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 walking with a gait belt suddenly starts to fall. What should the nurse do?
- APull the patient backwards quickly toward the bed
- BGrab the patient under both arms and try hard to keep them standing up
- CHold the belt, widen the stance and ease the patient gently to the floor
- DLet go of the belt and run to call for help
2.Infection control & patient safetyHard
A patient with severe dementia gets out of bed alone at night and has fallen twice. Which plan is most appropriate?
- AFour raised side rails, with the door closed at night for quiet
- BA sedative every night to keep the patient in bed
- CLow bed, bed alarm, toileting rounds, night light and nonslip socks
- DTying the patient into the chair overnight
3.Nursing fundamentalsMedium
A catheterised patient has had no urine in the bag for two hours. What should the nurse check first?
- AThe patient's blood glucose level and recent insulin doses
- BNothing, as two hours without urine is normal
- CThe tubing for kinks or blockage and where the bag is
- DWhether the patient has eaten or drunk anything recently
4.Nursing fundamentalsHard
On the sacrum there is a shallow open area with a pink wound bed and no slough. How is this pressure ulcer classified?
- ACategory 4
- BCategory 2
- CCategory 1
- DCategory 3
5.MicrobiologyMedium
Toxoplasma gondii is a risk in pregnancy. Which advice reduces exposure?
- AAvoid all fruit and vegetables
- BAvoid swimming pools and all other public bathing areas
- CAvoid cleaning cat litter and avoid undercooked meat
- DAvoid contact with dogs
6.MicrobiologyHard
Corynebacterium diphtheriae causes diphtheria only if it produces diphtheria toxin. When does it make this toxin?
- AOnly after it has conjugated with E. coli and received a plasmid
- BWhenever it is exposed to antibiotics
- CWhen it carries a bacteriophage with the toxin gene
- DOnly when it is grown at high temperature
3Solutions
1.Infection control & patient safety
Answer: C · Hold the belt, widen the stance and ease the patient gently to the floor
Why this is the answer
The nurse keeps hold of the gait belt, takes a wide base of support and slides the patient down along their own leg to the floor, protecting the head. This controls the fall and protects the nurse’s back.
C · Hold the belt, widen the stance and ease the patient gently to the floor
2.Infection control & patient safety
Answer: C · Low bed, bed alarm, toileting rounds, night light and nonslip socks
Why this is the answer
Combined measures reduce falls best: a low bed, alarms, scheduled rounding and toileting, good lighting and nonslip footwear. Four side rails, routine sedatives and restraint increase injury risk.
C · Low bed, bed alarm, toileting rounds, night light and nonslip socks
3.Nursing fundamentals
Answer: C · The tubing for kinks or blockage and where the bag is
Why this is the answer
Kinked or trapped tubing, a bag above bladder level or a blocked catheter are common causes. If these are fine, the patient is assessed for low output and the doctor informed.
C · The tubing for kinks or blockage and where the bag is
4.Nursing fundamentals
Answer: B · Category 2
Why this is the answer
Category 2 (Stage 2 in the US NPIAP system) is partial-thickness skin loss, seen as a shallow open ulcer with a pink-red bed or as a blister. Category 1 is intact skin; categories 3 and 4 are full thickness.
5.Microbiology
Answer: C · Avoid cleaning cat litter and avoid undercooked meat
Why this is the answer
Toxoplasma oocysts are shed in cat faeces and cysts are found in undercooked meat. Infection during pregnancy can damage the fetal brain and eyes.
C · Avoid cleaning cat litter and avoid undercooked meat
6.Microbiology
Answer: C · When it carries a bacteriophage with the toxin gene
Why this is the answer
The tox gene is carried by a bacteriophage. When the phage is integrated as a prophage, the bacterium can produce toxin. Strains without the phage are non-toxigenic.
C · When it carries a bacteriophage with the toxin gene