CPNRE Infection Prevention and Control 2 — Questions and Answers
Question 1: When entering a room for Contact Precautions, what is the correct sequence for donning PPE?
- Mask, gloves, gown, eye protection
- Gown then gloves (Correct answer)
- Gloves, gown, mask, eye protection
- Mask, gown, eye protection, gloves
Correct answer: Gown then gloves
For Contact Precautions, gown first then gloves (gloves go last to cover gown cuffs and prevent skin contamination).
IPAC Canada PPE donning for Contact Precautions: (1) hand hygiene; (2) don gown (tie at neck and waist); (3) don gloves (pull cuffs over gown sleeves). For droplet added: gown, surgical mask, eye protection, gloves. Gloves go on last so they cover gown cuffs, preventing pathogen contact with skin. Incorrect sequences increase self-contamination risk. These sequences are specified by IPAC Canada and tested on the CPNRE.
Question 2: A client is diagnosed with C. difficile (CDI). Which type of precautions are required?
- Droplet precautions with N95 mask
- Contact precautions with mandatory ABHR use
- Contact precautions with soap and water hand washing (Correct answer)
- Airborne precautions in negative pressure room
Correct answer: Contact precautions with soap and water hand washing
C. difficile requires Contact Precautions and soap and water hand washing because ABHR does not eliminate C. diff spores.
C. diff infection requires: Contact Precautions (gown and gloves); dedicated equipment; soap and water hand washing mandatory (not ABHR) because C. diff spores are highly resistant to alcohol; thorough environmental cleaning with sporicidal disinfectant (bleach 1:10). ABHR does not kill C. diff spores. IPAC Canada guidelines specify soap and water as mandatory for C. diff. This is a critical distinction frequently tested in CPNRE assessments.
Question 3: A practical nurse with a suspected respiratory infection arrives for work. What is most appropriate?
- Continue working and wear a surgical mask all shift
- Contact occupational health or the charge nurse to determine fitness to work (Correct answer)
- Work the shift but avoid clients in isolation rooms
- Self-monitor and determine independently whether to stay
Correct answer: Contact occupational health or the charge nurse to determine fitness to work
Healthcare workers with suspected infections must consult occupational health or facility policy to determine fitness for work.
Healthcare workers with respiratory symptoms have an occupational health obligation to: contact occupational health or the charge nurse before beginning the shift; follow facility health screening policy; not place immunocompromised clients at risk. Working while ill violates duty of care. During COVID-19, respiratory symptoms required mandatory screening. Provincial OH&S legislation in all Canadian provinces governs workplace health and safety. Practical nurses must follow their facility's illness policy per IPAC Canada standards.
Question 4: In which situation must the practical nurse change gloves and perform hand hygiene without leaving the room?
- Moving from a contaminated body site to a clean site on the same client (Correct answer)
- Beginning care for a different client in the same room
- Answering the phone while wearing gloves
- All of the above
Correct answer: Moving from a contaminated body site to a clean site on the same client
Moving from a contaminated to a clean site on the same client requires glove change and hand hygiene to prevent cross-contamination.
Gloves must be changed when: moving from contaminated to clean site on the same client (e.g., perineal care to wound dressing); before and after caring for each client; when gloves become visibly soiled or torn; before invasive procedures; when moving from non-intact to intact skin. WHO 5 Moments for Hand Hygiene and IPAC Canada guidelines specify these indications. Failure to change gloves between contaminated and clean sites transfers pathogens to vulnerable areas.
Question 5: A practical nurse accidentally has a needlestick injury while recapping a needle. What is the first action?
- Complete an incident report form immediately
- Notify the charge nurse and occupational health
- Wash the site with soap and water for at least 15 seconds (Correct answer)
- Apply pressure to stop bleeding
Correct answer: Wash the site with soap and water for at least 15 seconds
Following a needlestick, the first action is immediate first aid: wash the wound with soap and water for at least 15 seconds.
Post-exposure needlestick protocol (PHAC, provincial OH&S): (1) FIRST AID: wash with soap and water at least 15 seconds; allow bleeding; do NOT squeeze or use bleach; (2) report to charge nurse; (3) contact occupational health/emergency; (4) identify source client and request baseline testing; (5) assess HIV, HBV, HCV risk; (6) HIV post-exposure prophylaxis must start within 2 hours; (7) complete incident report. Recapping needles with two hands is a major cause of needlestick injuries and is against IPAC Canada guidelines.
Question 6: An outbreak of norovirus is declared on a medical unit. Which measure is most effective?
- Administering antivirals prophylactically to all staff
- Strict hand hygiene with soap and water and cohort nursing for affected clients (Correct answer)
- Universal masking regardless of symptoms
- Closing the unit and discharging all clients
Correct answer: Strict hand hygiene with soap and water and cohort nursing for affected clients
Soap and water hand washing combined with cohorting infected clients are the most effective norovirus outbreak control measures.
Norovirus outbreak control per IPAC Canada and PHAC: mandatory soap and water hand washing (ABHR less effective against norovirus); cohort nursing (group infected clients, assign dedicated staff); strict Contact Precautions; dedicated equipment; environmental cleaning with bleach (1000-5000 ppm); exclude symptomatic staff until 48 hours post-symptom resolution; symptomatic clients confined to rooms; visitor restrictions. No approved antivirals for norovirus prophylaxis. Unit closure to new admissions may occur but discharging all clients is not the first-line measure.
CPNRE Infection Prevention and Control 2
When entering a room for Contact Precautions, what is the correct sequence for donning PPE?