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 a defibrillator shock is delivered, what must the person operating it do?
- ACall “all clear” and check that nobody is touching the patient or bed
- BHold the patient’s hand to keep them still
- CAsk a colleague to hold the paddles in place
- DKeep the oxygen mask on the patient’s face, held against the chest
2.Infection control & patient safetyHard
Two look-alike vials of different drugs are stored next to each other, and a nurse almost picks the wrong one. Which response best reflects a just culture?
- AKeep the incident quiet to protect the unit’s reputation
- BReport it and fix the system, for example by separating the vials
- CTell the nurse to be more careful and do nothing else
- DDiscipline the nurse who nearly picked the wrong vial
3.Nursing fundamentalsMedium
A caller says they are a patient's daughter and asks for details of the patient's condition. What should the nurse do?
- ACheck the patient's wishes and the caller's identity first
- BHang up without saying anything
- CRead out the latest notes over the phone
- DGive full details, as close family members have a right to know
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
- CTemperature 37.4 °C on the first day
- DUrine output of 50 mL in the last hour
5.MicrobiologyMedium
Which is a function of the complement system?
- AForming pores in the membranes of some bacteria
- BPresenting antigens to T cells
- CMaking new red blood cells
- DProducing antibodies against newly encountered antigens
6.MicrobiologyHard
After eating home-canned vegetables, a patient develops double vision, difficulty swallowing and a descending flaccid paralysis. What is the most likely cause?
- AA viral infection of the motor neurons
- BTetanus toxin, which blocks inhibitory neurotransmitters
- CEndotoxin from Gram-negative bacteria
- DBotulinum toxin, which blocks acetylcholine release
3Solutions
1.Infection control & patient safety
Answer: A · Call “all clear” and check that nobody is touching the patient or bed
Why this is the answer
Anyone touching the patient or bed could receive the shock. The operator announces “clear” and looks to confirm that nobody is in contact, and oxygen is moved away from the chest.
A · Call “all clear” and check that nobody is touching the patient or bed
2.Infection control & patient safety
Answer: B · Report it and fix the system, for example by separating the vials
Why this is the answer
A just culture recognizes that human errors are often caused by system design. Separating look-alike drugs, using labels and Tall Man lettering prevents repeats. Blaming the person alone leaves the hazard in place.
B · Report it and fix the system, for example by separating the vials
3.Nursing fundamentals
Answer: A · Check the patient's wishes and the caller's identity first
Why this is the answer
Information is shared only with people the patient has agreed to, and the caller's identity is checked as per policy. Often only limited information is given by phone.
A · Check the patient's wishes and the caller's identity first
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 · Forming pores in the membranes of some bacteria
Why this is the answer
Complement proteins coat microbes for phagocytosis (opsonisation), attract immune cells and form the membrane attack complex that punches holes in some bacteria.
A · Forming pores in the membranes of some bacteria
6.Microbiology
Answer: D · Botulinum toxin, which blocks acetylcholine release
Why this is the answer
Clostridium botulinum can grow in poorly canned, low-acid foods and produce botulinum toxin. The toxin blocks acetylcholine release at nerve endings, causing descending flaccid paralysis.
D · Botulinum toxin, which blocks acetylcholine release