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 small spill of blood is found on the floor. How should it be cleaned?
- AWipe it up quickly with a dry cloth using bare hands, then wash the hands well
- BWear gloves, absorb the blood, then clean the area with an approved disinfectant
- CCover it with a clean sheet and keep working
- DLeave it until housekeeping arrives the next morning
2.Infection control & patient safetyHard
An 82-year-old patient is prescribed diphenhydramine at bedtime for sleep. Why should the nurse raise this with the prescriber?
- AIt is too weak to help an older person sleep
- BIt is only available as an IV drug and cannot be given by mouth at bedtime
- CIt is strongly anticholinergic and can cause confusion and falls in older adults
- DIt raises blood pressure in most older adults
3.Nursing fundamentalsMedium
A dying patient is no longer drinking and breathes through the mouth. What mouth care is most appropriate?
- AGive large drinks of water every hour
- BClean the mouth only once a day with a hard toothbrush
- CAvoid mouth care so the patient is not disturbed
- DKeep the mouth and lips moist with frequent gentle care
4.Nursing fundamentalsHard
After treatment for hypoglycaemia a patient's glucose is now 5.2 mmol/L (94 mg/dL) and the next meal is hours away. What should the nurse do next?
- AGive nothing more, as the glucose is now normal
- BGive a second glucose drink every 15 minutes
- CGive another dose of insulin to balance out the extra sugar
- DGive a longer-acting carbohydrate, such as a sandwich
5.MicrobiologyMedium
Pneumocystis jirovecii pneumonia in a person with advanced HIV is an example of:
- AA vector-borne infection
- BAn opportunistic infection
- CA food-borne infection
- DA zoonotic infection
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
- BSalmonella Typhi
- CListeria monocytogenes
- DBacillus cereus
3Solutions
1.Infection control & patient safety
Answer: B · Wear gloves, absorb the blood, then clean the area with an approved disinfectant
Why this is the answer
Blood spills are cleaned promptly by staff wearing gloves. The blood is absorbed with disposable material, then the area is cleaned and disinfected with a hospital disinfectant, and waste goes into clinical waste.
B · Wear gloves, absorb the blood, then clean the area with an approved disinfectant
2.Infection control & patient safety
Answer: C · It is strongly anticholinergic and can cause confusion and falls in older adults
Why this is the answer
First-generation antihistamines such as diphenhydramine are on the Beers list because they cause confusion, constipation, urinary retention and falls in older adults. Safer approaches to sleep should be discussed.
C · It is strongly anticholinergic and can cause confusion and falls in older adults
3.Nursing fundamentals
Answer: D · Keep the mouth and lips moist with frequent gentle care
Why this is the answer
Frequent gentle mouth care with moist swabs, water sprays and lip balm keeps the patient comfortable. Forcing fluids risks choking and aspiration.
D · Keep the mouth and lips moist with frequent gentle care
4.Nursing fundamentals
Answer: D · Give a longer-acting carbohydrate, such as a sandwich
Why this is the answer
Fast-acting glucose raises the level quickly but briefly. A starchy snack, or the next meal if due, keeps it from falling again. The episode is recorded and its cause reviewed.
D · Give a longer-acting carbohydrate, such as a sandwich
5.Microbiology
Answer: B · An opportunistic infection
Why this is the answer
Opportunistic infections take advantage of a weakened immune system. In HIV they become common when the CD4 count falls to low levels.
B · An opportunistic infection
6.Microbiology
Answer: D · 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.