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 newly hired nurse had BCG vaccine as a child. Which TB screening test is usually preferred?
- AA chest x-ray every month for the first year
- BA tuberculin skin test, which is read 24 hours after it is placed
- CAn interferon-gamma release assay (IGRA) blood test
- DNo screening, because BCG prevents all TB
2.Infection control & patient safetyHard
A patient’s allergy band says “penicillin”, and an order has been written for amoxicillin. What should the nurse do?
- AAsk the patient whether they would like to take it anyway
- BGive the drug and watch the patient closely
- CHold the drug and contact the prescriber
- DGive an antihistamine first and then the drug
3.Nursing fundamentalsMedium
Which of these is one of the five rights of delegation?
- AThe right time of year
- BThe right supervision
- CThe right uniform
- DThe right salary
4.Nursing fundamentalsHard
For a patient at risk of pressure ulcers, why is the head of the bed usually kept at 30 degrees or less if their condition allows?
- AHigher angles make the patient slide down, causing shear over the sacrum
- BHigher angles always cause breathing problems in patients who are bedbound
- CLower angles increase blood flow to the heels
- DLower angles stop the patient from getting out of bed
5.MicrobiologyMedium
Which organism causes tuberculosis, and what makes it hard to stain with the Gram method?
- AMycoplasma pneumoniae, which has no cell wall to take up the stain
- BMycobacterium tuberculosis, which has a waxy mycolic acid wall
- CStreptococcus pneumoniae, which has a capsule
- DLegionella pneumophila, which lives inside amoebae
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?
- AClostridium botulinum
- BListeria monocytogenes
- CSalmonella Typhi
- DBacillus cereus
3Solutions
1.Infection control & patient safety
Answer: C · An interferon-gamma release assay (IGRA) blood test
Why this is the answer
BCG vaccine can cause a false-positive tuberculin skin test. IGRA blood tests are not affected by BCG, so they are preferred for people who have had the vaccine.
C · An interferon-gamma release assay (IGRA) blood test
2.Infection control & patient safety
Answer: C · Hold the drug and contact the prescriber
Why this is the answer
Amoxicillin is a penicillin, so it could cause a serious allergic reaction. The nurse holds the drug, clarifies the allergy and contacts the prescriber for a safe alternative.
C · Hold the drug and contact the prescriber
3.Nursing fundamentals
Answer: B · The right supervision
Why this is the answer
The five rights of delegation are the right task, circumstance, person, direction or communication, and supervision or evaluation. The registered nurse stays accountable for the decision to delegate.
B · The right supervision
4.Nursing fundamentals
Answer: A · Higher angles make the patient slide down, causing shear over the sacrum
Why this is the answer
When the head is raised high, the body tends to slide while the skin stays still, distorting the tissues over the sacrum. Keeping the angle low, where safe, reduces this shear.
A · Higher angles make the patient slide down, causing shear over the sacrum
5.Microbiology
Answer: B · Mycobacterium tuberculosis, which has a waxy mycolic acid wall
Why this is the answer
M. tuberculosis has a cell wall rich in mycolic acids, so it resists Gram staining and is identified with acid-fast stains.
B · Mycobacterium tuberculosis, which has a waxy mycolic acid wall
6.Microbiology
Answer: D · 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.