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 has patient-controlled analgesia (PCA). A family member presses the button while the patient sleeps. What should the nurse explain?
- AOnly the patient should press it, because this keeps the system safe
- BFamily can press it as long as they count the presses
- CThe pump will always stop any overdose
- DPressing it while the patient sleeps prevents the pain from getting worse later
2.Infection control & patient safetyHard
A confused patient in wrist restraints has cool, pale fingers on one hand and a weak radial pulse on that side. What should the nurse do first?
- ALoosen that restraint and assess the hand’s circulation
- BRaise the hand on a pillow, leaving the restraint as it is
- CTighten the other restraint to stop the patient pulling
- DDocument the findings carefully and recheck in two hours
3.Nursing fundamentalsMedium
Which stool sample is suitable for Clostridioides difficile testing?
- AA stool sample mixed with urine
- BA hard, formed stool collected first thing in the morning
- CA dry smear of stool on a tissue
- DA loose stool that takes the shape of the container
4.Nursing fundamentalsHard
Why must medicines for Parkinson's disease, such as levodopa, be given on time?
- ALate doses cause the patient to fall asleep
- BThe timing does not matter as long as the full daily total is given
- CLate doses can cause severe stiffness, falls and swallowing problems
- DThe drug becomes poisonous if it is given late
5.MicrobiologyMedium
Which infection is a typical complication of broad-spectrum antibiotic use, causing severe diarrhoea?
- ASalmonella infection
- BClostridioides difficile infection
- CHepatitis A
- DHelicobacter pylori infection
6.MicrobiologyHard
In Griffith's 1928 experiment, mice died after injection of heat-killed smooth (S) pneumococci mixed with live rough (R) pneumococci. What did this show?
- AHeat does not kill pneumococci
- BRough pneumococci are always more virulent than smooth ones
- CA "transforming principle" from dead bacteria could change harmless bacteria into virulent ones
- DViruses carry genes between bacteria
3Solutions
1.Infection control & patient safety
Answer: A · Only the patient should press it, because this keeps the system safe
Why this is the answer
PCA is safe because a patient who becomes drowsy stops pressing the button. When others press it (“PCA by proxy”), sedation and respiratory depression can occur.
A · Only the patient should press it, because this keeps the system safe
2.Infection control & patient safety
Answer: A · Loosen that restraint and assess the hand’s circulation
Why this is the answer
Signs of poor circulation distal to a restraint require immediate release and assessment. The restraint is then reapplied correctly only if still needed, with the two-finger check, and the findings are reported and documented.
A · Loosen that restraint and assess the hand’s circulation
3.Nursing fundamentals
Answer: D · A loose stool that takes the shape of the container
Why this is the answer
Only diarrhoeal stool (types 5–7 on the Bristol Stool Chart) is tested for C. difficile. The sample is collected in a clean pot without urine contamination.
D · A loose stool that takes the shape of the container
4.Nursing fundamentals
Answer: C · Late doses can cause severe stiffness, falls and swallowing problems
Why this is the answer
Levodopa wears off quickly, and delays can cause rigidity, falls, swallowing difficulty and aspiration. It is a time-critical medicine in hospital.
C · Late doses can cause severe stiffness, falls and swallowing problems
5.Microbiology
Answer: B · Clostridioides difficile infection
Why this is the answer
Antibiotics kill normal gut bacteria, letting toxin-producing C. difficile overgrow. Its spores are not killed by alcohol gel, so soap and water handwashing is needed.
B · Clostridioides difficile infection
6.Microbiology
Answer: C · A "transforming principle" from dead bacteria could change harmless bacteria into virulent ones
Why this is the answer
Something from the dead S strain turned live R bacteria into capsule-forming, virulent S bacteria. Avery, MacLeod and McCarty later showed that this transforming principle was DNA.
C · A "transforming principle" from dead bacteria could change harmless bacteria into virulent ones