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 has received oral radioactive iodine therapy. Which precaution is usually taken?
- ALimit time close to the patient and handle body fluids per radiation policy
- BEncourage pregnant visitors to sit close to the patient to give emotional support
- CLet the patient share a bathroom with other patients
- DPlace the patient on droplet precautions with a surgical mask
2.Infection control & patient safetyHard
A nurse is about to give IV morphine. The patient’s respiratory rate is 9/min and they are very drowsy. What should the nurse do?
- AGive half the dose
- BWithhold the dose, assess the patient and inform the prescriber
- CGive the dose and recheck the respiratory rate tomorrow
- DGive the dose because pain was reported earlier
3.Nursing fundamentalsMedium
How should a patient receiving tube feeding be positioned to reduce the risk of aspiration?
- AIn the head-down position
- BLying completely flat
- CWith the head of the bed raised to about 30–45 degrees
- DLying on the stomach
4.Nursing fundamentalsHard
Which pair of details is best for confirming a patient's identity before giving a medicine?
- ABed number and the patient's first name, checked against the ward list
- BFull name and date of birth, checked against the wristband
- CThe name on the door and the patient's face
- DRoom number and diagnosis
5.MicrobiologyMedium
Why does high vaccination coverage also protect babies too young to be vaccinated?
- AFewer people can pass on the infection, so it spreads less
- BVaccines kill the pathogen in the environment
- CBabies are naturally immune to all vaccine-preventable diseases
- DVaccinated people pass antibodies to everyone they meet
6.MicrobiologyHard
A positive blood culture shows Gram-positive cocci in clusters. Which organism is most likely?
- AStreptococcus
- BNeisseria
- CEnterococcus in short chains
- DStaphylococcus
3Solutions
1.Infection control & patient safety
Answer: A · Limit time close to the patient and handle body fluids per radiation policy
Why this is the answer
Radioactive iodine is excreted in urine, sweat and saliva, so the patient is usually in a private room with their own bathroom. Staff limit time near them, use distance and follow policy for body fluids and waste.
A · Limit time close to the patient and handle body fluids per radiation policy
2.Infection control & patient safety
Answer: B · Withhold the dose, assess the patient and inform the prescriber
Why this is the answer
Slow breathing and sedation suggest opioid excess, so another dose could cause respiratory arrest. The nurse holds the dose, stimulates and assesses the patient, prepares naloxone per order and escalates.
B · Withhold the dose, assess the patient and inform the prescriber
3.Nursing fundamentals
Answer: C · With the head of the bed raised to about 30–45 degrees
Why this is the answer
Raising the head of the bed during and after feeding helps prevent reflux and aspiration into the lungs.
C · With the head of the bed raised to about 30–45 degrees
4.Nursing fundamentals
Answer: B · Full name and date of birth, checked against the wristband
Why this is the answer
At least two personal identifiers, such as name, date of birth and hospital number, are checked with the patient and the wristband. Bed and room numbers change and are not identifiers.
B · Full name and date of birth, checked against the wristband
5.Microbiology
Answer: A · Fewer people can pass on the infection, so it spreads less
Why this is the answer
When enough people are immune, chains of transmission break and the pathogen rarely reaches susceptible people, such as young babies or immunosuppressed patients.
A · Fewer people can pass on the infection, so it spreads less
6.Microbiology
Answer: D · Staphylococcus
Why this is the answer
Staphylococci grow in grape-like clusters; streptococci and enterococci in chains or pairs. Neisseria are Gram-negative diplococci.