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 with difficulty swallowing is prescribed an extended-release tablet. What should the nurse do?
- ACrush the tablet finely and mix it into a spoonful of applesauce or yogurt
- BAsk the prescriber or pharmacist for another form and not crush the tablet
- CCut the tablet in half so it is easier to swallow
- DDissolve the tablet in a glass of hot water
2.Infection control & patient safetyHard
Which patient with a suspected infection meets at least two SIRS criteria?
- ATemperature 38.6 °C and heart rate 112/min
- BTemperature 37.2 °C and heart rate 80/min
- CRespiratory rate 16/min and WBC 8,000/mm3
- DTemperature 36.8 °C and respiratory rate 18/min
3.Nursing fundamentalsMedium
Why is an IV giving set primed before connecting it to the patient?
- ATo check the speed of the pump
- BTo warm the fluid to body temperature
- CTo test whether the patient is allergic to the fluid
- DTo remove air from the line
4.Nursing fundamentalsHard
A patient taking furosemide has a serum potassium of 3.0 mmol/L (3.0 mEq/L). Why is this important?
- AFurosemide raises potassium, so this level is falsely low and can be ignored
- BThe level is normal and needs no action
- CLoop diuretics cause potassium loss, and low levels can cause arrhythmias
- DLow potassium only causes mild thirst
5.MicrobiologyMedium
Which part of the immune system produces antibodies?
- APlasma cells derived from B lymphocytes
- BNeutrophils
- CCytotoxic T cells activated in the lymph nodes
- DNatural killer cells
6.MicrobiologyHard
Several people vomit within a few hours of eating fried rice that was cooked the day before and kept at room temperature. Which organism is the classic cause?
- ASalmonella Typhi
- BBacillus cereus
- CClostridium botulinum
- DListeria monocytogenes
3Solutions
1.Infection control & patient safety
Answer: B · Ask the prescriber or pharmacist for another form and not crush the tablet
Why this is the answer
Crushing or splitting an extended-release product can release the whole dose at once and cause toxicity. The nurse asks for a suitable alternative, such as a liquid or immediate-release form.
B · Ask the prescriber or pharmacist for another form and not crush the tablet
2.Infection control & patient safety
Answer: A · Temperature 38.6 °C and heart rate 112/min
Why this is the answer
SIRS criteria include a temperature above 38 °C or below 36 °C, heart rate above 90/min, respiratory rate above 20/min and a WBC above 12,000 or below 4,000/mm3. Only the first patient meets two.
A · Temperature 38.6 °C and heart rate 112/min
3.Nursing fundamentals
Answer: D · To remove air from the line
Why this is the answer
Priming fills the line with fluid and removes air, which could otherwise enter the vein and cause an air embolism.
D · To remove air from the line
4.Nursing fundamentals
Answer: C · Loop diuretics cause potassium loss, and low levels can cause arrhythmias
Why this is the answer
Furosemide increases potassium loss in the urine. Hypokalaemia causes muscle weakness and cardiac arrhythmias, so the result is reported and replacement considered.
C · Loop diuretics cause potassium loss, and low levels can cause arrhythmias
5.Microbiology
Answer: A · 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.
A · Plasma cells derived from B lymphocytes
6.Microbiology
Answer: B · Bacillus cereus
Why this is the answer
Bacillus cereus spores survive boiling. If cooked rice is left warm, the bacteria grow and make a heat-stable emetic toxin, so reheating does not make the rice safe.