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 nurse wants to set up a sterile field in the morning for a procedure that will take place after lunch. What is correct?
- ASet it up in the morning and cover it with a clean towel until the procedure starts
- BSet it up in the morning and leave it uncovered in an empty room
- CSet it up just before the procedure, because a waiting field may become contaminated
- DSet it up in the morning and ask a colleague to check it once
2.Infection control & patient safetyHard
A conscious patient who is at risk of choking is being given oral medicines. Which practice is safest?
- AGive all the tablets together to save time
- BSit the patient upright and give one tablet at a time
- CCrush all the tablets without checking whether this is allowed
- DLay the patient flat on the back to make swallowing easier
3.Nursing fundamentalsMedium
A nurse posts about an "interesting patient" on social media without naming them. Why is this a problem?
- AIt is not a problem because no name was given
- BIt is only a problem if the post also includes a photograph of the patient
- CIt is not a problem if the account is private
- DThe patient may still be identifiable, which breaches confidentiality
4.Nursing fundamentalsHard
Which of these patients should the nurse attend to first?
- AA patient who wants to talk about the results of a scan
- BA patient with diabetes who is sweaty and shaky with a glucose of 2.9 mmol/L (52 mg/dL)
- CA patient asking for their regular evening medicines
- DA patient with a pain score of 4/10 who had analgesia 30 minutes ago
5.MicrobiologyMedium
What is the main difference between innate and adaptive immunity?
- AAdaptive immunity acts within minutes of infection
- BInnate immunity develops only after vaccination
- CAdaptive immunity is specific and forms memory; innate immunity does not
- DInnate immunity uses antibodies and forms memory; adaptive immunity does not
6.MicrobiologyHard
Which mechanism of antibiotic resistance does a bacterium use when it pumps the drug out of the cell?
- AReduced porin uptake only
- BEnzymatic inactivation
- CEfflux pumps
- DTarget modification
3Solutions
1.Infection control & patient safety
Answer: C · Set it up just before the procedure, because a waiting field may become contaminated
Why this is the answer
The longer a sterile field is exposed, the more likely it is to be contaminated, and an unattended field cannot be considered sterile. It is prepared just before use.
C · Set it up just before the procedure, because a waiting field may become contaminated
2.Infection control & patient safety
Answer: B · Sit the patient upright and give one tablet at a time
Why this is the answer
Upright positioning and giving medicines one at a time reduce choking risk. Crushing is only done when the pharmacy confirms it is safe, because some modified-release and enteric-coated products are dangerous when crushed.
B · Sit the patient upright and give one tablet at a time
3.Nursing fundamentals
Answer: D · The patient may still be identifiable, which breaches confidentiality
Why this is the answer
Details such as the ward, the condition or the date can reveal who a patient is. Professional codes forbid sharing patient information on social media, even without names.
D · The patient may still be identifiable, which breaches confidentiality
4.Nursing fundamentals
Answer: B · A patient with diabetes who is sweaty and shaky with a glucose of 2.9 mmol/L (52 mg/dL)
Why this is the answer
Hypoglycaemia can quickly lead to unconsciousness and seizures and needs immediate treatment. The other patients' needs are important but can wait a few minutes.
B · A patient with diabetes who is sweaty and shaky with a glucose of 2.9 mmol/L (52 mg/dL)
5.Microbiology
Answer: C · 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.
C · Adaptive immunity is specific and forms memory; innate immunity does not
6.Microbiology
Answer: C · Efflux pumps
Why this is the answer
Efflux pumps actively export antibiotics such as tetracyclines and fluoroquinolones, keeping the inside concentration too low to work.