RNC-NIC Infection Control 5 — Questions and Answers
Question 1: A NICU nurse notes that a neonate who was improving has developed recurrent temperature instability, abdominal distension, and bloody stools. The infant is on broad-spectrum antibiotics for EOS. What is the MOST likely complication?
- Antibiotic-associated diarrhea from Clostridioides difficile
- Necrotizing enterocolitis (NEC) developing despite antibiotic therapy (Correct answer)
- Viral gastroenteritis from nosocomial transmission
- Feeding intolerance due to formula composition
Correct answer: Necrotizing enterocolitis (NEC) developing despite antibiotic therapy
Recurrent deterioration with abdominal distension and bloody stools in a preterm neonate should raise immediate concern for NEC, which can develop independently of antibiotic therapy.
Question 2: When transporting a neonate in Contact Precautions to radiology, what is the CORRECT procedure?
- Remove Contact Precautions signage during transport and replace upon return
- Ensure the neonate is covered with a clean sheet or blanket and notify receiving area in advance (Correct answer)
- Discontinue Contact Precautions for transport since the neonate is covered in an isolette
- Transport is contraindicated for neonates in Contact Precautions
Correct answer: Ensure the neonate is covered with a clean sheet or blanket and notify receiving area in advance
Covering the neonate and pre-notifying the receiving area allows staff there to prepare appropriate precautions, preventing transmission along the transport route and at the destination.
Question 3: A nurse washes their hands with soap and water for 20 seconds after caring for a neonate with suspected Clostridioides difficile infection. Why is soap and water preferred over alcohol-based hand rub for this pathogen?
- Soap and water kills C. difficile vegetative cells more effectively than alcohol
- Alcohol-based hand rubs do not effectively remove C. difficile spores, which require mechanical removal with soap and water (Correct answer)
- C. difficile is resistant to all standard hand hygiene agents
- Soap and water provides longer-lasting skin protection against spore-forming organisms
Correct answer: Alcohol-based hand rubs do not effectively remove C. difficile spores, which require mechanical removal with soap and water
C. difficile forms spores that are not killed by alcohol; soap and water mechanically removes spores from the hands, making it the only effective hand hygiene method for this pathogen.
Question 4: Which neonatal population has the HIGHEST risk for developing invasive group B Streptococcus (GBS) disease in the late-onset form (7-89 days of life)?
- Term neonates born to GBS-negative mothers
- Preterm neonates born before 34 weeks, particularly those with prior hospitalization (Correct answer)
- Term neonates whose mothers received adequate intrapartum antibiotics
- Post-term neonates born after 42 weeks gestation
Correct answer: Preterm neonates born before 34 weeks, particularly those with prior hospitalization
Late-onset GBS disproportionately affects preterm neonates due to immature immune function, reduced maternal antibody transfer, and prolonged NICU exposure with potential nosocomial acquisition.
Question 5: A NICU nurse is setting up a breast milk feeding for a neonate. The pumped human milk label shows it was pumped 5 days ago and stored in the NICU refrigerator. What action should the nurse take?
- Use the milk immediately since refrigerated breast milk is safe for up to 8 days
- Discard the milk as it exceeds the recommended 4-day refrigerated storage limit and obtain a fresh supply (Correct answer)
- Freeze the milk since it can be used after freezing if the refrigerated storage limit is exceeded
- Check the milk color and smell; if acceptable, use it for the feeding
Correct answer: Discard the milk as it exceeds the recommended 4-day refrigerated storage limit and obtain a fresh supply
CDC and HMBANA guidelines recommend discarding refrigerated expressed breast milk after 4 days in the NICU setting; the milk should not be frozen after refrigerator storage limit is exceeded.
Question 6: A neonate develops signs consistent with congenital cytomegalovirus (CMV) infection including hepatosplenomegaly, petechiae, and microcephaly. Which precaution is MOST important when providing care?
- Airborne Precautions due to risk of CMV aerosol transmission
- Standard Precautions are sufficient since CMV is not highly contagious in healthy adults
- Contact Precautions because CMV spreads via urine, saliva, and secretions through direct contact (Correct answer)
- Droplet Precautions because CMV spreads via large respiratory droplets
Correct answer: Contact Precautions because CMV spreads via urine, saliva, and secretions through direct contact
CMV is transmitted through contact with infected secretions including urine, saliva, and blood; Contact Precautions plus Standard Precautions protect staff and prevent nosocomial spread.
Question 7: During a shift, a NICU nurse cares for three neonates and uses alcohol-based hand rub between patients. One neonate is found to have active rotavirus infection. What is the MOST appropriate response?
- Continue using alcohol-based hand rub exclusively since it is sufficient for all enteric viruses
- Switch to soap and water handwashing for care of the infected neonate since alcohol is less effective against non-enveloped viruses like rotavirus (Correct answer)
- Use double-gloving instead of changing hand hygiene technique
- Disinfect hands with 2% chlorhexidine solution instead of alcohol rub
Correct answer: Switch to soap and water handwashing for care of the infected neonate since alcohol is less effective against non-enveloped viruses like rotavirus
Rotavirus is a non-enveloped virus with reduced susceptibility to alcohol; soap and water handwashing with mechanical removal is more effective for this pathogen.
RNC-NIC Infection Control 5
A NICU nurse notes that a neonate who was improving has developed recurrent temperature instability, abdominal distension, and bloody stools.
The infant is on broad-spectrum antibiotics for EOS.
What is the MOST likely complication?