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
The barcode scanner warns that the medication does not match the patient’s record. What should the nurse do?
- AStop and find out why before giving the medication
- BOverride the warning and give the medication
- CGive the medication and report the warning later in the shift
- DScan a different patient’s wristband
2.Infection control & patient safetyHard
A patient sitting in a chair starts to have a generalized seizure. What should the nurse do?
- ALeave to get the provider, then return
- BHold the patient firmly in the chair until the seizure stops
- CPut a padded tongue blade between the teeth to protect the tongue and airway
- DEase the patient to the floor, protect the head and turn them on their side
3.Nursing fundamentalsMedium
A patient's blood pressure is much higher than in all previous readings. What is the best first step?
- AIgnore it, as it must be a machine error
- BTell the patient they are having a stroke
- CRecheck it, making sure the technique and cuff size are correct
- DRecord it and give an extra dose of the blood pressure tablet
4.Nursing fundamentalsHard
An AED is about to deliver a shock. What must the rescuer do?
- AMake sure no one is touching the patient
- BHold the patient's hand to reassure them
- CRemove the pads and place them again
- DKeep doing chest compressions during the shock
5.MicrobiologyMedium
MRSA is resistant to methicillin because it has:
- AA polysaccharide capsule that blocks the entry of all beta-lactams
- BAn efflux pump for every antibiotic
- CNo cell wall at all
- DAn altered penicillin-binding protein (PBP2a)
6.MicrobiologyHard
A urinary catheter has become colonised by bacteria in a biofilm. Why is the catheter usually replaced instead of just giving antibiotics?
- AAntibiotics damage the catheter material
- BBiofilm bacteria cannot cause disease
- CBiofilms contain only viruses, so antibiotics do not work
- DBacteria in biofilms are protected and much harder for antibiotics to kill
3Solutions
1.Infection control & patient safety
Answer: A · Stop and find out why before giving the medication
Why this is the answer
Barcode warnings exist to catch wrong-patient, wrong-drug and wrong-dose errors. The nurse stops and checks the order and the product, and contacts the pharmacy or prescriber. Overriding warnings out of habit causes errors.
A · Stop and find out why before giving the medication
2.Infection control & patient safety
Answer: D · Ease the patient to the floor, protect the head and turn them on their side
Why this is the answer
The nurse guides the patient gently to the floor, cushions the head, moves objects away and turns the patient on their side to protect the airway. The nurse stays, times the seizure and calls for help.
D · Ease the patient to the floor, protect the head and turn them on their side
3.Nursing fundamentals
Answer: C · Recheck it, making sure the technique and cuff size are correct
Why this is the answer
Unexpected findings are validated before action. If the repeat reading is still high, the nurse assesses for symptoms and reports it.
C · Recheck it, making sure the technique and cuff size are correct
4.Nursing fundamentals
Answer: A · Make sure no one is touching the patient
Why this is the answer
Before the shock the rescuer shouts a warning and checks that everyone is clear. Compressions restart straight after the shock as the AED instructs.
A · Make sure no one is touching the patient
5.Microbiology
Answer: D · An altered penicillin-binding protein (PBP2a)
Why this is the answer
The mecA gene codes for PBP2a, which has low affinity for beta-lactams, so the bacterium can keep building its cell wall despite methicillin.
D · An altered penicillin-binding protein (PBP2a)
6.Microbiology
Answer: D · Bacteria in biofilms are protected and much harder for antibiotics to kill
Why this is the answer
In a biofilm, bacteria live in a protective matrix, grow slowly and can tolerate high antibiotic levels. Removing the device removes the source of infection.
D · Bacteria in biofilms are protected and much harder for antibiotics to kill