Question 1

A female 36-year-old bank executive was recently promoted to vice president.She and her husband have two school-age children.The patient is being seen at the clinic and reports severe abdominal pain with diarrhea.During the assessment,the patient explains to the health care worker that she and her family will be moving to another state because of her promotion.Her children are upset about leaving their friends.The health care worker recognizes that which of the following information is a priority for patient teaching?

Accepted Answer

An adult experiencing a high level of stress is at a greater risk for accidents and certain stress-related illnesses such as headaches,depression,gastrointestinal disorders,and infections.Although it is important to give the patient information regarding normal stages of growth and development in school-age children; this is not the cause of the symptoms.Referral to a gastroenterologist would occur after stress management techniques have been tried; or symptoms become worse.Calling a moving company does not address the real problem of stress.

Question 2

The nurse is concerned because a 77-year-old patient is weak after abdominal surgery.Which of the following should be done to ensure that one of the preventable conditions identified by the Centers for Medicare and Medicaid does not occur?

Accepted Answer

Providing frequent opportunities to use the bathroom helps prevent pressure ulcers,falls,trauma,and even may help prevent an infection from the insertion of a catheter-all are listed on the preventable conditions.The Centers for Medicare and Medicaid Services (CMS)names select serious reportable events (SREs)as Never Events (adverse events that should never occur in a health care setting)(US Department of Health and Human Services,2008).The CMS now denies payment to hospitals for any hospital-acquired conditions resulting from or complicated by the occurrence of certain Never Events that were not present on admission.Many of the hospital-acquired conditions are nurse-sensitive indicators,meaning that nursing interventions directly affect their development.Whereas the "rights" of medication administration demonstrates safety it does not relate to the preventable conditions identified by CMS,but does relate to the National Patient Safety Goals.Thorough documentation is a legal issue,not a CMS preventable condition.Discharge teaching is not listed on the preventable list and it should not be done quickly.

Question 3

A registered nurse works in a small rural health clinic.During a routine well baby visit,a new mother questions the need to have her infant immunized.Which of the following is the best explanation for why it is recommended that her child receive immunizations?

Accepted Answer

Immunization is the process by which resistance to an infectious disease is produced or increased.A weakened or dead organism and modified toxins from the organism is injected into the body,not a live,strong organism.Immunizations do not definitely keep a child well.Passive immunity occurs when antibodies produced by other people or animals are introduced into a person's bloodstream,whereas active immunity is from a weakened or dead organisms or modified toxins from the organism.

Question 4

In an outpatient surgery center,the preoperative nurse has the responsibility of starting IVs prior to the patients' surgeries.One of the surgeons who works at the center orders a different type of IV fluid than the rest of the surgeons.Which of the following should the nurse be most concerned about in this situation?

Accepted Answer

Procedure-related accidents are caused by health care providers and include medication and fluid administration errors,improper application of external devices,and improper performance of procedures such as dressing changes.Following an organization's policies and procedures and standards of nursing practice helps prevent procedure-related accidents.Patient-inherent accidents are those in which a patient is the primary reason for the accident.The primary issue is a procedure-related accident because of the surgeon's use of a different type of IV,which could cause the nurse to improperly administer the medication; it is not an electrolyte imbalance or confusion.Electrolyte imbalance and confusion from medications are all potential issues that are out of the nurse's control.

Question 5

A patient is confused and has been restrained to prevent injury.Which of the following is a priority as the nurse plans care for the shift?

Accepted Answer

Assess proper placement of restraint,skin integrity,pulses,temperature,color,and sensation of the restrained body part.Remove restraints at least every 2 hours or more frequently as determined by agency policy.If patient is violent or noncompliant,remove one restraint at a time and/or have other staff present while removing restraints.Chemical restraints are medications,such as anxiolytics and sedatives,used to manage a patient's behavior and are not a standard treatment for a patient's condition.Always attempt restraint alternatives before using a restraint.If a restraint is needed,always use the least restrictive device.Checking restrained patients last is not appropriate.Legislation emphasizes reducing the use of restraints.The Joint Commission and Centers for Medicare and Medicaid Services enforce standards for the safe use of restraint devices.

Question 6

A nursing student is undergoing a community health clinical rotation.One of the patients is a 53-year-old grandmother who has recently assumed custody of her daughter's two young children,ages 3 and 5 years old.Regarding the children's welfare,which of the following is most important for the nursing student to assess on this visit?

Accepted Answer

Some patients are unaware of safety precautions,such as keeping medicine,poisonous plants,or other poisons away from children or reading the expiration date on food products.A nursing assessment will identify the patient's level of knowledge regarding home safety so that safety problems can be corrected with an individualized care plan.Although the other responses are important,they are not the focus of home safety issues,but financial and emotional aspects of care.

Question 7

The nurse identifies that one of the IV pumps has been malfunctioning and was placed outside a patient room until it could be repaired.To prevent an equipment-related accident from occurring,which action should the nurse take first?

Accepted Answer

Initiating the work order on the pump is important,but the first priority is to tag and remove the pump from service.Leaving the pump in the equipment closet could allow the pump to mistakenly be put back into service without be fixed.It is not the nurse's job to call the pump manufacturer to report the issues.Accidents that are equipment related result from the malfunction,disrepair,or misuse of equipment or from an electrical hazard.To avoid accidents,do not operate medical equipment without adequate instruction.If you discover a faulty piece of equipment,replace it with the proper working equipment,place a tag on the faulty one,take it out of service and promptly report any malfunctions.

Question 8

All hospital employees are concerned about the safety of patients in the hospital,especially regarding the transmission of pathogens.What is the most common means of transmission of pathogens in this environment?

Accepted Answer

A pathogen is any microorganism capable of producing an illness.The most common means of transmission of pathogens is by the hands.Pathogens are also transmitted through a human's blood and body fluids and by insects (e.g.,mosquitoes carrying malaria)and rodents.Although the other responses could spread pathogens,the most correct answer and most common method is insufficient hand hygiene.

Question 9

A nurse is giving anticipatory guidance to the mother of a 10-month-old child.The nurse is focusing on providing a safe environment for the child.Which of the following is the best statement regarding childhood safety?

Accepted Answer

Injuries,not contagious diseases,are a major cause of death during infancy,especially for children 6 to 12 months old.The leading causes of injury to infants are falls,ingestion injuries (poison,foreign body ingestion,and medication),and burns.Aspiration often occurs from the ingestion of foreign material such as small toys and food items.The question is asking for a safe environment assessment and childhood safety; measles is an illness/disease caused by a pathogen and does not relate to providing a safe environment or information about childhood safety.All infants and toddlers should ride in a rear-facing car safety seat until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer of the car seat.

Question 10

The registered nurse from the home health agency is performing an initial assessment on a 72-year-old patient who was released from a nursing home.The patient had been admitted to the nursing home for therapy after surgery for repair of a fractured left hip.During a survey of the home environment,which finding would cause the nurse to intervene?

Accepted Answer

Common physical hazards that lead to falls in the home include inadequate lighting,barriers along normal walking paths and stairways,and a lack of safety devices.All other answers do not indicate a safety risk to the home.

Question 11

A patient who underwent surgery for a bowel obstruction yesterday has become confused and has made several attempts to climb out of bed.The nurse is considering options to prevent the patient from harm.Which of the following actions could be delegated to assistive nursing personnel working with the nurse?

Accepted Answer

The skill of applying a restraint can be delegated to trained nursing assistive personnel.However,the nurse is responsible for assessing a patient's behavior,determining the need for restraint,the type of restraint to use,and performing patient assessments while restraints are in place.Patients,who are confused,disoriented,or who repeatedly fall or try to remove medical devices (e.g.,IV lines or dressings)may require the temporary use of restraints to keep them safe.Restraints are not a solution to a patient problem but rather a temporary means to maintain patient safety.All alternatives must be used before placing patients in restraints.Performing an assessment,obtaining orders from the physician and including the family in the discussion of why restraints are necessary are all jobs that cannot be delegated to a nursing assistive personnel (NAP); and must be performed by the nurse.

Question 12

Of the following,who is most at risk for accidental poisoning?

Accepted Answer

In the home,accidental poisoning is a greater risk for the toddler,preschooler,and young school-age child,who often ingest household cleaning solutions,medications,or personal hygiene products.Two of the responses have the word supervised in the response,which makes them incorrect for an accidental poisoning.The response which has the child's age of 2 months decreases the chance of accidental poisoning due to lack of coordination and dexterity (a 2-month-old cannot open a closed medication bottle).

Question 13

A student nurse has been asked by the registered nurse with whom the student nurse is working to apply wrist restraints to a patient who is confused and is trying to remove the endotracheal tube.The student nurse knows that it is important to tie the restraints to which part of the bed?

Accepted Answer

Attach restraint straps to the portion of the bed frame that moves when raising or lowering the head of the bed.Do not attach to the side rails.Attaching the restraint straps to a portion of the bed frame that does not move (headboard or footboard)will injure the patient.

Question 14

An 85-year-old retired man with arthritis has recently been prescribed a new medication by his health care provider for pain management.The health care provider identifies that the patient is currently taking 13 different medications on a daily basis.The health care provider is concerned about the patient's safety in the home.Which of the following is most important to assess?

Accepted Answer

The physiological changes associated with aging (85 years old),effects of multiple medications (13 different medications),psychological factors,and acute or chronic disease (arthritis)increase the older adult's risk for falls and other types of accidents.Fear of falling is common among community-dwelling older adults,who both do and do not have a history of falling.As a result of their fear,many older adults avoid activities or change the way in which they walk and position themselves,making them more at risk for falling.It is important to learn what conditions increase a person's fear of falling so that steps can be taken to remove or change any hazards in the home.Marital status and cultural beliefs are not priority assessment issues for home safety.Skin breakdown could occur if the patient was immobile but this is not the priority home safety issue for this patient and there is no data in the question to indicate the patient is immobile.

Question 15

A 16-year-old patient is being seen in the emergency department (ED)after being involved in a minor motor vehicle accident.The guardian has voiced that the patient has been spending more time in his or her room,has difficulties getting along with friends,and has declining grades over the past 3 months.The patient seems distant and angry all the time.Which of the following topics is most important for the nurse to discuss with the guardian?

Accepted Answer

To assess for possible substance abuse,have parents look for environmental and psychosocial clues.Environmental clues include the presence of drug-oriented magazines,beer and liquor bottles,drug paraphernalia,blood spots on clothing,and the continual wearing of long-sleeved shirts in hot weather and dark glasses indoors.Psychosocial clues include failing grades,change in dress,increased absenteeism from school,isolation,increased aggressiveness,and changes in interpersonal relationships.Fatal crash rates for teens are high largely because of their immaturity combined with driving inexperience.Accident prevention measures,a defensive driving course,and automobile insurance are not the most important topics.Accident prevention,defensive driving,and insurance will not be effective if substance abuse is not addressed.

Question 16

The parent of a 13-year-old boy is concerned because the teenager wants to hang out with friends all the time and has stated that he wants to get his ear pierced because all his friends have piercings.What is the best response from the nurse?

Accepted Answer

As children enter adolescence,they develop greater independence and a sense of identity.The adolescent begins to separate emotionally from the family,and the peer group begins to have a stronger influence.To relieve the tensions associated with the physical and psychosocial changes,as well as peer pressure,adolescents often engage in risk-taking behaviors such as smoking,drinking alcohol,and using drugs.This increases the risk for accidents such as drowning and motor vehicle accidents.Counseling and finding new friends are not needed because the boy is demonstrating normal signs of development.Adolescence does not quickly pass.

Question 17

A nursing student is volunteering with a local agency to help prepare the community for a potential bioterrorist attack.On which of the following threats would be the nursing student's primary focus?

Accepted Answer

A new potential environmental health threat is the possibility of a bioterrorist attack.Threats of this type come in the form of biological,chemical,and radiological attacks.Bioterrorism,or the use of biological agents to create fear and threat,is the most likely form of a terrorist attack to occur.The other responses (hurricane,earthquake,and tornado)are classified as natural disasters.

Question 18

A 5-year-old child was admitted to the pediatric unit of the hospital with the diagnosis of fever of unknown origin.Currently the patient's temperature is 105° F.Which of the following is the best way to prevent a patient-inherent accident from occurring?

Accepted Answer

One of the more common precipitating factors for a patient-inherent accident is a seizure.Place patients with a seizure disorder on seizure precautions,which are designed to protect patients when seizures occur.Keeping electric receptacles and cleaning up patient spills,and not allowing the child to play in the playroom are all extrinsic factors that are environmentally related and include room clutter,loose electrical cords,and spills.

Question 19

The patient has recently moved into a newly renovated home in the inner city.The patient is being seen in the clinic for complaints of ongoing headaches,nausea,dizziness and fatigue.The symptoms started shortly after moving into the new home.As the nurse gathers information,which of the following questions would be most appropriate to ask the patient?

Accepted Answer

A furnace,stove,or fireplace that is not properly vented introduces carbon monoxide into the environment.This gas binds strongly with hemoglobin; preventing the formation of oxyhemoglobin and thus reducing the supply of oxygen delivered to the tissues.Low concentrations cause nausea,dizziness,headache,and fatigue.The importance of having a proper working smoke detector will decrease the chance of smoke inhalation and potential death owing to a fire but does not produce the symptoms listed.A balanced diet and proper storage of food is essential to decrease the chance of infection to the gastrointestinal system but does not produce the symptoms listed.Painting would not produce the symptoms listed even if the paint is old and contains lead as it must be ingested.

Question 20

A 75-year-old patient in an acute care hospital who underwent surgery for an abdominal aneurysm developed a urinary tract infection 3 days after placement of a Foley catheter.The nurse believes that this is a reportable incident,and which of the following will happen as a result?

Accepted Answer

The Centers for Medicare and Medicaid Services (CMS)names select serious reportable events (SREs)as Never Events (adverse events that should never occur in a health care setting)(US Department of Health and Human Services,2008).The CMS now denies payment to hospitals for any hospital-acquired conditions resulting from or complicated by the occurrence of certain Never Events that were not present on admission.Many of the hospital-acquired conditions are nurse-sensitive indicators,meaning that nursing interventions directly affect their development.Medicare is not denied to the patient and this is a reportable incident.Medicare does not take hospitals to court; it just denies payment for the Never Event.

Quiz 28: Safety