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 dressing waste should be disposed of in clinical (biohazard) waste?
- AThe outer paper wrapping of a sterile dressing pack
- BA dressing soaked with fluid from an infected wound
- CAn unused, still-sealed dressing past its date
- DA clean paper towel used to dry hands
2.Infection control & patient safetyHard
Which patient with a suspected infection meets at least two SIRS criteria?
- ATemperature 37.2 °C and heart rate 80/min
- BRespiratory rate 16/min and WBC 8,000/mm3
- CTemperature 36.8 °C and respiratory rate 18/min
- DTemperature 38.6 °C and heart rate 112/min
3.Nursing fundamentalsMedium
A smoker says, "I know I should stop, and I'm thinking about it some time in the next few months." Which stage of change is this?
- AMaintenance
- BPrecontemplation
- CPreparation
- DContemplation
4.Nursing fundamentalsHard
A colleague asks the nurse to countersign the controlled drug register for a dose the nurse did not see being prepared or given. What should the nurse do?
- ASign, as the colleague is trustworthy
- BRefuse, as they can only sign for what they have witnessed
- CSign it later, at the end of the shift, once the colleague explains
- DSign, but only if the colleague is senior
5.MicrobiologyMedium
Which bacterium causes whooping cough (pertussis)?
- ABordetella pertussis
- BHaemophilus influenzae
- CMycoplasma pneumoniae
- DCorynebacterium diphtheriae
6.MicrobiologyHard
Why can a person get influenza many times but measles usually only once?
- AInfluenza viruses change their surface antigens often
- BMeasles virus has no surface antigens
- CMeasles is caused by a bacterium
- DInfluenza attacks and destroys the memory cells formed after infection
3Solutions
1.Infection control & patient safety
Answer: B · A dressing soaked with fluid from an infected wound
Why this is the answer
Items contaminated with blood or infectious body fluids go into clinical waste according to local rules. Clean packaging goes into general or recycling waste, so the volume of clinical waste stays as small as possible.
B · A dressing soaked with fluid from an infected wound
2.Infection control & patient safety
Answer: D · 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.
D · Temperature 38.6 °C and heart rate 112/min
3.Nursing fundamentals
Answer: D · Contemplation
Why this is the answer
In the stages-of-change model, contemplation means considering change within about six months without a firm plan. Precontemplation means not thinking about change yet.
4.Nursing fundamentals
Answer: B · Refuse, as they can only sign for what they have witnessed
Why this is the answer
Countersigning means confirming that you witnessed the check and administration. Signing for something you did not see is dishonest and removes an important safety check.
B · Refuse, as they can only sign for what they have witnessed
5.Microbiology
Answer: A · Bordetella pertussis
Why this is the answer
Bordetella pertussis causes long coughing fits with a "whoop". It is most dangerous for young babies, which is why vaccination in pregnancy is offered in many countries.
6.Microbiology
Answer: A · Influenza viruses change their surface antigens often
Why this is the answer
Influenza haemagglutinin and neuraminidase change through drift (small mutations) and shift (reassortment), so old antibodies may not recognise new strains. Measles is antigenically stable.
A · Influenza viruses change their surface antigens often