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
A visitor with a cold wants to see a patient who has severe neutropenia. What should the nurse advise?
- AVisit only if the cold started more than a day ago
- BVisit but avoid touching the patient’s bed
- CVisit as usual after washing the hands
- DPostpone the visit until the visitor is well
2.Infection control & patient safetyHard
A patient’s white cell differential shows a raised eosinophil count. Which cause is most consistent with this finding?
- AAn allergic reaction or a parasitic infection
- BBone marrow suppression from chemotherapy
- CAn acute bacterial infection
- DA viral infection such as a cold
3.Nursing fundamentalsMedium
How can a patient reduce pain when coughing after abdominal surgery?
- ALie flat on their back with arms by their sides
- BCough while bending forward with no support
- CAvoid coughing completely until the stitches have been removed
- DHold a pillow firmly against the wound while coughing
4.Nursing fundamentalsHard
When is a "clean" (non-sterile) technique acceptable instead of an aseptic technique?
- AFor inserting a urinary catheter
- BFor dressing a fresh surgical wound in theatre, provided that non-sterile gloves are worn throughout
- CFor inserting a central venous catheter
- DFor procedures that do not enter sterile body areas, such as giving an oral medicine
5.MicrobiologyMedium
Which organism causes tuberculosis, and what makes it hard to stain with the Gram method?
- AMycoplasma pneumoniae, which has no cell wall to take up the stain
- BMycobacterium tuberculosis, which has a waxy mycolic acid wall
- CLegionella pneumophila, which lives inside amoebae
- DStreptococcus pneumoniae, which has a capsule
6.MicrobiologyHard
An older adult develops a painful blistering rash in a band on one side of the chest. What explains this pattern?
- AA new chickenpox infection spreads through the blood to one side
- BBacteria spread along the lymphatic vessels of the chest
- CVaricella-zoster virus reactivates from one sensory ganglion and travels along its nerve
- DAn allergic reaction to clothing affects one dermatome
3Solutions
1.Infection control & patient safety
Answer: D · Postpone the visit until the visitor is well
Why this is the answer
Patients with severe neutropenia cannot fight infections well. People with respiratory or other infections should not visit until they are well; other visitors perform hand hygiene.
D · Postpone the visit until the visitor is well
2.Infection control & patient safety
Answer: A · An allergic reaction or a parasitic infection
Why this is the answer
Eosinophils rise in allergic conditions such as asthma and drug reactions and in parasitic infections. Acute bacterial infection mainly raises neutrophils, and viral infection often raises lymphocytes.
A · An allergic reaction or a parasitic infection
3.Nursing fundamentals
Answer: D · Hold a pillow firmly against the wound while coughing
Why this is the answer
Splinting the incision with a pillow or folded towel supports the wound and reduces pain, so the patient can cough effectively and clear secretions.
D · Hold a pillow firmly against the wound while coughing
4.Nursing fundamentals
Answer: D · For procedures that do not enter sterile body areas, such as giving an oral medicine
Why this is the answer
Aseptic technique is required when entering normally sterile sites or handling key parts of invasive devices. Routine non-invasive tasks only need standard precautions.
D · For procedures that do not enter sterile body areas, such as giving an oral medicine
5.Microbiology
Answer: B · Mycobacterium tuberculosis, which has a waxy mycolic acid wall
Why this is the answer
M. tuberculosis has a cell wall rich in mycolic acids, so it resists Gram staining and is identified with acid-fast stains.
B · Mycobacterium tuberculosis, which has a waxy mycolic acid wall
6.Microbiology
Answer: C · Varicella-zoster virus reactivates from one sensory ganglion and travels along its nerve
Why this is the answer
After chickenpox, VZV stays latent in a dorsal root or cranial nerve ganglion. When immunity weakens it can reactivate, travelling down that nerve to cause shingles in its dermatome.
C · Varicella-zoster virus reactivates from one sensory ganglion and travels along its nerve