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
Before a defibrillator shock is delivered, what must the person operating it do?
- AHold the patient’s hand to keep them still
- BKeep the oxygen mask on the patient’s face, held against the chest
- CAsk a colleague to hold the paddles in place
- DCall “all clear” and check that nobody is touching the patient or bed
2.Infection control & patient safetyHard
A patient receiving chemotherapy has an absolute neutrophil count of 400/mm3 (0.4 × 109/L) and a new temperature of 38.3 °C (100.9 °F). What should the nurse do?
- AReport it at once, because fever with severe neutropenia is an emergency
- BEncourage oral fluids and record the result in the chart
- CRecheck the temperature in four hours before calling anyone about it
- DGive an antipyretic and reassess at the next routine round
3.Nursing fundamentalsMedium
How is a 24-hour urine collection started?
- AThe first urine of the morning is discarded and the time noted, then all urine is kept
- BOnly urine passed at night is collected
- CThe first urine of the morning is kept and the rest of the day's urine is discarded
- DA sample is taken every four hours and the rest discarded
4.Nursing fundamentalsHard
Which group of signs suggests a patient may be in the last days of life?
- AA rising urine output and warm hands
- BBetter mobility and more energy
- CRising appetite and increasing alertness
- DChanges in breathing pattern, cool mottled skin and reduced intake
5.MicrobiologyMedium
Cholera causes profuse "rice-water" diarrhoea. What is the most important treatment?
- AReplacing fluid and salts by oral or intravenous rehydration
- BAntiviral drugs
- CAntifungal drugs
- DStopping all oral fluid intake so that the bowel can rest and recover
6.MicrobiologyHard
In 1854 John Snow traced a cholera outbreak in London to the Broad Street water pump. Why is this study important?
- AIt proved that cholera is caused by a virus
- BIt led directly to the first cholera vaccine
- CIt showed that cholera spreads through contaminated water, founding modern epidemiology
- DIt showed that cholera spreads through "bad air" (miasma)
3Solutions
1.Infection control & patient safety
Answer: D · Call “all clear” and check that nobody is touching the patient or bed
Why this is the answer
Anyone touching the patient or bed could receive the shock. The operator announces “clear” and looks to confirm that nobody is in contact, and oxygen is moved away from the chest.
D · Call “all clear” and check that nobody is touching the patient or bed
2.Infection control & patient safety
Answer: A · Report it at once, because fever with severe neutropenia is an emergency
Why this is the answer
Febrile neutropenia can progress to sepsis quickly. The nurse reports it immediately so cultures can be taken and antibiotics started without delay.
A · Report it at once, because fever with severe neutropenia is an emergency
3.Nursing fundamentals
Answer: A · The first urine of the morning is discarded and the time noted, then all urine is kept
Why this is the answer
The patient empties the bladder at the start and that urine is discarded. All urine for the next 24 hours is kept, including a final void at the end time.
A · The first urine of the morning is discarded and the time noted, then all urine is kept
4.Nursing fundamentals
Answer: D · Changes in breathing pattern, cool mottled skin and reduced intake
Why this is the answer
As death approaches, breathing may become irregular or noisy, the skin may become cool and mottled, and people eat and drink less and sleep more. Comfort, mouth care and family support become the focus.
D · Changes in breathing pattern, cool mottled skin and reduced intake
5.Microbiology
Answer: A · Replacing fluid and salts by oral or intravenous rehydration
Why this is the answer
Cholera toxin makes gut cells secrete large amounts of water and salt. Rapid rehydration saves most lives; antibiotics only shorten the illness.
A · Replacing fluid and salts by oral or intravenous rehydration
6.Microbiology
Answer: C · It showed that cholera spreads through contaminated water, founding modern epidemiology
Why this is the answer
Snow mapped cases around the pump and linked them to its water. Removing the pump handle is a classic example of using epidemiology to find and stop a source, before the bacterium was identified.
C · It showed that cholera spreads through contaminated water, founding modern epidemiology