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 only matters if the patch is on the chest
- BHeat makes the patch last longer, so fewer patches are needed each month
- CHeat is fine to use, because it helps the patch stick better to the skin
- DAvoid heat on or near the patch, because it increases how fast the drug is absorbed
2.Infection control & patient safetyHard
A patient’s white cell differential shows a raised number of band (immature) neutrophils, called a “shift to the left”. What does this usually suggest?
- AA typical viral infection
- BAn acute bacterial infection
- CA long-standing parasitic infection
- DAn allergic reaction
3.Nursing fundamentalsMedium
The skin along a peripheral IV cannula is red, painful and swollen. What is the appropriate action?
- ARemove the cannula and document it, then resite if still needed
- BIncrease the infusion rate
- CCover it with a fresh dressing and continue the infusion as prescribed
- DFlush the cannula harder to clear it
4.Nursing fundamentalsHard
Vaccinating staff against influenza breaks the chain of infection at which link?
- AThe mode of transmission
- BThe portal of exit
- CThe reservoir
- DThe susceptible host
5.MicrobiologyMedium
Which part of the immune system produces antibodies?
- ANeutrophils
- BPlasma cells derived from B lymphocytes
- CNatural killer cells
- DCytotoxic T cells activated in the lymph nodes
6.MicrobiologyHard
A deep, dirty wound becomes swollen and very painful, and gas can be felt under the skin. Which organism is most likely?
- ANeisseria gonorrhoeae
- BStreptococcus pneumoniae
- CBordetella pertussis
- DClostridium perfringens
3Solutions
1.Infection control & patient safety
Answer: D · 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.
D · Avoid heat on or near the patch, because it increases how fast the drug is absorbed
2.Infection control & patient safety
Answer: B · An acute bacterial infection
Why this is the answer
In acute bacterial infection, the bone marrow releases neutrophils before they mature, raising the proportion of bands. Allergies and parasites raise eosinophils, and viral infections more often raise lymphocytes.
B · An acute bacterial infection
3.Nursing fundamentals
Answer: A · Remove the cannula and document it, then resite if still needed
Why this is the answer
Phlebitis is inflammation of the vein. The cannula should be removed, the site recorded and monitored, and a new cannula placed elsewhere only if it is still needed.
A · Remove the cannula and document it, then resite if still needed
4.Nursing fundamentals
Answer: D · The susceptible host
Why this is the answer
Immunisation makes a person no longer susceptible, so the infection cannot establish itself in them. Hand hygiene, by contrast, breaks the mode of transmission.
5.Microbiology
Answer: B · Plasma cells derived from B lymphocytes
Why this is the answer
Activated B cells differentiate into plasma cells, which secrete antibodies. Cytotoxic T cells and NK cells kill infected cells directly.
B · Plasma cells derived from B lymphocytes
6.Microbiology
Answer: D · Clostridium perfringens
Why this is the answer
Clostridium perfringens causes gas gangrene in poorly oxygenated wounds. Its toxins destroy muscle and its metabolism produces gas, felt as crepitus. Urgent surgery and antibiotics are needed.
D · Clostridium perfringens