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 is on a ventilator. Which bed position helps to prevent ventilator-associated pneumonia?
- AHead of the bed raised 30 to 45 degrees
- BTrendelenburg position
- CLying completely flat
- DHead of the bed raised about 10 degrees
2.Infection control & patient safetyHard
The laboratory reports that a blood sample labeled with one patient’s name has a blood group different from that patient’s previous result. What is the most likely problem and response?
- AA laboratory machine fault, so no action is needed
- BA wrong-patient sample, so the test is repeated and the event reported
- CThe previous result was wrong, so it is deleted
- DA normal change in the patient’s blood group over the years since the last test
3.Nursing fundamentalsMedium
When opening a sterile pack on a table, which flap is opened first?
- AAny flap, as long as you wear sterile gloves
- BThe flap furthest away from you
- CThe flap on your dominant side
- DThe flap nearest to you
4.Nursing fundamentalsHard
A patient with diabetes is found unresponsive with a very low blood glucose and cannot swallow. What is the correct approach?
- AWait for the patient to wake up and then give food
- BGive the patient's usual dose of insulin
- CCall for help and give glucose by another route, such as IV glucose or IM glucagon, as per protocol
- DPour sugary juice into the patient's mouth
5.MicrobiologyMedium
What is endotoxin?
- AThe lipopolysaccharide in the outer membrane of Gram-negative bacteria
- BA toxin made by fungi in damp buildings
- CA toxin produced only inside human cells
- DA protein toxin secreted by Gram-positive bacteria into the surrounding tissue
6.MicrobiologyHard
A traveller returns from sub-Saharan Africa with fever. Malaria is suspected. Which species is most likely to cause severe and cerebral malaria?
- APlasmodium malariae
- BPlasmodium falciparum
- CPlasmodium ovale
- DPlasmodium vivax
3Solutions
1.Infection control & patient safety
Answer: A · Head of the bed raised 30 to 45 degrees
Why this is the answer
Raising the head of the bed to 30–45 degrees reduces aspiration of oral and gastric secretions into the lungs. It is part of the usual ventilator care bundle, unless contraindicated.
A · Head of the bed raised 30 to 45 degrees
2.Infection control & patient safety
Answer: B · A wrong-patient sample, so the test is repeated and the event reported
Why this is the answer
A different blood group strongly suggests the sample came from another patient. A new sample is taken with careful bedside identification and labeling, and the event is reported as a serious near miss.
B · A wrong-patient sample, so the test is repeated and the event reported
3.Nursing fundamentals
Answer: B · The flap furthest away from you
Why this is the answer
Opening the far flap first means the nurse never reaches across the exposed sterile contents. The side flaps follow, and the nearest flap is opened last.
B · The flap furthest away from you
4.Nursing fundamentals
Answer: C · Call for help and give glucose by another route, such as IV glucose or IM glucagon, as per protocol
Why this is the answer
Oral glucose risks aspiration when a patient cannot swallow. Following local protocol, the nurse calls for help, protects the airway and gives IV glucose or IM glucagon, then rechecks glucose.
C · Call for help and give glucose by another route, such as IV glucose or IM glucagon, as per protocol
5.Microbiology
Answer: A · The lipopolysaccharide in the outer membrane of Gram-negative bacteria
Why this is the answer
Endotoxin is lipid A of lipopolysaccharide. It triggers strong immune responses with fever and, in large amounts, septic shock.
A · The lipopolysaccharide in the outer membrane of Gram-negative bacteria
6.Microbiology
Answer: B · Plasmodium falciparum
Why this is the answer
P. falciparum causes very high parasite levels and makes infected red cells stick in small vessels, including in the brain. It is common in sub-Saharan Africa and is a medical emergency.
B · Plasmodium falciparum