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
During a surgical hand scrub, how are the hands held?
- AAbove the elbows, so water runs from the fingertips toward the elbows
- BAt the level of the waist, close to the body
- CPointing downward into the sink at all times
- DBelow the elbows, so water runs off the fingertips into the sink
2.Infection control & patient safetyHard
Over a few hours, the emergency department sees many previously healthy people with the same unusual severe symptoms. What should the nurse do?
- ASend the patients home quickly to avoid crowding the emergency department
- BTell only the patients’ families about the pattern
- CTreat each patient and wait to see if more arrive next week
- DReport it to infection prevention and public health authorities promptly
3.Nursing fundamentalsMedium
When are non-sterile gloves needed?
- AOnly when the patient is known to have an infection
- BFor every patient contact, including taking a pulse or blood pressure
- COnly when handling medicines
- DWhen contact with blood, body fluids or broken skin is expected
4.Nursing fundamentalsHard
A patient with dementia keeps getting out of bed at night. What is the best first nursing approach?
- ATie a sheet across the bed to keep the patient in
- BLook for an unmet need such as toileting, pain, hunger or thirst
- CAsk the doctor to prescribe a sedative so the patient sleeps through the night
- DRaise the bed rails and leave the patient alone
5.MicrobiologyMedium
Which part of the immune system produces antibodies?
- ANeutrophils
- BPlasma cells derived from B lymphocytes
- CCytotoxic T cells activated in the lymph nodes
- DNatural killer cells
6.MicrobiologyHard
A patient with suspected infectious pulmonary tuberculosis is admitted. Which precautions are needed?
- AContact precautions only, with gloves and an apron
- BAirborne precautions, ideally a negative-pressure room and respirator masks for staff
- CDroplet precautions with a surgical mask, and only within one metre
- DNo special precautions, because TB spreads only by blood
3Solutions
1.Infection control & patient safety
Answer: A · Above the elbows, so water runs from the fingertips toward the elbows
Why this is the answer
After a surgical scrub, the hands are the cleanest area, so they are held above the elbows to let water drain away from them toward the less clean elbows.
A · Above the elbows, so water runs from the fingertips toward the elbows
2.Infection control & patient safety
Answer: D · Report it to infection prevention and public health authorities promptly
Why this is the answer
Clusters of similar unusual illness can signal an outbreak or bioterrorism. Early reporting allows public health to investigate, guide precautions and treatment, and protect the community.
D · Report it to infection prevention and public health authorities promptly
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: B · Look for an unmet need such as toileting, pain, hunger or thirst
Why this is the answer
Restlessness in dementia often has a cause, such as needing the toilet, pain or being cold. Meeting the need is safer than restraint or sedation, which increase the risk of harm.
B · Look for an unmet need such as toileting, pain, hunger or thirst
5.Microbiology
Answer: B · Plasma cells derived from B lymphocytes
Why this is the answer
Activated B cells differentiate into plasma cells, which secrete antibodies. Cytotoxic T cells and NK cells kill infected cells directly.
B · Plasma cells derived from B lymphocytes
6.Microbiology
Answer: B · Airborne precautions, ideally a negative-pressure room and respirator masks for staff
Why this is the answer
M. tuberculosis spreads in airborne droplet nuclei that can stay suspended for long periods. Patients need a single room with negative pressure where possible, and staff wear FFP2/FFP3 or N95 respirators.
B · Airborne precautions, ideally a negative-pressure room and respirator masks for staff