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’s identification wristband is missing. A medication is due. What should the nurse do?
- AGive it, because the nurse recognizes the patient from yesterday
- BUse the room and bed number to confirm identity
- CConfirm identity with two identifiers and apply a new wristband first
- DSkip the medication until the next day
2.Infection control & patient safetyHard
A nurse who has a cold sore (herpes labialis) is assigned to the newborn nursery. What is most appropriate?
- ATell no one, and cover the lesion with makeup during shifts
- BInform the manager, who may reassign the nurse for now
- CWear gloves and carry on as usual
- DWork as usual, since cold sores are very common
3.Nursing fundamentalsMedium
A patient's radial pulse is irregular. How should you count it?
- AFor a full 60 seconds, ideally at the apex of the heart
- BOnly on the automatic blood pressure machine
- CFor 10 seconds and multiply by six
- DFor 15 seconds and multiply by four
4.Nursing fundamentalsHard
A patient with type 1 diabetes is vomiting and not eating. Which advice is correct?
- AStop all insulin until eating normally again
- BHalve every dose and stop testing the glucose
- CKeep taking basal insulin and check glucose and ketones more often
- DDrink only sugar-free fluids and stop testing for ketones until better
5.MicrobiologyMedium
Which laboratory test separates Staphylococcus aureus from most other staphylococci?
- AThe catalase test
- BThe coagulase test
- CThe acid-fast stain
- DThe Gram stain
6.MicrobiologyHard
Prions differ from all other infectious agents because they:
- AContain no nucleic acid and consist of misfolded protein
- BAre killed by normal cooking and disinfection
- CCan only infect bacteria
- DContain only RNA, with no protein coat surrounding the genome
3Solutions
1.Infection control & patient safety
Answer: C · Confirm identity with two identifiers and apply a new wristband first
Why this is the answer
Every medication requires a confirmed identity. The nurse replaces the wristband after confirming the patient’s identity with two identifiers. Familiarity and room numbers are not acceptable identifiers.
C · Confirm identity with two identifiers and apply a new wristband first
2.Infection control & patient safety
Answer: B · Inform the manager, who may reassign the nurse for now
Why this is the answer
Herpes simplex can cause severe infection in newborns. Staff with active lesions inform their manager and follow occupational health advice, which often means avoiding contact with newborns and other high-risk patients until the lesion has healed.
B · Inform the manager, who may reassign the nurse for now
3.Nursing fundamentals
Answer: A · For a full 60 seconds, ideally at the apex of the heart
Why this is the answer
An irregular pulse should be counted for a full minute. An apical count with a stethoscope is more accurate, as some beats may be too weak to feel at the wrist.
A · For a full 60 seconds, ideally at the apex of the heart
4.Nursing fundamentals
Answer: C · Keep taking basal insulin and check glucose and ketones more often
Why this is the answer
Sick-day rules say people with type 1 diabetes should never stop their insulin, as illness increases glucose and the risk of ketoacidosis. Frequent testing and early advice are needed.
C · Keep taking basal insulin and check glucose and ketones more often
5.Microbiology
Answer: B · The coagulase test
Why this is the answer
S. aureus produces coagulase, which converts fibrinogen to fibrin. All staphylococci are Gram-positive and catalase-positive, so those tests do not separate them.
6.Microbiology
Answer: A · Contain no nucleic acid and consist of misfolded protein
Why this is the answer
Prions are misfolded proteins that induce normal proteins to misfold. They contain no DNA or RNA and are very resistant to standard sterilisation.
A · Contain no nucleic acid and consist of misfolded protein