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
The laboratory calls with a critical lab result by phone. What should the nurse do?
- AWait for the printed report to arrive before telling the provider about it
- BWrite it down, read it back to confirm and report it to the provider promptly
- CRemember the value and enter it in the chart at the end of the shift
- DTell the patient the result first and then call the provider
2.Infection control & patient safetyHard
Two look-alike vials of different drugs are stored next to each other, and a nurse almost picks the wrong one. Which response best reflects a just culture?
- AKeep the incident quiet to protect the unit’s reputation
- BTell the nurse to be more careful and do nothing else
- CReport it and fix the system, for example by separating the vials
- DDiscipline the nurse who nearly picked the wrong vial
3.Nursing fundamentalsMedium
In which direction should a female patient's perineum be cleaned?
- AIn circles starting at the anus
- BEither way, as long as soap is used
- CFrom front to back
- DFrom back to front
4.Nursing fundamentalsHard
Which measure is most important in protecting a patient with severe neutropenia from infection?
- AKeeping the room door open for fresh air
- BStrict hand hygiene by everyone who enters the room
- CGiving the patient a high-protein diet with extra vitamin supplements
- DTaking the temperature every hour
5.MicrobiologyMedium
Toxoplasma gondii is a risk in pregnancy. Which advice reduces exposure?
- AAvoid cleaning cat litter and avoid undercooked meat
- BAvoid all fruit and vegetables
- CAvoid contact with dogs
- DAvoid swimming pools and all other public bathing areas
6.MicrobiologyHard
Which mechanism of antibiotic resistance does a bacterium use when it pumps the drug out of the cell?
- AReduced porin uptake only
- BEfflux pumps
- CTarget modification
- DEnzymatic inactivation
3Solutions
1.Infection control & patient safety
Answer: B · Write it down, read it back to confirm and report it to the provider promptly
Why this is the answer
Writing down and reading back critical results confirms they were heard correctly. The nurse then reports them promptly to the responsible provider and documents who was told and when.
B · Write it down, read it back to confirm and report it to the provider promptly
2.Infection control & patient safety
Answer: C · Report it and fix the system, for example by separating the vials
Why this is the answer
A just culture recognizes that human errors are often caused by system design. Separating look-alike drugs, using labels and Tall Man lettering prevents repeats. Blaming the person alone leaves the hazard in place.
C · Report it and fix the system, for example by separating the vials
3.Nursing fundamentals
Answer: C · From front to back
Why this is the answer
Cleaning from the urethra towards the anus moves bacteria away from the urinary tract and lowers the risk of urinary tract infection.
4.Nursing fundamentals
Answer: B · Strict hand hygiene by everyone who enters the room
Why this is the answer
A neutropenic patient cannot fight infection well, and hand hygiene is the key protective measure. Other steps include a single room and keeping away visitors who are unwell.
B · Strict hand hygiene by everyone who enters the room
5.Microbiology
Answer: A · Avoid cleaning cat litter and avoid undercooked meat
Why this is the answer
Toxoplasma oocysts are shed in cat faeces and cysts are found in undercooked meat. Infection during pregnancy can damage the fetal brain and eyes.
A · Avoid cleaning cat litter and avoid undercooked meat
6.Microbiology
Answer: B · Efflux pumps
Why this is the answer
Efflux pumps actively export antibiotics such as tetracyclines and fluoroquinolones, keeping the inside concentration too low to work.