感染控制与患者安全：速成包

公式表、每个专题的关键方法步骤和 6 道练习题，完整解答附在最后。

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1公式与方法

感染控制与患者安全

方法

  1. 对每位患者都从标准预防开始：手卫生、针对预期暴露的个人防护装备、安全使用锐器。
  2. 按传播途径追加预防措施：接触传播（隔离衣、手套）、飞沫传播（外科口罩）、空气传播（N95、负压病房）。
  3. 保持无菌物品的无菌状态：如有疑问就视为不无菌；更换，绝不擦拭。
  4. 预防环境中的伤害：防跌倒措施，约束仅作为最后手段，火灾时用 RACE 和 PASS。
  5. 核对给药的正确原则、两个身份识别信息，以及对高警示药物的额外保障；报告差错和险兆事件。

2练习题

1.感染控制与患者安全中等

A patient with difficulty swallowing is prescribed an extended-release tablet. What should the nurse do?

  1. ADissolve the tablet in a glass of hot water
  2. BCrush the tablet finely and mix it into a spoonful of applesauce or yogurt
  3. CAsk the prescriber or pharmacist for another form and not crush the tablet
  4. DCut the tablet in half so it is easier to swallow
2.感染控制与患者安全困难

A patient is on contact precautions. Which task is appropriate for the nurse to delegate to assistive personnel?

  1. ATeaching the family how to follow the precautions
  2. BHelping the patient bathe while wearing a gown and gloves
  3. CDeciding when the precautions can be stopped
  4. DAssessing the wound for new signs of infection during the bath
3.护理学基础中等

When should blood cultures be taken in a patient with suspected sepsis?

  1. AOnly after three days of antibiotics, to see if they are working
  2. BBefore antibiotics are given, as long as this does not delay them
  3. CAfter the patient has recovered from the infection
  4. DOnly if the temperature rises above 40 °C
4.护理学基础困难

A patient with dementia keeps getting out of bed at night. What is the best first nursing approach?

  1. AAsk the doctor to prescribe a sedative so the patient sleeps through the night
  2. BRaise the bed rails and leave the patient alone
  3. CLook for an unmet need such as toileting, pain, hunger or thirst
  4. DTie a sheet across the bed to keep the patient in
5.微生物学中等

新感染时哪类抗体最先升高？

  1. AIgM
  2. BIgE
  3. CIgG
  4. DIgA
6.微生物学困难

一份尿液标本在麦康凯琼脂上长出了粉红色菌落。这说明了什么？

  1. A该生物不发酵乳糖，因此很可能是沙门氏菌
  2. B该生物是革兰氏阳性球菌
  3. C该生物是真菌
  4. D该生物可能是能发酵乳糖的革兰氏阴性杆菌

3溶液

1.感染控制与患者安全

答案: C · Ask the prescriber or pharmacist for another form and not crush the tablet

为什么是这个答案

Crushing or splitting an extended-release product can release the whole dose at once and cause toxicity. The nurse asks for a suitable alternative, such as a liquid or immediate-release form.

答案

C · Ask the prescriber or pharmacist for another form and not crush the tablet
2.感染控制与患者安全

答案: B · Helping the patient bathe while wearing a gown and gloves

为什么是这个答案

Assistive personnel can carry out routine care for a stable patient, using the correct PPE. Assessment, teaching and clinical judgement, such as deciding when to stop precautions, cannot be delegated to them.

答案

B · Helping the patient bathe while wearing a gown and gloves
3.护理学基础

答案: B · Before antibiotics are given, as long as this does not delay them

为什么是这个答案

Taking cultures first gives the best chance of identifying the organism. They are collected with strict asepsis, but antibiotics must not be delayed in sepsis.

答案

B · Before antibiotics are given, as long as this does not delay them
4.护理学基础

答案: C · Look for an unmet need such as toileting, pain, hunger or thirst

为什么是这个答案

Restlessness in dementia often has a cause, such as needing the toilet, pain or being cold. Meeting the need is safer than restraint or sedation, which increase the risk of harm.

答案

C · Look for an unmet need such as toileting, pain, hunger or thirst
5.微生物学

答案: A · IgM

为什么是这个答案

在初次免疫应答中 IgM 最先出现；随后出现 IgG，提供长期保护。因此 IgM 阳性提示近期感染。

答案

A · IgM
6.微生物学

答案: D · 该生物可能是能发酵乳糖的革兰氏阴性杆菌

为什么是这个答案

麦康凯琼脂含有抑制革兰氏阳性菌的胆盐和结晶紫（选择性），以及乳糖和 pH 指示剂（鉴别性）。E. coli 等乳糖发酵菌产酸而呈粉红色。

答案

D · 该生物可能是能发酵乳糖的革兰氏阴性杆菌

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