Nursing Home Infection Preventionist Post-Test Exam
Infection Control Comprehensive Review Examination
Q1. Which component of the chain of infection represents the pathogen that causes disease?
A. Susceptible host
B. Portal of exit
C. Causative agent [CORRECT]
D. Mode of transmission
Correct Answer: C
Rationale: Correct because the causative agent is the specific microorganism responsible for causing an infectious
disease, which is the first link in the chain of infection. This matches the standard definition used in infection
prevention training for all healthcare settings.
Q2. A nursing assistant reports that a resident has developed a new onset of fever, cough, and productive sputum.
The resident is on contact precautions for a wound infection. What is the most appropriate initial action by the
infection preventionist?
A. Transfer the resident to the emergency department immediately
B. Add droplet precautions in addition to existing contact precautions [CORRECT]
C. Discontinue contact precautions since the respiratory symptoms are unrelated
D. Wait 48 hours to see if symptoms resolve before taking any action
Correct Answer: B
Rationale: Correct because new respiratory symptoms in a resident already on isolation requires expanding
precautions to include droplet measures until the new symptoms are evaluated. Priority is preventing transmission of
a potential respiratory pathogen to other residents and staff.
Q3. When performing hand hygiene with alcohol-based hand rub (ABHR), which technique is correct according to
CDC guidelines?
A. Apply a dime-sized amount and rub until hands feel dry, approximately 5 seconds
B. Apply a penny-sized amount and wipe hands on a paper towel after 10 seconds
C. Apply the product to the palm of one hand and rub hands together, covering all surfaces until
completely dry, approximately 20 seconds [CORRECT]
D. Apply the product and immediately rinse with water to remove residual alcohol
Correct Answer: C
Rationale: Correct because CDC guidelines specify that ABHR should be applied to the palm of one hand, hands
rubbed together covering all surfaces including fingers, and continued until completely dry, which takes
approximately 20 seconds. This matches the WHO and CDC-recommended technique for effective hand antisepsis.
Q4. A resident has a confirmed diagnosis of Clostridioides difficile infection (CDI). Which environmental
cleaning protocol is most appropriate for this resident's room?
A. Clean with standard quaternary ammonium compound and allow to air dry
B. Clean with an EPA-registered sporicidal agent such as sodium hypochlorite (bleach) [CORRECT]
, C. Use standard multi-purpose cleaner since C. diff is not environmentally transmitted
D. Clean with alcohol-based disinfectant wipes only on high-touch surfaces
Correct Answer: B
Rationale: Correct because C. difficile forms spores that are resistant to standard disinfectants and require sporicidal
agents such as sodium hypochlorite (bleach) at appropriate concentrations. This matches CDC recommendations for
environmental cleaning in rooms housing residents with CDI.
Q5. What is the primary purpose of an Exposure Control Plan (ECP) in a nursing home setting?
A. To track employee attendance during flu season
B. To document resident satisfaction with infection control measures
C. To eliminate or minimize occupational exposure to bloodborne pathogens [CORRECT]
D. To schedule routine environmental cleaning rotations
Correct Answer: C
Rationale: Correct because the Exposure Control Plan is mandated by OSHA's Bloodborne Pathogens Standard (29
CFR 1910.1030) and its primary purpose is to identify and implement measures to eliminate or minimize employee
exposure to blood and other potentially infectious materials. This matches the regulatory requirement for all
healthcare facilities.
Q6. A nursing home reports 4 new cases of MRSA bacteremia within a 2-week period among residents on the
same unit. What is the most appropriate next step in the outbreak investigation process?
A. Close the unit to all new admissions immediately
B. Begin active surveillance cultures on all residents and staff on the affected unit [CORRECT]
C. Send a notification letter to all families without further investigation
D. Wait for the monthly surveillance report before taking any action
Correct Answer: B
Rationale: Correct because the number of cases exceeds the expected baseline and active surveillance cultures are the
essential next step to determine the extent of colonization and identify the reservoir. Priority is establishing the scope
of the outbreak before implementing additional control measures.
Q7. Which type of personal protective equipment (PPE) is required when caring for a resident on airborne
precautions for suspected tuberculosis?
A. Standard surgical mask
B. N95 respirator or higher-level respiratory protection [CORRECT]
C. Face shield without a mask
D. Cloth face covering
Correct Answer: B
Rationale: Correct because airborne precautions for tuberculosis require the use of an N95 respirator or higher-level
respiratory protection that is fit-tested for the individual healthcare worker. This matches CDC and OSHA
requirements for preventing inhalation of airborne particles containing Mycobacterium tuberculosis.
Q8. During a competency evaluation of hand hygiene technique, which observation would indicate the need for
remedial training?
, A. The nurse performs hand hygiene before and after each resident contact
B. The nurse removes jewelry before performing hand hygiene
C. The nurse uses soap and water when hands are visibly soiled
D. The nurse applies ABHR and immediately dons gloves without allowing the product to dry
[CORRECT]
Correct Answer: D
Rationale: Correct because ABHR must be allowed to dry completely on hands before donning gloves, as residual
alcohol can degrade glove material and the product requires full contact time for antimicrobial efficacy. Priority is
ensuring the hand hygiene product achieves its intended antimicrobial effect.
Q9. What is the recommended approach for antibiotic stewardship in a nursing home setting?
A. Prescribe broad-spectrum antibiotics empirically for all suspected infections
B. Obtain cultures before initiating antibiotics whenever possible and use the narrowest-spectrum agent
appropriate [CORRECT]
C. Delay antibiotic therapy for 72 hours regardless of clinical presentation
D. Rotate antibiotics on a monthly schedule to prevent resistance
Correct Answer: B
Rationale: Correct because obtaining cultures before initiating antibiotics allows for targeted therapy, and using the
narrowest-spectrum agent reduces the development of antimicrobial resistance. This matches CDC core elements of
antibiotic stewardship for nursing homes.
Q10. A catheterized resident develops signs and symptoms of a urinary tract infection 5 days after insertion.
Which action is most important for CAUTI prevention in this scenario?
A. Replace the catheter with a larger gauge to improve drainage
B. Assess the continued need for the catheter daily and remove it as soon as medically possible
[CORRECT]
C. Irrigate the catheter with antiseptic solution every shift
D. Administer prophylactic antibiotics to prevent systemic infection
Correct Answer: B
Rationale: Correct because the most important CAUTI prevention strategy is removing the catheter as soon as it is no
longer medically indicated, as the risk of infection increases with each day the device remains in place. This matches
CDC guidelines for prevention of catheter-associated urinary tract infections.
Q11. Which sterilization method is most appropriate for heat-sensitive critical instruments in a nursing home?
A. Steam sterilization (autoclave)
B. Chemical vapor sterilization
C. Low-temperature hydrogen peroxide gas plasma sterilization [CORRECT]
D. Dry heat sterilization
Correct Answer: C
Rationale: Correct because heat-sensitive critical instruments cannot withstand the high temperatures of steam or dry
heat sterilization and require low-temperature methods such as hydrogen peroxide gas plasma. This matches AAMI
and CDC recommendations for sterilization of heat-sensitive medical devices.
Infection Control Comprehensive Review Examination
Q1. Which component of the chain of infection represents the pathogen that causes disease?
A. Susceptible host
B. Portal of exit
C. Causative agent [CORRECT]
D. Mode of transmission
Correct Answer: C
Rationale: Correct because the causative agent is the specific microorganism responsible for causing an infectious
disease, which is the first link in the chain of infection. This matches the standard definition used in infection
prevention training for all healthcare settings.
Q2. A nursing assistant reports that a resident has developed a new onset of fever, cough, and productive sputum.
The resident is on contact precautions for a wound infection. What is the most appropriate initial action by the
infection preventionist?
A. Transfer the resident to the emergency department immediately
B. Add droplet precautions in addition to existing contact precautions [CORRECT]
C. Discontinue contact precautions since the respiratory symptoms are unrelated
D. Wait 48 hours to see if symptoms resolve before taking any action
Correct Answer: B
Rationale: Correct because new respiratory symptoms in a resident already on isolation requires expanding
precautions to include droplet measures until the new symptoms are evaluated. Priority is preventing transmission of
a potential respiratory pathogen to other residents and staff.
Q3. When performing hand hygiene with alcohol-based hand rub (ABHR), which technique is correct according to
CDC guidelines?
A. Apply a dime-sized amount and rub until hands feel dry, approximately 5 seconds
B. Apply a penny-sized amount and wipe hands on a paper towel after 10 seconds
C. Apply the product to the palm of one hand and rub hands together, covering all surfaces until
completely dry, approximately 20 seconds [CORRECT]
D. Apply the product and immediately rinse with water to remove residual alcohol
Correct Answer: C
Rationale: Correct because CDC guidelines specify that ABHR should be applied to the palm of one hand, hands
rubbed together covering all surfaces including fingers, and continued until completely dry, which takes
approximately 20 seconds. This matches the WHO and CDC-recommended technique for effective hand antisepsis.
Q4. A resident has a confirmed diagnosis of Clostridioides difficile infection (CDI). Which environmental
cleaning protocol is most appropriate for this resident's room?
A. Clean with standard quaternary ammonium compound and allow to air dry
B. Clean with an EPA-registered sporicidal agent such as sodium hypochlorite (bleach) [CORRECT]
, C. Use standard multi-purpose cleaner since C. diff is not environmentally transmitted
D. Clean with alcohol-based disinfectant wipes only on high-touch surfaces
Correct Answer: B
Rationale: Correct because C. difficile forms spores that are resistant to standard disinfectants and require sporicidal
agents such as sodium hypochlorite (bleach) at appropriate concentrations. This matches CDC recommendations for
environmental cleaning in rooms housing residents with CDI.
Q5. What is the primary purpose of an Exposure Control Plan (ECP) in a nursing home setting?
A. To track employee attendance during flu season
B. To document resident satisfaction with infection control measures
C. To eliminate or minimize occupational exposure to bloodborne pathogens [CORRECT]
D. To schedule routine environmental cleaning rotations
Correct Answer: C
Rationale: Correct because the Exposure Control Plan is mandated by OSHA's Bloodborne Pathogens Standard (29
CFR 1910.1030) and its primary purpose is to identify and implement measures to eliminate or minimize employee
exposure to blood and other potentially infectious materials. This matches the regulatory requirement for all
healthcare facilities.
Q6. A nursing home reports 4 new cases of MRSA bacteremia within a 2-week period among residents on the
same unit. What is the most appropriate next step in the outbreak investigation process?
A. Close the unit to all new admissions immediately
B. Begin active surveillance cultures on all residents and staff on the affected unit [CORRECT]
C. Send a notification letter to all families without further investigation
D. Wait for the monthly surveillance report before taking any action
Correct Answer: B
Rationale: Correct because the number of cases exceeds the expected baseline and active surveillance cultures are the
essential next step to determine the extent of colonization and identify the reservoir. Priority is establishing the scope
of the outbreak before implementing additional control measures.
Q7. Which type of personal protective equipment (PPE) is required when caring for a resident on airborne
precautions for suspected tuberculosis?
A. Standard surgical mask
B. N95 respirator or higher-level respiratory protection [CORRECT]
C. Face shield without a mask
D. Cloth face covering
Correct Answer: B
Rationale: Correct because airborne precautions for tuberculosis require the use of an N95 respirator or higher-level
respiratory protection that is fit-tested for the individual healthcare worker. This matches CDC and OSHA
requirements for preventing inhalation of airborne particles containing Mycobacterium tuberculosis.
Q8. During a competency evaluation of hand hygiene technique, which observation would indicate the need for
remedial training?
, A. The nurse performs hand hygiene before and after each resident contact
B. The nurse removes jewelry before performing hand hygiene
C. The nurse uses soap and water when hands are visibly soiled
D. The nurse applies ABHR and immediately dons gloves without allowing the product to dry
[CORRECT]
Correct Answer: D
Rationale: Correct because ABHR must be allowed to dry completely on hands before donning gloves, as residual
alcohol can degrade glove material and the product requires full contact time for antimicrobial efficacy. Priority is
ensuring the hand hygiene product achieves its intended antimicrobial effect.
Q9. What is the recommended approach for antibiotic stewardship in a nursing home setting?
A. Prescribe broad-spectrum antibiotics empirically for all suspected infections
B. Obtain cultures before initiating antibiotics whenever possible and use the narrowest-spectrum agent
appropriate [CORRECT]
C. Delay antibiotic therapy for 72 hours regardless of clinical presentation
D. Rotate antibiotics on a monthly schedule to prevent resistance
Correct Answer: B
Rationale: Correct because obtaining cultures before initiating antibiotics allows for targeted therapy, and using the
narrowest-spectrum agent reduces the development of antimicrobial resistance. This matches CDC core elements of
antibiotic stewardship for nursing homes.
Q10. A catheterized resident develops signs and symptoms of a urinary tract infection 5 days after insertion.
Which action is most important for CAUTI prevention in this scenario?
A. Replace the catheter with a larger gauge to improve drainage
B. Assess the continued need for the catheter daily and remove it as soon as medically possible
[CORRECT]
C. Irrigate the catheter with antiseptic solution every shift
D. Administer prophylactic antibiotics to prevent systemic infection
Correct Answer: B
Rationale: Correct because the most important CAUTI prevention strategy is removing the catheter as soon as it is no
longer medically indicated, as the risk of infection increases with each day the device remains in place. This matches
CDC guidelines for prevention of catheter-associated urinary tract infections.
Q11. Which sterilization method is most appropriate for heat-sensitive critical instruments in a nursing home?
A. Steam sterilization (autoclave)
B. Chemical vapor sterilization
C. Low-temperature hydrogen peroxide gas plasma sterilization [CORRECT]
D. Dry heat sterilization
Correct Answer: C
Rationale: Correct because heat-sensitive critical instruments cannot withstand the high temperatures of steam or dry
heat sterilization and require low-temperature methods such as hydrogen peroxide gas plasma. This matches AAMI
and CDC recommendations for sterilization of heat-sensitive medical devices.
