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 cleaning product is recommended for the room of a patient with Clostridioides difficile?
- AAlcohol-based wipes, used on every surface twice a day
- BPlain water and a clean microfiber cloth
- CA scented air freshener spray
- DA sporicidal agent, such as a chlorine-based solution
2.Infection control & patient safetyHard
During a disaster, the hospital needs to free beds quickly. Which patient is the best candidate for early discharge?
- AA patient admitted overnight for observation who is now stable with normal tests
- BA patient with ongoing chest pain awaiting cardiac tests
- CA patient on a ventilator in the intensive care unit who is slowly improving
- DA patient on an IV heparin infusion that is still being adjusted
3.Nursing fundamentalsMedium
During a manual blood pressure measurement in an adult, which point is usually recorded as the diastolic pressure?
- AWhen the first clear tapping sound is heard
- BWhen the cuff is fully deflated
- CWhen the sounds become loudest
- DWhen the sounds disappear completely
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?
- ARefuse, as they can only sign for what they have witnessed
- BSign, as the colleague is trustworthy
- CSign it later, at the end of the shift, once the colleague explains
- DSign, but only if the colleague is senior
5.MicrobiologyMedium
What is the main virulence factor of Streptococcus pneumoniae, and the target of its vaccines?
- AIts flagella
- BIts polysaccharide capsule
- CIts cholera-like toxin
- DIts endospores
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: D · A sporicidal agent, such as a chlorine-based solution
Why this is the answer
C. difficile spores resist alcohol and many standard disinfectants, so a sporicidal agent such as a chlorine-based product is used for the environment and equipment.
D · A sporicidal agent, such as a chlorine-based solution
2.Infection control & patient safety
Answer: A · A patient admitted overnight for observation who is now stable with normal tests
Why this is the answer
In a surge, stable patients who could be safely cared for at home are discharged first. Patients who are unstable or need close monitoring or titrated infusions must stay.
A · A patient admitted overnight for observation who is now stable with normal tests
3.Nursing fundamentals
Answer: D · When the sounds disappear completely
Why this is the answer
The first clear sound marks the systolic pressure; in adults the point at which the sounds disappear (phase 5) is recorded as diastolic.
D · When the sounds disappear completely
4.Nursing fundamentals
Answer: A · 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.
A · Refuse, as they can only sign for what they have witnessed
5.Microbiology
Answer: B · Its polysaccharide capsule
Why this is the answer
The capsule protects S. pneumoniae from phagocytosis. There are many capsular types, and pneumococcal vaccines contain capsular polysaccharides from the most common ones.
B · Its polysaccharide capsule
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