CNO - College of Nurses of Ontario Infection Prevention and Control Questions and Answers — Questions and Answers
Question 1: A nurse is leaving the room of a client on contact and droplet precautions for influenza. The nurse has worn gloves, a gown, a surgical mask, and eye protection. Which sequence for removing (doffing) Personal Protective Equipment (PPE) is correct to minimize self-contamination?
- Mask, eye protection, gown, gloves.
- Gloves, gown, perform hand hygiene, eye protection, mask, perform hand hygiene. (Correct answer)
- Gown, gloves, mask, eye protection.
- Gloves, hand hygiene, gown, hand hygiene, mask, eye protection.
Correct answer: Gloves, gown, perform hand hygiene, eye protection, mask, perform hand hygiene.
According to Public Health Ontario guidelines, the correct doffing sequence is designed to remove the most contaminated items first. Gloves and the gown are considered the most contaminated and are removed first. Hand hygiene is performed, followed by the removal of eye protection and the mask. A final hand hygiene is performed after all PPE has been removed.
Question 2: When caring for a client with a confirmed Clostridioides difficile (C. diff) infection, which of the following hand hygiene practices is mandatory after removing gloves and before exiting the room?
- Using an alcohol-based hand rub (ABHR) with at least 70% alcohol.
- Wiping hands with a disinfectant wipe used for surfaces.
- Washing hands with soap and running water. (Correct answer)
- Performing hand hygiene is only necessary if the hands are visibly soiled.
Correct answer: Washing hands with soap and running water.
Clostridioides difficile produces spores that are highly resistant to the alcohol found in hand sanitizers. The mechanical action of washing with soap and rinsing with running water is required to physically remove the spores from the hands. This is a critical practice to prevent the transmission of C. diff.
Question 3: A nurse on a long-term care unit notes that two residents in the same wing have developed a new onset of cough and fever within a 48-hour period. According to provincial guidelines, what is the most appropriate initial action?
- Wait for laboratory confirmation before reporting the illnesses.
- Document the findings and continue to monitor the residents for the next 24 hours.
- Transfer the two symptomatic residents to an acute care hospital immediately.
- Implement respiratory outbreak control measures and report the suspicion to the local public health unit. (Correct answer)
Correct answer: Implement respiratory outbreak control measures and report the suspicion to the local public health unit.
Public Health Ontario's guidelines define a suspected respiratory outbreak in an institution like a long-term care home as two cases of acute respiratory illness within 48 hours in a specific geographic area (e.g., a unit or wing). The standard of practice is to act on this suspicion immediately by implementing control measures (e.g., isolating symptomatic residents, enhancing cleaning, using appropriate PPE) and reporting to the local public health unit for investigation and guidance.
Question 4: A nurse is preparing to administer an intramuscular injection. According to the principles of Routine Practices, what is the minimum Personal Protective Equipment (PPE) the nurse should wear?
- Gloves only. (Correct answer)
- No PPE is required as injections are a sterile procedure.
- A gown and gloves.
- A surgical mask and eye protection.
Correct answer: Gloves only.
Routine Practices are based on a point-of-care risk assessment (PCRA). When performing a procedure like an intramuscular injection, there is a risk of exposure to blood or body fluids, even if minimal. Therefore, wearing gloves is the minimum required PPE to protect the nurse from potential exposure at the injection site.
Question 5: A nurse provides education to a client about the importance of handwashing after using the washroom. This action is primarily aimed at breaking which link in the chain of infection?
- Reservoir
- Mode of Transmission (Correct answer)
- Susceptible Host
- Portal of Entry
Correct answer: Mode of Transmission
The chain of infection consists of an infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host. Handwashing is the single most effective way to prevent the spread of infections. It breaks the chain by interrupting the mode of transmission, preventing infectious agents from being transferred from a surface (reservoir) to a susceptible host via the hands.
Question 6: A nurse is assigned to care for a client with confirmed pulmonary tuberculosis. Which of the following infection control measures is a mandatory component of Airborne Precautions for this client?
- Placing the client in a positive-pressure isolation room.
- Wearing a fluid-resistant surgical mask when entering the client's room.
- Ensuring healthcare providers wear a fit-tested N95 respirator when entering the client's room. (Correct answer)
- Keeping the door to the client's room open to promote air circulation.
Correct answer: Ensuring healthcare providers wear a fit-tested N95 respirator when entering the client's room.
Airborne Precautions are required for pathogens transmitted by small airborne particles (droplet nuclei), like tuberculosis. These particles can remain suspended in the air for extended periods. To protect healthcare workers, it is mandatory to wear a fit-tested N95 respirator (or equivalent) that filters these small particles. Other requirements include placing the client in a negative-pressure room and keeping the door closed.
CNO - College of Nurses of Ontario Infection Prevention and Control Questions and Answers
A nurse is leaving the room of a client on contact and droplet precautions for influenza.
The nurse has worn gloves, a gown, a surgical mask, and eye protection.
Which sequence for removing (doffing) Personal Protective Equipment (PPE) is correct to minimize self-contamination?