Evidence-based Practice & Safety

What is the single most effective measure to prevent the spread of healthcare-associated infection?

• AIsolating new admissions
• BWearing surgical masks
• CEffective hand hygiene✓
• DAdministering prophylactic antibiotics

Answer: Hand hygiene is recognised as the single most effective intervention to reduce healthcare-associated infections. The WHO 'Five Moments for Hand Hygiene' guide when decontamination should occur.

According to the WHO 'Five Moments for Hand Hygiene', when should hands be decontaminated in relation to a patient?

• AOnly when hands look visibly dirty
• BOnly after leaving the ward at the end of the shift has been completed
• CBefore touching a patient and before a clean or aseptic procedure✓
• DOnce at the start of each shift is enough, provided gloves are worn after

Answer: The WHO Five Moments include before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient and after touching patient surroundings. These moments interrupt the transmission of pathogens.

What does 'evidence-based practice' require a nurse to do?

• AUse whichever method happens to be the quickest one available
• BIntegrate the best available evidence with clinical expertise and patient preferences✓
• CFollow the most experienced colleague's habits
• DRely only on what was taught during initial training

Answer: Evidence-based practice combines the best available research evidence with clinical expertise and the patient's values and preferences. This approach ensures care is current, safe and individualised.

A nurse notices a near-miss medication incident that caused no harm to the patient. What should they do?

• AMention it verbally to the nurse in charge if somebody asks about it
• BRecord it in the patient's own diary at home rather than in ward records
• CIgnore it, because no harm came to the patient on this occasion
• DReport it through the incident reporting system to support learning✓

Answer: Near misses must be reported through the incident reporting system so that themes can be analysed and care improved. A just, open culture treats reporting as learning rather than blame.

Before carrying out an aseptic non-touch technique (ANTT) for a wound dressing, what is a key principle?

• ATouching key parts directly with clean bare hands is acceptable
• BKey parts and key sites must be protected from contamination✓
• CThe dressing can be left open to air during preparation
• DSterile gloves remove the need for hand hygiene

Answer: ANTT relies on identifying and protecting key parts and key sites from contamination throughout the procedure. Hand hygiene remains essential even when gloves are worn.

A patient on a NEWS2 pathway has a respiratory rate of 9 breaths per minute. How should the nurse interpret this finding?

• AIt only matters if the patient's oxygen saturations are also found to be low
• BIt is abnormal and adds 1 point to the patient's aggregate NEWS2 score✓
• CIt is normal and needs no further action
• DRespiratory rate is not one of the parameters included in the NEWS2 chart

Answer: Respiratory rate is a core NEWS2 parameter: 12 to 20 breaths per minute scores 0, 9 to 11 scores 1 and 8 or fewer scores 3. A rate of 9 is abnormal and adds 1 to the aggregate score, and the response is set by that total. An aggregate of 1 to 4 means a registered nurse assesses the patient and decides whether to increase monitoring or escalate care, while a score of 3 in any single parameter or a total of 5 or more needs an urgent response.

What should you do with a used needle after giving an injection?

• ALeave it on the tray to dispose of at the end
• BResheath it carefully before taking it to the bin
• CBend it so that it cannot be used again
• DDispose of it in a sharps bin at the point of use✓

Answer: Used sharps should be disposed of immediately at the point of use into a sharps container. Resheathing and bending needles cause needlestick injuries.

You sustain a needlestick injury from a used needle. What should you do first?

• AEncourage it to bleed and wash it with soap and running water✓
• BCover it with a plaster and finish your shift before reporting
• CScrub the area hard with an alcohol hand rub for a minute
• DSuck the wound to draw out any blood that may be infected

Answer: First aid is to encourage gentle bleeding, wash with soap and running water, and cover it, without sucking or scrubbing. Then report it at once and contact occupational health, as treatment may be time-critical.

When removing personal protective equipment, which item is usually taken off first?

• AFace mask
• BEye protection
• CGloves✓
• DApron or gown

Answer: UK guidance for removing PPE starts with gloves, the most contaminated item, followed by the apron or gown, eye protection and then the mask, with hand hygiene after.

Why should hands be washed with soap and water, rather than alcohol hand rub, when caring for a patient with Clostridioides difficile?

• ASoap and water is faster than alcohol hand rub
• BAlcohol rub does not kill C. difficile spores✓
• CC. difficile is spread only by coughing
• DAlcohol rub stains the skin of the patient

Answer: C. difficile forms spores that alcohol does not destroy. Washing with soap and running water physically removes them from the hands.

Which type of evidence is usually placed at the top of the hierarchy of evidence for treatment decisions?

• AExpert opinion from senior clinicians in the specialty
• BSystematic reviews of randomised controlled trials✓
• CSingle case reports and small case series from one unit
• DCross-sectional surveys of patients

Answer: Systematic reviews and meta-analyses of randomised controlled trials are generally regarded as the strongest evidence about the effects of treatments.

In a PICO research question, what does the 'C' stand for?

• AComparison✓
• BCost
• CCause
• DClinical setting

Answer: PICO stands for Population (or patient/problem), Intervention, Comparison and Outcome. It helps frame a focused question for searching the evidence.

What is qualitative research best suited to?

• AMeasuring how well a drug lowers blood pressure
• BComparing costs between two hospital wards
• CCounting how many patients develop infections
• DExploring people's experiences and views✓

Answer: Qualitative research uses methods such as interviews to explore experiences, beliefs and meanings. Quantitative methods measure and compare numbers.

How does a clinical audit differ from research?

• AAudit always needs a randomised controlled trial
• BAudit is carried out only by university staff
• CAudit creates new knowledge about what works best
• DAudit measures practice against an agreed standard✓

Answer: Clinical audit checks whether current practice meets an agreed standard and drives improvement. Research aims to generate new knowledge.

What checks are normally required when a controlled drug is given on a hospital ward?

• ATwo staff check it, and it is recorded in the controlled drug register✓
• BThe pharmacist checks it by phone before each dose is given
• CThe patient checks it and signs the drug register themselves
• DOne nurse checks it, and it is recorded on the drug chart alone

Answer: Local policies in line with national guidance require controlled drugs to be checked by two people, usually a registrant and a second trained person, and recorded in the controlled drug register.

A patient with a documented penicillin allergy is prescribed co-amoxiclav. What should the nurse do?

• AWithhold it and contact the prescriber, as it contains a penicillin✓
• BGive it, as co-amoxiclav is a different class from penicillin
• CGive it with an antihistamine to prevent any allergic reaction
• DGive half the dose and watch the patient closely for a reaction

Answer: Co-amoxiclav contains amoxicillin, which is a penicillin. The dose should not be given, and the prescriber must be contacted for an alternative.

A patient who has difficulty swallowing is prescribed a modified-release tablet. What should the nurse do?

• ABreak it in half so it is easier to swallow
• BAsk the pharmacist, as it should not be crushed✓
• CDissolve it in water and give it through a straw
• DCrush it and mix it with a spoonful of yoghurt

Answer: Crushing modified-release preparations can release the whole dose at once and cause harm. The pharmacist or prescriber can advise on a suitable alternative formulation.

Where should a urinary catheter drainage bag be positioned to reduce the risk of infection?

• AOn the bed beside the patient
• BOn the floor, touching it
• CAbove the level of the bladder
• DBelow the level of the bladder✓

Answer: Keeping the bag below bladder level lets urine drain freely and prevents backflow. The bag should not touch the floor.