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
An infusion pump’s drug library warns that the programmed dose is above the safe limit. What should the nurse do?
- ARecheck the order, the calculation and the pump settings first
- BSwitch off the drug library for this infusion
- CContinue the infusion and recheck the pump at the end of the shift
- DOverride the alert, because pump alerts are often wrong
2.Infection control & patient safetyHard
A nurse has weeping dermatitis on both hands. What is the most appropriate action?
- ACover the lesions with a waterproof bandage and keep working with patients as usual
- BUse extra alcohol hand rub on the lesions
- CAvoid direct patient care and handling of equipment until it heals, and see occupational health
- DContinue care as usual and wear one pair of gloves
3.Nursing fundamentalsMedium
Which patient is at greatest risk of injury from a heat pack?
- AA patient with reduced sensation from diabetic neuropathy
- BA patient with period pain
- CA patient with a sore lower back after gardening
- DA young adult with a stiff neck after sleeping in an awkward position
4.Nursing fundamentalsHard
A patient with dementia keeps getting out of bed at night. What is the best first nursing approach?
- ARaise the bed rails and leave the patient alone
- BAsk the doctor to prescribe a sedative so the patient sleeps through the night
- CLook for an unmet need such as toileting, pain, hunger or thirst
- DTie a sheet across the bed to keep the patient in
5.MicrobiologyMedium
How is DNA transferred between bacteria during conjugation?
- AThrough direct contact using a sex pilus
- BBy a bacteriophage carrying bacterial DNA
- CBy fusion of two bacterial cells into one
- DBy uptake of free DNA from the environment
6.MicrobiologyHard
Why are beta-lactamase inhibitors such as clavulanic acid combined with amoxicillin?
- AThey make amoxicillin active against viruses
- BThey protect amoxicillin from bacterial enzymes that destroy it
- CThey slow the excretion of amoxicillin by the kidneys, raising its level
- DThey kill bacteria by themselves through the cell membrane
3Solutions
1.Infection control & patient safety
Answer: A · Recheck the order, the calculation and the pump settings first
Why this is the answer
Smart pump limits are set to catch programming and calculation errors. The nurse checks the order, the concentration, the dose and the rate before deciding whether an override is truly appropriate.
A · Recheck the order, the calculation and the pump settings first
2.Infection control & patient safety
Answer: C · Avoid direct patient care and handling of equipment until it heals, and see occupational health
Why this is the answer
Weeping skin lesions increase the risk of passing organisms to patients and of the nurse picking up bloodborne pathogens. The nurse should avoid direct patient contact and handling of patient equipment until the condition is assessed and resolved.
C · Avoid direct patient care and handling of equipment until it heals, and see occupational health
3.Nursing fundamentals
Answer: A · A patient with reduced sensation from diabetic neuropathy
Why this is the answer
Patients who cannot feel heat properly, such as those with neuropathy, spinal injury or reduced consciousness, can be burned without noticing. Their skin needs extra checks or heat should be avoided.
A · A patient with reduced sensation from diabetic neuropathy
4.Nursing fundamentals
Answer: C · 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.
C · Look for an unmet need such as toileting, pain, hunger or thirst
5.Microbiology
Answer: A · 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.
A · Through direct contact using a sex pilus
6.Microbiology
Answer: B · They protect amoxicillin from bacterial enzymes that destroy it
Why this is the answer
Beta-lactamases hydrolyse the beta-lactam ring. Clavulanic acid binds these enzymes, so amoxicillin stays active against beta-lactamase-producing bacteria.
B · They protect amoxicillin from bacterial enzymes that destroy it