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
Why are independent double checks used for some medicines, such as insulin and heparin infusions?
- ATo make the preparation process faster
- BBecause these drugs are very expensive to waste
- CA second person checking separately catches missed errors
- DTo share responsibility between two nurses if an error happens
2.Infection control & patient safetyHard
A woman in late pregnancy is choking and cannot speak or cough. Which technique should the rescuer use?
- AChest thrusts
- BBack blows only
- CAbdominal thrusts
- DBlind finger sweeps
3.Nursing fundamentalsMedium
What is tolerance to an opioid?
- AAn allergic reaction to the drug
- BA craving to take the drug for its mental effects
- CFeeling no side effects at all from the drug
- DNeeding a higher dose to get the same pain relief
4.Nursing fundamentalsHard
A patient describes burning, shooting pain with pins and needles in both feet. Which type of pain is most likely?
- AReferred pain
- BNeuropathic pain
- CAcute somatic pain
- DVisceral pain
5.MicrobiologyMedium
Cholera causes profuse "rice-water" diarrhoea. What is the most important treatment?
- AAntifungal drugs
- BAntiviral drugs
- CReplacing fluid and salts by oral or intravenous rehydration
- DStopping all oral fluid intake so that the bowel can rest and recover
6.MicrobiologyHard
On MacConkey agar, pink colonies grow from a urine sample. What does this tell you?
- AThe organism is a Gram-positive coccus
- BThe organism is probably a Gram-negative rod that ferments lactose
- CThe organism is a fungus
- DThe organism does not ferment lactose, so it is probably Salmonella
3Solutions
1.Infection control & patient safety
Answer: C · A second person checking separately catches missed errors
Why this is the answer
In an independent double check, a second qualified person checks the order, the drug, the dose, the calculation and the pump settings on their own. This catches errors that could cause serious harm with high-alert medications.
C · A second person checking separately catches missed errors
2.Infection control & patient safety
Answer: A · Chest thrusts
Why this is the answer
For people in late pregnancy or who are very obese, chest thrusts replace abdominal thrusts because the rescuer cannot get around the abdomen effectively. Blind finger sweeps can push the object deeper.
3.Nursing fundamentals
Answer: D · Needing a higher dose to get the same pain relief
Why this is the answer
Tolerance is a physical adaptation in which the same dose has less effect over time. It is not the same as addiction, which involves craving and harmful use.
D · Needing a higher dose to get the same pain relief
4.Nursing fundamentals
Answer: B · Neuropathic pain
Why this is the answer
Neuropathic pain comes from damage to nerves, for example in diabetes, and is often burning, shooting or tingling. It may respond poorly to standard analgesics and need specific drugs.
5.Microbiology
Answer: C · 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.
C · Replacing fluid and salts by oral or intravenous rehydration
6.Microbiology
Answer: B · The organism is probably a Gram-negative rod that ferments lactose
Why this is the answer
MacConkey agar contains bile salts and crystal violet that inhibit Gram-positive bacteria (selective) and lactose with a pH indicator (differential). Lactose fermenters such as E. coli produce acid and turn pink.
B · The organism is probably a Gram-negative rod that ferments lactose