NMC CBT - Nursing and Midwifery Council Computer-Based Test Infection Prevention and Control 1 — Questions and Answers
Question 1: A patient is admitted with confirmed pulmonary tuberculosis. Which transmission-based precaution must be implemented in addition to standard precautions?
- Contact precautions in a side room with door closed
- Droplet precautions with a standard surgical mask
- Airborne precautions in a negative-pressure room with an FFP3 respirator (Correct answer)
- Reverse barrier nursing to protect the immunocompromised patient
Correct answer: Airborne precautions in a negative-pressure room with an FFP3 respirator
Mycobacterium tuberculosis is transmitted via airborne droplet nuclei smaller than 5 micrometres that remain suspended in the air for prolonged periods. This requires airborne precautions: a negative-pressure isolation room and an FFP3 (N95-equivalent) respirator for staff entering the room, not a standard surgical mask.
Question 2: What is the correct sequence for DONNING personal protective equipment (PPE) before entering a contact-precaution room?
- Gloves → apron → mask → eye protection
- Mask → eye protection → apron → gloves
- Apron → mask → eye protection → gloves (Correct answer)
- Eye protection → apron → gloves → mask
Correct answer: Apron → mask → eye protection → gloves
The correct donning sequence is: apron/gown first (to protect clothing), then mask/respirator (to protect airways), then eye protection, and gloves last so they cover the cuffs of the apron/gown. This order ensures each item is applied without contaminating the next.
Question 3: A patient presents with profuse, watery diarrhoea and norovirus is suspected. Which infection control measure is MOST important when performing hand hygiene after patient contact?
- Alcohol-based hand rub applied for a minimum of 20 seconds
- Soap and water handwash for a minimum of 40–60 seconds (Correct answer)
- Chlorhexidine-impregnated wipes applied to both hands
- Either soap and water or alcohol gel — both are equally effective against norovirus
Correct answer: Soap and water handwash for a minimum of 40–60 seconds
Norovirus is a non-enveloped virus and is resistant to alcohol-based hand rubs. Soap and water is required because the mechanical action of washing physically removes viral particles from the skin. Alcohol gel alone is insufficient and should not be used as the sole method during norovirus outbreaks.
Question 4: Using the Spaulding classification of medical devices, which item is categorised as 'critical' and therefore requires sterilisation before use?
- A flexible bronchoscope used for diagnostic inspection
- A bedpan used by a patient with a gastrointestinal infection
- A reusable surgical instrument that enters sterile body tissue (Correct answer)
- A blood pressure cuff used on a patient with a wound infection
Correct answer: A reusable surgical instrument that enters sterile body tissue
The Spaulding classification defines 'critical' items as those that enter sterile tissue or the vascular system (e.g., surgical instruments, implants, cardiac catheters). These carry the highest risk of infection transmission and must be sterilised. Flexible endoscopes are 'semi-critical' (requiring high-level disinfection), while blood pressure cuffs and bedpans are 'non-critical'.
Question 5: During an aseptic wound dressing procedure, a nurse accidentally touches the sterile field with a non-sterile gloved hand. What is the CORRECT action?
- Continue the procedure as gloves provide sufficient protection against contamination
- Wipe the contaminated area with a chlorhexidine swab and continue
- Discard all contaminated sterile items and restart the procedure with new sterile equipment (Correct answer)
- Apply alcohol hand rub over the gloves and continue with the dressing
Correct answer: Discard all contaminated sterile items and restart the procedure with new sterile equipment
Once the sterile field has been breached, it is no longer considered sterile regardless of the method used to attempt recovery. The key parts — sterile equipment and the wound bed — must never be directly touched. The only safe course is to discard all contaminated items, reperform hand hygiene, and restart with fresh sterile equipment.
Question 6: A surgical ward has an identified MRSA outbreak. Which decolonisation regimen is recommended by UK Health Security Agency (UKHSA) guidance for MRSA carriers?
- Oral vancomycin for 5 days combined with a chlorhexidine body wash
- Topical 2% mupirocin nasal ointment combined with chlorhexidine gluconate body wash (Correct answer)
- Systemic flucloxacillin for 7 days to eradicate deep tissue carriage
- Topical fusidic acid cream applied to all skin surfaces twice daily for 10 days
Correct answer: Topical 2% mupirocin nasal ointment combined with chlorhexidine gluconate body wash
UKHSA guidelines recommend a 5-day decolonisation course comprising 2% mupirocin nasal ointment applied three times daily (targeting nasal carriage, the most common reservoir) alongside daily 4% chlorhexidine gluconate body and hair wash. Mupirocin resistance is a concern, so throat and perineal swabs may also guide treatment.
NMC CBT - Nursing and Midwifery Council Computer-Based Test Infection Prevention and Control 1
A patient is admitted with confirmed pulmonary tuberculosis.
Which transmission-based precaution must be implemented in addition to standard precautions?