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
Which nursing care reduces the risk of ventilator-associated pneumonia?
- ALeaving secretions in the mouth to protect the airway
- BLying the patient flat for most of the day
- CRegular oral care to reduce bacteria in the mouth
- DChanging the ventilator circuit every few hours
2.Infection control & patient safetyHard
A patient with pulmonary tuberculosis has been on treatment. Which findings usually allow airborne isolation to end?
- AOne negative chest x-ray after starting treatment
- BThe patient has been in hospital for one week and has taken every dose of medicine
- CThree negative sputum smears, clinical improvement and continued therapy
- DThe cough has stopped, even with no sputum tests
3.Nursing fundamentalsMedium
How should dentures be cleaned to avoid breaking them?
- AWith an abrasive cleaning powder to remove stains
- BOver an empty, hard sink so they can be seen clearly
- COver a sink lined with a towel or partly filled with water
- DBy soaking them in very hot water to sterilise them
4.Nursing fundamentalsHard
An older patient with diarrhoea for three days is dizzy on standing and passing small amounts of dark urine. What is the most likely problem?
- ANormal ageing that needs no action
- BFluid overload from drinking too much
- CDehydration from fluid loss
- DUrinary retention caused by a full bladder
5.MicrobiologyMedium
MRSA is resistant to methicillin because it has:
- AA polysaccharide capsule that blocks the entry of all beta-lactams
- BNo cell wall at all
- CAn altered penicillin-binding protein (PBP2a)
- DAn efflux pump for every antibiotic
6.MicrobiologyHard
Why are beta-lactamase inhibitors such as clavulanic acid combined with amoxicillin?
- AThey kill bacteria by themselves through the cell membrane
- BThey slow the excretion of amoxicillin by the kidneys, raising its level
- CThey protect amoxicillin from bacterial enzymes that destroy it
- DThey make amoxicillin active against viruses
3Solutions
1.Infection control & patient safety
Answer: C · Regular oral care to reduce bacteria in the mouth
Why this is the answer
Oral care, including tooth brushing, reduces the bacteria that can be aspirated around the endotracheal tube. It is part of ventilator care along with head elevation and sedation review.
C · Regular oral care to reduce bacteria in the mouth
2.Infection control & patient safety
Answer: C · Three negative sputum smears, clinical improvement and continued therapy
Why this is the answer
Airborne precautions usually continue until the patient is on effective therapy, is improving clinically and has three negative sputum smears for acid-fast bacilli, according to policy.
C · Three negative sputum smears, clinical improvement and continued therapy
3.Nursing fundamentals
Answer: C · Over a sink lined with a towel or partly filled with water
Why this is the answer
Cleaning over a padded or water-filled sink cushions a fall. Hot water can warp dentures, and abrasives scratch them; they are stored in a labelled denture pot.
C · Over a sink lined with a towel or partly filled with water
4.Nursing fundamentals
Answer: C · Dehydration from fluid loss
Why this is the answer
Diarrhoea causes loss of water and electrolytes. Postural dizziness and concentrated low-volume urine show dehydration, which needs fluid replacement, electrolyte checks and close monitoring.
C · Dehydration from fluid loss
5.Microbiology
Answer: C · An altered penicillin-binding protein (PBP2a)
Why this is the answer
The mecA gene codes for PBP2a, which has low affinity for beta-lactams, so the bacterium can keep building its cell wall despite methicillin.
C · An altered penicillin-binding protein (PBP2a)
6.Microbiology
Answer: C · 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.
C · They protect amoxicillin from bacterial enzymes that destroy it