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
What is the main aim of purposeful hourly rounding?
- ATo check pain, toileting, position and personal items before the patient needs to ask
- BTo wake the patient every hour to check orientation
- CTo replace the need for a call light
- DTo count the patient’s medications every hour and check that none are missing
2.Infection control & patient safetyHard
A nurse notices that the wrong drug was drawn up, but realizes it before giving it. What should the nurse do?
- ASay nothing, because the patient was not harmed
- BDiscard it, prepare the correct drug and report a near miss
- CReport it only if the same mistake happens again on the unit
- DGive the drug anyway, since it is already drawn up
3.Nursing fundamentalsMedium
A patient is getting up for the first time after several days in bed. What should the nurse do first?
- AAsk the patient to walk to the bathroom alone
- BHave the patient sit on the edge of the bed for a short time before standing
- CHelp the patient stand up quickly, so that the dizziness has less time to start
- DGive the patient a large drink of water while standing
4.Nursing fundamentalsHard
Five days after hip surgery, a patient suddenly becomes breathless with sharp chest pain and a fast heart rate. What should the nurse suspect?
- ANormal recovery after hip surgery
- BA pulmonary embolism
- CA chest infection developing slowly
- DAnxiety about going home
5.MicrobiologyMedium
In which phase of the bacterial growth curve do the cells divide at their fastest constant rate?
- AStationary (plateau) phase
- BDeath phase
- CLog (exponential) phase
- DLag (adaptation) phase
6.MicrobiologyHard
Which mechanism of antibiotic resistance does a bacterium use when it pumps the drug out of the cell?
- AEnzymatic inactivation
- BReduced porin uptake only
- CTarget modification
- DEfflux pumps
3Solutions
1.Infection control & patient safety
Answer: A · To check pain, toileting, position and personal items before the patient needs to ask
Why this is the answer
Regular, planned rounding that addresses pain, toileting, positioning and possessions within reach reduces falls and call-light use. The call light stays within reach as well.
A · To check pain, toileting, position and personal items before the patient needs to ask
2.Infection control & patient safety
Answer: B · Discard it, prepare the correct drug and report a near miss
Why this is the answer
A near miss shows a weakness in the system, such as similar packaging or storage. Reporting allows the risk to be fixed before a patient is harmed. A just culture supports such reporting.
B · Discard it, prepare the correct drug and report a near miss
3.Nursing fundamentals
Answer: B · Have the patient sit on the edge of the bed for a short time before standing
Why this is the answer
After bed rest blood pressure may drop on standing. Sitting on the edge of the bed first, with the feet on the floor, lets the body adjust and lowers the risk of fainting and falls.
B · Have the patient sit on the edge of the bed for a short time before standing
4.Nursing fundamentals
Answer: B · A pulmonary embolism
Why this is the answer
Sudden breathlessness, pleuritic chest pain and tachycardia after surgery suggest a clot from the leg has reached the lungs. This is an emergency needing urgent medical review.
5.Microbiology
Answer: C · Log (exponential) phase
Why this is the answer
After the lag phase of adjustment, cells enter the log phase and grow exponentially. Growth stops in the stationary phase as nutrients run out and waste builds up.
C · Log (exponential) phase
6.Microbiology
Answer: D · Efflux pumps
Why this is the answer
Efflux pumps actively export antibiotics such as tetracyclines and fluoroquinolones, keeping the inside concentration too low to work.