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
An infant has had a cleft lip repair. Why are elbow restraints often used?
- ATo stop the infant’s hands reaching the mouth while still allowing arm movement
- BTo prevent the infant from sucking a pacifier
- CTo hold the IV line in place during feeds and stop it being pulled out
- DTo keep the infant from rolling over in the crib
2.Infection control & patient safetyHard
A patient weighs 180 kg and needs to be moved from bed to chair. The standard ceiling lift on the unit has a lower weight limit. What should the nurse do?
- AAsk the patient to stand and pivot without help
- BHave two staff lift the patient by hand
- CUse bariatric-rated equipment and enough trained staff
- DUse the standard lift, because limits include a safety margin
3.Nursing fundamentalsMedium
A nurse posts about an "interesting patient" on social media without naming them. Why is this a problem?
- AIt is not a problem because no name was given
- BIt is not a problem if the account is private
- CIt is only a problem if the post also includes a photograph of the patient
- DThe patient may still be identifiable, which breaches confidentiality
4.Nursing fundamentalsHard
Which feature best helps distinguish delirium from dementia?
- ADelirium always lasts for many years
- BDementia starts within hours of an infection
- CDelirium starts suddenly and attention fluctuates during the day
- DDementia always improves once the underlying cause has been treated
5.MicrobiologyMedium
Transfer of bacterial genes from one bacterium to another by a virus is called:
- ATransduction
- BTranscription
- CTransformation
- DConjugation
6.MicrobiologyHard
Which bacterial toxin causes the muscle spasms of tetanus?
- ACholera toxin, which activates adenylate cyclase
- BBotulinum toxin, which blocks acetylcholine release at the neuromuscular junction
- CEndotoxin from the outer membrane
- DTetanospasmin, which blocks inhibitory neurotransmitter release
3Solutions
1.Infection control & patient safety
Answer: A · To stop the infant’s hands reaching the mouth while still allowing arm movement
Why this is the answer
Elbow restraints keep the elbows straight so the infant cannot touch the suture line. They are removed regularly, one at a time, for skin checks and movement under supervision.
A · To stop the infant’s hands reaching the mouth while still allowing arm movement
2.Infection control & patient safety
Answer: C · Use bariatric-rated equipment and enough trained staff
Why this is the answer
Using equipment above its rated capacity can cause collapse and injury. Bariatric lifts, chairs and beds are used, with enough trained staff and a plan agreed in advance.
C · Use bariatric-rated equipment and enough trained staff
3.Nursing fundamentals
Answer: D · The patient may still be identifiable, which breaches confidentiality
Why this is the answer
Details such as the ward, the condition or the date can reveal who a patient is. Professional codes forbid sharing patient information on social media, even without names.
D · The patient may still be identifiable, which breaches confidentiality
4.Nursing fundamentals
Answer: C · Delirium starts suddenly and attention fluctuates during the day
Why this is the answer
Delirium develops over hours to days with fluctuating attention and awareness, often from a physical cause. Dementia develops gradually over months or years. People with dementia are at higher risk of delirium.
C · Delirium starts suddenly and attention fluctuates during the day
5.Microbiology
Answer: A · Transduction
Why this is the answer
In transduction a bacteriophage accidentally packages bacterial DNA and delivers it to the next cell it infects. Transformation is uptake of free DNA and conjugation uses direct contact.
6.Microbiology
Answer: D · Tetanospasmin, which blocks inhibitory neurotransmitter release
Why this is the answer
Tetanospasmin from Clostridium tetani blocks the release of GABA and glycine from inhibitory interneurons, causing spastic paralysis. Botulinum toxin, by contrast, causes flaccid paralysis.
D · Tetanospasmin, which blocks inhibitory neurotransmitter release