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 colleague has drawn up a medication and asks the nurse to give it to her patient. What should the nurse do?
- ADecline, and give only medications that the nurse prepared or checked personally
- BGive it, because the colleague is experienced
- CGive it, and document that the colleague prepared it
- DGive it, as long as the syringe has a label with the drug name on it
2.Infection control & patient safetyHard
A nurse caring for a patient with influenza on droplet precautions will assist with an aerosol-generating procedure, such as bronchoscopy. What change in PPE is needed?
- AWear a fit-tested respirator (N95 or FFP3) and eye protection instead of a surgical mask
- BWear two surgical masks, one on top of the other, for the length of the procedure
- CNo change, because influenza only needs droplet precautions
- DWear gloves only, because the procedure is short
3.Nursing fundamentalsMedium
What is orthostatic (postural) hypotension?
- AA difference of more than 10 mmHg in blood pressure between the two arms
- BA fall in blood pressure on standing up, often causing dizziness
- CLow blood pressure only during sleep
- DHigh blood pressure when lying down
4.Nursing fundamentalsHard
A potassium result is unexpectedly high and the lab reports that the sample was haemolysed. What does this mean?
- AThe patient definitely has dangerous hyperkalaemia needing treatment
- BThe result is accurate and needs no follow-up
- CThe patient definitely has low potassium
- DThe result may be falsely high and the test should be repeated
5.MicrobiologyMedium
Which part of the immune system produces antibodies?
- ACytotoxic T cells activated in the lymph nodes
- BNeutrophils
- CNatural killer cells
- DPlasma cells derived from B lymphocytes
6.MicrobiologyHard
Which process can produce a completely new influenza A subtype that causes a pandemic?
- AAntigenic drift through gradual accumulation of point mutations
- BLysogenic conversion by a bacteriophage
- CAntigenic shift through reassortment of gene segments
- DTransformation with free DNA
3Solutions
1.Infection control & patient safety
Answer: A · Decline, and give only medications that the nurse prepared or checked personally
Why this is the answer
Nurses give only medicines they prepared themselves or verified fully, because they are accountable for what they give. A drug prepared by someone else may be wrong in ways the nurse cannot see.
A · Decline, and give only medications that the nurse prepared or checked personally
2.Infection control & patient safety
Answer: A · Wear a fit-tested respirator (N95 or FFP3) and eye protection instead of a surgical mask
Why this is the answer
Aerosol-generating procedures can spread influenza in small particles that a surgical mask does not filter well. Staff wear a fit-tested respirator (N95 in the US, FFP3 in the UK), eye protection, gown and gloves, and the number of people in the room is kept low.
A · Wear a fit-tested respirator (N95 or FFP3) and eye protection instead of a surgical mask
3.Nursing fundamentals
Answer: B · A fall in blood pressure on standing up, often causing dizziness
Why this is the answer
Orthostatic hypotension is a drop in blood pressure when moving to an upright position. It is common in older people and with some medicines and increases fall risk.
B · A fall in blood pressure on standing up, often causing dizziness
4.Nursing fundamentals
Answer: D · The result may be falsely high and the test should be repeated
Why this is the answer
Red cells contain a lot of potassium, so haemolysis during collection can falsely raise the result. The sample is repeated, with the patient assessed in the meantime.
D · The result may be falsely high and the test should be repeated
5.Microbiology
Answer: D · Plasma cells derived from B lymphocytes
Why this is the answer
Activated B cells differentiate into plasma cells, which secrete antibodies. Cytotoxic T cells and NK cells kill infected cells directly.
D · Plasma cells derived from B lymphocytes
6.Microbiology
Answer: C · 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.
C · Antigenic shift through reassortment of gene segments