1Formulas and methods
Infection control & patient safety
Method
- Start with standard precautions for every patient: hand hygiene, PPE for the expected exposure, safe sharps.
- Add precautions by route: contact (gown, gloves), droplet (surgical mask), airborne (N95, negative-pressure room).
- Keep sterile items sterile: if in doubt, it is not sterile; replace, never wipe.
- Prevent harm in the environment: fall measures, restraints only as a last resort, RACE and PASS for fire.
- Check the rights of medication administration, two identifiers and extra safeguards for high-alert drugs; report errors and near misses.
2Practice problems
1.Infection control & patient safetyMedium
A patient with a fentanyl skin patch wants to use a heating pad on the area. What should the nurse teach?
- AHeat is fine to use, because it helps the patch stick better to the skin
- BHeat makes the patch last longer, so fewer patches are needed each month
- CAvoid heat on or near the patch, because it increases how fast the drug is absorbed
- DHeat only matters if the patch is on the chest
2.Infection control & patient safetyHard
On admission, the medication list from home includes a blood thinner that is not on the new hospital orders. What should the nurse do?
- ATell the patient to take their own supply secretly
- BIgnore it, as the hospital orders replace home medicines
- CClarify the discrepancy with the prescriber
- DGive the home dose without an order
3.Nursing fundamentalsMedium
An older patient is found to be mildly hypothermic. Which care is most appropriate?
- APlacing hot water bottles directly on the skin
- BGradual rewarming with blankets and warm surroundings
- CPutting the patient in a very hot bath straight away
- DGiving an alcoholic drink to warm them up
4.Nursing fundamentalsHard
A patient says they have no pain, but grimaces and holds their side whenever they move. What should the nurse do?
- AExplore the difference gently and assess the pain further
- BGive the strongest analgesic available straight away
- CTell the patient they are not being honest
- DRecord "no pain" and take no further action
5.MicrobiologyMedium
How does an mRNA vaccine produce immunity?
- AThe mRNA is inserted permanently into human DNA
- BThe mRNA contains weakened live virus
- CThe mRNA kills the virus directly in the blood
- DBody cells use the mRNA to make a viral protein that the immune system learns to recognise
6.MicrobiologyHard
Several people vomit within a few hours of eating fried rice that was cooked the day before and kept at room temperature. Which organism is the classic cause?
- AClostridium botulinum
- BListeria monocytogenes
- CBacillus cereus
- DSalmonella Typhi
3Solutions
1.Infection control & patient safety
Answer: C · Avoid heat on or near the patch, because it increases how fast the drug is absorbed
Why this is the answer
Heat from heating pads, electric blankets, hot tubs or fever increases fentanyl absorption and can cause an overdose. Patients are taught to avoid heat over the patch.
C · Avoid heat on or near the patch, because it increases how fast the drug is absorbed
2.Infection control & patient safety
Answer: C · Clarify the discrepancy with the prescriber
Why this is the answer
An unexplained difference between home medicines and hospital orders can be an omission or an intentional change. The nurse asks the prescriber, so the decision is deliberate and documented. Unintended omission of an anticoagulant can lead to clots.
C · Clarify the discrepancy with the prescriber
3.Nursing fundamentals
Answer: B · Gradual rewarming with blankets and warm surroundings
Why this is the answer
Gradual passive rewarming with blankets, a warm room and warm drinks if they can swallow is safe for mild hypothermia. Direct heat can burn and rapid rewarming can be dangerous.
B · Gradual rewarming with blankets and warm surroundings
4.Nursing fundamentals
Answer: A · Explore the difference gently and assess the pain further
Why this is the answer
When cues conflict, the nurse looks further. Patients may play pain down for many reasons, such as not wanting to bother staff or fearing side effects.
A · Explore the difference gently and assess the pain further
5.Microbiology
Answer: D · Body cells use the mRNA to make a viral protein that the immune system learns to recognise
Why this is the answer
The mRNA is translated by cells into an antigen, such as a coronavirus spike protein. The immune system responds to it. The mRNA is broken down and does not enter the nucleus.
D · Body cells use the mRNA to make a viral protein that the immune system learns to recognise
6.Microbiology
Answer: C · Bacillus cereus
Why this is the answer
Bacillus cereus spores survive boiling. If cooked rice is left warm, the bacteria grow and make a heat-stable emetic toxin, so reheating does not make the rice safe.