Week 3: Safety EAQ

Which of these age groups has the highest incidence of lead poisoning?

Adult Toddler Adolescent School-age child Rationale The incidence of lead poisoning is highest in late infancy and toddlerhood. Children at this stage explore the environment and because of their increased level of oral activity, put objects into their mouths. Adults have a greater risk of cardiovascular or pulmonary disease. Drowning and motor vehicle accidents are more common among adolescents. Bicycle accidents are more common among school-aged children.

A 7 year old child is admitted for surgery. What is the PRIORITY nursing action?

Allowing a favorite toy to remain with the child Documenting the child's ASO titer and C-reactive protein level Inspecting the child's mouth for loose teeth and reporting the findings Encouraging a parent to stay until the child leaves for the operating room. Rationale School-aged children lose their primary teeth, which may be aspirated during surgery. Special precautions must be taken to maintain safety. Allowing a favorite toy to remain with the child is a comforting gesture, but it is not essential. There is no reason to obtain an antistreptolysin O (ASO) titer or a C-reactive protein level. Encouraging a parent to stay until the child leaves for the operating room is important but not always possible.

A 15-month-old child is hospitalized after ingesting toilet bowl cleaner. The mother confides that she feels guilty about leaving the cleaner where her child could get it. What is the best response by the nurse?

Anyone could make a mistake. Don't dwell on it." "Let's not worry about the past. Your child is going to get better." "It was an accident, but you should consider special locks on your closets." "That was careless of you. Please make sure that you poison-proof your house." Rationale Describing the incident as an accident and recommending locks on closets accepts the mother's statement and helps the mother express her guilt while providing directions to safeguard her child. Poisoning is not an everyday occurrence; teaching should be incorporated to protect the child. Telling the mother that the child will get better is false reassurance; the child's condition is still in question. Calling the mother careless only increases the mother's guilt and provides nothing more than a vague suggestion of how to remedy the problem.

The nurse is caring for a client with Alzheimer disease who exhibits behaviors associated with hyperorality. To meet the client's need for a safe milieu, what instructions will the nurse give the staff to monitor the client?

At meals to help prevent choking For the presence of mouth ulcers To prevent injury caused by hot foods For attempts at eating inedible objects Rationale Hyperorality is the compulsive need to taste and chew inedible objects. Hyperorality is not related to choking, a tendency to mouth ulcers, or the inability to perceive temperature properly.

After assessing a client, the nurse suspects that the client has shift-work sleep disorder (SWSD). Which medication would be prescribed to the client?

Caffeine Modafinil Atomoxetine Methylphenidate Rationale Modafinil is a unique nonamphetamine stimulant used to treat shift-work sleep disorder (SWSD). This drug promotes wakefulness in clients suffering from excessive sleepiness associated with SWSD. Caffeine is a central nervous stimulant used to promote wakefulness, but this drug is not as effective in the treatment of SWSD. Atomoxetine is a nonstimulant used to treat attention deficit hyperactivity disorder (ADHD). Methylphenidate is considered the first choice drug for the treatment of attention deficit hyperactivity disorder (ADHD).

A nurse is caring for a client who is angry and agitated. What is the best approach for the nurse to use with this client?

Confronting the client about the behavior Turning on the television to distract the client Maintaining a calm, consistent approach with the client Explaining to the client why the behavior is unacceptable Rationale Consistency ensures an approach that is known and less frightening than the unknown. A calming approach can decrease agitation. Confronting the client about the behavior may escalate the client's anger and agitation. Environmental stimulants should be decreased, not increased. An agitated client is not capable of comprehending logical explanations; the nurse must avoid criticisms and arguments with the client.

What should the nurse encourage the parents of a child with plumbism (lead poisoning) to do?

Discourage the child's pica by providing nutritious snacks. Move the family away from areas that are next to gas stations. Assess the family's home environment for lead sources and have them removed. Have the child take repeat x-rays of the wrist and forearm for signs of a lead line. Rationale All sources of lead must be removed from the home if the problem is to be controlled. Sources include lead-painted surfaces and old plumbing that has lead solder. Although pica must be controlled if it is present, this alone will not eliminate the environmental risks. The data do not indicate that the child is engaging in pica. Leaded gasoline is no longer used in the United States. Chelation therapy is based on the blood lead level; changes in bone take longer to evaluate.

After surgery for creation of an ileostomy, a client is to be discharged. Before discharge, what is the primary nursing intervention?

Emphasizing that it is essential that the client can care for the ileostomy without assistance Evaluating the client's ability to care for the ileostomy Ensuring that the client understands the dietary limitations that must be followed Ensuring that the client is competent at changing the dry sterile dressing on the incision Rationale The client's feelings, knowledge, and skills concerning the ileostomy must be assessed before discharge. People should not be pressured into performing self-care before they are physically and emotionally ready. The diet is not limited; however, the client should be encouraged to eat a high-protein diet or a regular diet with supplemental protein. A high-fluid intake should be maintained. Often the client no longer needs a dressing on the incision at the time of discharge; a collection pouch is used over the stoma.

Which drug used to promote fertility may cause esophageal burns?

Estrogen Clomiphene Nifedipine Indomethacin Rationale Clomiphene is a serum selective receptor modulator that may cause esophageal burns. Estrogen may cause a thromboembolism. Nifedipine may cause maternal fetal problems. Indomethacin may cause birth defects.

For which illness should airborne precautions be implemented?

Influenza Chickenpox Pneumonia Respiratory syncytial virus Rationale Chickenpox is known or suspected to be transmitted by air. Diseases that are known or suspected to be transmitted by droplet include influenza and pneumonia. A disease that is known or suspected to be transmitted by direct contact is respiratory syncytial virus.

A nurse is caring for a young, hyperactive child with attention deficit-hyperactivity disorder who engages in self-destructive behavior. What is the most important nursing objective in the planning of care for this child?

Keeping the child from inflicting any self-injury Helping the child improve communication skills Helping the child formulate realistic ego boundaries Providing the child with opportunities to discharge energy Rationale All nursing care should be directed toward preventing injury, particularly with a self-destructive child. Although improved communication skills, formulation of realistic ego boundaries, and opportunities to discharge energy are all important, prevention of injury is the priority.

Which vaccine is administered orally in children?

MMR vaccine Rotavirus vaccine Live influenza vaccine Meningococcal conjugate vaccine (MCV4) Rationale Rotavirus vaccines are generally administered orally because these live viruses should replicate in the gut of the infant. MMR vaccines are generally administered subcutaneously in the upper region of the arm. Live influenza vaccines are administered nasally. Meningococcal conjugate vaccines (MCV4) are administered intramuscularly in the deltoid region.

Which hospital department plays a primary role in disaster preparedness?

Medical department Surgical department Emergency department Mental health department Rationale The emergency department plays a primary role in emergency disaster preparedness. While all departments in the hospital contribute to disaster planning, the only department that plays a primary role is the emergency department.

Immediately after cataract surgery a client reports feeling nauseated. What should the nurse do?

Provide some dry crackers to eat Administer the prescribed antiemetic Explain that this is expected after surgery Encourage deep breathing until the nausea subsides Rationale An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Aggressive intervention is required rather than dry crackers. Explaining that this is expected after surgery is incorrect. Deep breathing will not minimize nausea; aggressive intervention is required to prevent vomiting.

A client is going for a magnetic resonance imaging (MRI). What should the nurse ascertain before taking the client to the procedure?

Scheduled medications have been given. All metal, such as jewelry and hair ornaments, has been removed. Adequate prehydration has been given. The client has emptied the bladder. Rationale All metal must be removed because the MRI emits a strong magnetic field[1][2]. All medications may not be necessary before the test. Prehydration is not necessary and may cause interruptions for client to void. The client should have the opportunity to void before going for the test.

A client who had a transurethral resection of the prostate is transferred to the postanesthesia care unit with an intravenous (IV) line and a urinary retention catheter. For which major complication is it most important for the nurse to assess during the immediate postoperative period?

Sepsis Phlebitis Hemorrhage Leakage around the IV catheter Rationale After transurethral surgery[1][2], hemorrhage is common because of venous oozing and bleeding from many small arteries in the area. Sepsis is unusual, and if it occurs it will manifest later in the postoperative course. Phlebitis is assessed for, but it is not the most important complication. Hemorrhage is more important than phlebitis. Leaking around the IV catheter is not a major complication.

A client with mild chronic heart failure is to be discharged with prescriptions for daily oral doses of an antidysrhythmic, potassium chloride 40 mEq, docusate sodium 100 mg, and furosemide 40 mg twice a day. The client reports having no family members who can help after discharge. What should the nurse help this client identify?

Support systems that can assist the client at home Potential nursing homes in which the client can recuperate Agencies that can help the client regain activities of daily living Ways that the client can develop relationships with neighbors Rationale The rehabilitative phase requires a balance between activity and rest; supportive individuals are needed to perform more strenuous household tasks and to provide emotional support. A client with mild heart failure does not need inpatient care. A support system should be identified before considering community agencies. More information is needed before encouraging the development of relationships with neighbors.

Imipramine, 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when this medication is being administered?

Telling the client that barbiturates and steroids will not be prescribed Warning the client not to eat cheese, fermented products, and chicken liver Monitoring the client for increased tolerance and reporting when the dosage is no longer effective Having the client checked for increased intraocular pressure and teaching about glaucoma symptoms Rationale Glaucoma is one of the side effects of imipramine, and the client should be taught about the symptoms. Tolerance is not an issue with tricyclic antidepressants such as imipramine. The other actions are true of monoamine oxidase inhibitors (MAOIs); imipramine is not an MAOI.

A school nurse teaches a 13-year-old child with hay fever that the prescribed phenylephrine nasal spray must be used exactly as directed. What complication may occur if the nasal spray is used more frequently or longer than recommended?

Tinnitus Nasal polyps Bleeding tendencies Increased nasal congestion Rationale Frequent and continued use of phenylephrine can cause rebound congestion of mucous membranes. Tinnitus is not a side effect of phenylephrine nasal spray; however, hypotension, tachycardia, and tingling of the extremities may occur. Nasal polyps may be associated with allergies but are unrelated to phenylephrine nasal spray. Bleeding tendencies are unrelated to the use of phenylephrine nasal spray.

A postpartum nurse is reviewing principles related to automobile infant restraint systems with the parents of a newborn who is to be discharged in the morning. What information should be included in the teaching session? Select all that apply.

Use a forward-facing infant car seat. Secure the infant seat so that it faces the rear. Position the seat between the driver's and passenger's seats in the front seat. Follow the manufacturer's directions to secure the infant seat in the back seat. Be sure to follow weight guidelines set forth in the manufacturer's instructions. Rationale An infant seat should face the rear, not the front, of the automobile, because the head and neck are better protected from a whiplash injury in the event of an accident. Research demonstrates that passengers in the front seat sustain more serious injuries than do individuals in the rear seat in most accidents. Using a forward-facing infant car seat and positioning the seat between the driver's and passenger's seats in the front seat is dangerous for the infant and not recommended by the infant car seat safety information guidelines.