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 instruction about using a standard walker is correct?
- ACarry the walker and use it only when tired
- BPush up from the walker to stand from a chair
- CWalk well ahead of the walker for balance
- DMove the walker forward, then step into it
2.Infection control & patient safetyHard
Two look-alike vials of different drugs are stored next to each other, and a nurse almost picks the wrong one. Which response best reflects a just culture?
- AReport it and fix the system, for example by separating the vials
- BKeep the incident quiet to protect the unit’s reputation
- CDiscipline the nurse who nearly picked the wrong vial
- DTell the nurse to be more careful and do nothing else
3.Nursing fundamentalsMedium
A patient refuses their regular evening tablets. What should the nurse do first?
- AHide the tablets in their food
- BThrow the tablets away without telling anyone
- CExplore the reason for refusing
- DInsist until the patient takes them
4.Nursing fundamentalsHard
Why should only the patient press the button of a patient-controlled analgesia (PCA) pump?
- AA drowsy patient stops pressing, which helps prevent overdose
- BVisitors might damage the pump or change its settings if they touch it
- CThe pump only works with the patient's fingerprint
- DNurses are not allowed to give opioids
5.MicrobiologyMedium
Why are pregnant women advised to avoid unpasteurised soft cheeses?
- AThey contain too much lactose for the fetus
- BThey may contain tapeworm eggs
- CThey often contain the hepatitis C virus, which crosses the placenta
- DThey may contain Listeria, which can harm the fetus
6.MicrobiologyHard
Which hepatitis viruses are mainly spread through contaminated food and water?
- AHepatitis B and C
- BHepatitis A and E
- CHepatitis B and D
- DHepatitis C and E
3Solutions
1.Infection control & patient safety
Answer: D · Move the walker forward, then step into it
Why this is the answer
The patient moves the walker forward, sets it down with all legs on the floor and then steps into it. To stand, they push up from the chair arms, because a walker can tip if used to pull up.
D · Move the walker forward, then step into it
2.Infection control & patient safety
Answer: A · Report it and fix the system, for example by separating the vials
Why this is the answer
A just culture recognizes that human errors are often caused by system design. Separating look-alike drugs, using labels and Tall Man lettering prevents repeats. Blaming the person alone leaves the hazard in place.
A · Report it and fix the system, for example by separating the vials
3.Nursing fundamentals
Answer: C · Explore the reason for refusing
Why this is the answer
Patients with capacity may refuse medicines. The nurse explores why, for example side effects or misunderstanding, gives information, documents the refusal and informs the prescriber if needed.
C · Explore the reason for refusing
4.Nursing fundamentals
Answer: A · A drowsy patient stops pressing, which helps prevent overdose
Why this is the answer
If the patient becomes too sleepy they cannot press the button, so no more opioid is given. When others press it this safety is lost and respiratory depression can follow.
A · A drowsy patient stops pressing, which helps prevent overdose
5.Microbiology
Answer: D · They may contain Listeria, which can harm the fetus
Why this is the answer
Listeria monocytogenes can grow in chilled foods and cross the placenta. It can cause miscarriage, stillbirth or severe neonatal infection.
D · They may contain Listeria, which can harm the fetus
6.Microbiology
Answer: B · 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.