Annex B: Procedures & Clinical Skills

What is the purpose of the 'aseptic non-touch technique' (ANTT) when changing a wound dressing?

• ATo sterilise the wound before a new dressing is applied
• BTo avoid the need for hand hygiene before the procedure
• CTo prevent micro-organisms being introduced to the wound by protecting the key parts and key sites✓
• DTo make the dressing change quicker by reducing the number of steps

Answer: ANTT protects the parts of equipment that touch the wound and the wound itself from contamination; hand hygiene remains essential, and wounds are cleaned, not sterilised.

When measuring a patient's temperature with a tympanic thermometer, what should the nursing associate do?

• AReuse the probe cover if the previous patient had no known infection, since covers are expensive and the risk is low
• BTake the reading in the ear that has the most wax, since wax retains heat and gives a more stable temperature reading
• CUse a new probe cover for each patient and gently straighten the ear canal by pulling the ear up and back in an adult✓
• DPush the probe as far into the ear canal as it will comfortably go, to ensure the sensor is as close to the eardrum as possible

Answer: A clean cover for every patient prevents cross-infection, and straightening the canal lets the sensor see the eardrum. Forcing the probe or reading through wax gives inaccurate results and risks injury.

Which of these is correct when collecting a mid-stream urine sample?

• AThe sample is poured from the patient's bedpan into a container after they have finished, so that nothing is spilled
• BThe patient passes the first part of the stream into the toilet and collects the middle part in a sterile container✓
• CThe patient drinks a litre of water first so that the sample is dilute
• DThe patient collects the first urine passed on waking into any clean container from home, since morning urine is most concentrated

Answer: A mid-stream sample reduces contamination from the urethra and skin, and a sterile container prevents false-positive cultures. Bedpan samples and non-sterile containers are contaminated, and dilution lowers the accuracy of the test.

A nursing associate is about to administer a subcutaneous injection of insulin. Which site and technique are appropriate?

• AThe abdomen, thigh or upper outer arm, rotating sites, using a short needle at 90 degrees into a lifted skin fold if the patient is slim✓
• BThe upper outer quadrant of the buttock with the needle at 45 degrees, aspirating first to check that a blood vessel has not been entered
• CThe deltoid muscle at 90 degrees with a long needle, as for a vaccine, so that the insulin is absorbed quickly into the bloodstream
• DThe same site each day at the same time, so that absorption is consistent and the patient's blood glucose is easier to predict

Answer: Insulin is given subcutaneously into fatty tissue, with site rotation to prevent lipohypertrophy; short needles at 90 degrees are standard, with a skin fold in slim patients. The deltoid and buttock approaches described are intramuscular, and repeated use of one site causes lumps that alter absorption.

Before applying compression stockings for DVT prevention, what must be done?

• AApply them only to the leg the patient reports as painful, since a clot can only form where there is pain
• BAsk the patient to stand for ten minutes first to fill the veins, which makes the stockings easier to pull on
• CApply the largest size available so that the stockings are easy to put on and do not feel tight on the legs
• DMeasure the legs and check for contraindications such as peripheral arterial disease or skin damage✓

Answer: Anti-embolism stockings must be correctly sized from leg measurements, and are contraindicated where arterial disease, neuropathy, dermatitis or oedema make them unsafe. Oversized stockings give no benefit and can roll and constrict.

When assisting a patient to eat, which action reduces the risk of choking?

• AFeed the patient quickly and steadily so that the meal does not go cold and the next patient on the list is not kept waiting
• BGive drinks only at the very end of the meal to avoid interruptions, since sipping between mouthfuls slows eating down
• CPosition the patient reclining at about 30 degrees so that gravity helps the food down and they can rest while they eat
• DEnsure the patient is sitting upright, offer small amounts at their pace, and check the mouth is empty before the next mouthful✓

Answer: Upright positioning, small mouthfuls and an unhurried pace are the basics of safe assisted eating, especially for people with swallowing difficulties. Rushing and reclining both increase aspiration risk.

What is the correct way to dispose of a used incontinence pad on a ward?

• AInto the correct clinical waste stream according to local policy, with hand hygiene afterwards✓
• BLeft in a tied bag at the bedside for the domestic staff to remove when they next come round the ward
• CInto the sluice sink, broken up and flushed away with plenty of water so that nothing is left in the bin
• DInto the domestic waste bin on the ward, since pads are not sharp and do not count as clinical waste

Answer: Used pads are offensive or clinical waste depending on the patient's infection status and local policy, and are bagged and disposed of promptly. Domestic bins, the sluice sink and bedside bags all create infection and odour risks.

A patient is prescribed oxygen via a nasal cannula at 2 litres per minute. Which statement is correct?

• ANasal cannulae are suitable for low flow rates up to about 4 litres per minute and allow the patient to eat and talk✓
• BA flow of 2 litres per minute requires a non-rebreathe mask with a reservoir bag
• CNasal cannulae deliver a fixed concentration of oxygen regardless of the flow rate
• DOxygen via nasal cannula does not need to be prescribed because the dose is low

Answer: Nasal cannulae are a variable-performance device for low flows, well tolerated for longer-term use; higher concentrations need masks. Oxygen is a prescribed medicine at every flow rate, with a target saturation range recorded.