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
How does a nurse add a sterile gauze pack to a sterile field that is already set up?
- AOpen the wrapper away from the field and drop the item on it without reaching over
- BReach across the field with clean gloves to place the item
- CTip the item onto the field and push it into place with the wrapper
- DPlace the whole wrapped pack on the field and open it there with sterile gloves
2.Infection control & patient safetyHard
A patient rescued from a house fire has a headache and confusion, but the pulse oximeter reads 99%. Why might this reading be misleading?
- APulse oximetry cannot tell carbon monoxide-bound hemoglobin from oxygen-bound hemoglobin
- BThe reading is accurate, so carbon monoxide poisoning is ruled out
- CPulse oximeters always read falsely low after any kind of smoke exposure
- DConfusion and headache make pulse oximetry readings inaccurate in every patient
3.Nursing fundamentalsMedium
A registered nurse delegates a task to a healthcare assistant. Who is accountable for the decision to delegate?
- ANobody, once the task is handed over
- BThe patient
- CThe registered nurse
- DOnly the healthcare assistant
4.Nursing fundamentalsHard
On the day after surgery, a patient's new stoma has turned dark purple. What should the nurse do?
- AWait a week to see whether it changes
- BRecord it as normal bruising after surgery and recheck tomorrow
- CReport it urgently, as the stoma may be losing its blood supply
- DClean it firmly to remove the colour
5.MicrobiologyMedium
Which cells does HIV mainly infect and destroy?
- ARed blood cells
- BPlatelets
- CCD4 T helper cells
- DNeutrophils
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?
- AListeria monocytogenes
- BBacillus cereus
- CClostridium botulinum
- DSalmonella Typhi
3Solutions
1.Infection control & patient safety
Answer: A · Open the wrapper away from the field and drop the item on it without reaching over
Why this is the answer
The nurse opens the package so the sterile item can be dropped onto the field from a short height, without the wrapper or arms crossing over the sterile area. The item must land well inside the non-sterile border.
A · Open the wrapper away from the field and drop the item on it without reaching over
2.Infection control & patient safety
Answer: A · Pulse oximetry cannot tell carbon monoxide-bound hemoglobin from oxygen-bound hemoglobin
Why this is the answer
Standard pulse oximeters read carboxyhemoglobin as oxyhemoglobin, so SpO2 can look normal in carbon monoxide poisoning. A blood carboxyhemoglobin level confirms it, and high-flow oxygen is given.
A · Pulse oximetry cannot tell carbon monoxide-bound hemoglobin from oxygen-bound hemoglobin
3.Nursing fundamentals
Answer: C · 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 · Report it urgently, as the stoma may be losing its blood supply
Why this is the answer
A dusky, purple or black stoma suggests ischaemia or necrosis, which can need surgery. The nurse reports it to the surgical team at once.
C · Report it urgently, as the stoma may be losing its blood supply
5.Microbiology
Answer: C · CD4 T helper cells
Why this is the answer
HIV binds CD4 and a co-receptor on T helper cells. Loss of these cells weakens both antibody and cell-mediated immunity, leading to AIDS.
6.Microbiology
Answer: B · 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.