RNC-NIC Infection Control 4 — Questions and Answers
Question 1: A preterm neonate at 30 weeks gestation requires TPN through a PICC line. The nurse notices the insertion site is red, warm, and has purulent discharge. What is the FIRST nursing action?
- Apply a new sterile dressing and document the findings
- Notify the physician, obtain blood cultures, and prepare for line removal (Correct answer)
- Increase the frequency of dressing changes to every 12 hours
- Administer topical mupirocin to the insertion site
Correct answer: Notify the physician, obtain blood cultures, and prepare for line removal
Signs of local infection at a PICC site with systemic risk require immediate provider notification, blood cultures before antibiotics, and likely line removal to prevent bacteremia.
Question 2: Which laboratory finding is MOST consistent with bacterial sepsis in a neonate?
- White blood cell count of 12,000/mm³ with normal differential
- Immature-to-total neutrophil ratio (I:T ratio) greater than 0.2 (Correct answer)
- C-reactive protein (CRP) of 0.5 mg/L at 12 hours of life
- Platelet count of 200,000/mm³
Correct answer: Immature-to-total neutrophil ratio (I:T ratio) greater than 0.2
An elevated I:T ratio greater than 0.2 indicates a left shift with immature neutrophils released in response to bacterial infection and is a sensitive marker for neonatal sepsis.
Question 3: During an outbreak of Klebsiella pneumoniae in the NICU, which environmental control measure is MOST important to implement?
- Administer prophylactic antibiotics to all NICU patients
- Perform enhanced environmental cleaning with EPA-approved disinfectants and cohort affected neonates (Correct answer)
- Close the NICU to all new admissions immediately
- Change all staff assignments to prevent further spread
Correct answer: Perform enhanced environmental cleaning with EPA-approved disinfectants and cohort affected neonates
Cohorting infected neonates, enhanced environmental disinfection, and strict contact precautions are the cornerstone of NICU outbreak management for gram-negative organisms.
Question 4: A nurse is caring for a neonate with suspected meningitis. Which assessment finding would MOST likely be present in a neonate with bacterial meningitis rather than viral meningitis?
- CSF glucose less than 40 mg/dL with CSF protein greater than 150 mg/dL (Correct answer)
- CSF lymphocytosis with normal glucose
- Low-grade fever with normal fontanelle
- CSF white cell count of 5-10 cells/mm³ with clear appearance
Correct answer: CSF glucose less than 40 mg/dL with CSF protein greater than 150 mg/dL
Bacterial meningitis in neonates typically produces low CSF glucose (bacteria consume it) and elevated protein, distinguishing it from viral meningitis.
Question 5: Which intervention is part of the evidence-based 'PICC bundle' to prevent CLABSI in the NICU?
- Routine replacement of the PICC every 5 days to prevent biofilm formation
- Scrubbing the hub with antiseptic for at least 15 seconds before each access ('scrub the hub') (Correct answer)
- Using sterile water to flush lines between medication administrations
- Applying gauze dressings rather than transparent semipermeable dressings
Correct answer: Scrubbing the hub with antiseptic for at least 15 seconds before each access ('scrub the hub')
The 'scrub the hub' technique with 70% alcohol or chlorhexidine-alcohol for 15 seconds before each access is a critical CLABSI bundle element that reduces intraluminal contamination.
Question 6: A neonate at 26 weeks gestation is prescribed fluconazole prophylaxis. What is the PRIMARY indication for antifungal prophylaxis in this population?
- Confirmed Candida bloodstream infection requiring treatment
- Prevention of invasive fungal infection in VLBW neonates in units with high invasive candidiasis rates (Correct answer)
- Treatment of oral thrush identified on assessment
- Prevention of fungal diaper dermatitis in preterm neonates
Correct answer: Prevention of invasive fungal infection in VLBW neonates in units with high invasive candidiasis rates
Fluconazole prophylaxis is recommended in NICUs with high invasive candidiasis rates for VLBW neonates to prevent candidemia and its associated morbidity.
Question 7: Which finding on a neonate's skin assessment should alert the NICU nurse to potential disseminated HSV infection?
- Diffuse erythematous macular rash over the trunk
- Vesicular lesions on the scalp, face, or around the eyes (Correct answer)
- Petechiae limited to the face and scalp from birth trauma
- Mongolian spots over the sacral region
Correct answer: Vesicular lesions on the scalp, face, or around the eyes
Vesicular lesions on the scalp, face, or periorbital area in a neonate are classic cutaneous manifestations of HSV that may indicate disseminated or CNS infection.
RNC-NIC Infection Control 4
A preterm neonate at 30 weeks gestation requires TPN through a PICC line.
The nurse notices the insertion site is red, warm, and has purulent discharge.
What is the FIRST nursing action?