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 patient is on suicide precautions. Which room safety measure is appropriate?
- ARemove items that could be used for self-harm, such as belts and cords
- BLet the patient keep a personal razor for shaving, as long as staff are told
- CAllow glass bottles if the patient seems calm
- DKeep the door closed at all times so the patient has privacy
2.Infection control & patient safetyHard
A patient punches a nurse during care. The nurse is not seriously hurt. What should the nurse do?
- ASay nothing, because violence is part of the job
- BRefuse to care for any patient for the rest of the week until the patient is moved
- CPunch the patient back in self-defense
- DGet medical assessment and report the assault according to policy
3.Nursing fundamentalsMedium
In adult basic life support, how long should the rescuer take to check for normal breathing?
- AAs long as it takes to be certain
- BNo more than 10 seconds
- CAbout 30 seconds
- DAt least one minute
4.Nursing fundamentalsHard
A competent adult who is a Jehovah's Witness refuses a blood transfusion that the team believes is needed. Which two ethical principles are in conflict?
- AVeracity and non-maleficence
- BJustice and veracity
- CAutonomy and beneficence
- DFidelity and justice
5.MicrobiologyMedium
Which laboratory test separates Staphylococcus aureus from most other staphylococci?
- AThe acid-fast stain
- BThe catalase test
- CThe Gram stain
- DThe coagulase test
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: A · Remove items that could be used for self-harm, such as belts and cords
Why this is the answer
Patients at risk of suicide need a safe environment, with belts, cords, sharp objects and glass removed, and observation at the level ordered. Privacy is secondary to safety in this situation.
A · Remove items that could be used for self-harm, such as belts and cords
2.Infection control & patient safety
Answer: D · Get medical assessment and report the assault according to policy
Why this is the answer
Workplace violence should always be reported. Reporting allows care for the injured staff member, review of risks and changes to the patient’s care plan to protect staff and other patients.
D · Get medical assessment and report the assault according to policy
3.Nursing fundamentals
Answer: B · No more than 10 seconds
Why this is the answer
Rescuers look, listen and feel for normal breathing for no more than 10 seconds. If breathing is absent or not normal, they call for help and start CPR.
B · No more than 10 seconds
4.Nursing fundamentals
Answer: C · Autonomy and beneficence
Why this is the answer
The patient's right to decide (autonomy) conflicts with the team's wish to do good (beneficence). A valid refusal by a competent adult is respected, and alternatives to blood are explored.
C · Autonomy and beneficence
5.Microbiology
Answer: D · The coagulase test
Why this is the answer
S. aureus produces coagulase, which converts fibrinogen to fibrin. All staphylococci are Gram-positive and catalase-positive, so those tests do not separate them.
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.