safety

a nurse is attempting to help a client who has self-care difficulty due to left-sided paralysis. which intervention should the nurse plan to include? select all: 1. provide the client with a button hook for dressing 2. clip plate guards on plate 3. offer to place the client on the toilet every 2 hours during the day 4. choose clothes without fastenings 5. have client pivot on left foot to sit in chair placed on right side parallel to the bed 6. choose shoes with velcro fastenings

1,2,3,4,6- all common sense, avoid clothes with zips! just easy clothes 5. have client pivot with the RIGHT foot with the chair placed on the left side parallel to bed

which information does the nurse need to include in planning a session on the effects of cannabis use for a high school health class? select all: 1. cannabis ingestion can cause tachycardia 2. inhaled cannabis produces a greater amount of tar than tobacco 3. cannabis smoke contains more carcinogens than tobacco smoke 4. cannabis ingestion reduces the risk for heart disease 5. orthostatic hypotension can be caused bu cannabis ingestion

1,2,3,5- all true 4. it increases the risk

what instruction should the nurse provide to this client who has recurrent episodes of allergic rhinitis who asked the nurse what could be done to decrease symptoms? select all: 1. remove pets from interior of home 2. treat a stuffy nose with warm salt water 3. remove carpeting 4. stay inside when pollen count is at its lowest 5. wash bed linens in hot water

1,2,3,5- is seasonal allergies! control pet dander and other pet allergens will help, so keep pets outside, clean nasal passages with saline solution, control dust and dust mites by dusting regularly, all that other stuff listed 4. so wrong and stupid

which should the nurse teach the client due to this lab value of absolute neutrophil count (ANC) being 950/mm3? select all: 1. avoid people who are sick 2. wear a face mask when going out in public 3. eat only well-done meat, fish, and eggs 4. eat iron-rich foods 5. shower or bathe every other day 6. wear gloves when handling pet wastes

1,2,3,6- normal ANC is 2500-8000/mm3, since less then patient at risk for infection; germs will be killed in well cooked foods 4. recommended for people with anemia so no! 5. stupid

what should the nurse include in this teaching session about planning how to discuss prevention of pesticide ingestion at a local health fair? select all: 1. discard the outer leaves of lettuce 2. wash fruits and vegetables with dish soap 3. buy organic produce 4. peel fruits prior to eating 5. dry produce thoroughly with disposable paper towels after washing 6. use a scrub brush when washing fresh fruits and vegetables

1,3,4,5,6- common sense 2. dont use dish soap bc not good enough and possibly bad

which clients should the nurse recommend receive the human papillomavirus (HPV) vaccine? select all: 1. twelve year old male 2. eight year old female 3. twenty-five year old bisexual male 4. twenty-two year old female with compromised immune system 5. twenty-nine year old male who has not received the HPV vaccine

1,3,4- HPV vaccine is recommended for routine vaccination at age 11 or 12 or start at age 9 through age 26! 2. too young still 5. too old so no

which intervention should the nurse include in attempting planning care for a client who has self-care difficulty due to left-sided hemiparesis? select all: 1. offer to take the client to the toilet every 2 hours 2. instruct client to use disposable razors once to prevent infection 3. encourage family members to comb hair for client 4. provide the client with a button hook for dressing 5. teach the client to rely on furniture for support when walking

1,4- good to offer toilet often since needs help and has weakness on one side, and button hook helps them with independence 2. not really true or relevant, recommend electric razor smh! 3. should allow the patient do their own things at times so not right! 5. they should not rely on furniture, rely on assistive devices duh

what should the nurse include in sharing best practice for preventing pressure injuries in clients? select all: 1. use moisturizer daily on dry skin 2. massage reddened skin areas 3. prevent shearing by maintaining the HOB at 45 degrees or higher 4. place rubber ring (donut) under client's sacral area 5. position client at 30 degree tilt when placed on side

1,5- moist skin is more pliable than dry skin and 30 degrees help with decreasing dependency on bony prominences 2. do NOT massage reddened areas bc this can damage capillary beds and increase tissue necrosis! 3. raising the HOB any higher than 30 degrees will actually increase pressure on sacral/coccyx area 4. this can cause pressure to the area and can damage capillary beds and increase tissue necrosis!

when disposing of waste in a client's room, the nurse would place which item(s) in a biohazard red bag? select all: 1. chest drainage unit 2. doxorubicin IV bag and tubing 3. staples removed from an abdominal incision 4. tramadol 50 mg tablet prescribed but refused by client 5. soiled dressing 6. paper trash with identifying client information

1,5- stuff with human waste, blood, or body fluids should be disposed of in a red biohazard bag 2. chemo med so in yellow bag 3. staples are considered 'sharp' so sharps container 4. a narcotic so in medicinal waste container or sharps container, depending on policy 6. doesnt need to be in a red bag so just remove info and shred i guess

what safety adaptations should the nurse instruct the family to initiate at home for patient with Parkinson's? SELECT ALL 1. install grab bars on tub walls 2. place nightlights in hallways 3. add bran and fiber to daily diet 4. remover scatter rugs or loose cords 5. keep bedroom dark, cool and quiet 6. put tennis balls on legs of walker

1-5. parkinsons can cause constipation due to decreased peristalsis! a dark, cool room with no distractions is good for sleeping smh 6. i guess it makes it easier to slide and not be sturdy for these unsteady people, no control!

what activity should the nurse recognize as increasing the risk for a client developing a community-associated MRSA infection? 1. taking wrestling classes at the gym once a week 2. traveling on an airplane next to someone coughing 3. eating raw fruits without washing them 4. working in close proximity to several co-workers

1. staph aureus is easily transmitted from one person to another on the hands of individuals... so direct skin-to skin contact or contact of shared items or surfaces 2. not airborne 3. not likely 4. not airborne

as a member of the emergency preparedness planning team at the hospital, which action should the nurse encourage the team to implement? select all: 1. developing a response plan for each individual potential disease 2. providing education to employees on the response plan 3. practicing the response plan on a regular basis 4. evaluating the hospital's level of preparedness 5. every hospital should prepare for all the same emergencies 6. conduct a risk assessment to identify potential emergencies

2,3,4,6- common sense 1. one good response plan should be developed rather than multiple plans smh! 5. every hospital is different

what should a nurse include when planning an educational program for a group of women on how to prevent a UTI? select all: 1. empty bladder at least every 8 hours while awake 2. take showers rather than prolonged baths 3. use spermicidal jelly during intercourse 4. use tampons rather than sanitary napkins 5. wear cotton underwear

2,4,5- dont want to sit in all your dirt and germs for so long, tampons are advised to keep the bladder opening area drier than the pad, and wear cotton duh 1. 8 hours is too long to wait and go pee 3. spermicidal jelly also kills off the normal vaginal flora so no

a nurse is performing eye care for an unconscious client. which interventions should the nurse include? select all: 1. clean eyes with saline and cotton balls, wiping from outer to inner canthus 2. use a new cotton ball for each cleansing wipe 3. instill artificial tears onto the sclera as prescribed 4. protect the eyes with a protective shield 5. monitor eyes for redness and exudate

2,4,5- these actions will prevent infection, keep eyes moist, and protect the eyes from injury 1. opposite 3. instill artificial tears into the lower eyelids as prescribed!

which interventions should be included in the plan of care for a client with multiple episodes of diarrhea and suspected c.diff? select all: 1. institute contact precautions only after confirmation of stool culture 2. instituting contact precautions for all who enter the client's room 3. using alcohol based foam for hand hygiene 4. dedicating equipment for use only in the client's room 5. requesting antidiarrheal medication for the client

2,4- contact precautions for c.diff to prevention spread and specific equipment for patient 1. precautions should be initiated right away if c/diff suspected 3. alcohol based foam isnt strong enough to kill spores.. use soap and water! 5. meds to stop diarrhea will not be helpful! it will make it worse!

what should the nurse tell the group of women about the HPV putting women at risk for? 1. HIV 2. cervical cancer 3. Hepatitis B 4. cirrhosis

2. cervical cancer duh

the nursing staff have not been able to control the outbursts of a violent adult client. the primary healthcare provider prescribes physical restraints to be applied for the next 8 hours. what is the nurse's BEST action? 1. apply the restraints for the 8 hours, with a trial release every 2 hours 2. explain to the primary healthcare provider that the prescription will have to be reissued in 4 hours 3. refuse to place the client in restraints unless the primary healthcare provider gets a permit signed from the family 4. apply the restraints and observe the client hourly

2. must be reissued by doc every 4 hours for adults age 18 and older, every 2 hours for children and adolescents ages 9-17, and every hour for children less than 9 years 1. nope 3. no permit needed duh 4. clients in restraints or seclusion must be observed and assessed every 10-15 mins with regard to circulation, respiration, nutrition, hydration, and elimination

what teaching points should the nurse plan to include when planning to teach a group of manufacturing workers how to prevent back injuries? select all: 1. when sitting, keep knees slightly lower than the hips 2. bend at the waist with legs straight and knees locked 3. squarely face the direction of anticipated movement 4. pivot to turn while holding an object 5. wear comfortable, low-heeled shoes 6. when lifting an object, hold it away from your body

3,4,5- common sense 1. keep knees slightly higher than hips! 2. that will break your back and dont bend at the waist smh! 6. hold things close to the body smh!

muscle injuries can best be prevented by avoiding what action? 1. carry objects close to body but do not touch clothing 2. use the largest muscles for lifting, such as thigh muscles 3. move objects with quick fast tugs to avoid muscle fatigue 4. lean into objects such as a litter and push instead of pull

3. AVOID quick jerking motions bc can injure the body! read question!

when the unit manager asks for an indication of effective CPR on an adult, what new nurse response would be MOST accurate? 1. chest wall visibly rises with rescue breathing 2. skin color and temp becomes pink and warm 3. there is a palpable femoral pulse with a compression 4. a sinus beat appears on monitor during compression

3. that is considered effective CPR in a hospital setting! smh 1. its talking about the actual cardiopulmonary resuscitation and NOT the rescue breathing smh! 2. that wont happen unless a heartbeat is restored 4. any complex or rhythm should be accompanied by a pulse so not really accurate if good CPR

the nurse knows that teaching was successful when the client with HIV makes what statement about the proper handling of blood and body fluid at home? 1. 'as long as its my home, i can use normal cleaning methods' 2. 'i must scrub with hot, soapy water and allow it to air dry' 3. 'i should clean area with a 10% mixture of bleach and water' 4. 'i must sterilize with isopropyl alcohol and rinse with ammonia'

3. use bleach of 9 water:1 bleach... not just soap and water!

what is the PRIORITY nursing intervention for a client who came to the ED with a migraine headache unrelieved by OTC meds and is their 4th time here in 6 weeks? 1. refer the client to their primary healthcare provider in the morning 2. make the client an appt with the chronic pain clinic 3. rate the client's pain using the pain scale used in the ED 4. perform a visual acuity test

3. just assess the patient and dont be judgmental 1. does not address the pain issue duh 2. is somewhat judgmental and is not our scope to do 4. is not really doing anything the actual pain itself

what is the most common cause of violating patient privacy? 1. failure to cover client fully during bed bath 2. leaving chart open in full view when at the desk 3. discussing client with staff not providing direct care 4. healthcare provider not pulling curtain to talk to client

3. most common HIPAA violation!!! 2. is also bad but not as bad as the other one

which statement made by the client would indicate to the nurse that further teaching is needed for educating a client about home care considerations of a clean intermittent catheterization? 1.' i will wash the re-usable catheter thoroughly with soap and water after use.' 2. 'when urine stops flowing, i will press over the bladder area with my free hand' 3. ' it is important to maintain sterile technique when catheterizing myself' 4. ' catheterization should be done when i feel the need to void'

3. sterile technique is not needed to self catheterization intermittently at home 1. catheter can be reused and washed with soap and water 2. patient can do that 4. some patients can catheterize only when the need to so its okay

what personal protective equipment should the nurse wear into the room of a client who has been placed on droplet precaution? 1. gloves 2. gown 3. goggles 4. mask

4. a mask is work for close contact with the client and nothing is else needed in the question!

what should the summer camp nurse include when teaching a group of adolescents about west nile virus? 1. antiviral meds are used to treat west nile virus 2. using insect repellant containing diethyltoluamide (DEET) will kill the virus when a mosquito makes skin contact 3. nothing can be done to prevent west nile virus 4. symptoms of west nile virus include headache, fever, and fatigue

4. those are the symptoms and is most relevant 1. there is no med to treat this 2. thats stupid 3. there are prevention methods