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
Which assessment is most important while a patient is in wrist restraints?
- AThe patient’s height and weight
- BThe patient’s food and drink preferences for the day
- CCirculation, sensation and skin beyond the restraint
- DThe patient’s hearing in both ears with a watch test
2.Infection control & patient safetyHard
Several patients arrive with suspected inhalational anthrax after a deliberate release. Which precautions are needed for their care?
- AStandard precautions, because it is not spread from person to person
- BContact precautions with gowns and gloves
- CAirborne precautions in negative-pressure rooms, because spores are inhaled
- DDroplet precautions with surgical masks
3.Nursing fundamentalsMedium
A caller says they are a patient's daughter and asks for details of the patient's condition. What should the nurse do?
- ARead out the latest notes over the phone
- BCheck the patient's wishes and the caller's identity first
- CHang up without saying anything
- DGive full details, as close family members have a right to know
4.Nursing fundamentalsHard
What is the best way to check that a patient has learned to use an inhaler correctly?
- AAsk them to repeat the drug's name
- BAsk whether they have read the leaflet
- CAsk whether they have any questions
- DAsk the patient to show how they use it
5.MicrobiologyMedium
Why does high vaccination coverage also protect babies too young to be vaccinated?
- AVaccinated people pass antibodies to everyone they meet
- BVaccines kill the pathogen in the environment
- CFewer people can pass on the infection, so it spreads less
- DBabies are naturally immune to all vaccine-preventable diseases
6.MicrobiologyHard
A healthcare worker's blood test is positive for anti-HBs (hepatitis B surface antibody) and negative for HBsAg and anti-HBc. What does this most likely mean?
- AChronic hepatitis B infection
- BPast natural infection that has cleared
- CCurrent acute hepatitis B infection
- DImmunity from hepatitis B vaccination
3Solutions
1.Infection control & patient safety
Answer: C · Circulation, sensation and skin beyond the restraint
Why this is the answer
Restrained patients are checked often for circulation, sensation, skin condition, comfort, fluids and toileting, and the restraint is released at regular intervals for movement according to policy.
C · Circulation, sensation and skin beyond the restraint
2.Infection control & patient safety
Answer: A · Standard precautions, because it is not spread from person to person
Why this is the answer
Inhalational anthrax is caught by breathing in spores from the environment and does not spread from person to person, so standard precautions are enough. Decontamination may still be needed for people with spores on their skin or clothing.
A · Standard precautions, because it is not spread from person to person
3.Nursing fundamentals
Answer: B · Check the patient's wishes and the caller's identity first
Why this is the answer
Information is shared only with people the patient has agreed to, and the caller's identity is checked as per policy. Often only limited information is given by phone.
B · Check the patient's wishes and the caller's identity first
4.Nursing fundamentals
Answer: D · Ask the patient to show how they use it
Why this is the answer
A return demonstration shows whether a psychomotor skill has been learned and lets the nurse correct mistakes. Saying "yes, I understand" does not prove the technique is right.
D · Ask the patient to show how they use it
5.Microbiology
Answer: C · Fewer people can pass on the infection, so it spreads less
Why this is the answer
When enough people are immune, chains of transmission break and the pathogen rarely reaches susceptible people, such as young babies or immunosuppressed patients.
C · Fewer people can pass on the infection, so it spreads less
6.Microbiology
Answer: D · Immunity from hepatitis B vaccination
Why this is the answer
The vaccine contains HBsAg, so a vaccinated person makes anti-HBs but no anti-HBc. Past natural infection gives both anti-HBs and anti-HBc, and ongoing infection shows HBsAg.
D · Immunity from hepatitis B vaccination