CNA Infection Control 2 — Questions and Answers
Question 1: A resident on neutropenic precautions has a diet order for all food to be fully cooked. Which of the following meal trays delivered by the dietary aide would require the CNA to intervene?
- A plate with baked chicken, steamed green beans, and a fresh, unpeeled apple. (Correct answer)
- A bowl of well-done beef stew with cooked carrots and potatoes.
- A serving of scrambled eggs with a side of pasteurized orange juice.
- A plate with a thoroughly cooked fish fillet, mashed potatoes, and canned peaches.
Correct answer: A plate with baked chicken, steamed green beans, and a fresh, unpeeled apple.
Patients on neutropenic precautions have a severely weakened immune system and are highly susceptible to infections. A 'neutropenic diet' excludes raw or unpeeled fruits and vegetables, undercooked meats, and unpasteurized dairy products to minimize exposure to bacteria and fungi. A fresh, unpeeled apple is a raw fruit and could harbor microorganisms, posing a significant risk. The other options consist of fully cooked or pasteurized items, which are safe for consumption.
Question 2: A CNA is assisting a nurse with a sterile dressing change. The nurse, wearing sterile gloves, accidentally brushes her gloved hand against the resident's bed rail, which is outside the sterile field. What is the CNA's most appropriate immediate action?
- Say nothing, as the nurse is in charge of the procedure.
- Immediately state, 'Your glove just touched the bed rail. We need to stop and get a new pair.' (Correct answer)
- Hand the nurse an alcohol wipe to clean her glove.
- Continue with the procedure but watch the nurse's hand closely.
Correct answer: Immediately state, 'Your glove just touched the bed rail. We need to stop and get a new pair.'
Maintaining a sterile field is a team responsibility. When a break in sterile technique occurs, it must be corrected immediately to prevent patient infection. The CNA has a duty to speak up professionally and clearly to ensure patient safety. The nurse must stop, remove the contaminated gloves, perform hand hygiene, and don a new pair of sterile gloves. Cleaning a sterile glove with an alcohol wipe does not re-sterilize it, and continuing the procedure would introduce contamination to the wound.
Question 3: A long-term care facility is experiencing a norovirus outbreak. Which of the following is the MOST critical instruction for the CNA to follow regarding hand hygiene?
- Use an alcohol-based hand rub with at least 70% alcohol after each resident contact.
- Wash hands with soap and water for at least 20 seconds, especially after contact with symptomatic residents. (Correct answer)
- Wear gloves for all resident care and change them between rooms.
- Wash hands with water only if they are not visibly soiled.
Correct answer: Wash hands with soap and water for at least 20 seconds, especially after contact with symptomatic residents.
Norovirus is highly resistant to alcohol-based hand sanitizers. The CDC explicitly recommends washing hands with soap and water after caring for patients with suspected or confirmed norovirus. The friction from washing and rinsing physically removes the virus particles. While gloves are essential PPE, they are not a substitute for proper hand hygiene, which is the most critical step in preventing transmission during a norovirus outbreak.
Question 4: A CNA is assigned to a resident with scabies. When changing the resident's bed linens, which procedure is most important to prevent the spread of mites?
- Shake the linens vigorously in the room to dislodge any mites before bagging.
- Place the linens in a standard, open hamper in the hallway.
- Roll the linens carefully inward, place them in a designated, sealed bag inside the resident's room, and avoid contact with your uniform. (Correct answer)
- Take the linens to a dedicated sorting area to be shaken out before washing.
Correct answer: Roll the linens carefully inward, place them in a designated, sealed bag inside the resident's room, and avoid contact with your uniform.
To prevent the spread of scabies mites and their eggs, soiled linen should be handled minimally. Shaking linens can aerosolize mites and contaminate the air and surfaces. Linens should be carefully rolled, contained in a labeled, leak-proof bag within the patient's room, and carried away from the body to prevent contamination of the CNA's uniform and the facility environment.
Question 5: A shared blood pressure cuff is used on a resident in contact precautions for C. difficile. Before the cuff can be used on another resident, what is the priority action?
- Wipe it down with an alcohol-based sanitizer wipe.
- Clean any visible soil with a cloth and then disinfect with an EPA-registered, spore-killing disinfectant. (Correct answer)
- Let it air out for one hour before its next use.
- Place it in a plastic bag and label it as 'contaminated'.
Correct answer: Clean any visible soil with a cloth and then disinfect with an EPA-registered, spore-killing disinfectant.
C. difficile forms spores that are highly resistant to standard disinfectants, including alcohol. The correct procedure is to first clean the item to remove any organic matter, and then to disinfect it using an EPA-registered disinfectant that is specifically labeled as effective against C. difficile spores (a sporicidal agent), following the manufacturer's instructions for contact time. Alcohol wipes are not effective against C. diff spores.
Question 6: During a facility-wide influenza outbreak, a CNA observes a visitor who is coughing frequently in the hallway without covering their mouth. What is the CNA's most appropriate initial response?
- Ignore the visitor to avoid a confrontation.
- Immediately report the visitor to the director of nursing.
- Politely approach the visitor, offer them a tissue and a surgical mask, and explain the facility's respiratory hygiene policy. (Correct answer)
- Announce loudly in the hallway that everyone needs to cover their coughs.
Correct answer: Politely approach the visitor, offer them a tissue and a surgical mask, and explain the facility's respiratory hygiene policy.
A key part of infection control is patient and visitor education. The CNA should courteously and discreetly approach the visitor to address the situation directly. Providing a tissue and mask and explaining the importance of respiratory hygiene/cough etiquette helps protect residents and staff without being confrontational. This proactive, educational approach is more effective and professional than ignoring the problem or making a general announcement.
CNA Infection Control 2
A resident on neutropenic precautions has a diet order for all food to be fully cooked.
Which of the following meal trays delivered by the dietary aide would require the CNA to intervene?