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
Sputum specimens are ordered to look for acid-fast bacilli (TB). How are they usually collected?
- AOne specimen of sputum collected straight after the evening meal, when coughing is easiest
- BThree specimens collected after an antiseptic mouthwash
- CThree deep-cough specimens collected 8 to 24 hours apart, at least one early in the morning
- DOne saliva sample collected at any convenient time of day
2.Infection control & patient safetyHard
A patient with pneumonia has low blood pressure and a raised serum lactate. What does the raised lactate suggest?
- AMild dehydration from poor intake, with no further concern
- BRecovery from the infection is beginning
- CPoor tissue perfusion, a sign of sepsis-related shock
- DA normal response to having a fever
3.Nursing fundamentalsMedium
How can a patient reduce pain when coughing after abdominal surgery?
- AAvoid coughing completely until the stitches have been removed
- BCough while bending forward with no support
- CLie flat on their back with arms by their sides
- DHold a pillow firmly against the wound while coughing
4.Nursing fundamentalsHard
Under the Mental Capacity Act 2005 (England and Wales), which of these is part of the test of whether a person can make a decision?
- AWhether the decision they make agrees with the advice given by the doctor and the care team
- BWhether they can understand, retain and weigh the information and communicate a decision
- CWhether they have a diagnosis of dementia
- DWhether they are over 65 years old
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
Several people vomit within a few hours of eating fried rice that was cooked the day before and kept at room temperature. Which organism is the classic cause?
- ABacillus cereus
- BListeria monocytogenes
- CClostridium botulinum
- DSalmonella Typhi
3Solutions
1.Infection control & patient safety
Answer: C · Three deep-cough specimens collected 8 to 24 hours apart, at least one early in the morning
Why this is the answer
Several deep-cough sputum samples improve the chance of finding acid-fast bacilli, and early-morning samples contain the most secretions. Saliva is not sputum, and antiseptic mouthwash can affect the result.
C · Three deep-cough specimens collected 8 to 24 hours apart, at least one early in the morning
2.Infection control & patient safety
Answer: C · Poor tissue perfusion, a sign of sepsis-related shock
Why this is the answer
When tissues are poorly perfused, cells switch to anaerobic metabolism and lactate rises. In a patient with infection and hypotension, this points to septic shock and needs urgent treatment.
C · Poor tissue perfusion, a sign of sepsis-related shock
3.Nursing fundamentals
Answer: D · Hold a pillow firmly against the wound while coughing
Why this is the answer
Splinting the incision with a pillow or folded towel supports the wound and reduces pain, so the patient can cough effectively and clear secretions.
D · Hold a pillow firmly against the wound while coughing
4.Nursing fundamentals
Answer: B · Whether they can understand, retain and weigh the information and communicate a decision
Why this is the answer
A person lacks capacity for a decision if, because of an impairment of the mind or brain, they cannot understand, retain, use or weigh the information, or communicate their decision. An unwise choice does not by itself show lack of capacity.
B · Whether they can understand, retain and weigh the information and communicate a decision
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: A · Bacillus cereus
Why this is the answer
Bacillus cereus spores survive boiling. If cooked rice is left warm, the bacteria grow and make a heat-stable emetic toxin, so reheating does not make the rice safe.