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 glove-removal technique is correct?
- APull both gloves off at the same time by the fingertips
- BRemove the second glove by pinching its outside with the bare hand, then wash
- CWash the gloved hands and reuse the gloves for the next task
- DPeel the first off by its outside, then slide a bare finger under the second cuff
2.Infection control & patient safetyHard
Ten minutes into a red blood cell transfusion, the patient reports chills and low back pain and has a new fever. What should the nurse do first?
- ACall the blood bank and let the transfusion continue
- BSlow the transfusion and recheck vital signs in 15 minutes
- CStop the transfusion
- DGive an antipyretic and continue the transfusion
3.Nursing fundamentalsMedium
In which direction should a female patient's perineum be cleaned?
- AEither way, as long as soap is used
- BFrom front to back
- CFrom back to front
- DIn circles starting at the anus
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?
- ASign, but only if the colleague is senior
- BRefuse, as they can only sign for what they have witnessed
- CSign, as the colleague is trustworthy
- DSign it later, at the end of the shift, once the colleague explains
5.MicrobiologyMedium
Why are pregnant women advised to avoid unpasteurised soft cheeses?
- AThey may contain Listeria, which can harm the fetus
- BThey contain too much lactose for the fetus
- CThey often contain the hepatitis C virus, which crosses the placenta
- DThey may contain tapeworm eggs
6.MicrobiologyHard
A deep, dirty wound becomes swollen and very painful, and gas can be felt under the skin. Which organism is most likely?
- ABordetella pertussis
- BStreptococcus pneumoniae
- CNeisseria gonorrhoeae
- DClostridium perfringens
3Solutions
1.Infection control & patient safety
Answer: D · Peel the first off by its outside, then slide a bare finger under the second cuff
Why this is the answer
The outside of the gloves is contaminated, so it only touches the other glove; the bare hand only touches the inside of the second glove. Hand hygiene follows. Gloves are never washed and reused.
D · Peel the first off by its outside, then slide a bare finger under the second cuff
2.Infection control & patient safety
Answer: C · Stop the transfusion
Why this is the answer
These signs suggest an acute transfusion reaction, possibly hemolytic. The nurse stops the transfusion at once, keeps the IV open with normal saline through new tubing, assesses the patient and notifies the provider and blood bank.
3.Nursing fundamentals
Answer: B · From front to back
Why this is the answer
Cleaning from the urethra towards the anus moves bacteria away from the urinary tract and lowers the risk of urinary tract infection.
4.Nursing fundamentals
Answer: B · 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.
B · Refuse, as they can only sign for what they have witnessed
5.Microbiology
Answer: A · They may contain Listeria, which can harm the fetus
Why this is the answer
Listeria monocytogenes can grow in chilled foods and cross the placenta. It can cause miscarriage, stillbirth or severe neonatal infection.
A · They may contain Listeria, which can harm the fetus
6.Microbiology
Answer: D · Clostridium perfringens
Why this is the answer
Clostridium perfringens causes gas gangrene in poorly oxygenated wounds. Its toxins destroy muscle and its metabolism produces gas, felt as crepitus. Urgent surgery and antibiotics are needed.
D · Clostridium perfringens