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
Which part of a sterile surgical gown is considered sterile once it is on?
- AThe whole gown, including the back, the collar and the area below the waist
- BThe front from the neck down to the knees
- CThe front from chest to the level of the sterile field, and the sleeves
- DOnly the back of the gown, which nobody touches
2.Infection control & patient safetyHard
A nurse has weeping dermatitis on both hands. What is the most appropriate action?
- AContinue care as usual and wear one pair of gloves
- BCover the lesions with a waterproof bandage and keep working with patients as usual
- CAvoid direct patient care and handling of equipment until it heals, and see occupational health
- DUse extra alcohol hand rub on the lesions
3.Nursing fundamentalsMedium
How is a 24-hour urine collection started?
- AThe first urine of the morning is kept and the rest of the day's urine is discarded
- BA sample is taken every four hours and the rest discarded
- COnly urine passed at night is collected
- DThe first urine of the morning is discarded and the time noted, then all urine is kept
4.Nursing fundamentalsHard
A patient going home on warfarin has been taught about the drug. Which statement shows a need for further teaching?
- A"I'll report any blood in my urine or black stools."
- B"I'll stop eating all green vegetables from now on."
- C"I'll try to keep the amount of green vegetables I eat steady."
- D"I'll keep my appointments for blood tests."
5.MicrobiologyMedium
Cholera causes profuse "rice-water" diarrhoea. What is the most important treatment?
- AStopping all oral fluid intake so that the bowel can rest and recover
- BAntifungal drugs
- CAntiviral drugs
- DReplacing fluid and salts by oral or intravenous rehydration
6.MicrobiologyHard
Why can a person get influenza many times but measles usually only once?
- AInfluenza attacks and destroys the memory cells formed after infection
- BMeasles virus has no surface antigens
- CInfluenza viruses change their surface antigens often
- DMeasles is caused by a bacterium
3Solutions
1.Infection control & patient safety
Answer: C · The front from chest to the level of the sterile field, and the sleeves
Why this is the answer
Only the front of the gown from chest to the level of the sterile field and the sleeves from above the elbow to the cuffs are sterile. The back, the neckline and anything below the sterile field are non-sterile.
C · The front from chest to the level of the sterile field, and the sleeves
2.Infection control & patient safety
Answer: C · Avoid direct patient care and handling of equipment until it heals, and see occupational health
Why this is the answer
Weeping skin lesions increase the risk of passing organisms to patients and of the nurse picking up bloodborne pathogens. The nurse should avoid direct patient contact and handling of patient equipment until the condition is assessed and resolved.
C · Avoid direct patient care and handling of equipment until it heals, and see occupational health
3.Nursing fundamentals
Answer: D · The first urine of the morning is discarded and the time noted, then all urine is kept
Why this is the answer
The patient empties the bladder at the start and that urine is discarded. All urine for the next 24 hours is kept, including a final void at the end time.
D · The first urine of the morning is discarded and the time noted, then all urine is kept
4.Nursing fundamentals
Answer: B · "I'll stop eating all green vegetables from now on."
Why this is the answer
Vitamin K in green vegetables opposes warfarin, so a stable intake keeps the INR steady. Cutting them out suddenly can make the INR rise; bleeding signs and blood tests are correct points.
B · "I'll stop eating all green vegetables from now on."
5.Microbiology
Answer: D · Replacing fluid and salts by oral or intravenous rehydration
Why this is the answer
Cholera toxin makes gut cells secrete large amounts of water and salt. Rapid rehydration saves most lives; antibiotics only shorten the illness.
D · Replacing fluid and salts by oral or intravenous rehydration
6.Microbiology
Answer: C · Influenza viruses change their surface antigens often
Why this is the answer
Influenza haemagglutinin and neuraminidase change through drift (small mutations) and shift (reassortment), so old antibodies may not recognise new strains. Measles is antigenically stable.
C · Influenza viruses change their surface antigens often