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 patient with active pulmonary tuberculosis must go to the radiology department. How should the patient be transported?
- AWearing gloves and a gown, with no mask needed
- BWithout a mask, because the corridor is well ventilated and short
- CWearing an N95 respirator that has not been fit-tested
- DWearing a surgical mask, with radiology warned in advance
2.Infection control & patient safetyHard
In a mass-casualty incident with limited resources, why may a critically injured patient with little chance of survival receive care after others?
- APatients are treated in the order they arrive
- BResources go first to those most likely to survive with treatment
- CThe most severely injured are never given comfort care
- DCritical patients are always treated last in every situation, even outside disasters
3.Nursing fundamentalsMedium
A bedbound patient who has not opened their bowels for a week now has liquid stool leaking constantly. What should the nurse suspect?
- ANormal bowel function returning
- BA side effect of drinking too much water
- CFaecal impaction with overflow
- DAn infection that needs antidiarrhoeal drugs at once
4.Nursing fundamentalsHard
Which task is most appropriate for a registered nurse to delegate to a healthcare assistant (nursing assistant)?
- AHelping a stable patient walk to the bathroom
- BTeaching a patient how to use crutches
- CAssessing a newly admitted patient's falls risk
- DEvaluating a patient who has just fallen
5.MicrobiologyMedium
How is DNA transferred between bacteria during conjugation?
- AThrough direct contact using a sex pilus
- BBy uptake of free DNA from the environment
- CBy a bacteriophage carrying bacterial DNA
- DBy fusion of two bacterial cells into one
6.MicrobiologyHard
Which process can produce a completely new influenza A subtype that causes a pandemic?
- ATransformation with free DNA
- BLysogenic conversion by a bacteriophage
- CAntigenic shift through reassortment of gene segments
- DAntigenic drift through gradual accumulation of point mutations
3Solutions
1.Infection control & patient safety
Answer: D · Wearing a surgical mask, with radiology warned in advance
Why this is the answer
During transport, the patient wears a surgical mask to contain respiratory particles, and the receiving department is told so it can protect staff and other patients. Staff caring for the patient wear fit-tested respirators.
D · Wearing a surgical mask, with radiology warned in advance
2.Infection control & patient safety
Answer: B · Resources go first to those most likely to survive with treatment
Why this is the answer
In disasters, triage shifts from treating the sickest first to saving the most lives with available resources. Expectant patients still receive comfort care and are reassessed as resources change.
B · Resources go first to those most likely to survive with treatment
3.Nursing fundamentals
Answer: C · Faecal impaction with overflow
Why this is the answer
Overflow happens when liquid stool seeps around impacted hard faeces. Giving antidiarrhoeal drugs would make it worse; the nurse reports it for assessment and treatment.
C · Faecal impaction with overflow
4.Nursing fundamentals
Answer: A · Helping a stable patient walk to the bathroom
Why this is the answer
Routine help with care for a stable patient can be delegated. Assessment, teaching and evaluation need registered nurse judgement.
A · Helping a stable patient walk to the bathroom
5.Microbiology
Answer: A · Through direct contact using a sex pilus
Why this is the answer
In conjugation a donor cell forms a pilus to a recipient and transfers DNA, often a plasmid. It is an important way for antibiotic resistance genes to spread.
A · Through direct contact using a sex pilus
6.Microbiology
Answer: C · Antigenic shift through reassortment of gene segments
Why this is the answer
When two different influenza A viruses infect the same cell, their segments can mix, giving new haemagglutinin or neuraminidase combinations. Few people are immune, so pandemics can follow. Drift causes the smaller yearly changes.
C · Antigenic shift through reassortment of gene segments