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 giving a tablet, the patient says, “This pill looks different from my usual one.” What should the nurse do?
- ATell the patient that all pills look different in hospital
- BGive half the pill and watch for any unusual effects
- CStop and recheck the order and the drug before giving it
- DReassure the patient and give the pill
2.Infection control & patient safetyHard
A nurse discovers that an insulin infusion was programmed using the wrong drug concentration in the pump library. What should the nurse do first?
- AReprogram the pump and finish the shift before reporting
- BLeave it running and check the glucose at the next routine time
- CStop the infusion and check the patient’s blood glucose
- DDouble the rate to correct for the error
3.Nursing fundamentalsMedium
A patient has just finished a glass of iced water. How should this affect taking an oral temperature?
- ATake it straight away, as cold drinks do not affect the mouth
- BUse the reading but only if the patient says they feel warm
- CAdd half a degree to the reading to correct for the drink
- DWait about 15–30 minutes, as the reading may be falsely low
4.Nursing fundamentalsHard
Which postoperative finding should be reported most urgently?
- APain score of 4/10 at the wound site when moving
- BRespiratory rate 8/min and difficult to rouse
- CUrine output of 50 mL in the last hour
- DTemperature 37.4 °C on the first day
5.MicrobiologyMedium
Which organism causes tuberculosis, and what makes it hard to stain with the Gram method?
- AMycobacterium tuberculosis, which has a waxy mycolic acid wall
- BLegionella pneumophila, which lives inside amoebae
- CStreptococcus pneumoniae, which has a capsule
- DMycoplasma pneumoniae, which has no cell wall to take up the stain
6.MicrobiologyHard
Joseph Lister reduced infection after surgery in the 1860s. What was his main innovation?
- AUsing steam autoclaves to sterilise all surgical instruments before each operation
- BGiving sulfonamide antibiotics after every operation
- CUsing carbolic acid (phenol) as an antiseptic on wounds and instruments
- DVaccinating surgeons against staphylococci
3Solutions
1.Infection control & patient safety
Answer: C · Stop and recheck the order and the drug before giving it
Why this is the answer
A patient’s concern is a safety check. The nurse stops and checks the order, the drug, the dose and the patient, and contacts the pharmacy if needed. Sometimes the reason is a different brand, but this must be confirmed first.
C · Stop and recheck the order and the drug before giving it
2.Infection control & patient safety
Answer: C · Stop the infusion and check the patient’s blood glucose
Why this is the answer
A concentration error means the dose delivered was wrong. The nurse stops the infusion, assesses the patient including blood glucose, treats as needed, notifies the prescriber and reports the event.
C · Stop the infusion and check the patient’s blood glucose
3.Nursing fundamentals
Answer: D · Wait about 15–30 minutes, as the reading may be falsely low
Why this is the answer
Hot or cold drinks, eating and smoking change the temperature in the mouth for a while. The nurse waits 15–30 minutes or uses another site.
D · Wait about 15–30 minutes, as the reading may be falsely low
4.Nursing fundamentals
Answer: B · Respiratory rate 8/min and difficult to rouse
Why this is the answer
A low respiratory rate with reduced consciousness may mean opioid toxicity or deterioration and threatens the airway. The other findings are common after surgery and can be managed routinely.
B · Respiratory rate 8/min and difficult to rouse
5.Microbiology
Answer: A · 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.
A · Mycobacterium tuberculosis, which has a waxy mycolic acid wall
6.Microbiology
Answer: C · Using carbolic acid (phenol) as an antiseptic on wounds and instruments
Why this is the answer
Lister applied carbolic acid to wounds, dressings and instruments, which greatly reduced post-operative infection. This started antiseptic surgery.
C · Using carbolic acid (phenol) as an antiseptic on wounds and instruments