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DHA Allied Health Exam study materials
DHA Allied Health Exam study resources

DHA Allied Health Exam practice questions

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Question 1Patient Safety and Quality of Care

A patient is found on the floor next to the bed after attempting to get up alone. Which action should the health worker take first?

  1. Notify the charge nurse by phone
  2. Assess the patient for injury before moving them Correct answer.
  3. Document the event in the incident log
  4. Help the patient back into bed immediately

Explanation

After any fall, the priority is to assess for injury before any movement, since moving a patient with an occult fracture or head injury can worsen harm. Documentation and notification follow clinical assessment.

Question 2Patient Safety and Quality of Care

Which practice is the single most effective routine measure for preventing healthcare-associated infection transmission?

  1. Hand hygiene at the recommended moments Correct answer.
  2. Using alcohol wipes on equipment between shifts
  3. Wearing gloves for every patient contact
  4. Isolating every patient with a fever

Explanation

Hand hygiene at the WHO-recommended moments is the cornerstone of infection prevention and applies to all patient contact, with or without gloves. Gloves do not replace hand hygiene and equipment cleaning is complementary.

Question 3Patient Safety and Quality of Care

Before administering a medication, the nurse confirms the patient's identity. Which identifier set is acceptable?

  1. The patient's diagnosis and attending physician
  2. The patient's room number and bed position
  3. The patient's full name and date of birth Correct answer.
  4. The patient's insurance number and ward

Explanation

Safe identification requires two independent patient-specific identifiers, most commonly full name plus date of birth or medical record number. Location and diagnosis are not unique to the individual.

Question 4Patient Safety and Quality of Care

A health worker sustains a needlestick injury from a used needle. Which action should be taken first?

  1. Wash the site with soap and water and report immediately Correct answer.
  2. Apply a tight tourniquet above the injury
  3. Squeeze the wound firmly to express blood
  4. Wait for the source patient's blood results before acting

Explanation

Immediate washing of the wound with soap and water, followed by prompt reporting, allows timely post-exposure prophylaxis assessment. Delaying action until source results are available wastes the window for prophylaxis.

Question 5Patient Safety and Quality of Care

Which statement best describes the purpose of a root cause analysis after a serious safety event?

  1. To identify system failures that contributed to the event Correct answer.
  2. To satisfy insurance reporting requirements
  3. To determine which staff member should be disciplined
  4. To calculate the financial cost of the event

Explanation

Root cause analysis is a systems-focused method that looks beyond individual blame to find underlying process and system failures. Its aim is to prevent recurrence through redesign, not to assign individual fault.

Question 6Patient Safety and Quality of Care

A patient with a known penicillin allergy is prescribed amoxicillin. What is the most appropriate immediate action?

  1. Hold the drug and clarify the order with the prescriber Correct answer.
  2. Give half the dose as a test
  3. Administer the drug and monitor closely
  4. Ask the patient whether they want the drug

Explanation

A documented allergy to a drug class is a contraindication; the safe response is to withhold the medication and clarify with the prescriber. Administering or test-dosing an allergen risks a severe reaction.

Question 7Patient Safety and Quality of Care

Which element is essential for informed consent to be valid?

  1. The patient's family agreeing with the plan
  2. The patient understanding the risks, benefits, and alternatives Correct answer.
  3. The procedure being scheduled within 24 hours
  4. The consent form being signed by two witnesses

Explanation

Valid informed consent requires that the patient be informed of risks, benefits, and alternatives and voluntarily agrees. Witnesses and timing do not substitute for the patient's understanding and voluntariness.

Question 8Patient Safety and Quality of Care

A patient is at high risk for pressure injury. Which nursing intervention most directly prevents tissue breakdown?

  1. Repositioning the patient on a regular schedule Correct answer.
  2. Increasing dietary sodium
  3. Keeping the head of bed elevated at 45 degrees at all times
  4. Massaging reddened bony prominences

Explanation

Regular repositioning relieves sustained pressure over bony prominences, the key modifiable cause of pressure injury. Massaging reddened areas and prolonged high head-of-bed elevation increase risk.

Question 9Patient Safety and Quality of Care

Which of the following is a recognized safety practice for high-alert medications?

  1. Administering them only during night shifts
  2. Independent double-check before administration Correct answer.
  3. Storing them in unmarked containers
  4. Preparing them at the bedside without labels

Explanation

High-alert medications carry a heightened risk of serious harm, so an independent double-check by a second qualified person is a standard safeguard. Unlabeled or unmarked handling increases error risk.

Question 10Patient Safety and Quality of Care

A health worker notices a colleague repeatedly skipping hand hygiene before patient contact. What is the most appropriate first step?

  1. Report the colleague to the licensing authority immediately
  2. Speak with the colleague directly and respectfully about the observation Correct answer.
  3. Ignore it to avoid conflict
  4. Discuss it with other staff in the break room

Explanation

The first step in addressing a safety concern among colleagues is direct, respectful feedback focused on the behavior and patient risk. Escalation and gossip are inappropriate first responses.

Question 11Patient Safety and Quality of Care

Which measure best reflects the goal of a surgical safety checklist?

  1. Shortening operating room turnover
  2. Reducing documentation time for surgeons
  3. Standardizing key verification steps before and after procedures Correct answer.
  4. Replacing the need for informed consent

Explanation

Surgical safety checklists standardize critical communication and verification steps, such as site and patient confirmation, at defined points in the procedure. They complement rather than replace consent and clinical judgment.

Question 12Patient Safety and Quality of Care

A patient with limited English proficiency needs to consent to a procedure. Which approach is most appropriate?

  1. Use a trained medical interpreter Correct answer.
  2. Ask a bilingual family member to interpret
  3. Use gestures and simple words
  4. Proceed without interpretation if the patient nods

Explanation

Trained medical interpreters ensure accurate communication and protect against errors and confidentiality breaches. Relying on family members or gestures risks misunderstanding and invalidates informed consent.

Question 13Patient Safety and Quality of Care

Which of the following is a key principle of safe patient handling?

  1. Using mechanical lifts and assistive devices when indicated Correct answer.
  2. Bending at the waist to reach low surfaces
  3. Lifting patients manually whenever equipment is unavailable
  4. Twisting the torso while moving a patient

Explanation

Safe patient handling emphasizes using mechanical lifts and assistive devices to reduce musculoskeletal injury to both staff and patients. Manual lifting and awkward postures increase injury risk.

Question 14Patient Safety and Quality of Care

A medication error occurs but causes no harm to the patient. How should this be classified?

  1. A no-harm event that should still be reported Correct answer.
  2. An unavoidable consequence of care
  3. A sentinel event requiring immediate media notification
  4. A near miss requiring no documentation

Explanation

A no-harm event is still a reportable safety event because reporting supports learning and prevention of future harm. Near misses and no-harm events are valuable sources of system improvement.

Question 15Patient Safety and Quality of Care

Which practice reduces the risk of wrong-site surgery?

  1. Confirming the site only after incision
  2. Relying on memory of the surgical schedule
  3. Marking the site with the patient involved before the procedure Correct answer.
  4. Delegating site verification to a single team member

Explanation

Preoperative site marking with the patient involved, combined with team verification, is a core wrong-site prevention practice. Verification should be a team process occurring before the procedure begins.

Question 16Patient Safety and Quality of Care

A patient's oxygen saturation is falling and the nurse is unsure of the appropriate response. Which action demonstrates appropriate clinical escalation?

  1. Use an established escalation protocol to summon help Correct answer.
  2. Document the finding and continue monitoring
  3. Wait until the next scheduled round to report
  4. Adjust the oxygen without informing anyone

Explanation

Escalation protocols, such as early warning systems, exist so staff can summon timely help when a patient deteriorates. Waiting or acting silently delays definitive care.

Question 17Patient Safety and Quality of Care

Which of the following best describes a just culture in healthcare?

  1. Punishing all errors equally to deter recurrence
  2. Blaming individuals for every adverse outcome
  3. Balancing accountability with a non-punitive approach to system errors Correct answer.
  4. Eliminating all reporting to protect staff

Explanation

A just culture distinguishes between human error, at-risk behavior, and reckless conduct, supporting learning while maintaining accountability. It does not eliminate reporting or treat all errors identically.

Question 18Patient Safety and Quality of Care

A confused patient repeatedly attempts to climb out of bed. Which intervention is the least restrictive appropriate first measure?

  1. Sedating the patient to prevent movement
  2. Closing the door to reduce stimulation
  3. Placing the bed in the lowest position with a bed alarm Correct answer.
  4. Applying wrist restraints without an order

Explanation

Least restrictive measures, such as a low bed and alarm, should be tried before restraints, which require a specific order and monitoring. Sedation and unmonitored restraint use raise ethical and safety concerns.

Question 19Patient Safety and Quality of Care

Which of the following is an example of a never event?

  1. A mild rash from a new medication
  2. A patient requesting a different meal
  3. A delayed discharge due to transport
  4. Surgery performed on the wrong limb Correct answer.

Explanation

Never events are serious, largely preventable incidents such as wrong-site surgery that should not occur in safe care. Minor reactions and logistical delays are not classified as never events.

Question 20Patient Safety and Quality of Care

A health worker is asked to perform a task outside their scope of practice. What is the most appropriate response?

  1. Perform the task under informal supervision
  2. Perform the task to avoid delaying care
  3. Decline and refer the task to a qualified colleague Correct answer.
  4. Ask a student to perform the task instead

Explanation

Working within one's scope of practice protects patients and the worker; tasks outside that scope should be declined and referred to a qualified professional. Performing them, even under informal supervision, creates risk.

Question 21Patient Safety and Quality of Care

Which of the following is the best example of a process measure for quality improvement?

  1. The number of patient deaths in a year
  2. The percentage of patients who received a fall-risk assessment on admission Correct answer.
  3. The hospital's annual revenue
  4. The average length of stay

Explanation

Process measures assess whether recommended care was delivered, such as completion of a fall-risk assessment. Outcome measures, like mortality or length of stay, reflect results rather than the delivery of care.

Question 22Patient Safety and Quality of Care

Which action best supports patient-centered care during a bedside handover?

  1. Using abbreviations to save time
  2. Conducting handover away from the patient to protect privacy
  3. Involving the patient in confirming their care plan Correct answer.
  4. Excluding the patient to avoid confusion

Explanation

Bedside handover that includes the patient supports transparency, accuracy, and patient engagement in their own care. Excluding the patient or using unclear abbreviations undermines these goals.

Question 23Patient Safety and Quality of Care

A patient reports severe chest pain. Which response reflects appropriate prioritization?

  1. Ask the patient to wait until the next assessment
  2. Assess and escalate the chest pain immediately Correct answer.
  3. Document the complaint for the physician to review later
  4. Finish the scheduled medication round first

Explanation

Chest pain is a potentially life-threatening symptom requiring immediate assessment and escalation. Task completion and routine documentation should not delay response to a red-flag complaint.

Question 24Patient Safety and Quality of Care

Which of the following best describes the role of a morbidity and mortality conference?

  1. To assign blame for adverse outcomes
  2. To determine staffing levels
  3. To review adverse outcomes and identify learning points Correct answer.
  4. To evaluate staff salaries

Explanation

Morbidity and mortality conferences review adverse outcomes to identify system and clinical learning opportunities in a confidential forum. Their purpose is education and improvement, not blame or administrative decisions.

Question 25Patient Safety and Quality of Care

A patient is prescribed a new anticoagulant. Which monitoring practice best supports medication safety?

  1. Checking for interactions and monitoring relevant laboratory values Correct answer.
  2. Relying on the patient to remember previous reactions
  3. Administering the drug without reviewing the chart
  4. Skipping the dose if the patient is asleep

Explanation

Anticoagulants carry bleeding risk, so reviewing for interactions and monitoring relevant laboratory values supports safe use. Skipping doses or bypassing chart review increases the risk of harm.

Question 26Patient Safety and Quality of Care

Which of the following is the most reliable method for preventing central line-associated bloodstream infections (CLABSI)?

  1. Administering prophylactic antibiotics before insertion
  2. Changing the central line dressing every 24 hours
  3. Using maximal sterile barrier precautions during insertion Correct answer.
  4. Flushing the line with heparin every 8 hours

Explanation

Maximal sterile barrier precautions (cap, mask, sterile gown, sterile gloves, and full-body drape) during central line insertion are a core evidence-based practice to prevent CLABSI. Routine dressing changes and heparin flushes do not primarily prevent infection, and prophylactic antibiotics are not recommended due to resistance risk.

Question 27Patient Safety and Quality of Care

A nurse is preparing to administer a high-alert medication via infusion pump. Which action is most important to prevent a programming error?

  1. Relying on the pharmacy label alone for rate calculation
  2. Double-checking the dose calculation with a second nurse Correct answer.
  3. Programming the pump quickly to save time
  4. Using a standard infusion pump without a drug library

Explanation

Independent double-checks by two qualified staff are a key safety practice for high-alert medications, reducing the risk of programming and calculation errors. Using a pump without a drug library removes an important safety barrier, and speed or reliance on a single source increases error risk.

Question 28Patient Safety and Quality of Care

Which of the following is the best example of a structural measure in quality improvement?

  1. The average length of stay for patients with pneumonia
  2. The rate of surgical site infections after colorectal surgery
  3. The percentage of patients who received aspirin on arrival for chest pain
  4. The number of registered nurses per patient bed in a unit Correct answer.

Explanation

Structural measures assess the resources and infrastructure of care, such as staffing ratios, equipment, and organizational policies. Process measures (like aspirin administration) and outcome measures (like infection rates or length of stay) evaluate care delivery and results, not structure.

Question 29Patient Safety and Quality of Care

A patient with a do-not-resuscitate (DNR) order develops respiratory distress. Which action is most appropriate?

  1. Initiate full resuscitation
  2. Withhold all comfort measures
  3. Provide comfort-focused care and reassess the patient's goals Correct answer.
  4. Transfer the patient to the intensive care unit immediately

Explanation

A DNR order typically means no cardiopulmonary resuscitation, but it does not preclude other treatments, including comfort measures and symptom management. Care should align with the patient's expressed goals and current condition, often involving palliative interventions.

Question 30Patient Safety and Quality of Care

Which of the following is a key component of a root cause analysis (RCA) after a sentinel event?

  1. Identifying individual staff to discipline
  2. Focusing solely on the event's outcome
  3. Examining system factors that contributed to the event Correct answer.
  4. Limiting the analysis to the unit where the event occurred

Explanation

Root cause analysis is a systematic process that seeks to identify underlying system vulnerabilities and processes that contributed to an adverse event, rather than blaming individuals. The goal is to prevent recurrence by addressing system factors.

Question 31Patient Safety and Quality of Care

A patient is admitted with a new diagnosis of heart failure and has limited health literacy. Which strategy best supports patient education?

  1. Assuming the patient understands if they nod
  2. Providing a detailed written handout at discharge
  3. Using teach-back to confirm understanding Correct answer.
  4. Speaking quickly to cover all key points

Explanation

The teach-back method asks patients to explain information in their own words, confirming comprehension and allowing the educator to clarify misunderstandings. This is especially important for patients with limited health literacy.

Question 32Patient Safety and Quality of Care

Which of the following is the most appropriate first action when a patient is identified as a fall risk?

  1. Apply physical restraints immediately
  2. Place the patient in a room far from the nurses' station
  3. Implement a bed alarm and keep the call light within reach Correct answer.
  4. Encourage the patient to walk without assistance

Explanation

For fall prevention, less restrictive interventions such as bed alarms, keeping personal items within reach, and frequent rounding should be implemented first. Physical restraints are a last resort and require a physician order and monitoring.

Question 33Patient Safety and Quality of Care

Which of the following best describes the purpose of a failure mode and effects analysis (FMEA)?

  1. To proactively identify and mitigate risks in a process Correct answer.
  2. To discipline staff involved in errors
  3. To compare outcomes between different hospitals
  4. To investigate a sentinel event after it occurs

Explanation

FMEA is a proactive risk assessment tool used to identify potential failures in a process and prioritize actions to reduce their likelihood or impact before harm occurs. It differs from reactive methods like root cause analysis.

Question 34Patient Safety and Quality of Care

A nurse notices a small fire in a patient's room. Which action should the nurse take first?

  1. Attempt to extinguish the fire
  2. Activate the fire alarm
  3. Rescue the patient from immediate danger Correct answer.
  4. Close all doors to contain smoke

Explanation

The RACE acronym prioritizes Rescue of patients in immediate danger, then Alarm activation, Containment (closing doors), and Extinguishing or Evacuation. Rescue comes first to protect lives.

Question 35Patient Safety and Quality of Care

Which of the following is a key principle of medication reconciliation at hospital discharge?

  1. Comparing the patient's pre-admission medication list with discharge orders Correct answer.
  2. Relying solely on the patient's memory of their medications
  3. Having the pharmacist perform reconciliation without nurse involvement
  4. Discontinuing all home medications to avoid interactions

Explanation

Medication reconciliation is the process of comparing a patient's current medication regimen with newly prescribed medications to identify discrepancies and prevent errors. It requires a comprehensive review, often involving multiple providers and the patient.

Question 36Patient Safety and Quality of Care

Which of the following best describes the concept of 'speaking up' in patient safety?

  1. Voicing concerns about unsafe practices or potential errors Correct answer.
  2. Deferring all safety concerns to management
  3. Avoiding conflict by remaining silent
  4. Reporting errors only after they cause harm

Explanation

Speaking up refers to the willingness of healthcare workers to voice concerns about safety issues, such as unsafe practices or potential errors, to prevent harm. It is a cornerstone of a safety culture.

Question 37Patient Safety and Quality of Care

A patient with a history of clostridium difficile infection is placed in contact precautions. Which of the following is the most important action for healthcare workers?

  1. Using alcohol-based hand rub after glove removal
  2. Placing the patient in a negative pressure room
  3. Wearing gloves and a gown for all patient contact Correct answer.
  4. Sharing equipment between patients to save time

Explanation

Contact precautions require wearing gloves and a gown for all contact with the patient and their environment to prevent transmission of C. difficile. Hand hygiene with soap and water is preferred after glove removal because alcohol does not reliably kill C. difficile spores.

Question 38Patient Safety and Quality of Care

Which of the following is an example of an active failure in a system safety model?

  1. Inadequate staffing levels
  2. A nurse administers the wrong medication Correct answer.
  3. Lack of a barcode scanning system
  4. Poor lighting in a medication room

Explanation

Active failures are unsafe acts by individuals at the point of care, such as administering a wrong medication. Latent conditions are underlying system weaknesses (like inadequate staffing or poor lighting) that can contribute to active failures.

Question 39Patient Safety and Quality of Care

Which of the following is the most appropriate way to dispose of a used sharp?

  1. Break the needle off and discard it in a biohazard bag
  2. Recap the needle and place it in a regular trash bin
  3. Place it immediately in a puncture-resistant sharps container Correct answer.
  4. Leave it on the tray for the next shift to handle

Explanation

Used sharps should be disposed of immediately in a designated puncture-resistant sharps container to prevent needlestick injuries. Recapping, breaking, or leaving sharps unattended increases the risk of injury.

Question 40Patient Safety and Quality of Care

A patient is receiving a blood transfusion and develops fever, chills, and flank pain. What is the nurse's priority action?

  1. Stop the transfusion and maintain intravenous access Correct answer.
  2. Slow the transfusion rate and continue monitoring
  3. Administer an antipyretic and continue the transfusion
  4. Document the reaction and notify the provider at the end of the shift

Explanation

Signs of a possible acute hemolytic transfusion reaction require immediate cessation of the transfusion to prevent further harm, while maintaining IV access for emergency treatment. The provider and blood bank should be notified promptly.

Question 41Infection Prevention and Control

What is the single most effective routine measure for preventing transmission of healthcare-associated pathogens between patients?

  1. Changing uniforms after each shift
  2. Disinfecting the floor of the ward daily
  3. Wearing gloves for every patient contact
  4. Performing hand hygiene at the correct moments Correct answer.

Explanation

Hand hygiene at the WHO-defined moments removes transient organisms acquired from patients and the environment and interrupts the main route of cross-transmission via healthcare workers' hands. Gloves, environmental cleaning, and uniforms have roles but do not replace hand hygiene as the primary intervention.

Question 42Infection Prevention and Control

A nurse's hands are visibly soiled with blood after dressing a wound. Which hand hygiene method is appropriate?

  1. Alcohol rub followed by a water rinse
  2. Alcohol-based hand rub applied until dry
  3. Hand wipe with a dry paper towel
  4. Soap and water washing Correct answer.

Explanation

When hands are visibly soiled or contaminated with blood or body fluids, soap and water must be used because alcohol rubs are inactivated by organic material and do not physically remove it. Alcohol-based rubs are reserved for hands that are not visibly soiled.

Question 43Infection Prevention and Control

Which of the following is a standard precaution that applies to all patients regardless of diagnosis?

  1. Placing every patient in a negative-pressure room
  2. Using gloves and gowns for all patient contact
  3. Treating all blood and body fluids as potentially infectious Correct answer.
  4. Screening all visitors for respiratory symptoms

Explanation

Standard precautions are based on the principle that all blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes may carry transmissible agents. They are applied universally and include hand hygiene, PPE as indicated by risk, and safe handling of sharps.

Question 44Infection Prevention and Control

Which transmission-based precaution is required for a patient with suspected pulmonary tuberculosis?

  1. Droplet precautions
  2. Contact precautions
  3. Airborne precautions Correct answer.
  4. No additional precautions

Explanation

Mycobacterium tuberculosis is spread by airborne droplet nuclei that remain suspended and travel on air currents, so airborne precautions with a negative-pressure room and fitted N95 or equivalent respirator are required. Droplet precautions apply to larger droplets that fall out of the air quickly.

Question 45Infection Prevention and Control

What is the correct sequence for safely removing personal protective equipment after caring for a patient on contact precautions?

  1. Remove gloves, then gown, then perform hand hygiene, then remove mask Correct answer.
  2. Remove mask first, then gloves, then gown, then hand hygiene
  3. Remove gloves, then mask, then gown, then hand hygiene
  4. Remove gown, then mask, then gloves, then hand hygiene

Explanation

Gloves are removed first because they are the most contaminated, followed by the gown, with hand hygiene before touching the face or removing a mask. This sequence minimizes contamination of skin and mucous membranes during doffing.

Question 46Infection Prevention and Control

A patient is admitted with Clostridioides difficile diarrhea. Which measure is essential in addition to contact precautions?

  1. Use of alcohol-based hand rub alone after patient contact
  2. Airborne precautions with a negative-pressure room
  3. Restricting all visitors from entering the room
  4. Soap and water hand washing because alcohol does not reliably kill spores Correct answer.

Explanation

C. difficile spores are not reliably inactivated by alcohol, so soap and water washing with mechanical action is required to remove spores from hands. Contact precautions with gown and gloves and sporicidal environmental cleaning are also used.

Question 47Infection Prevention and Control

Which organism is the most common cause of catheter-associated urinary tract infections in hospitalized patients?

  1. Mycobacterium tuberculosis
  2. Staphylococcus aureus
  3. Clostridioides difficile
  4. Escherichia coli Correct answer.

Explanation

Escherichia coli is the most frequent pathogen in catheter-associated urinary tract infections, often followed by other Enterobacterales and enterococci. The urinary catheter provides a surface for biofilm formation and a route for ascending colonization.

Question 48Infection Prevention and Control

Which strategy is most effective for preventing central line-associated bloodstream infections?

  1. Changing the dressing only when the patient requests it
  2. Routine replacement of central catheters every 72 hours
  3. Daily review of catheter necessity and prompt removal Correct answer.
  4. Routine systemic antibiotic prophylaxis during catheter use

Explanation

Daily assessment of whether a central line is still needed and prompt removal when it is not reduces exposure time, which is the strongest modifiable risk factor for CLABSI. Bundled insertion and maintenance practices complement this approach.

Question 49Infection Prevention and Control

What is the purpose of performing surgical hand antisepsis before donning sterile gloves?

  1. To sterilize the skin so no organisms remain
  2. To soften the skin to improve glove fit
  3. To reduce transient and resident flora on the hands for the duration of the procedure Correct answer.
  4. To replace the need for sterile gowns

Explanation

Surgical hand antisepsis reduces both transient and resident skin flora and suppresses regrowth, lowering the risk that organisms from the surgeon's hands enter the surgical site if gloves are punctured. Skin cannot be sterilized, so the goal is sustained reduction rather than elimination.

Question 50Infection Prevention and Control

Which action best prevents needlestick injuries among healthcare workers?

  1. Immediately placing used needles in a puncture-resistant sharps container at the point of use Correct answer.
  2. Recapping needles using two hands
  3. Carrying used needles to a central disposal area at the end of the shift
  4. Bending needles before disposal to save space

Explanation

Immediate disposal of sharps in a puncture-resistant container located close to the point of use eliminates handling and transport, which are major contributors to needlestick injury. Recapping and bending needles are specifically discouraged.