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 patient with difficulty swallowing is prescribed an extended-release tablet. What should the nurse do?
- ACut the tablet in half so it is easier to swallow
- BDissolve the tablet in a glass of hot water
- CAsk the prescriber or pharmacist for another form and not crush the tablet
- DCrush the tablet finely and mix it into a spoonful of applesauce or yogurt
2.Infection control & patient safetyHard
A nurse discovers that an insulin infusion was programmed using the wrong drug concentration in the pump library. What should the nurse do first?
- AReprogram the pump and finish the shift before reporting
- BDouble the rate to correct for the error
- CLeave it running and check the glucose at the next routine time
- DStop the infusion and check the patient’s blood glucose
3.Nursing fundamentalsMedium
A patient speaks little English. Who should interpret during an important consent discussion?
- AA professional medical interpreter
- BAny staff member who knows a few words of the language
- CThe patient's young child
- DA visitor in the next bed
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?
- AGive the next morphine dose as prescribed
- BCall for help, support breathing, withhold the opioid and prepare naloxone as per protocol
- CGive a strong cup of coffee
- DLet the patient sleep and recheck in four hours
5.MicrobiologyMedium
Which organism causes typhoid fever?
- AVibrio cholerae
- BShigella dysenteriae
- CCampylobacter jejuni
- DSalmonella Typhi
6.MicrobiologyHard
Which hepatitis viruses are mainly spread through contaminated food and water?
- AHepatitis B and D
- BHepatitis C and E
- CHepatitis B and C
- DHepatitis A and E
3Solutions
1.Infection control & patient safety
Answer: C · Ask the prescriber or pharmacist for another form and not crush the tablet
Why this is the answer
Crushing or splitting an extended-release product can release the whole dose at once and cause toxicity. The nurse asks for a suitable alternative, such as a liquid or immediate-release form.
C · Ask the prescriber or pharmacist for another form and not crush the tablet
2.Infection control & patient safety
Answer: D · Stop the infusion and check the patient’s blood glucose
Why this is the answer
A concentration error means the dose delivered was wrong. The nurse stops the infusion, assesses the patient including blood glucose, treats as needed, notifies the prescriber and reports the event.
D · Stop the infusion and check the patient’s blood glucose
3.Nursing fundamentals
Answer: A · A professional medical interpreter
Why this is the answer
Professional interpreters translate accurately and keep confidentiality. Family members, especially children, may leave things out, add their own views or be burdened by the information.
A · A professional medical interpreter
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: D · Salmonella Typhi
Why this is the answer
Salmonella enterica serotype Typhi causes typhoid fever, a systemic illness with prolonged fever. Some people become chronic carriers, often in the gallbladder.
6.Microbiology
Answer: D · Hepatitis A and E
Why this is the answer
Hepatitis A and E spread by the faecal–oral route. B, C and D spread through blood and body fluids and can cause chronic infection.