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 in bed has a generalized tonic-clonic seizure. What should the nurse do?
- ATurn the patient on their side and protect them from injury without restraining
- BHold the arms and legs firmly to stop the movements
- CGive sips of water to keep the airway moist
- DPut a padded tongue blade between the teeth to protect the tongue from biting
2.Infection control & patient safetyHard
A patient on chemotherapy develops shingles over several areas on both sides of the body. Which precautions are needed?
- ADroplet precautions until the pain settles
- BStandard precautions only, with the lesions covered
- CContact precautions only, with gloves for dressing changes
- DAirborne and contact precautions until all lesions are crusted
3.Nursing fundamentalsMedium
How is body mass index (BMI) calculated?
- AWeight in kilograms divided by height in metres squared
- BWaist size divided by hip size
- CHeight in centimetres divided by weight in kilograms
- DWeight in kilograms multiplied by height in metres squared
4.Nursing fundamentalsHard
In an emergency a doctor gives a verbal order for a medicine. What should the nurse do?
- AGive it and tell the doctor nothing more
- BRefuse to give any medicine until a written prescription has been completed
- CAsk another nurse to remember the order
- DWrite it down, read it back and make sure it is signed later as per policy
5.MicrobiologyMedium
MRSA is resistant to methicillin because it has:
- AAn efflux pump for every antibiotic
- BAn altered penicillin-binding protein (PBP2a)
- CNo cell wall at all
- DA polysaccharide capsule that blocks the entry of all beta-lactams
6.MicrobiologyHard
Which bacterial toxin causes the muscle spasms of tetanus?
- ATetanospasmin, which blocks inhibitory neurotransmitter release
- BCholera toxin, which activates adenylate cyclase
- CEndotoxin from the outer membrane
- DBotulinum toxin, which blocks acetylcholine release at the neuromuscular junction
3Solutions
1.Infection control & patient safety
Answer: A · Turn the patient on their side and protect them from injury without restraining
Why this is the answer
The nurse stays with the patient, turns them to the side to keep the airway clear, moves hard objects away and times the seizure. Objects in the mouth and restraint can cause injury.
A · Turn the patient on their side and protect them from injury without restraining
2.Infection control & patient safety
Answer: D · Airborne and contact precautions until all lesions are crusted
Why this is the answer
Lesions over several areas on both sides mean disseminated zoster, which can spread through the air like chickenpox. Airborne and contact precautions are used until all lesions are dry and crusted. Localized zoster in an immunocompromised patient also needs airborne and contact precautions, but only until dissemination is ruled out.
D · Airborne and contact precautions until all lesions are crusted
3.Nursing fundamentals
Answer: A · Weight in kilograms divided by height in metres squared
Why this is the answer
BMI = weight (kg) ÷ height² (m²). For example, 70 kg and 1.75 m gives about 22.9 kg/m². It is a screening measure and does not show body composition.
A · Weight in kilograms divided by height in metres squared
4.Nursing fundamentals
Answer: D · Write it down, read it back and make sure it is signed later as per policy
Why this is the answer
Verbal orders are used only where local policy allows, such as emergencies. Reading back the drug, dose and route confirms the order, and it is documented and signed as soon as possible.
D · Write it down, read it back and make sure it is signed later as per policy
5.Microbiology
Answer: B · 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.
B · An altered penicillin-binding protein (PBP2a)
6.Microbiology
Answer: A · Tetanospasmin, which blocks inhibitory neurotransmitter release
Why this is the answer
Tetanospasmin from Clostridium tetani blocks the release of GABA and glycine from inhibitory interneurons, causing spastic paralysis. Botulinum toxin, by contrast, causes flaccid paralysis.
A · Tetanospasmin, which blocks inhibitory neurotransmitter release