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 nurse should not be assigned to a patient with a sealed radioactive implant?
- AA nurse trained in radiation safety
- BA nurse who has worked on the unit for two years
- CA nurse wearing a dosimeter badge
- DA nurse who is pregnant
2.Infection control & patient safetyHard
A nurse floated to an unfamiliar unit is asked to manage a device they have never been trained to use. What should the nurse do?
- ADo it anyway, using only the device manual and the instructions on the screen
- BAsk the patient or the family to explain how the device works
- CTell the charge nurse and ask for help or a change of assignment
- DLeave the device untouched and not tell anyone
3.Nursing fundamentalsMedium
How should the heels of a bedbound patient at high risk be protected?
- ARub them with cream several times a day
- BLift them off the mattress with a pillow under the calves
- CWrap them tightly in bandages
- DRest them on a rolled towel placed directly under each heel
4.Nursing fundamentalsHard
Which feature suggests that a sore area is a moisture lesion rather than a pressure ulcer?
- AA circular area of damage directly over the sacral bone
- BA dark area of necrotic tissue over the heel
- CA deep wound with straight edges over the hip
- DDiffuse, irregular redness in a skin fold, not over a bone
5.MicrobiologyMedium
Which antibody class is the first to rise in a new infection?
- AIgG
- BIgE
- CIgM
- DIgA
6.MicrobiologyHard
A healthcare worker's blood test is positive for anti-HBs (hepatitis B surface antibody) and negative for HBsAg and anti-HBc. What does this most likely mean?
- AChronic hepatitis B infection
- BCurrent acute hepatitis B infection
- CImmunity from hepatitis B vaccination
- DPast natural infection that has cleared
3Solutions
1.Infection control & patient safety
Answer: D · A nurse who is pregnant
Why this is the answer
Pregnant staff and visitors are not assigned to patients with radioactive implants. Other staff limit the time spent with the patient, keep their distance, use shielding and wear a dosimeter.
D · A nurse who is pregnant
2.Infection control & patient safety
Answer: C · Tell the charge nurse and ask for help or a change of assignment
Why this is the answer
Accepting a task beyond one’s competence puts the patient at risk. The nurse explains the limit to the charge nurse, who can arrange help, training or reassignment.
C · Tell the charge nurse and ask for help or a change of assignment
3.Nursing fundamentals
Answer: B · Lift them off the mattress with a pillow under the calves
Why this is the answer
Heels have little padding and develop ulcers quickly. "Floating" them, with the support under the calves and the knee slightly bent, removes pressure from the heel.
B · Lift them off the mattress with a pillow under the calves
4.Nursing fundamentals
Answer: D · Diffuse, irregular redness in a skin fold, not over a bone
Why this is the answer
Moisture lesions are usually superficial, diffuse and irregular, often in the natal cleft or skin folds. Pressure ulcers are typically over bony prominences and may have necrotic tissue.
D · Diffuse, irregular redness in a skin fold, not over a bone
5.Microbiology
Answer: C · IgM
Why this is the answer
IgM appears first in a primary response; IgG follows and provides long-term protection. A positive IgM therefore suggests recent infection.
6.Microbiology
Answer: C · Immunity from hepatitis B vaccination
Why this is the answer
The vaccine contains HBsAg, so a vaccinated person makes anti-HBs but no anti-HBc. Past natural infection gives both anti-HBs and anti-HBc, and ongoing infection shows HBsAg.
C · Immunity from hepatitis B vaccination