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
An order uses the abbreviation “MS”. Why is this unsafe?
- AIt is reserved for drugs used in multiple sclerosis
- BIt means the drug must be given by mouth only
- CIt is the abbreviation for milliseconds, not a drug
- DIt can mean either morphine sulfate or magnesium sulfate
2.Infection control & patient safetyHard
A nurse notices that the wrong drug was drawn up, but realizes it before giving it. What should the nurse do?
- AGive the drug anyway, since it is already drawn up
- BDiscard it, prepare the correct drug and report a near miss
- CSay nothing, because the patient was not harmed
- DReport it only if the same mistake happens again on the unit
3.Nursing fundamentalsMedium
When opening a sterile pack on a table, which flap is opened first?
- AThe flap nearest to you
- BThe flap on your dominant side
- CAny flap, as long as you wear sterile gloves
- DThe flap furthest away from you
4.Nursing fundamentalsHard
During medicines reconciliation, the patient says they take an anticoagulant at home, but it has not been prescribed in hospital. What should the nurse do?
- AIgnore it, as the hospital doctor knows best
- BTell the patient to stop it for good
- CInform the prescriber so the omission can be reviewed
- DGive the patient's own supply without telling anyone
5.MicrobiologyMedium
What is the main difference between innate and adaptive immunity?
- AAdaptive immunity is specific and forms memory; innate immunity does not
- BInnate immunity develops only after vaccination
- CInnate immunity uses antibodies and forms memory; adaptive immunity does not
- DAdaptive immunity acts within minutes of infection
6.MicrobiologyHard
Which feature distinguishes most exotoxins from endotoxin?
- AExotoxins are proteins and can be turned into toxoid vaccines
- BExotoxins are heat-stable lipids
- CExotoxins are lipopolysaccharides of the Gram-negative outer membrane
- DExotoxins are only released when bacteria die
3Solutions
1.Infection control & patient safety
Answer: D · It can mean either morphine sulfate or magnesium sulfate
Why this is the answer
“MS”, “MSO4” and “MgSO4” can be confused, and giving one drug instead of the other can cause serious harm. Drug names are written in full.
D · It can mean either morphine sulfate or magnesium sulfate
2.Infection control & patient safety
Answer: B · Discard it, prepare the correct drug and report a near miss
Why this is the answer
A near miss shows a weakness in the system, such as similar packaging or storage. Reporting allows the risk to be fixed before a patient is harmed. A just culture supports such reporting.
B · Discard it, prepare the correct drug and report a near miss
3.Nursing fundamentals
Answer: D · The flap furthest away from you
Why this is the answer
Opening the far flap first means the nurse never reaches across the exposed sterile contents. The side flaps follow, and the nearest flap is opened last.
D · The flap furthest away from you
4.Nursing fundamentals
Answer: C · Inform the prescriber so the omission can be reviewed
Why this is the answer
Unexplained differences between home and hospital medicines are reported to the prescriber. Missed anticoagulants can cause clots, and some omissions are deliberate, for example before surgery.
C · Inform the prescriber so the omission can be reviewed
5.Microbiology
Answer: A · Adaptive immunity is specific and forms memory; innate immunity does not
Why this is the answer
Innate defences (barriers, phagocytes, complement) act fast and in the same way each time. Adaptive immunity (B and T cells) takes days, is specific to each antigen and forms memory.
A · Adaptive immunity is specific and forms memory; innate immunity does not
6.Microbiology
Answer: A · Exotoxins are proteins and can be turned into toxoid vaccines
Why this is the answer
Exotoxins are secreted proteins with specific actions and are often very potent; many can be inactivated into toxoids. Endotoxin is lipopolysaccharide, more heat-stable and cannot be made into a toxoid.
A · Exotoxins are proteins and can be turned into toxoid vaccines