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?
- APlace the whole wrapped pack on the field and open it there with sterile gloves
- BOpen the wrapper away from the field and drop the item on it without reaching over
- CTip the item onto the field and push it into place with the wrapper
- DReach across the field with clean gloves to place the item
2.Infection control & patient safetyHard
A flexible bronchoscope contacts mucous membranes but does not enter sterile tissue. Which level of processing is required at a minimum between patients?
- ACleaning with soap and water only
- BHigh-level disinfection
- CLow-level disinfection
- DWiping with an alcohol wipe
3.Nursing fundamentalsMedium
How is pitting oedema checked?
- APress on the nail bed and time the return of colour
- BMeasure the width of both calves with a tape measure once a week and compare them
- CPress over a bony area such as the shin for a few seconds and look for a dent
- DPinch the skin on the back of the hand and see how fast it falls back
4.Nursing fundamentalsHard
Which finding suggests a patient may be developing a pressure ulcer category 1?
- AFull-thickness skin loss with visible fat but no exposed bone
- BIntact skin with non-blanching redness over a bony area
- CExposed bone or tendon
- DAn open blister with a red base
5.MicrobiologyMedium
Transfer of bacterial genes from one bacterium to another by a virus is called:
- ATranscription
- BConjugation
- CTransformation
- DTransduction
6.MicrobiologyHard
Joseph Lister reduced infection after surgery in the 1860s. What was his main innovation?
- AUsing carbolic acid (phenol) as an antiseptic on wounds and instruments
- BVaccinating surgeons against staphylococci
- CUsing steam autoclaves to sterilise all surgical instruments before each operation
- DGiving sulfonamide antibiotics after every operation
3Solutions
1.Infection control & patient safety
Answer: B · 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.
B · Open the wrapper away from the field and drop the item on it without reaching over
2.Infection control & patient safety
Answer: B · High-level disinfection
Why this is the answer
Items that touch mucous membranes or non-intact skin are semi-critical and need at least high-level disinfection after thorough cleaning. Inadequate reprocessing of endoscopes has caused outbreaks.
B · High-level disinfection
3.Nursing fundamentals
Answer: C · Press over a bony area such as the shin for a few seconds and look for a dent
Why this is the answer
Pressing over a bony surface pushes fluid out of the tissue; a dent that stays shows pitting oedema. Its depth and how long it lasts are recorded.
C · Press over a bony area such as the shin for a few seconds and look for a dent
4.Nursing fundamentals
Answer: B · Intact skin with non-blanching redness over a bony area
Why this is the answer
Category 1 is intact skin with non-blanchable erythema. Category 2 involves partial-thickness loss such as a blister; categories 3 and 4 are deeper.
B · Intact skin with non-blanching redness over a bony area
5.Microbiology
Answer: D · Transduction
Why this is the answer
In transduction a bacteriophage accidentally packages bacterial DNA and delivers it to the next cell it infects. Transformation is uptake of free DNA and conjugation uses direct contact.
6.Microbiology
Answer: A · Using carbolic acid (phenol) as an antiseptic on wounds and instruments
Why this is the answer
Lister applied carbolic acid to wounds, dressings and instruments, which greatly reduced post-operative infection. This started antiseptic surgery.
A · Using carbolic acid (phenol) as an antiseptic on wounds and instruments