are resistant to infection by common bacterial spores but are susceptible to other organisms, such as bacteria, mycobacteria, and viruses. Semicritical items minimally require high-level disinfection using chemical disinfectants. 8. A new Environmental Services employee has been asked to clean up a large blood spill on the floor in the OR. How should he proceed? a. He should mix an EPA-registered disinfectant with water in a bucket and mop up the spill b. He should place absorbent material over the spill and pour the correct dilution of disinfectant over the material for the recommended contact time c. He should pour undiluted bleach directly on the blood spill, wait 10 minutes, and then mop up the spill d. He should place absorbent material over the spill, dispose of the material after absorption, and then mop the floor with an EA-registered disinfectant - B He should place absorbent material over the spill and pour the correct dilution of disinfectant over the material for the recommended contact time Rationale: Cleaning of a large blood spill may be a risk for acquisition of bloodborne pathogens, so immediate inactivation of any pathogens before cleaning is important to reduce this risk. Absorbent material may be placed over the spill to contain it and the correct dilution of an EPA-registered disinfectant can be poured on the absorbent material to reduce the bioburden. After this, the absorbent materials can be gathered up and disposed of and the area can be cleaned. 9. Which of the following statements is true regarding an asymptomatic employee with a newly positive tuberculin skin test (TST) of 10 mm induration in a medium to high risk setting?1) The employee has latent tuberculosis (TB) infection 2) The employee is capable of transmitting TB to others 3) The employee is not infectious 4) The employee has TB disease a. 3, 4 b. 2, 4 c. 1, 3 d. 1, 2 - C 1, 3 Rationale: Latent tuberculosis infection (LTBI) is the presence of M. tuberculosis organisms (tubercle bacilli) without symptoms or radiographic or bacteriologic evidence of TB. Approximately 90 to 95 percent of those infected are able to mount an immune response that halts the progression from LTBI to TB. Persons with LTBI are asymptomatic (they have no symptoms of TB) and are not infectious. 10. While rounding in an ambulatory care center, an IP discovers that healthcare personnel (HCP) have been using single-dose vials (SDVs) of lidocaine for multiple patients. She informs the clinic manager that the practice must end immediately. Which of the following statements about SDVs should the IP include in her explanation to the clinic manager? 1) SDVs lack antimicrobial preservatives 2) Inappropriate use of SDVs can lead to contamination 3) A needleless access device (spike) must be applied when reusing an SDV 4) All medications from an SDV must be prepared in a pharmacy a. 1, 2 b. 2, 3 c. 3, 4 d. 2, 4 - 0. A 1, 2 Rationale: The CDC's guidelines call for medications labeled as "single dose" or "single use" to be used for only one patient. This practice protects patients from life-threatening infections that occur when medications get contaminated from unsafe use. Vials labeled by the manufacturer as "single dose" or "single use" should only be used for a single patient. These medications typically lack antimicrobial preservatives and can become contaminated and serve as a source of infection when they are used inappropriately. 11. A patient is admitted with measles and placed on Airborne Isolation. How many days after symptom onset would the characteristic blotchy red rash appear? a. On days 1-2 b. On days 7-10 c. On days 3-7 d. On days 21-25 - 11. C On days 3-7 Rationale: Measles symptoms generally appear in two stages. In the first stage, which lasts 2 to 4 days, the individual may have a runny nose, cough, and a slight fever. The eyes may become reddened and sensitive to light, while the fever gradually rises each day, often peaking as high as 103° to 105°F. Koplik spots (small bluish white spots surrounded by a reddish area) may also appear on the gums and inside of the cheeks. The second stage begins on the third to seventh day and consists of a red blotchy rash lasting 5 to 6 days. The rash usually begins on the face and then spreads downward and outward, reaching the hands and feet. The rash fades in the same order that it appeared, from head to extremities. 12. The annual education budget for the Infection Prevention Department is $1,650.00. In October, the Infection Prevention Manager allocated 20 percent of the department education budget towards resources for the annual flu shot program. However, in November, the financial report indicates that only 15 percent was spent. How much of the budgeted amount remains unspent? a. $330.00 b. $247.50 c. $82.50 d. $66.00 - 12. C $82.50 Rationale: A budget is a quantitative expression of a plan for a defined period of time. It may include planned sales volumes and revenues, resource quantities, costs and expenses, assets, liabilities, and cash folws. It expresses strategic plans of business units, organizations, activities, or events in measurable terms. The manager's budget for the flu shot program is 20 percent of $1,650 (1,650 × 0.20), or $330. However, only 15 percent (1,650 × 0.15), or $247.50 was spent. This leaves a remainder of $82.50. 13. An IP is assisting local public health with a Hepatitis A outbreak in the community. She has been asked to contact the Health Department with any patients who are admitted to her facility with a test positive for Hepatitis A virus (HAV). Patients who test positive in the acute phase of the illness will have a positive: a. Immunoglobulin G (IgG) anti-HAV b. Immunoglobulin M (IgM) anti-HAV c. Immunoglobulin A (IgA) anti-HAV d. IgG, IgM anti-HAV - 13. B Immunoglobulin M (IgM) anti-HAV Rationale: HAV is of the genus Hepatovirus in the family Picornaviridae of enteroviruses. It is a nonenveloped, 27-nm single-stranded RNA virus. HAV is transmitted primarily by the fecal-oral route, facilitated by intimate personal contact (household, sexual, etc.), poor hygiene, unsanitary conditions, or contaminated water, milk, or food, especially raw shellfish. Clinical eatures of acute hepatitis are not specific or HAV infection, so serological diagnosis is necessary. Demonstration of the IgM antibodies against HAV (IgM anti-HAV) in the serum of acutely or recently ill patients establishes the diagnosis.