CIC Practice Test 2 Graded A+ 202425 Version

CIC Practice Test 2 Graded A+ 202425 Version1. 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,