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
Why can side rails be dangerous for a confused, restless patient?
- ASide rails make the bed move by itself
- BSide rails always cause pressure injuries
- CThe patient may climb over them or get trapped in gaps
- DSide rails stop staff from reaching the patient in an emergency
2.Infection control & patient safetyHard
Shortly after a patient falls, the team holds a brief “post-fall huddle”. What is its main purpose?
- ATo complete the patient’s discharge paperwork
- BTo decide which staff member was to blame for the fall
- CTo find out quickly why the fall happened and change the care plan to prevent another
- DTo agree on what the team will tell the patient’s lawyer and the family
3.Nursing fundamentalsMedium
How should a rectal suppository be inserted?
- APast the internal sphincter, against the rectal wall
- BInto the middle of the stool in the rectum so it softens it
- CAfter the patient has stood up and bent forward
- DJust inside the anus, without passing the sphincter
4.Nursing fundamentalsHard
Which of these patients should the nurse attend to first?
- AA patient with a pain score of 4/10 who had analgesia 30 minutes ago
- BA patient asking for their regular evening medicines
- CA patient with diabetes who is sweaty and shaky with a glucose of 2.9 mmol/L (52 mg/dL)
- DA patient who wants to talk about the results of a scan
5.MicrobiologyMedium
Which bacterium causes whooping cough (pertussis)?
- AHaemophilus influenzae
- BCorynebacterium diphtheriae
- CMycoplasma pneumoniae
- DBordetella pertussis
6.MicrobiologyHard
A urinary catheter has become colonised by bacteria in a biofilm. Why is the catheter usually replaced instead of just giving antibiotics?
- ABacteria in biofilms are protected and much harder for antibiotics to kill
- BAntibiotics damage the catheter material
- CBiofilms contain only viruses, so antibiotics do not work
- DBiofilm bacteria cannot cause disease
3Solutions
1.Infection control & patient safety
Answer: C · The patient may climb over them or get trapped in gaps
Why this is the answer
Confused patients may climb over rails and fall from a greater height or become trapped between the rail and mattress. Alternatives such as low beds and close observation are often safer.
C · The patient may climb over them or get trapped in gaps
2.Infection control & patient safety
Answer: C · To find out quickly why the fall happened and change the care plan to prevent another
Why this is the answer
A post-fall huddle brings the team together soon after the fall to identify causes such as toileting, medication or footwear and to update the plan. It supports a just culture rather than blame.
C · To find out quickly why the fall happened and change the care plan to prevent another
3.Nursing fundamentals
Answer: A · Past the internal sphincter, against the rectal wall
Why this is the answer
The suppository is pushed past the internal anal sphincter and placed against the rectal wall, usually with the patient lying on the left side. Placing it in stool stops absorption.
A · Past the internal sphincter, against the rectal wall
4.Nursing fundamentals
Answer: C · A patient with diabetes who is sweaty and shaky with a glucose of 2.9 mmol/L (52 mg/dL)
Why this is the answer
Hypoglycaemia can quickly lead to unconsciousness and seizures and needs immediate treatment. The other patients' needs are important but can wait a few minutes.
C · A patient with diabetes who is sweaty and shaky with a glucose of 2.9 mmol/L (52 mg/dL)
5.Microbiology
Answer: D · Bordetella pertussis
Why this is the answer
Bordetella pertussis causes long coughing fits with a "whoop". It is most dangerous for young babies, which is why vaccination in pregnancy is offered in many countries.
6.Microbiology
Answer: A · Bacteria in biofilms are protected and much harder for antibiotics to kill
Why this is the answer
In a biofilm, bacteria live in a protective matrix, grow slowly and can tolerate high antibiotic levels. Removing the device removes the source of infection.
A · Bacteria in biofilms are protected and much harder for antibiotics to kill