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 cleaning product is recommended for the room of a patient with Clostridioides difficile?
- AAlcohol-based wipes, used on every surface twice a day
- BA scented air freshener spray
- CA sporicidal agent, such as a chlorine-based solution
- DPlain water and a clean microfiber cloth
2.Infection control & patient safetyHard
An 82-year-old patient is prescribed diphenhydramine at bedtime for sleep. Why should the nurse raise this with the prescriber?
- AIt is too weak to help an older person sleep
- BIt is only available as an IV drug and cannot be given by mouth at bedtime
- CIt raises blood pressure in most older adults
- DIt is strongly anticholinergic and can cause confusion and falls in older adults
3.Nursing fundamentalsMedium
A patient with advanced dementia cannot describe their pain. How should pain be assessed?
- ABy assuming there is no pain as long as the patient does not complain or call for help
- BBy using the 0–10 numeric rating scale only
- CWith an observational pain tool that scores behaviour such as facial expression
- DBy asking a visitor to guess the pain score
4.Nursing fundamentalsHard
A patient with suspected pulmonary tuberculosis has to go to the X-ray department. What is correct?
- AThe patient wears a surgical mask during transport
- BNo precautions are needed outside the ward
- CThe patient cannot leave the room under any circumstances
- DThe patient wears a respirator and staff wear nothing
5.MicrobiologyMedium
How is DNA transferred between bacteria during conjugation?
- ABy fusion of two bacterial cells into one
- BThrough direct contact using a sex pilus
- CBy a bacteriophage carrying bacterial DNA
- DBy uptake of free DNA from the environment
6.MicrobiologyHard
A healthcare worker's blood test is positive for anti-HBs (hepatitis B surface antibody) and negative for HBsAg and anti-HBc. What does this most likely mean?
- APast natural infection that has cleared
- BChronic hepatitis B infection
- CImmunity from hepatitis B vaccination
- DCurrent acute hepatitis B infection
3Solutions
1.Infection control & patient safety
Answer: C · A sporicidal agent, such as a chlorine-based solution
Why this is the answer
C. difficile spores resist alcohol and many standard disinfectants, so a sporicidal agent such as a chlorine-based product is used for the environment and equipment.
C · A sporicidal agent, such as a chlorine-based solution
2.Infection control & patient safety
Answer: D · It is strongly anticholinergic and can cause confusion and falls in older adults
Why this is the answer
First-generation antihistamines such as diphenhydramine are on the Beers list because they cause confusion, constipation, urinary retention and falls in older adults. Safer approaches to sleep should be discussed.
D · It is strongly anticholinergic and can cause confusion and falls in older adults
3.Nursing fundamentals
Answer: C · With an observational pain tool that scores behaviour such as facial expression
Why this is the answer
Observational tools score signs such as facial expression, vocalisation, body language and changes in behaviour. People with dementia often have pain that is missed.
C · With an observational pain tool that scores behaviour such as facial expression
4.Nursing fundamentals
Answer: A · The patient wears a surgical mask during transport
Why this is the answer
When an airborne-precaution patient must leave the room, they wear a surgical mask to contain respiratory secretions. Staff in close contact still wear respirators as per policy, and the receiving department is informed.
A · The patient wears a surgical mask during transport
5.Microbiology
Answer: B · Through direct contact using a sex pilus
Why this is the answer
In conjugation a donor cell forms a pilus to a recipient and transfers DNA, often a plasmid. It is an important way for antibiotic resistance genes to spread.
B · Through direct contact using a sex pilus
6.Microbiology
Answer: C · Immunity from hepatitis B vaccination
Why this is the answer
The vaccine contains HBsAg, so a vaccinated person makes anti-HBs but no anti-HBc. Past natural infection gives both anti-HBs and anti-HBc, and ongoing infection shows HBsAg.
C · Immunity from hepatitis B vaccination