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 has leftover opioid tablets after surgery. Which advice about disposal is best?
- AGive them to a friend or relative who has back pain
- BKeep them in an unlocked drawer at home in case of future pain
- CLeave them in the bathroom cabinet indefinitely
- DReturn them to a pharmacy or an approved take-back site
2.Infection control & patient safetyHard
A nurse often skips barcode scanning to save time, as many colleagues do. In a just culture, how is this behavior classed?
- ASimple human error, managed only by consoling the nurse and moving on
- BReckless behavior, managed by immediate dismissal and reporting to the licensing board
- CAt-risk behavior, managed by coaching and fixing the system pressures behind it
- DAcceptable behavior, because it is common on the unit
3.Nursing fundamentalsMedium
A catheterised patient has had no urine in the bag for two hours. What should the nurse check first?
- AThe patient's blood glucose level and recent insulin doses
- BNothing, as two hours without urine is normal
- CWhether the patient has eaten or drunk anything recently
- DThe tubing for kinks or blockage and where the bag is
4.Nursing fundamentalsHard
A healthcare assistant (nursing assistant) has recorded a blood pressure of 82/50 mmHg during routine observations but did not report it. What should the registered nurse do first?
- ATalk to the healthcare assistant about reporting
- BRepeat the observations at the next routine time
- CAssess the patient straight away
- DComplete an incident report
5.MicrobiologyMedium
Why are pregnant women advised to avoid unpasteurised soft cheeses?
- AThey may contain tapeworm eggs
- BThey may contain Listeria, which can harm the fetus
- CThey often contain the hepatitis C virus, which crosses the placenta
- DThey contain too much lactose for the fetus
6.MicrobiologyHard
Why are beta-lactamase inhibitors such as clavulanic acid combined with amoxicillin?
- AThey kill bacteria by themselves through the cell membrane
- BThey slow the excretion of amoxicillin by the kidneys, raising its level
- CThey protect amoxicillin from bacterial enzymes that destroy it
- DThey make amoxicillin active against viruses
3Solutions
1.Infection control & patient safety
Answer: D · Return them to a pharmacy or an approved take-back site
Why this is the answer
Returning unused opioids to a pharmacy or an approved take-back site is the preferred way to dispose of them. Leftover opioids at home can be misused or taken by children or pets.
D · Return them to a pharmacy or an approved take-back site
2.Infection control & patient safety
Answer: C · At-risk behavior, managed by coaching and fixing the system pressures behind it
Why this is the answer
At-risk behavior is a choice whose risk is not recognized or is believed to be justified, often because shortcuts have become normal. It is managed by coaching and removing the pressures behind it, while reckless behavior may need disciplinary action.
C · At-risk behavior, managed by coaching and fixing the system pressures behind it
3.Nursing fundamentals
Answer: D · The tubing for kinks or blockage and where the bag is
Why this is the answer
Kinked or trapped tubing, a bag above bladder level or a blocked catheter are common causes. If these are fine, the patient is assessed for low output and the doctor informed.
D · The tubing for kinks or blockage and where the bag is
4.Nursing fundamentals
Answer: C · Assess the patient straight away
Why this is the answer
A low blood pressure may mean deterioration, so the nurse assesses the patient at once and escalates if needed. Feedback to the assistant and reporting follow afterwards.
C · Assess the patient straight away
5.Microbiology
Answer: B · They may contain Listeria, which can harm the fetus
Why this is the answer
Listeria monocytogenes can grow in chilled foods and cross the placenta. It can cause miscarriage, stillbirth or severe neonatal infection.
B · They may contain Listeria, which can harm the fetus
6.Microbiology
Answer: C · They protect amoxicillin from bacterial enzymes that destroy it
Why this is the answer
Beta-lactamases hydrolyse the beta-lactam ring. Clavulanic acid binds these enzymes, so amoxicillin stays active against beta-lactamase-producing bacteria.
C · They protect amoxicillin from bacterial enzymes that destroy it