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
How tight should a wrist restraint be?
- AAs tight as possible so the patient cannot move the arm
- BTight enough to slow the pulse at the wrist
- CLoose enough for the patient’s hand to slip out
- DLoose enough to fit two fingers between the restraint and the skin
2.Infection control & patient safetyHard
A child with chickenpox is admitted. Which staff member is the best choice to care for the child?
- AA nurse who has never had chickenpox or the vaccine
- BA nurse with documented immunity to varicella
- CA nurse who is pregnant and unsure of her immunity
- DA student nurse with unknown immunity
3.Nursing fundamentalsMedium
Which Glasgow Coma Scale score indicates a fully alert patient?
- A15
- B3
- C12
- D10
4.Nursing fundamentalsHard
A colleague suggests giving a patient who "asks for pain relief too often" a saline injection to check whether the pain is real. What is correct?
- AIt is acceptable if the doctor agrees
- BIt is a good way to test whether the patient's pain is real
- CIt is acceptable, provided the patient is not told about it
- DIt is deceptive; the pain should be assessed and treated
5.MicrobiologyMedium
Which virus family includes the viruses that cause cold sores and chickenpox?
- ACoronaviruses
- BHerpesviruses
- CPicornaviruses
- DRetroviruses
6.MicrobiologyHard
On MacConkey agar, pink colonies grow from a urine sample. What does this tell you?
- AThe organism is a fungus
- BThe organism is a Gram-positive coccus
- CThe organism is probably a Gram-negative rod that ferments lactose
- DThe organism does not ferment lactose, so it is probably Salmonella
3Solutions
1.Infection control & patient safety
Answer: D · Loose enough to fit two fingers between the restraint and the skin
Why this is the answer
Being able to slip two fingers under the restraint keeps it secure without cutting off circulation or damaging the skin. Circulation, sensation and skin are checked often.
D · Loose enough to fit two fingers between the restraint and the skin
2.Infection control & patient safety
Answer: B · A nurse with documented immunity to varicella
Why this is the answer
Staff with proven immunity, from vaccination or past infection, should care for patients with varicella. Non-immune staff, especially pregnant staff, risk infection and can spread the virus to other patients.
B · A nurse with documented immunity to varicella
3.Nursing fundamentals
Answer: A · 15
Why this is the answer
The GCS ranges from 3 (deep coma) to 15 (fully alert). A score of 8 or less usually means the airway is at risk.
4.Nursing fundamentals
Answer: D · It is deceptive; the pain should be assessed and treated
Why this is the answer
Using a placebo without consent deceives the patient and damages trust. Response to a placebo does not prove the pain is not real. The patient's report should be believed and reassessed.
D · It is deceptive; the pain should be assessed and treated
5.Microbiology
Answer: B · Herpesviruses
Why this is the answer
Herpes simplex (cold sores) and varicella-zoster (chickenpox, shingles) are herpesviruses that remain latent in sensory ganglia and can reactivate.
6.Microbiology
Answer: C · The organism is probably a Gram-negative rod that ferments lactose
Why this is the answer
MacConkey agar contains bile salts and crystal violet that inhibit Gram-positive bacteria (selective) and lactose with a pH indicator (differential). Lactose fermenters such as E. coli produce acid and turn pink.
C · The organism is probably a Gram-negative rod that ferments lactose