Chapter 10 study guide

SRDs

Safety reminder devices

The nurse is giving instructions to the UAP about patient safety and fall prevention. What would the nurse tell the UAP about helping the older adult patient to go to the bathroom?

"Have her put on her glasses before getting up."

A mother brings her alert and playful child to the clinic because she "found him playing with this empty bottle of baby aspirin." Which question is the most important to ask the mother?

"How many pills do you think were in the container?"

Which instructions would be given to the UAP who is assigned to assist in the care of a patient who is being treated with internal radiation?

"Wear your personal dosimeter during care or when handling patient items"

The nurse is conducting a fall risk assessment on an older adult patient who is moving into an assisted living center. Which questions would the nurse ask? Select all that apply

1. "Have you had any falls in the past year?" 2. "Do you feel unsteady when you stand up?" 3. "Are you able to independently walk from room to room?" 4. "What medications are you taking?" 5. "Do you use a cane or other assistive device?"

The nurse is preparing to give an IM injection to a patient. What factors would increase the risk of needlestick injury to the nurse? Select all that apply

1. Applying a band-aid to the injection site immediately after administering injection 2. Using a new type of safety device injection system 3. Recapping the needle after the injection 4. Cleansing the skin with an alcohol swab after uncapping the needle

The older adult residents in a nursing home must be evacuated because the facility is at risk for flooding and damage due to a hurricane that will pass through the area in several days. The nurse is assigned to keep a log to document the events. Which information is most important to record? Select all that apply

1. How each resident was transported 2. Names of residents 3. Where the residents were sent 4. Who transported each resident 5. Notification of family members and HCPs

The nurse is planning to teach a community group about fire safety in the home. Which information would be included in the presentation? Select all that apply

1. No smoking by the patient, family, or visitors in areas where oxygen is used. 2. Install fire alarms, smoke detectors, and carbon monoxide detectors. 3. Practice fire escapes routes from each room and practice exit drills.

The nurse is considering the us of an SRD to a prevent a patient from self-injury. When using an SRD, what would the nurse do? Select all that apply

1. Obtain and order from HCP for the SRD 2. Explain the purpose of the SRD to the patient 3. Explain the purpose of the SRD to the family 4. Exhaust all alternatives before using an SRD

The nurse is reviewing the disaster preparedness plan for a small nursing home. What would be included in the plan? Select all that apply

1. Possible admission to a hospital or transfer to a temporary shelter 2. Log to document residents' names and locations 3. System to notify families and providers 4. Method of patient identification, such as a bracelet or picture ID

The hospitalized patient is confused and has a history of falls. Which action would the nurse take to help avoid the use of SRDs? Select all that apply

1. Review the patient's medication list 2. Use a sitter if needed if family members are not available 3. Use a bed alarm 4. Use relaxation techniques such as massage or music to create a calm atmosphere for the patient

A confused patient is yelling at the UAP. As the nurse enters the room, the patient throws the food tray at the UAP. What would the nurse do first?

Calmly talk to the patient and respectfully address him by name

Before the nurse can intervene, a UAP pushes contaminated material into an overfilled sharps container and sustains a puncture wound. What should the nurse do first?

Assist the UAP to scrub the wound with copious amounts of soap and water

The postoperative patient demonstrates some mild dizziness and mild SOB when moving from sitting to standing position. Which action would the nurse perform first?

Assist the patient to sit back down

The nurse is teaching a new group of UAP how to evacuate residents from a long-term care facility in case of a fire or other emergency. Which item would be needed for the universal carry method?

A blanket

Which occurrence is most likely to be investigated as "sentinel event"?

An older patient sustains a broken arm related to the use of an SRD

The patient reports dizziness when standing up too fast. Which OTC medication is most likely to be contributing to the patient's orthostatic hypotension?

Antihistamine

CDC

Centers for Disease Control and Prevention

For the care of the patient who has an SRD in place, which task can be delegated to a UAP?

Change position every 2 hours

The nurse is caring for a patient who relies on mechanical ventilation. The nurse hears a fire alarm and flames are visible in a back corridor. What would the nurse do first?

Delegate the UAP to move the ambulatory patients toward the exit

In the event of a mercury spill, what is the priority nursing action?

Evacuate everyone from the room

The nurse is talking to a young mother who has an infant who has just started to crawl. Based on knowledge of growth and development, which safety issue is currently the most important to discuss with the mother?

How to manage the electrical sockets and cords

The nurse is working in a local health department and has noted an unusually large number of phone calls about food-borne illness. Which question is the nurse most likely to ask callers to differentiate the possible involvement of the bioterrorist agent that causes botulism from other more common cause of food-borne illness?

In addition to GI symptoms have you had drooping eyelids or difficulty swallowing or speaking?

An infant has a wound with a dressing on the left upper arm. He repeatedly attempts to remove the dressing. Which SRD would the nurse select?

Right elbow SRD

The nurse is sitting at the front desk at a walk-in clinic. A patient comes in and reports fever, malaise, and muscle aches with a rash on the tongue, mouth, and throat. The nurse notes pustules on the patient's palms. What would the nurse do first?

Isolate the patient

A patient with a latex allergy is exposed to latex. Which sign or symptom is cause for the greatest concern?

Laryngeal edema

In which clinic settings is the nurse most likely to need knowledge of how to apply SRDs and manage the care of these patients?

Mental health walk-in clinic

A patient begins to have a grand mal seizure. What is the priority action?

Monitor the patency of the airway

An older adult patient in a long-term care facility has been wandering around outside of the room during the late evening hours. The patient has a history of falls. How would the nurse intervene?

Obtain an order for a bed and chair alarm

OSHA

Occupational Safety and Health Administration

The nurse applies a gait belt to a male patient of average build who has some weakness on the left side. How does the nurse position herself before assisting the patient to ambulate?

On the patient's left side and holding the back of the gait belt

Which newly obtained piece of equipment creates the greatest risk for falls for an older adult?

Prescription lenses

PASS

Pull, Aim, Squeeze, Sweep

The nurse notices smoke coming from the wastebasket in a patient's room. Upon entering the room, the nurse sees a fire that is starting to flare up. What would the nurse do first?

Remove the patient from the room

It is suspected that a patient has been exposed to cyanide gas. The nurse is alert for which symptom?

Respiratory distress

The nurse started a new job in a small LTC facility in a rural area. The back exit hallway is being used as a storage area while a new storage area is being planned. What would the nurse do first?

Review the facility's policies/procedures for emergencies

The patient with mild cognitive impairment is being discharged from the hospital with several new medications. Which action by the nurse would be most effective in reducing the risk of accidental poisoning by medication misuse?

Teach the patient how to use a medication box and reminders

The older adult tells the nurse that he is having trouble reading labels on his medication bottles. What is the best strategy that the nurse could suggest to reduce the risk of an accidental medication error?

Teach the patient to use a medication organizer to manage the medication

RACE

rescue, alarm, contain, extinguish