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 alcohol-based skin prep has been used before surgery with electrosurgery. What must happen before the drapes are placed?
- AThe prep must be wiped off with saline
- BThe prep must be covered with the drapes while it is still wet
- CThe prep must be fully dry and any pooled liquid removed
- DThe prep must be warmed with a hair dryer
2.Infection control & patient safetyHard
Which patient should the nurse assess first?
- AA patient on chemotherapy with a new temperature of 38.4 °C (101.1 °F)
- BA patient with an MRSA wound due for a routine dressing change
- CA patient who wants more alcohol hand rub in the room
- DA patient with tuberculosis who is asking to have visitors
3.Nursing fundamentalsMedium
What is informed consent?
- AA signed form that removes all liability from staff for any harm caused by the procedure
- BAgreement obtained after the procedure
- CA signature from any family member
- DVoluntary agreement by a patient with capacity, after receiving adequate information
4.Nursing fundamentalsHard
A patient's potassium result is 6.8 mmol/L (6.8 mEq/L). Why is this urgent?
- AHigh potassium causes only mild muscle cramps that settle without treatment
- BVery high potassium can cause life-threatening heart arrhythmias
- CIt is normal for patients after surgery
- DIt means the patient urgently needs more potassium
5.MicrobiologyMedium
Which cells does HIV mainly infect and destroy?
- ARed blood cells
- BCD4 T helper cells
- CNeutrophils
- DPlatelets
6.MicrobiologyHard
Why are beta-lactamase inhibitors such as clavulanic acid combined with amoxicillin?
- AThey kill bacteria by themselves through the cell membrane
- BThey make amoxicillin active against viruses
- CThey slow the excretion of amoxicillin by the kidneys, raising its level
- DThey protect amoxicillin from bacterial enzymes that destroy it
3Solutions
1.Infection control & patient safety
Answer: C · The prep must be fully dry and any pooled liquid removed
Why this is the answer
Wet alcohol prep and its vapors under drapes can be ignited by electrosurgery or lasers. The prep is allowed to dry fully, and pooling in skin folds or linen is prevented.
C · The prep must be fully dry and any pooled liquid removed
2.Infection control & patient safety
Answer: A · A patient on chemotherapy with a new temperature of 38.4 °C (101.1 °F)
Why this is the answer
Fever in a patient who may be neutropenic can be the first sign of sepsis and needs urgent assessment. The other needs are real but stable and can wait a short time.
A · A patient on chemotherapy with a new temperature of 38.4 °C (101.1 °F)
3.Nursing fundamentals
Answer: D · Voluntary agreement by a patient with capacity, after receiving adequate information
Why this is the answer
Valid consent requires a patient with capacity, enough information about risks, benefits and alternatives, and a free choice. It can be withdrawn at any time.
D · Voluntary agreement by a patient with capacity, after receiving adequate information
4.Nursing fundamentals
Answer: B · Very high potassium can cause life-threatening heart arrhythmias
Why this is the answer
Severe hyperkalaemia can cause cardiac arrest. The result is escalated at once; an ECG and treatment follow, and a repeat sample checks whether the result was falsely raised.
B · Very high potassium can cause life-threatening heart arrhythmias
5.Microbiology
Answer: B · CD4 T helper cells
Why this is the answer
HIV binds CD4 and a co-receptor on T helper cells. Loss of these cells weakens both antibody and cell-mediated immunity, leading to AIDS.
6.Microbiology
Answer: D · 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.
D · They protect amoxicillin from bacterial enzymes that destroy it