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 a fentanyl skin patch wants to use a heating pad on the area. What should the nurse teach?
- AHeat makes the patch last longer, so fewer patches are needed each month
- BHeat only matters if the patch is on the chest
- CAvoid heat on or near the patch, because it increases how fast the drug is absorbed
- DHeat is fine to use, because it helps the patch stick better to the skin
2.Infection control & patient safetyHard
During a sterile central line dressing change, a colleague reaches across the open sterile field to pass the nurse a roll of tape. What should the nurse do?
- ACover the field with a sterile towel and continue on top of it
- BRemove only the items nearest to where the arm passed over
- CContinue, because the colleague did not touch any sterile item
- DTreat the field as contaminated and set up a new one
3.Nursing fundamentalsMedium
When are non-sterile gloves needed?
- AOnly when handling medicines
- BFor every patient contact, including taking a pulse or blood pressure
- COnly when the patient is known to have an infection
- DWhen contact with blood, body fluids or broken skin is expected
4.Nursing fundamentalsHard
A pulse oximeter reads 82% on a patient with cold hands who is talking in full sentences with a normal respiratory rate. What is the best first action?
- ACheck the patient and probe, then warm the hand or move the probe
- BRemove any oxygen because the reading must be wrong
- CIgnore the reading because the patient looks well
- DRecord the reading and recheck it at the next routine set of observations
5.MicrobiologyMedium
Transfer of bacterial genes from one bacterium to another by a virus is called:
- ATransduction
- BConjugation
- CTranscription
- DTransformation
6.MicrobiologyHard
Gram-positive cocci are found. Which test quickly separates staphylococci from streptococci?
- AThe coagulase test
- BThe catalase test
- CThe acid-fast stain
- DGrowth on MacConkey agar
3Solutions
1.Infection control & patient safety
Answer: C · Avoid heat on or near the patch, because it increases how fast the drug is absorbed
Why this is the answer
Heat from heating pads, electric blankets, hot tubs or fever increases fentanyl absorption and can cause an overdose. Patients are taught to avoid heat over the patch.
C · Avoid heat on or near the patch, because it increases how fast the drug is absorbed
2.Infection control & patient safety
Answer: D · Treat the field as contaminated and set up a new one
Why this is the answer
Reaching across a sterile field with non-sterile arms or items contaminates it, even without touching. The field is replaced, and non-sterile items are passed around the field, not over it. When sterility is in doubt, the field is treated as contaminated.
D · Treat the field as contaminated and set up a new one
3.Nursing fundamentals
Answer: D · When contact with blood, body fluids or broken skin is expected
Why this is the answer
Under standard precautions, gloves are worn when exposure to blood or body fluids is likely. Wearing them for all contact gives false security and can spread germs if not changed.
D · When contact with blood, body fluids or broken skin is expected
4.Nursing fundamentals
Answer: A · Check the patient and probe, then warm the hand or move the probe
Why this is the answer
Cold peripheries, movement and nail varnish can give falsely low readings. The nurse assesses the patient first, then checks the waveform and probe site; a low reading is never ignored until it is explained.
A · Check the patient and probe, then warm the hand or move the probe
5.Microbiology
Answer: A · Transduction
Why this is the answer
In transduction a bacteriophage accidentally packages bacterial DNA and delivers it to the next cell it infects. Transformation is uptake of free DNA and conjugation uses direct contact.
6.Microbiology
Answer: B · The catalase test
Why this is the answer
Staphylococci produce catalase, which breaks hydrogen peroxide into water and oxygen bubbles; streptococci do not. The coagulase test is then used to identify S. aureus among staphylococci.