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 parent calls because a toddler has swallowed some household cleaner. The child is awake and breathing normally. What should the nurse advise first?
- AMake the child vomit, using a finger at the back of the throat
- BContact the local poison advice service now for specific advice
- CWait to see whether any symptoms develop over the next day
- DGive syrup of ipecac from the medicine cabinet
2.Infection control & patient safetyHard
A patient with suspected pertussis needs to stay in a shared bay because no single room is free. What is the most appropriate arrangement while infection control is contacted?
- AUse no precautions at all until a single room becomes free
- BCurtains drawn, over 1 meter (3 feet) of space, masks for close contact
- CUse airborne precautions with an N95 respirator for everyone
- DPlace the patient next to an immunocompromised patient
3.Nursing fundamentalsMedium
A patient tells the nurse about abuse and asks them to keep it a secret. What should the nurse say?
- AThat they cannot promise secrecy if someone is at risk of harm
- BThat they promise to keep it secret, so the patient keeps trusting them
- CThat they will tell everyone on the ward so the patient is safe
- DThat they cannot listen to this and the patient should tell a doctor
4.Nursing fundamentalsHard
After treatment for hypoglycaemia a patient's glucose is now 5.2 mmol/L (94 mg/dL) and the next meal is hours away. What should the nurse do next?
- AGive nothing more, as the glucose is now normal
- BGive a longer-acting carbohydrate, such as a sandwich
- CGive another dose of insulin to balance out the extra sugar
- DGive a second glucose drink every 15 minutes
5.MicrobiologyMedium
Which type of immunity is given by breast milk antibodies?
- ANatural passive immunity
- BArtificial passive immunity
- CArtificial active immunity
- DNatural active immunity
6.MicrobiologyHard
Which process can produce a completely new influenza A subtype that causes a pandemic?
- ALysogenic conversion by a bacteriophage
- BAntigenic shift through reassortment of gene segments
- CAntigenic drift through gradual accumulation of point mutations
- DTransformation with free DNA
3Solutions
1.Infection control & patient safety
Answer: B · Contact the local poison advice service now for specific advice
Why this is the answer
A poison advice service (poison control in the US, or NHS 111 in the UK) can give advice for the exact product. Inducing vomiting is not recommended, because corrosive products can burn the esophagus again and vomit can be aspirated. Emergency services are called if the child has trouble breathing or is drowsy.
B · Contact the local poison advice service now for specific advice
2.Infection control & patient safety
Answer: B · Curtains drawn, over 1 meter (3 feet) of space, masks for close contact
Why this is the answer
Droplet precautions focus on distance, masks and barriers. A single room is preferred, so infection control is contacted. Placing the patient near a vulnerable patient would be dangerous.
B · Curtains drawn, over 1 meter (3 feet) of space, masks for close contact
3.Nursing fundamentals
Answer: A · That they cannot promise secrecy if someone is at risk of harm
Why this is the answer
Nurses must not promise secrecy when there is a risk of harm. They listen, stay calm, explain what will happen, record the disclosure and follow safeguarding procedures.
A · That they cannot promise secrecy if someone is at risk of harm
4.Nursing fundamentals
Answer: B · Give a longer-acting carbohydrate, such as a sandwich
Why this is the answer
Fast-acting glucose raises the level quickly but briefly. A starchy snack, or the next meal if due, keeps it from falling again. The episode is recorded and its cause reviewed.
B · Give a longer-acting carbohydrate, such as a sandwich
5.Microbiology
Answer: A · Natural passive immunity
Why this is the answer
Antibodies (mainly IgA) passed in breast milk give passive immunity acquired naturally. It is short-lived because no memory cells form.
A · Natural passive immunity
6.Microbiology
Answer: B · Antigenic shift through reassortment of gene segments
Why this is the answer
When two different influenza A viruses infect the same cell, their segments can mix, giving new haemagglutinin or neuraminidase combinations. Few people are immune, so pandemics can follow. Drift causes the smaller yearly changes.
B · Antigenic shift through reassortment of gene segments