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 nurse has been fit-tested for an N95 respirator. What should the nurse do each time it is put on?
- AWear a surgical mask underneath it
- BPerform a user seal check
- CMoisten the edges so it seals better
- DArrange a new fit test
2.Infection control & patient safetyHard
A nurse notices that the wrong drug was drawn up, but realizes it before giving it. What should the nurse do?
- ASay nothing, because the patient was not harmed
- BReport it only if the same mistake happens again on the unit
- CGive the drug anyway, since it is already drawn up
- DDiscard it, prepare the correct drug and report a near miss
3.Nursing fundamentalsMedium
A registered nurse delegates a task to a healthcare assistant. Who is accountable for the decision to delegate?
- AThe registered nurse
- BOnly the healthcare assistant
- CNobody, once the task is handed over
- DThe patient
4.Nursing fundamentalsHard
A patient has a platelet count of 40 × 10⁹/L (40,000/mm³). Which nursing measure is appropriate?
- AUse a firm toothbrush and floss hard to keep the gums healthy
- BEncourage contact sports to raise the count
- CUse a soft toothbrush and avoid IM injections where possible
- DGive aspirin for any headaches
5.MicrobiologyMedium
Which organism is a Gram-negative diplococcus that causes a sexually transmitted infection?
- ATrichomonas vaginalis
- BNeisseria gonorrhoeae
- CTreponema pallidum
- DChlamydia trachomatis
6.MicrobiologyHard
A patient taking high-dose immunosuppressive drugs after a transplant is due for vaccinations. Which vaccine type is generally avoided?
- ALive attenuated vaccines
- BInactivated whole-virus vaccines
- CToxoid vaccines
- DSubunit vaccines
3Solutions
1.Infection control & patient safety
Answer: B · Perform a user seal check
Why this is the answer
A fit test confirms that a model and size suit the person. A user seal check, breathing in and out to feel for leaks at the edges, is done every time the respirator is put on.
B · Perform a user seal check
2.Infection control & patient safety
Answer: D · Discard it, prepare the correct drug and report a near miss
Why this is the answer
A near miss shows a weakness in the system, such as similar packaging or storage. Reporting allows the risk to be fixed before a patient is harmed. A just culture supports such reporting.
D · Discard it, prepare the correct drug and report a near miss
3.Nursing fundamentals
Answer: A · The registered nurse
Why this is the answer
The nurse is accountable for delegating appropriately, to someone competent, with supervision as needed. The person who accepts the task is accountable for carrying it out properly.
4.Nursing fundamentals
Answer: C · Use a soft toothbrush and avoid IM injections where possible
Why this is the answer
A low platelet count raises the risk of bleeding. Bleeding precautions include soft toothbrushes, electric razors, avoiding IM injections and avoiding aspirin and NSAIDs.
C · Use a soft toothbrush and avoid IM injections where possible
5.Microbiology
Answer: B · Neisseria gonorrhoeae
Why this is the answer
Neisseria gonorrhoeae appears as pairs of Gram-negative cocci, often inside neutrophils. Treponema is a spirochaete, Chlamydia is an intracellular bacterium and Trichomonas is a protozoan.
B · Neisseria gonorrhoeae
6.Microbiology
Answer: A · Live attenuated vaccines
Why this is the answer
Live vaccines contain weakened organisms that can cause disease when the immune system is severely suppressed. Inactivated, toxoid and subunit vaccines are safe, although the response may be weaker.
A · Live attenuated vaccines