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?
- AAllow glass bottles if the patient seems calm
- BRemove items that could be used for self-harm, such as belts and cords
- CLet the patient keep a personal razor for shaving, as long as staff are told
- DKeep the door closed at all times so the patient has privacy
2.Infection control & patient safetyHard
Several patients on a ward develop vomiting and diarrhea within two days, and a norovirus outbreak is suspected. What should the nurse do first?
- ANotify the infection prevention team and place affected patients on contact precautions
- BWait for all the stool results to come back before taking any action
- CAsk visitors to bring in bottled water for all patients
- DMove the affected patients to different wards so that fewer people are exposed
3.Nursing fundamentalsMedium
Where should a urinary catheter drainage bag be kept?
- AOn the patient's abdomen
- BOn the floor next to the bed
- CAbove the level of the bladder
- DBelow the level of the bladder, off the floor
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
- BLower angles stop the patient from getting out of bed
- CHigher angles always cause breathing problems in patients who are bedbound
- DLower angles increase blood flow to the heels
5.MicrobiologyMedium
Transfer of bacterial genes from one bacterium to another by a virus is called:
- AConjugation
- BTransformation
- CTranscription
- DTransduction
6.MicrobiologyHard
A deep, dirty wound becomes swollen and very painful, and gas can be felt under the skin. Which organism is most likely?
- ABordetella pertussis
- BStreptococcus pneumoniae
- CNeisseria gonorrhoeae
- DClostridium perfringens
3Solutions
1.Infection control & patient safety
Answer: B · 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.
B · Remove items that could be used for self-harm, such as belts and cords
2.Infection control & patient safety
Answer: A · Notify the infection prevention team and place affected patients on contact precautions
Why this is the answer
Early reporting lets infection prevention organize testing, cohorting, closing of the ward if needed, cleaning with suitable agents and soap-and-water hand hygiene. Moving patients around can spread the outbreak.
A · Notify the infection prevention team and place affected patients on contact precautions
3.Nursing fundamentals
Answer: D · Below the level of the bladder, off the floor
Why this is the answer
Keeping the bag below bladder level lets urine drain by gravity and prevents backflow. Keeping it off the floor reduces contamination and infection risk.
D · Below the level of the bladder, off the floor
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: D · Transduction
Why this is the answer
In transduction a bacteriophage accidentally packages bacterial DNA and delivers it to the next cell it infects. Transformation is uptake of free DNA and conjugation uses direct contact.
6.Microbiology
Answer: D · 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.
D · Clostridium perfringens