A nurse is assisting with teaching a newly licensed about hand hygiene. Which of the following instructions should the nurse include?
Use hot water when washing hands with soap and water.
Use alcohol-based hand sanitizers on hands for at least 10 seconds.
Wash hands with soap and water if they are visibly soiled.
Wash hands with an alcohol-based hand sanitizer when caring for a client who has Clostridium difficile.
The Correct Answer is C
A. While water temperature can be a matter of personal preference, it is not necessary to use hot water. In fact, the temperature of the water (whether warm or cold) does not significantly impact the effectiveness of handwashing. The most important factor is to use soap and rub the hands thoroughly for at least 20 seconds.
B. This statement is partially correct but requires clarification. Alcohol-based hand sanitizers should be rubbed on all surfaces of the hands until they are dry, which typically takes about 20 seconds. Ten seconds is insufficient for effective sanitization, so this instruction should be revised.
C. This statement is correct and should definitely be included. When hands are visibly soiled, washing them with soap and water is the most effective way to remove dirt, bacteria, and viruses. Alcohol-based hand sanitizers are not effective when hands are dirty or greasy.
D. Clostridium difficile (C. diff) infections require soap and water for handwashing, as alcohol-based hand sanitizers are ineffective against the spores of C. diff. Therefore, this instruction should not be included.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The nurse should wear a surgical mask when within 0.6 m (2 ft) of the client to prevent the spread of infection. This is one of the key precautions for droplet isolation.
B. Clients who are placed on droplet precautions should wear a surgical mask when they leave their room to prevent the spread of infection to others. However, it is not necessary for the nurse to place a mask on the client.
C. Clients who are placed on droplet precautions should be isolated in a private room or in a room with other clients who have the same infection. A positive airflow room is typically used for clients who are immunocompromised or have airborne infections.
D. Fresh flowers do not pose a significant risk of infection transmission and can be kept in the client's room.
Correct Answer is D
Explanation
A. Offering approval or disapproval can create a judgmental atmosphere, potentially making clients feel defensive or unsupported. Therapeutic communication should focus on understanding and empathizing with the client rather than evaluating their feelings or actions.
B. This technique can be problematic in therapeutic communication. Asking clients to explain their feelings or behaviors may come off as interrogative or dismissive, which can hinder open dialogue. It’s often more effective to explore the client’s feelings without requiring justification.
C. While offering sympathy may seem caring, it can shift the focus from the client’s feelings to the nurse's emotions. Sympathy often implies pity and can create a power imbalance, whereas therapeutic communication should aim for empathy—understanding and validating the client's experiences without imposing one's own feelings.
D. This is a key technique in therapeutic communication. Open-ended questions encourage clients to express themselves freely, providing more information and facilitating deeper conversations. They invite exploration and help build rapport, making clients feel heard and understood.
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