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
Sputum specimens are ordered to look for acid-fast bacilli (TB). How are they usually collected?
- AOne saliva sample collected at any convenient time of day
- BThree specimens collected after an antiseptic mouthwash
- COne specimen of sputum collected straight after the evening meal, when coughing is easiest
- DThree deep-cough specimens collected 8 to 24 hours apart, at least one early in the morning
2.Infection control & patient safetyHard
A patient’s white cell differential shows a raised number of band (immature) neutrophils, called a “shift to the left”. What does this usually suggest?
- AAn acute bacterial infection
- BA long-standing parasitic infection
- CA typical viral infection
- DAn allergic reaction
3.Nursing fundamentalsMedium
What is the most reliable way to check that a nasogastric tube is in the stomach before use?
- AListening for a "whoosh" after injecting air
- BAsking the patient whether it feels right
- CPlacing the end of the tube in water to look for bubbles
- DTesting aspirate pH, with a chest X-ray if needed
4.Nursing fundamentalsHard
Which nursing diagnosis is written in the problem–aetiology–signs (PES) format?
- APain related to pain, as shown by the patient saying that it hurts a lot
- BTurn the patient every two hours to protect the skin
- CImpaired skin integrity related to immobility, as shown by a sacral wound
- DPneumonia related to a bacterial infection in the right lung
5.MicrobiologyMedium
Many antifungal drugs target ergosterol. Why does this work?
- AErgosterol is the main structural component of bacterial cell walls
- BErgosterol is in fungal cell membranes but not in human cells
- CHuman cells use ergosterol to make energy
- DErgosterol is only found in viruses
6.MicrobiologyHard
A patient with suspected infectious pulmonary tuberculosis is admitted. Which precautions are needed?
- ADroplet precautions with a surgical mask, and only within one metre
- BContact precautions only, with gloves and an apron
- CNo special precautions, because TB spreads only by blood
- DAirborne precautions, ideally a negative-pressure room and respirator masks for staff
3Solutions
1.Infection control & patient safety
Answer: D · Three deep-cough specimens collected 8 to 24 hours apart, at least one early in the morning
Why this is the answer
Several deep-cough sputum samples improve the chance of finding acid-fast bacilli, and early-morning samples contain the most secretions. Saliva is not sputum, and antiseptic mouthwash can affect the result.
D · Three deep-cough specimens collected 8 to 24 hours apart, at least one early in the morning
2.Infection control & patient safety
Answer: A · An acute bacterial infection
Why this is the answer
In acute bacterial infection, the bone marrow releases neutrophils before they mature, raising the proportion of bands. Allergies and parasites raise eosinophils, and viral infections more often raise lymphocytes.
A · An acute bacterial infection
3.Nursing fundamentals
Answer: D · Testing aspirate pH, with a chest X-ray if needed
Why this is the answer
Aspirate pH supports gastric placement (5.5 or less in UK guidance; 5 or less is typical in US guidance). An X-ray is the most accurate confirmation, used for first placement in many US settings and whenever pH is unclear or no aspirate is obtained. The air insufflation test is unreliable.
D · Testing aspirate pH, with a chest X-ray if needed
4.Nursing fundamentals
Answer: C · Impaired skin integrity related to immobility, as shown by a sacral wound
Why this is the answer
A PES statement gives the nursing problem, the related cause and the defining signs. Pneumonia is a medical diagnosis, turning is an intervention, and a cause cannot repeat the problem.
C · Impaired skin integrity related to immobility, as shown by a sacral wound
5.Microbiology
Answer: B · Ergosterol is in fungal cell membranes but not in human cells
Why this is the answer
Fungal membranes contain ergosterol, while human membranes contain cholesterol. Azoles block ergosterol synthesis and amphotericin binds ergosterol, so they target fungi selectively.
B · Ergosterol is in fungal cell membranes but not in human cells
6.Microbiology
Answer: D · 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.
D · Airborne precautions, ideally a negative-pressure room and respirator masks for staff