M. 51 Concept of Safety

h action by a nurse would require immediate intervention by another healthcare team​ member? A. Recapping a needle while holding the cap. B. Disposing of a needle in the sharps container. C. Recapping a needle using the scoop method. D. Recapping a needle with the use of a hemostat.

A When working with used or contaminated​ sharps, nurses will employ extra precautions so as to avoid unnecessary injuries. Needles that have been used will be disposed of in an appropriate sharps container. If sharps do need to be​ recapped, this should be done with the use of another device​ (such as a​ hemostat), or with the scoop method. Nurses should never hold the cap in one hand while trying to guide the tip of the needle into the cap with the otherdashthis method substantially increases the risk of a​ sharp-related injury.

The nurse is providing care to a​ 12-year-old child with special needs and his caregiver. What strategies should the nurse help the caregiver teach the child to improve the​ child's safety? A. Teach the child how to use a telephone to call for help B. Teach the child to schedule routine immunizations C. Teach the child to avoid secondhand smoke exposure D. Teach the child to maintain airway with suctioning

A For children with special​ needs, the caregiver can work with the child to teach the child how to use a telephone to call for help when needed. The other actions are typically the responsibility of the caregiver or require the​ caregiver's help, including scheduling routine​ immunizations, keeping the child away from secondhand​ smoke, and suctioning the airway.

A client asks the nurse if the staff members make many mistakes because there are so many posters and signs about safety on the walls. Which response by the nurse is​ best? A. ​"You don't need to worry about posters on the wall. Our primary concern is getting you​ well." B. ​"There is a potential for errors in all healthcare settings. The posters remind the staff and the clients of the need to work together to prevent​ them." C. ​"We never make mistakes here. We want the public to know that we have client safety goals​ here." D. ​"The nurses here are safe. The posters are directed at certain members of the healthcare team who have been making more mistakes than​ usual.

B

A hospital has had higher than average reports of client handling and movement injuries. What could the nurse advocate for that could most help reduce the number of client handling​ injuries? A. Hire more nurses B. Keep the clients restricted to bed C. Encourage clients to lose weight D. Purchase lifting devices

D Client handling and movement injuries are one of the leading causes of​ work-related injuries for nurses. Resources such as lifting​ devices, training, and lift teams can potentially reduce the number of occupational injuries of healthcare workers. Keeping the clients stationary would increase complications and slow the healing process. Encouraging clients to lose weight would not reduce injuries. Unless the hospital is​ understaffed, hiring more nurses would not help reduce injuries.​ Instead, nurses need to form lift teams to help reduce injuries.

A client who is living independently but needs skilled nursing services may take advantage of what type of​ healthcare? A. ​Long-term care B. Assisted living C. Telehealth D. Home healthcare

D Home healthcare provides a variety of​ medical, therapeutic, and nonmedical​ services, such as wound​ care, dietary​ counseling, physical​ therapy, occupational​ therapy, skilled nursing​ services, and homemaker services. These services are available in private homes from healthcare professionals. Telehealth would not be adequate for providing skilled nursing services. Assisted living facilities do not typically include skilled nursing services. One aspect of​ long-term care is skilled nursing​ services, but the clients do not live independently.

A novice nurse has accepted a position on a​ medical-surgical unit at a local university hospital. In order to provide safe care to​ clients, the nurse should plan to develop which​ competency? A. Promoting appropriate values that clients should adopt B. Reporting families for bringing food to the​ client's room C. Creating a culture of trust within the hospital D. Functioning as a member of the healthcare team

D New nurses should learn about the healthcare team members and determine whom to collaborate with in certain situations. Rather than reporting​ families, the nurse would work with families to help meet their needs if food is not allowed in the room. The nurse would respect the values of clients and not seek to impose any on the clients. Creating a culture of trust is a system change that is implemented by the administration.

An experienced nurse has accepted a new position in the mental health unit after working in the​ medical-surgical floor for the past 4 years. What training would be beneficial for the nurse to refresh before starting her new​ position? A. How to safely lift and move clients B. How to prevent needlestick injuries C. How to properly use respirators D. How to manage aggressive behaviors

D The nurse is exposed to a higher risk of injuries from assaults by clients or their families in a mental health unit compared to a​ medical-surgical unit.​ Therefore, the nurse may benefit from receiving training related to managing aggressive behaviors. Because of her experience on the​ medical-surgical unit, the nurse is already likely familiar with how to safely lift and move clients and how to prevent needlestick injuries. Knowing how to use a respirator is more important for an infectious disease​ unit, not a mental health unit.

After completing an​ assessment, the nurse determines a client is at risk for safety issues. Which data supports the​ nurse's conclusion? A. Occasional dizziness with walking B. Follows a vegetarian diet C. Receives an annual ophthalmologic examination D. Lives with adult married daughter and family

A

The nurse working in a healthcare setting is charged with inappropriate delegation after asking an unlicensed assistive personnel​ (UAP) to change the IV bag for a client. To which agency should this action be​ reported? A. Board of nursing B. Occupational Health Safety Network C. Health Hazard Evaluation Program D. Occupational Health and Safety Administration

A The state board of nursing has established procedures for reporting errors and violations made by licensed nurses and acts to investigate those reports. Complaints can include unsafe nursing​ practices, such as inappropriate delegation. The other agencies do not investigate nursing errors.

Which practices support promotion of health​ safety? Select all that apply. A. Eliminate all foods containing fat B. Wear seat belts C. Exercise every day D. Only see healthcare providers when sick E. Avoid driving when sleepy or tired

B, C, E

While reviewing safety precautions with the staff in a​ long-term care​ facility, which step should the nurse emphasize that helps to promote a safe environment for the​ clients? A. Provide dim lighting. B. Turn off alarms to reduce noise. C. Have the client wear shoes with rubber​ skid-resistant soles. D. Keep clutter out of the hallway and inside the​ client's room.

C Having the client wear shoes with rubber​ skid-resistant soles is the most appropriate intervention to decrease the risk of client​ falls, which will promote a safe environment. Dim lighting will increase the risk of client falls. Both the hallways and the​ clients' rooms should be clutter free. Noise should be kept to a​ minimum, but turning off alarms would endanger clients.

When a nurse performs or observes nursing practices that are not​ safe, the nurse has a responsibility to report those actions. This principle ties the concept of safety to what other nursing​ concept? A. Clinical Decision Making B. Advocacy C. Accountability D. Assessment

C. Nurses are accountable for their​ actions, so all unsafe nursing practices should be reported and addressed. This principle does not reflect​ advocacy, assessment, or clinical decision making.

The nurse is providing care to a pregnant client who has type 2 diabetes mellitus. The client has asked about how the medications she is taking will affect her fetus. How should the nurse​ respond? A. ​"The medications you are taking have a risk of causing fetal defects. You should stop taking your medications while you are​ pregnant." B. ​"If you have any concerns about how your medication will affect your​ fetus, you should talk to your primary care​ physician." C. ​"The medications you are taking will not work as well when you are​ pregnant, so you should increase the dose of your​ medications." D. ​"The medications you are taking will not adversely affect your fetus. You should continue taking them as you did before your​ pregnancy."

B Encouraging the client to change medication​ dosages, stop taking​ medications, or continue with the present treatment plan after a major change in health status is outside the nursing scope of practice. If the client has concerns about​ medications, she should talk to her primary care physician or other provider. Depending on the medication and the​ client's health​ status, the provider may recommend​ increasing, decreasing, or stopping treatment during​ pregnancy, or the client may continue the present treatment plan.​ However, the nurse can reinforce any teaching provided by the physician.

The home healthcare nurse is traveling to a​ client's home for the first time. What observation would suggest a safety hazard for the​ nurse? A. Absence of street lights in the neighborhood B. Porch steps that are broken and rotting C. Neighbor walking a dog on a leash D. Client medications on the kitchen counter

B Unhygienic or dangerous​ surroundings, such as broken and rotting porch​ steps, may pose a safety hazard for the nurse. Unrestrained and hostile animals may pose a safety​ threat, but a neighbor walking a dog on a leash is not a safety hazard for the nurse. Client medications on the kitchen counter may be a safety hazard if small children are present in the​ home, but this does not pose a safety hazard for the nurse. The nurse should only make home visits during daylight hours to maintain​ safety, so the absence of street lights in the neighborhood should not affect the nurse.

The home health nurse is talking with the parents outside the bathroom door while their​ 1-year-old twins are playing in the tub. Which client statement would require further safety​ teaching? A. ​"Let me get the children out of the tub so we can​ talk." B. ​"Why don't we talk in the living​ room?" C. ​"I do not like to leave the children alone in the​ bathroom." D. ​"I often bathe the children​ together."

B Infants and toddlers are at risk for​ drowning, even in small amounts of water. The nurse would want to teach the parent that it is never appropriate to leave young children unsupervised in the tub. Taking the children out of the tub and not wanting to leave toddlers alone in the bathroom demonstrates an awareness of risk. There is no risk with bathing the children together.

The nurse is caring for a client with a​ self-reported latex allergy. Which strategy can the nurse use to ensure the safety of this​ client? A. Keep beta adrenergic agonists on hand B. Wash hands after taking gloves off C. Wear gloves with powder D. Wear hypoallergenic glove

B The nurse should wear​ latex-free gloves that are hypoallergenic and powderless. Not all hypoallergenic gloves are​ latex-free. Powder from the gloves can absorb the latex and be transferred to clients through touch or through the air.​ Therefore, it is important to wash hands after removing​ gloves, especially gloves with powder. Beta adrenergic agonists are used for the treatment of​ asthma, which may develop with chronic latex exposure in a sensitive​ individual, but it will not affect the early symptoms of latex allergy.

The nurse is conducting a home risk assessment for a family with toddler and​ preschool-age children. Which should the nurse identify as the priority safety​ hazard? A. Safety plugs in electrical outlets B. Medications on the kitchen counter C. Lack of helmets next to bicycles D. Child locks on the doors

B The nurse would instruct the parents to keep medications out of the​ children's reach. Medication poisoning happens easily with young toddlers and​ preschool-age children who think the medication is candy. Safety plugs are appropriate for this age group. Child locks are appropriate to keep toddlers from wandering out to the street. A lack of a helmet next to a bike does not mean there are no helmets in the house. This finding would cause the nurse to ask more questions but is not considered a definite safety risk.

The nurse is caring for a​ 230-lb client who needs to be repositioned every 2 hours. While repositioning the​ client, the nurse injured a muscle in her back. To prevent the injury and ensure safety for both the nurse and​ client, what should the nurse have done differently in this​ situation? A. She should have used proper lifting techniques. B. She should have asked for help from another nurse. C. She should have questioned the physician about the need to reposition the client. D. She should have repositioned the client only if the client requested it.

B When moving or repositioning​ clients, especially larger​ clients, the nurse should always ask for help from another healthcare worker to prevent injury. Although using proper lifting techniques is​ important, they do not guarantee that injuries will not occur. In​ addition, there is no evidence that the nurse was not already using proper lifting techniques. The nurse should question physician orders if she is unclear about the reasoning for the​ order, but this is a standard best practice and would likely not require questioning. The nurse should reposition the client as​ ordered, not only when the client requests it.

The nurse is developing a plan of care for a client who is at risk for falls. Which interventions would be appropriate for the nurse to include in the plan of​ care? Select all that apply. A. Provide slippers for the client to wear while ambulating. B. Assess the​ client's vision and make sure he is using any prescribed eyewear. C. Apply physical restraints if the client gets out of bed. D. Keep frequently used items within easy reach. E. Use side rails on client beds.

B, D, E Assessing the​ client's vision and making sure he is using any prescribed eyewear is an appropriate action. Poor and blurry vision increases the​ client's risk of falling. Using side rails on the client bed to prevent falls while the client is sleeping is an appropriate intervention.​ Furthermore, it is appropriate to keep frequently used items within easy reach in an effort to prevent falls. It is not appropriate for the nurse to apply physical restraints if the client gets out of bed. The nurse should ensure that the client wears shoes with adequate traction while ambulating. Slippers may increase the risk for falls.

hospital has created a culture of safety by providing organizational support for safety initiatives and by training and encouraging healthcare employees in the area of safety. What other step is needed to promote safety for everyone in the healthcare​ environment? A. Post signs related to safety on the walls B. Keep a mindset for quality of safe practice C. Engage clients in their own safety D. Be a safety advocate for others

C

A nurse conducted a class on fall prevention for a group of older adult clients in the community. Which observation during a client home visit indicates that teaching on fall prevention was​ effective? A. Scatter rugs are placed in the kitchen. B. The locks were changed on the doors. C. A shower seat was placed in the shower. D. All meat is placed in the freezer.

C A shower seat in the shower can prevent falls. The client who installed the seat has understood the​ nurse's teaching. Changing the locks may promote safety if there have been frequent​ break-ins, but there is no evidence of that. Scatter rugs in any area of the home are a safety hazard. Placing meat in the freezer does not help prevent falls.

A complaint about unsafe working conditions should be reported to which​ agency? A. American Nurses Association B. State board of nursing C. Occupational Safety and Health Administration D. National Institute for Occupational Safety and Health

C OSHA enforces the rights of workers to have a safe work environment.​ Therefore, complaints about unsafe work conditions should be filed with OSHA. NIOSH conducts research to provide advances in safety. State boards of nursing ensure that nurses are prepared and competent to provide safe nursing care. The American Nurses Association is a professional organization for nurses.

A client in the intensive care unit is combative and pulling at the endotracheal​ tube, which must remain in place. After exhausting all​ alternatives, the nurse applies soft restraints to protect the​ client's airway. Which action should the nurse take​ next? A. Notify the family of the need for restraints. B. Document the application of restraints in the chart. C. Notify the primary healthcare provider. D. Reassess the need for the restraints in 8 hours.

C Restraints can only be applied under the order of a physician. When there is an urgency to protect the client and​ others, restraints can be applied and then the physician should be notified immediately to write an order for the restraints. The nurse would notify the family if​ present, but that is not the legal priority. The nurse would document the use of restraints as soon as possible after notifying the primary healthcare provider. Most agencies require reassessment of need every​ 1-2 hours.

What nursing intervention is appropriate for a client with dry and cracked​ feet? A. Provide slippers for the client to wear at all times B. Massage the​ client's feet daily C. Apply lotion to the​ client's feet after bathing D. Soak the​ client's feet in water several times daily

C For clients with dry and cracked​ feet, the nurse should apply lotion to the​ client's feet after the​ client's bathing time. Providing slippers and massaging the​ client's feet will not heal dry and cracked feet. Soaking the​ client's feet in water without any added moisturizers may make the​ client's condition worse.

The nurse is caring for a​ 43-year-old client. What education should the nurse implement to best address the overall health promotion needs of someone in this age​ group? A. Tell the client to seek medical help for injuries B. Teach the client about ergonomic aids for computer use C. Teach the client about​ age-appropriate medical screenings D. Encourage the client to not drive while distracted

C The nurse can provide education in many areas related to disease​ prevention, including teaching about​ age-appropriate medical screenings. Teaching the client about ergonomic aids for computer​ use, telling the client to seek medical help for​ injuries, and encouraging the client to not drive while distracted are all methods to prevent​ injury, not disease.

Several nurses are discussing the Joint​ Commission's 2016 National Patient Safety Goals during a staff meeting. Which element of performance should the nurses implement to meet the goal of identifying clients​ correctly? A. Marking the intended surgical site on the client B. Asking the​ client's name before conducting assessments C. Labeling all medications with the​ client's name D. Consistently using two methods to identify the client

D

The nurse is assessing a​ 12-year-old male client. The client is within the normal range for​ height, weight, and body mass index​ (BMI) for his age. The client plans to play contact sports at school this year. He lives with his mother and attends​ after-school events when she is working late. What education should the nurse identify as a priority for this client to promote​ safety? A. The importance of good hygiene practices and healthy diet B. The importance of maintaining a normal weight and participating in physical activity C. The importance of learning how to feel secure when he is at home alone D. The importance of using safety equipment when playing contact sports

D The​ client's biggest safety risk is a risk of injury from contact sports. The nurse should encourage the client to use proper safety equipment to avoid injury. Promoting a sense of security is important for latchkey​ children, but this client does not appear to be home alone for extended periods based on participation in​ school, sports, and​ after-school activities. The client already has a normal weight and participates in physical​ activity, so education related to these topics is not as important as sports safety. There is no evidence that this client has poor hygiene or an unhealthy diet.

The nurse is caring for a​ 3-year-old child who is in the hospital for the first time. The child appears frightened and is clinging to her parents. What action can the nurse take to help the child feel more secure if the child needs to stay at the hospital without her​ parents? A. Make sure the child wears proper identification at all times B. Stay with the child when the parents go home C. Keep dangerous medications and equipment out of the​ child's reach D. Have the parents bring comfort items from home to leave with the child

D To help a child feel more​ secure, the nurse can suggest that parents bring in a few comfort items the child is familiar​ with, such as​ photos, a favorite​ blanket, or a favorite toy. Having the nurse stay with the child at all times once the parents have left is not practical and could cause harm to other clients under the​ nurse's care. Although the nurse should keep dangerous medications and equipment out of the​ child's reach and make sure the child wears proper identification at all​ times, these actions will likely not help the child feel more secure.

The nurse is conducting a class for a group of pregnant clients. Which topics should the nurse include when teaching this group about safety of the​ fetus? A. Drowning B. Pedestrian accidents C. Suffocation in the crib D. Alcohol consumption

D Alcohol consumption is a safety hazard for the​ fetus, and pregnant women should be educated about the importance of not drinking alcoholic beverages while pregnant. Suffocation in the crib is a safety hazard for both newborns and infants. Drowning is seen in toddlers and​ preschoolers, and pedestrian accidents are seen in the older adult.

Reducing the risk of functional decline in older adults can help prevent which​ complication? A. Hyperglycemia B. Macular degeneration C. Hearing loss D. Pressure ulcers

D By reducing the risk of functional​ decline, nurses and independent older adults can help prevent complications such as pressure​ ulcers, delirium and​ depression, decreased​ mobility, loss of​ independence, and incontinence. Macular​ degeneration, hearing​ loss, and hyperglycemia are not complications that occur as a result of functional decline.

The staff nurses are discussing interventions to reduce the risk of infection for the client population. Which intervention is the most important to decrease client​ infection? A. Raise the temperature in the​ client's room. B. Wear a mask for all client care. C. Assess vital signs once daily. D. Practice appropriate hand hygiene

D Hand hygiene is always the first and best way to stop the spread of​ microorganisms, which cause infections. Assessing vital signs is important but should be done more frequently than once daily. Raising the temperature in a​ client's room would contribute to the growth of microorganisms. Wearing a mask for all clients is not practical and is unnecessary unless a microorganism is airborne and the client is in isolation.

A nurse is assessing the hospital environment in order to decrease the risk for client falls. Which intervention should the nurse implement to decrease the risk of client​ falls? A. Lower side rails on client beds. B. Encourage the client to wear diapers. C. Read label directions. D. Clean the environment of clutter.

D Keeping the environment tidy and free of clutter will go a long way in preventing falls. Lowering side rails on client beds would increase the risk of falls. Reading label directions will prevent the wrong use of substances given to the client but would not directly prevent falls. Encouraging the client to wear diapers would increase functional​ decline, and it is not an appropriate strategy to help reduce falls.