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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000435346.23040.99
Feature Articles

CE Test 2.3 Hours: Mouth Care to Reduce Ventilator-Associated Pneumonia

Contrada, Emily

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Continued Education
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* To take the test online, go to our secure Web site at .

* To use the form provided in this issue, record your answers in the test answer section of the CE enrollment form below. Each question has only one correct answer. You may make copies of the form.

* Complete the registration information and course evaluation. Mail the completed enrollment form and registration fee to:Lippincott Williams and Wilkins,CE Group, 74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723. You will receive your certificate in four to six weeks. For faster service, include a fax number and we will fax your certificate within two business days of receiving your enrollment form. You will receive your CE certificate of earned contact hours and an answer key to review your results. There is no minimum passing grade.

* Registration deadline is October 31, 2015.

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* Send in together two or more tests from any nursing journal published by Lippincott, Williams and Wilkins (LWW), and deduct $0.95 from the price of each test.

* We also offer CE accounts for hospitals and other health care facilities online at Call1-800-787-8985 for details.

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LWW, publisher of AJN, will award the number of contact hours indicated for each continuing nursing education activity. LWW is accredited as a provider of continuing nursing education by the Commission on Accreditation of the American Nurses Credentialing Center (ANCC).

These activities are also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for the number of contact hours indicated. LWW is also an approved provider of continuing nursing education by the District of Columbia and Florida #50-1223. Your certificate is valid in all states.

The ANCC's accreditation status of the LWW Department of Continuing Education refers to its continuing nursing educational activities only and does not imply Commission on Accreditation approval or endorsement of any commercial product.

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To explain the pathophysiology of ventilator-associated pneumonia and an evidence-based, step-by-step guide to providing optimal oral care for intubated patients.

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After reading this article and taking this test, you will be able to

* recognize the association between optimal oral hygiene and the prevention of ventilator-associated pneumonia.

* identify evidence-based guidelines for providing appropriate oral care for intubated patients.

1. Ventilator-associated pneumonia (VAP) can emerge as early as how soon after respiratory intubation?

a. 12 to 24 hours

b. 1 to 2 days

c. 2 to 4 days

d. 4 to 6 days

2. Per 1,000 ventilator days in adult critical care units, mean VAP rates range from 0 to

a. 2.

b. 4.

c. 6.

d. 8.

3. Each case of VAP increases hospital expenses by an estimated

a. $3,000 to $10,000.

b. $10,000 to $25,000.

c. $25,000 to $35,000.

d. $35,000 to $50,000.

4. Research shows that VAP most often results from

a. contiguous spread.

b. gastric colonization.

c. hematogenous seeding.

d. aspiration of oropharyngeal pathogens.

5. Routine oral care has which of the following beneficial actions?

a. It increases the flow of saliva.

b. It eliminates xerostomia.

c. It removes tartar.

d. It relieves the pain of dental caries.

6. Which of the following respiratory pathogens resists many antibiotics and has a grape-like odor?

a. Staphylococcus aureus

b. Klebsiella pneumoniae

c. Pseudomonas aeruginosa

d. Escherichia coli

7. Research indicates that implementing an oral care protocol can reduce the incidence of VAP by 46% to nearly

a. 60%.

b. 70%.

c. 80%.

d. 90%.

8. Which of the following oral care products is best to use for removing plaque?

a. lemon-glycerin swabs

b. interdentate sticks

c. foam sponges

d. soft toothbrushes

9. Studies suggest that ICU patients are least likely to receive routine oral care

a. within the first 2 days after admission to the unit.

b. during evening hours.

c. after the first 3 days spent in the unit.

d. during nighttime hours.

10. According to the American Association of Critical-Care Nurses, comprehensive oral hygiene is

a. a comfort measure.

b. an expected nursing practice.

c. a costly addition to care.

d. a specialized intervention.

11. Because it can irritate sensitive gums, brushing and rinsing with which of the following is considered potentially harmful to critically ill patients?

a. tap water

b. chlorhexidine

c. lemon and glycerin

d. undiluted hydrogen peroxide

12. According to the authors’ guide to oral care, the first step is to wash the hands

a. using gentle friction.

b. for about 30 seconds.

c. using plain soap.

d. using hot water.

13. The authors’ guide to oral care specifies brushing the patient's teeth

a. for 1 to 2 minutes.

b. at least once per day.

c. for 3 to 4 minutes.

d. at least 3 times per day.

14. The nursing staff should brush patients’ teeth

a. in a circular fashion.

b. beginning in the lower center.

c. ending at the upper molars.

d. on the lingual and buccal surfaces.

15. The nursing staff should apply rinse to all surfaces of the oral cavity

a. using gentle pressure.

b. using a side-to-side motion.

c. for at least 2 minutes.

d. using about 30 mL of rinse.

16. When suctioning subglottic secretions, the nursing staff should

a. deliver 100% oxygen for 2 minutes before suctioning.

b. instill normal saline prior to suctioning.

c. suction for no more than 10 to 15 seconds.

d. suction with a maximum of 3 passes.

17. To manage patients’ endotracheal tube during oral care, nurses should

a. maintain cuff pressure between 30 and 40 cm H2O.

b. lower cuff pressure to prevent aspiration of secretions.

c. use gentle palpation to assess cuff pressure reliably.

d. change the position of the tube after brushing and suctioning.

18. To inhibit bacterial overgrowth, nursing staff should do which of the following with reusable oral care tools?

a. Rinse them with tap water.

b. Place them in a container that allows some airflow.

c. Rinse them with hydrogen peroxide.

d. Place them in a container filled with chlorhexidine.

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