三管试题

ICU“三管监测”培训考核

科室：姓名：

一、单选题

1、留置导尿管感染控制措施错误的是：( )

A、严格执行留置导尿管的适应症，只有在必须时才能使用，并尽早拔除。

B、不使用抗菌药物作连续膀胱冲洗预防感染。

C、集尿袋应高于膀胱水平。

D、定期作病原学检查。

2、发生医院内尿路感染最常见的诱因是（）

Ａ、长期卧床Ｂ、留置导尿管Ｃ、膀胱冲洗Ｄ、膀胱内注射

3、院内尿路感染中，与长期留置导尿管的相关者占？（）

A、70%

B、80%

C、90%

D、100%

4、有关最大无菌屏障是指？（）

A、洗手

B、无菌隔离衣及无菌手套

C、大的无菌单覆盖

D、以上皆是

5、病人经血管介入性操作后，发热＞380C，局部有压痛、无其它原因可解释，临床可诊断为：（）

A、输血相关感染

B、局部感染

C、血管相关性感染

D、败血症

6、紧急状态下血管导管置管，若不能保证有效的无菌原则，应当在（）小时内尽早拔除导管。（）

A 12

B 24

C 48

D 36

7、呼吸机相关肺炎是指无肺部感染的病人，在入院（）小时后并发的肺部感染。

A 12

B 24

C 36

D 48

8、以下哪项不属于V AP的危险因素。（）

A 误吸

B 静脉营养

C COP

D D 应用抗酸药物或H2受体阻滞剂

9、半卧体位是防止口咽部分泌物的吸入的重要措施，气管插管病人预防V AP半卧体位应采取（）为宜。

A 15～25度

B 20～35度

C 30～45度

D 35～55度

10、保护胃粘膜特性为预防V AP手段之一，以下哪项无助于保护胃粘膜特性。（）

A 尽可能的给予肠内营养

B 使用PPI，预防消化道出血

C 使用硫糖铝来预防应激性溃疡的发生

D 对于重症患者，要保持抗休克及低氧血症与降低V AP发生率的平衡

二、多选题

1、预防泌尿道感染的措施包括（）

A．严格掌握导尿指征，减少不必要的导尿；

B．导尿时无菌操作，留置尿管采用封闭式无菌引流；

C．保持尿液引流通畅，尽量缩短尿管留置的时间；

D．对长期卧床、慢性疾病、免疫功能低下的病人，要提高机体的抵抗力；E．做好会阴部护理。

2、下列哪些情况不应当进行置管操作（）

A 患疖肿、湿疹等皮肤病的医务人员

B 患感冒、流感等呼吸道疾病的医务人员

C 携带或感染多重耐药菌的医务人员

D 主治医师以下的临床医师

E 患冠心病的医务人员

3、下列哪些情况应立即拔管（）

A 导尿管堵塞B导尿管留置超过7天 C 留置导尿装置无菌性或密闭性被破坏D出现尿路感染时 E 患者有尿路不适症状时

4、对于静脉置管哪项做法正确（）

A 在输血、输入血制品、脂肪乳剂后的24小时内应当及时更换输液管路。

B 外周及中心静脉置管后，应当用生理盐水或肝素盐水进行常规冲管，预防导管内血栓形成。

C 每天对保留导管的必要性进行评估，不需要时应当尽早拔除导管。

D 怀疑患者导管相关感染时，必要时应当进行导管尖端的微生物培养。

E 深静脉置管至少每周更换一次。

5、中心静脉置管后下列哪些操作正确（）

A 尽量使用无菌透明、透气性好的敷料覆盖穿刺点

B 对高热、出汗、穿刺点出血、渗出的患者应当使用无菌纱布覆盖

C 需要注射用药时应直接向导管内注入药物

D 医护人员接触穿刺点或更换敷料时，严格执行手卫生

E 通过国家执业医师考试并取得注册资格的医师即可行穿刺手术

6、导尿管相关尿路感染临床诊断包括（）

A 患者出现尿频、尿急、尿痛等尿路刺激症状，或有下腹痛、肾区扣痛、伴有或不伴有发热

B 尿检白细胞男性≥5个/高倍视野

C 尿检白细胞女性≥10个/高倍视野D插尿管患者应当结合尿培养E 尿道局部红肿、疼痛

7、以下哪项属于V AP的预防措施。（）

A、严格执行手卫生措施；

B、气管插管首选经口途径；

C、加强口腔护理；

D、使用人工鼻或加热湿化器进行气道湿化管理；

E、无体位限制时抬高床头45度.

8、以下哪项不属于V AP的预防措施。（）

A、尽早脱离呼吸机；

B、采用密闭式吸痰管和进行声门下吸引；

C、充分镇静，减少患者呼吸拮抗；

D、监测胃液PH及胃残留量，避免胃液PH升高和胃液反流；

E、呼吸环路每日更换一次，冷凝水及时清除。

9、呼吸机辅助呼吸的重症患者，以下哪项不正确。（）

A、24—48小时更换呼吸回路一次；

B、气管导管内给予适量庆大预防生物膜形成；

C、全身性预防使用抗生素；

D、高价免疫球蛋白静脉滴注；

E、床头抬太高10-15度。

10、V AP的一般预防措施包括（）。

A、医务人员在接触病人和操作前后要严格洗手，戴口罩、手套、严格规范无菌技术操作是最有效的预防措施之一。

B、保持室内良好通风，对室内空气、所以可再利用的物品和器械定时消毒。

C、严格静脉营养，避免消化道误吸。

D、加强对ICU内感染病原菌监测、通报，为经验用药提供依据。

E、减少病人外出检查、治疗次数，适时隔离某些特殊感染、耐药菌株和易感人群，减少交叉感染和感染爆发流行的发生。

答案：

一、1-5 CBBDC 6-10 CDBCB 二 1. ABCDE 2. ABCE 3. ABCD 4. ABCD 5. ABD 6. ABCD 7.ABCDE 8. ABE 9.ACE 10 . ABDE

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