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 pours sterile saline into a bowl on a sterile field. Which technique is correct?
- AHold the bottle with the label in the palm and pour without touching the bowl
- BPour from below the level of the field to reduce splashing
- CRest the lip of the bottle on the edge of the bowl so that the saline does not splash
- DReach across the field to fill the bowl at the far side
2.Infection control & patient safetyHard
A nurse has a needlestick from a patient whose HIV and hepatitis status is unknown. What should happen?
- AThe nurse waits six months before having any blood tests at all
- BNothing, because the source patient is probably not infected
- CThe nurse is assumed to be infected and stops all work
- DThe source patient is tested per policy, and the nurse has baseline tests
3.Nursing fundamentalsMedium
The skin along a peripheral IV cannula is red, painful and swollen. What is the appropriate action?
- AIncrease the infusion rate
- BRemove the cannula and document it, then resite if still needed
- CCover it with a fresh dressing and continue the infusion as prescribed
- DFlush the cannula harder to clear it
4.Nursing fundamentalsHard
A patient on regular morphine is very drowsy, has pinpoint pupils and is breathing 8 times a minute. What is the priority?
- ALet the patient sleep and recheck in four hours
- BCall for help, support breathing, withhold the opioid and prepare naloxone as per protocol
- CGive a strong cup of coffee
- DGive the next morphine dose as prescribed
5.MicrobiologyMedium
What does PCR do in a diagnostic laboratory?
- AIt measures the level of specific antibodies in a patient's serum sample
- BIt makes many copies of a specific DNA sequence so it can be detected
- CIt stains bacteria so they can be seen
- DIt grows bacteria faster on agar plates
6.MicrobiologyHard
Why is Chlamydia trachomatis usually diagnosed with nucleic acid amplification tests instead of routine culture on agar?
- AIt is an obligate intracellular bacterium that cannot grow on ordinary media
- BIt is too large to grow on agar plates
- CIt dies immediately in the presence of oxygen
- DIt is a virus and has no DNA
3Solutions
1.Infection control & patient safety
Answer: A · Hold the bottle with the label in the palm and pour without touching the bowl
Why this is the answer
The nurse pours from a little height without touching the sterile bowl, avoiding splashes that would wet the field. Holding the label in the palm keeps it readable and free of drips.
A · Hold the bottle with the label in the palm and pour without touching the bowl
2.Infection control & patient safety
Answer: D · The source patient is tested per policy, and the nurse has baseline tests
Why this is the answer
After first aid and reporting, the source patient is tested according to law and policy, and the nurse has baseline testing. A rapid risk assessment decides whether HIV prophylaxis is started while results are awaited.
D · The source patient is tested per policy, and the nurse has baseline tests
3.Nursing fundamentals
Answer: B · 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.
B · Remove the cannula and document it, then resite if still needed
4.Nursing fundamentals
Answer: B · Call for help, support breathing, withhold the opioid and prepare naloxone as per protocol
Why this is the answer
Reduced consciousness, slow breathing and pinpoint pupils suggest opioid toxicity. The nurse should get help, maintain the airway and give oxygen as needed, stop further opioids and use naloxone as prescribed by protocol.
B · Call for help, support breathing, withhold the opioid and prepare naloxone as per protocol
5.Microbiology
Answer: B · It makes many copies of a specific DNA sequence so it can be detected
Why this is the answer
The polymerase chain reaction amplifies a target sequence millions of times. It can detect pathogens that are hard to culture; RNA viruses are first converted to DNA (RT-PCR).
B · It makes many copies of a specific DNA sequence so it can be detected
6.Microbiology
Answer: A · It is an obligate intracellular bacterium that cannot grow on ordinary media
Why this is the answer
Chlamydia replicates only inside host cells, so it cannot be grown on agar. NAATs such as PCR on urine or swabs are sensitive and are the standard diagnostic test.
A · It is an obligate intracellular bacterium that cannot grow on ordinary media