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 fire starts in a waste bin in a patient’s room while the patient is in bed. What does the nurse do first?
- APhone the manager to report the fire
- BOpen the windows to clear the smoke
- CRemove the patient from immediate danger
- DGo and look for the nearest fire extinguisher
2.Infection control & patient safetyHard
A patient’s allergy band says “penicillin”, and an order has been written for amoxicillin. What should the nurse do?
- AHold the drug and contact the prescriber
- BGive an antihistamine first and then the drug
- CGive the drug and watch the patient closely
- DAsk the patient whether they would like to take it anyway
3.Nursing fundamentalsMedium
Which technique is used when inserting a urinary catheter?
- AAseptic technique
- BClean technique without gloves
- CNo special technique is needed
- DSterile technique only for male patients
4.Nursing fundamentalsHard
A patient who now lacks capacity made a valid, applicable advance decision refusing a specific life-sustaining treatment. What should staff do (England and Wales)?
- AIgnore it, because only verbal wishes count
- BGive the treatment because the patient cannot decide now
- CFollow the advance decision and not give that treatment
- DAsk the family to overrule it
5.MicrobiologyMedium
Why does high vaccination coverage also protect babies too young to be vaccinated?
- AVaccinated people pass antibodies to everyone they meet
- BBabies are naturally immune to all vaccine-preventable diseases
- CVaccines kill the pathogen in the environment
- DFewer people can pass on the infection, so it spreads less
6.MicrobiologyHard
Which bacterial toxin causes the muscle spasms of tetanus?
- ABotulinum toxin, which blocks acetylcholine release at the neuromuscular junction
- BEndotoxin from the outer membrane
- CTetanospasmin, which blocks inhibitory neurotransmitter release
- DCholera toxin, which activates adenylate cyclase
3Solutions
1.Infection control & patient safety
Answer: C · Remove the patient from immediate danger
Why this is the answer
Rescue comes first: move the patient away from the fire. Then raise the alarm, contain the fire by closing doors, and extinguish it if safe. Opening windows feeds the fire with oxygen.
C · Remove the patient from immediate danger
2.Infection control & patient safety
Answer: A · Hold the drug and contact the prescriber
Why this is the answer
Amoxicillin is a penicillin, so it could cause a serious allergic reaction. The nurse holds the drug, clarifies the allergy and contacts the prescriber for a safe alternative.
A · Hold the drug and contact the prescriber
3.Nursing fundamentals
Answer: A · Aseptic technique
Why this is the answer
Urinary catheters are inserted with an aseptic technique and sterile equipment to reduce catheter-associated urinary tract infections.
4.Nursing fundamentals
Answer: C · Follow the advance decision and not give that treatment
Why this is the answer
A valid and applicable advance decision has the same effect as a refusal by a patient with capacity. Refusals of life-sustaining treatment must be written, signed, witnessed and state that they apply even if life is at risk.
C · Follow the advance decision and not give that treatment
5.Microbiology
Answer: D · Fewer people can pass on the infection, so it spreads less
Why this is the answer
When enough people are immune, chains of transmission break and the pathogen rarely reaches susceptible people, such as young babies or immunosuppressed patients.
D · Fewer people can pass on the infection, so it spreads less
6.Microbiology
Answer: C · Tetanospasmin, which blocks inhibitory neurotransmitter release
Why this is the answer
Tetanospasmin from Clostridium tetani blocks the release of GABA and glycine from inhibitory interneurons, causing spastic paralysis. Botulinum toxin, by contrast, causes flaccid paralysis.
C · Tetanospasmin, which blocks inhibitory neurotransmitter release