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 nurse gives part of a dose of an opioid from a vial and must discard the rest. What is correct?
- ADiscard it alone in the sink and document the amount wasted later in the shift
- BKeep the rest for the patient’s next dose
- CDiscard it in front of a second licensed (registered) nurse, who witnesses and documents it
- DReturn the rest to the patient’s medication drawer
2.Infection control & patient safetyHard
A patient has signed a surgical consent form but tells the nurse, “I don’t really understand what they are going to do.” What should the nurse do?
- AGive the preoperative sedative so the patient relaxes
- BReassure the patient that the surgeon knows best and continue with the preparation
- CInform the surgeon so the procedure can be explained again before any sedation
- DExplain the risks and benefits in place of the surgeon
3.Nursing fundamentalsMedium
What is the purpose of a negative-pressure isolation room?
- AThe low pressure kills bacteria inside the room
- BAir flows into the room, so airborne particles do not escape into the corridor
- CAir flows out of the room, keeping germs from the corridor away from the patient
- DIt makes it easier for patients to breathe
4.Nursing fundamentalsHard
A pressure ulcer's base is completely covered with slough and dark eschar. How is it classified?
- AUnstageable, because the depth cannot be seen
- BHealed, because a scab has formed
- CCategory 2, because it is covered
- DCategory 1, because the skin is not open
5.MicrobiologyMedium
Why are Gram-negative bacteria often harder to treat with antibiotics?
- AThey divide much more slowly
- BThey have a thicker peptidoglycan layer
- CThey have no ribosomes
- DTheir outer membrane blocks many drugs
6.MicrobiologyHard
How do high-risk HPV types contribute to cervical cancer?
- AThe virus kills cells so quickly that they are replaced by cancer cells
- BThe virus destroys CD4 T cells in the cervix
- CViral E6 and E7 proteins inactivate the tumour suppressors p53 and Rb
- DThe virus produces an endotoxin that damages DNA
3Solutions
1.Infection control & patient safety
Answer: C · Discard it in front of a second licensed (registered) nurse, who witnesses and documents it
Why this is the answer
Wasting controlled substances requires a witness, usually another licensed nurse, and both document the waste. This prevents and detects drug diversion.
C · Discard it in front of a second licensed (registered) nurse, who witnesses and documents it
2.Infection control & patient safety
Answer: C · Inform the surgeon so the procedure can be explained again before any sedation
Why this is the answer
Informed consent is the responsibility of the person doing the procedure. If the patient does not understand, the nurse pauses the process and tells the surgeon, before any sedative drug is given.
C · Inform the surgeon so the procedure can be explained again before any sedation
3.Nursing fundamentals
Answer: B · Air flows into the room, so airborne particles do not escape into the corridor
Why this is the answer
Negative pressure draws air into the room and out through filtered exhaust. It is used for airborne infections such as tuberculosis; positive pressure is used to protect patients with very weak immunity.
B · Air flows into the room, so airborne particles do not escape into the corridor
4.Nursing fundamentals
Answer: A · Unstageable, because the depth cannot be seen
Why this is the answer
When slough or eschar hides the wound base, the true depth is unknown, so the ulcer is recorded as unstageable until the base can be seen.
A · Unstageable, because the depth cannot be seen
5.Microbiology
Answer: D · Their outer membrane blocks many drugs
Why this is the answer
The outer membrane of Gram-negative bacteria, with lipopolysaccharide and porins, keeps many antibiotics out and adds efflux and enzyme defences.
D · Their outer membrane blocks many drugs
6.Microbiology
Answer: C · Viral E6 and E7 proteins inactivate the tumour suppressors p53 and Rb
Why this is the answer
E6 promotes the breakdown of p53 and E7 binds Rb, removing controls on cell division and DNA repair. Infected cells can then accumulate mutations and become cancerous over years.
C · Viral E6 and E7 proteins inactivate the tumour suppressors p53 and Rb