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
Before a blood transfusion is started, which check is required?
- AThe nurse checks only that the bag number matches the order
- BThe patient signs the blood bag label to confirm their name before it is hung
- CThe patient’s identity is checked against the blood product and its paperwork at the bedside
- DOne nurse checks the blood product against the order at the nurses’ station
2.Infection control & patient safetyHard
A patient with suspected pertussis needs to stay in a shared bay because no single room is free. What is the most appropriate arrangement while infection control is contacted?
- AUse airborne precautions with an N95 respirator for everyone
- BPlace the patient next to an immunocompromised patient
- CUse no precautions at all until a single room becomes free
- DCurtains drawn, over 1 meter (3 feet) of space, masks for close contact
3.Nursing fundamentalsMedium
Which measure helps prevent deep vein thrombosis in hospital patients?
- AEarly mobilisation and leg exercises
- BCrossing the legs while sitting
- CRestricting fluids
- DKeeping the patient in bed as long as possible
4.Nursing fundamentalsHard
Why must medicines for Parkinson's disease, such as levodopa, be given on time?
- AThe timing does not matter as long as the full daily total is given
- BLate doses can cause severe stiffness, falls and swallowing problems
- CLate doses cause the patient to fall asleep
- DThe drug becomes poisonous if it is given late
5.MicrobiologyMedium
Why are Gram-negative bacteria often harder to treat with antibiotics?
- AThey have a thicker peptidoglycan layer
- BTheir outer membrane blocks many drugs
- CThey have no ribosomes
- DThey divide much more slowly
6.MicrobiologyHard
A deep, dirty wound becomes swollen and very painful, and gas can be felt under the skin. Which organism is most likely?
- AStreptococcus pneumoniae
- BClostridium perfringens
- CNeisseria gonorrhoeae
- DBordetella pertussis
3Solutions
1.Infection control & patient safety
Answer: C · The patient’s identity is checked against the blood product and its paperwork at the bedside
Why this is the answer
Wrong-patient transfusion can cause a fatal ABO reaction, so the final check is always done at the bedside, with positive patient identification against the product label, compatibility tag and order. Many US hospitals require two qualified people for this check, while UK guidance allows one trained person if positive identification is used. Local policy decides who checks.
C · The patient’s identity is checked against the blood product and its paperwork at the bedside
2.Infection control & patient safety
Answer: D · Curtains drawn, over 1 meter (3 feet) of space, masks for close contact
Why this is the answer
Droplet precautions focus on distance, masks and barriers. A single room is preferred, so infection control is contacted. Placing the patient near a vulnerable patient would be dangerous.
D · Curtains drawn, over 1 meter (3 feet) of space, masks for close contact
3.Nursing fundamentals
Answer: A · Early mobilisation and leg exercises
Why this is the answer
Moving early, leg exercises, good hydration and, where assessed as appropriate, compression or anticoagulant drugs reduce venous stasis and the risk of thrombosis.
A · Early mobilisation and leg exercises
4.Nursing fundamentals
Answer: B · Late doses can cause severe stiffness, falls and swallowing problems
Why this is the answer
Levodopa wears off quickly, and delays can cause rigidity, falls, swallowing difficulty and aspiration. It is a time-critical medicine in hospital.
B · Late doses can cause severe stiffness, falls and swallowing problems
5.Microbiology
Answer: B · Their outer membrane blocks many drugs
Why this is the answer
The outer membrane of Gram-negative bacteria, with lipopolysaccharide and porins, keeps many antibiotics out and adds efflux and enzyme defences.
B · Their outer membrane blocks many drugs
6.Microbiology
Answer: B · Clostridium perfringens
Why this is the answer
Clostridium perfringens causes gas gangrene in poorly oxygenated wounds. Its toxins destroy muscle and its metabolism produces gas, felt as crepitus. Urgent surgery and antibiotics are needed.
B · Clostridium perfringens