17: Safety
When educating parents about the safety of preschool-aged children, which is most important for the nurse to include in the presentation?
At home chemicals should be kept in a locked cabinet. Increasing mobility, lack of life experience and judgment, and immature musculoskeletal and neurologic systems lead to potentially hazardous encounters for toddlers and preschool-aged children. Parents must be taught to keep chemicals in a locked cabinet to reduce exposure. Weapons should be secure, preferably in locked gun cabinets to prevent access by children. The recommended safety equipment for sports should be used by people of all ages to prevent injury, not to decrease fear.
A nurse visits an older adult client at home and assesses the safety of the client's environment. Multiple small rugs are located in the home. Which statement by the nurse is appropriate when addressing the client's safety?
"I am concerned that the small rugs in your home can be a tripping hazard." The nurse can open up the conversation by stating concern about the small rugs. The conversation provides education through problem-solving. If the nurse demands or states generalities, the nurse will not gain the needed cooperation from the client. The older adult client should remove all area rugs, even if skid resistant, to prevent accidental injury.
A nurse is assigned to care for a hospitalized toddler. Which activity should be the highest priority for the nurse?
Protect the toddler from injury. The highest priority for the nurse should be to protect the toddler from injury; a toddler is at high risk of injury due to his developmental abilities. Providing medications on time is important, but the highest priority is to protect the child from potential injuries. Spending time with the toddler in the play room and providing health education to parents are not as important as the security of the toddler.
A fire has erupted in a trash can on the unit. The nurse obtains the fire extinguisher and is preparing to use it. Arrange the sequence of steps that the nurse should follow. Use all options. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order
Pull the pin. Aim the nozzle. Squeeze the handle. Sweep back and forth. When using a fire extinguisher, the nurse should follow the PASS mnemonic: Pull the pin, aim the nozzle, squeeze the handle, and sweep back and forth over the fire.
A nurse is preparing discharge education for a client with a newborn baby. What is the highest priority item that must be included in the education plan?
Restrain the baby in a car seat. The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falling off changing tables or being unrestrained in automobiles. Locking the cabinets, giving warm bottles of formula to the baby, and keeping all pots and pans in lower cabinets are secondary teachings.
Nurses provide many interventions to prevent falls in health care settings. What would be an appropriate intervention to prevent falls?
Lock wheels on beds and wheelchairs Locking wheels on beds and wheelchairs prevents them from rolling and precipitating a fall. Beds should be kept in low positions with the side rails down in most situations; restraints should be applied only as a last resort.
A nurse is admitting a client to a geriatric medicine unit. Which nursing action would the nurse perform to reduce the client's risk for a fall?
Orient the client to the room and environment upon admission. A person who is familiar with his surroundings is less likely to experience an unintentional injury. As part of the hospital admission routine, it is important to orient the client to the safety features and equipment in the room. A bedpan should not be used for the sole reason of reducing the risk of falls, and pain medication should be provided in doses sufficient to treat the client's pain. A client should never be charged with supervising the safety of another client.
The nurse is preparing an education session on injury prevention for parents with toddlers. What will the nurse prioritize during this session to help parents to reduce the risk of injury for toddler, given their developmental stage? Select all that apply.
safety with stairs water safety electric outlet safety childproof latches Infants and toddlers are vulnerable and often the victims of accidental poisoning, falls from stairs or high chairs, burns, electrocution from exploring outlets or manipulating electric cords, and drowning. As children do not begin to learn how to ride a bike independently until at least the preschool age (more commonly during the school-aged years), the nurse will not prioritize teaching the parents about bike helmet safety.
A new parent asks about the use of a car seat for a newborn. What information would the nurse prioritize when teaching the parent about car safety seat use with newborns?
"You should use a rear-facing safety seat in the back seat for the first year or until your infant weighs more than 20 lb (9 kg)." According to the Centers for Disease Control and Prevention, nearly 40% of all children who ride with an unbelted driver are not secured with child safety seats or seat belts. A rear-facing safety seat placed in the back seat is recommended for infants who are younger than 1 year old and weigh less than 20 lb (9 kg). The high force of sudden air bag inflation can cause injury to an infant in a safety seat or a child in the front seat. Nothing should be placed in the car seat around the baby's head as it can cause suffocation. Second-hand car seats are not recommended by the American Pediatrics Association and when strapping in an infant, you should allow two fingers, not four.
Owen is a 15-year-old client who is waking up postoperatively. He became combative and tried to strangle one of the nurses. A support team was called and 4-point restraints were applied in this emergent situation. How soon does a licensed provider need to assess the client and place the restraint order?
1 hour Restraints can be placed emergently without the order of a licensed provider. However, a face-to-face assessment of the client must be made within 1 hour of restraint placement.
Which statement by a client would indicate that a nurse had successfully implemented an educational strategy to prevent injury in the home?
"I have removed all throw rugs on the floor." Nurses must evaluate the effectiveness of their interventions to promote safety and prevent injury. If the expected client outcomes have been met and evaluative criteria satisfied, the client should be able to correctly identify real and potential unsafe environmental situations and implement safety measures in the environment. Keeping the outside lights on would help to deter outside intruders. Placing a phone by the bed does not prevent injury. While taking courses in cardiopulmonary resuscitation (CPR) and first aid is a great way to be prepared for injury, it is not a method of preventing injury.
A nurse is caring for a restrained client who has suicidal tendencies. How should the nurse intervene to decrease the risk of injury?
Assess for circulation, movement and sensation Risk for Injury is the most appropriate nursing diagnosis for the client who is restrained because the client has the tendency to harm oneself. It is important to choose the correct size of restraint. Choosing the wrong size of restraint could harm the client further. A nurse would not remove two restraints at a time so that the client can perform activities of daily living; the nurse should only remove one at a time. An important aspect of restraints is checking for circulation, movement and sensation. The purpose of restraints is to restrict movement, so any movement that would allow for maintaining personal hygiene would be contraindicated.
A grade school nurse is addressing parents regarding car safety. What is a recommended safety guideline for this age group?
Booster seats should be used for children until they are 4'9" (1.43 m) tall or at least 8 years of age. All school-age children need to be secured in safety seats, belt-positioning booster seats, or shoulder lap belts for their size. The National Highway Traffic Safety Administration recommends booster seats for children until they are 4'9" (1.43 m) tall or at least 8 years of age, and all children 12 and under should ride in the back seat to eliminate the risk of injury from airbag deployment.
The nurse is caring for a client that is disoriented. The nurse places the client in soft wrist restraints to discourage pulling at a nasogastric tube. Which nursing action(s) is appropriate? Select all that apply.
Obtain order from a licensed provider within minutes of restraint application. Check circulation and skin condition every 2 hours. Offer regular, frequent opportunities for toileting An order for restraints from the licensed health care provider must be obtained within minutes after the restraint is applied. Frequent and regular nursing assessments are required of the restrained client's vital signs; circulation; skin condition or signs of injury; psychological status and comfort; and readiness for discontinuing the restraint. The nurse must explain the need for restraints with the family. When the assessment findings indicate that the client has improved, restraints must be removed.
Mr. Ames, age 84, has just been admitted to the hospital for the treatment of pneumonia. In addition to this diagnosis, Mr. Ames also has stage II Alzheimer's disease and is disoriented to place and time. As the night has progressed, he has become increasingly agitated, pulling out his intravenous catheter and wandering throughout the unit. He has become more agitated as the nurses have attempted to reorient and redirect him. Which intervention should the nurses perform?
Position Mr. Ames' bed closer to the nurses' station and perform an assessment It is important to rule out causes of agitation by performing an assessment and to attempt alternatives to restraints or calling a "code gray." Side rails may pose an increased risk to Mr. Ames in his confused state.
The nurse is admitting a client to a medical-surgical unit who states, "If someone brings balloons to me, I might have trouble breathing." What is the appropriate nursing action?
Replace common health care items with latex-free equipment. The client has described a reaction to latex, so the environment should be as free from latex as possible. The nurse will replace all health care equipment with latex-free versions. The molecular structure of latex is similar to avocados, bananas, almonds, peaches, kiwi, and tomatoes, not oranges and spinach.
A nurse finds a client in his room asphyxiated with carbon monoxide (CO) inhalation. Which activity should be the priority for the nurse?
Get the victim out of the present environment. The nurse should take the client out of the present environment to prevent further inhalation of carbon monoxide. The nurse can go and call for help after the client has been removed from the site because delay in shifting the client can aggravate the condition. Providing oxygen and hyperbaric oxygen can be given once the client is removed from the site, but the first step is to shift the client from the room.
What teaching will the community health nurse include for parents of toddlers?
Household cleaners must be kept out of reach. Toddlers are naturally inquisitive and more mobile than infants and fail to understand dangers; therefore, it is appropriate to teach parents of toddlers to keep household cleaners out of reach. Teaching about changing table safety is more appropriate for infants. Teaching about protective sporting gear is appropriate for school-age children who are physically active. Teaching about peer pressure is more appropriate for adolescents.
A nurse working in a long-term care facility institutes interventions to prevent falls in the older adult population. Which intervention would be an appropriate alternative to the use of restraints for ensuring client safety and preventing falls?
Involve family members in client's care Family members are an invaluable resource in assessing a client's risk for a fall because they can provide information regarding periods of weakness, confusion/disorientation, and a history of unreported falls. Allowing the client to ambulate independently may further increase the risk of a fall. Sedating a client is a form of chemical restraint, and may cause the client to have an unsteady gait when ambulating. If the client attempts to get out of bed a high bed position would cause more injury to the client if a fall occurs.
A nurse is educating a mother about caring for a newborn baby. What should the nurse teach the client as a precautionary measure to protect the infant from burns?
Keep hot substances away from the baby. The nurse should teach the client to keep hot substances away from the baby to prevent burns in the baby. Infants are not very mobile and depend on their parents for their care. Keeping hot substances on the table, monitoring the activities of the infant closely, and keeping the infant away from the kitchen are important but may not be appropriate, as the baby is not yet mobile.
A nurse is preparing to provide care to a client who is receiving radiation therapy for cancer; the radiation source will be kept in the client's room. Which action would be most important for the nurse to do?
Limit own exposure to radiation to the minimum time The nurse should be aware that ionizing radiation can adversely affect the health. Consequently, the time of exposure should be minimized. Linens should be kept in the room until the radiation source is removed. They require special labeling and disposal. Nurses should use a lead apron, not one made of thick cotton. The client should be admitted to a private room with a private bath, not to a general unit, in order to prevent exposure to other clients.
Which age group is most vulnerable to toxic fumes or asphyxiation?
Young children Most exposure to toxic fumes, such as carbon monoxide, occurs in the home. Young children and older adults are more vulnerable to toxic fumes. Suffocation, or asphyxiation, can occur at any age, but the incidence is greater in children.
A staff development nurse is providing an in-service to a group of nurses on the use of restraints in health care facilities. What is an example of a chemical restraint?
a dose of an antipsychotic Drugs that are used to control behavior and are not included in the person's normal medical regimen can be considered a chemical restraint. Side rails and a geriatric chair with a tray are examples of physical restraints. Analgesics address pain and are not a restraint.
A nurse is filing a safety event report for an older adult client who tripped and fell when getting out of bed. Which action exemplifies an accurate step of this process?
The nurse details the client's response and the examination and treatment of the client after the incident An unintentional injury or incident that compromises safety in a health care agency requires the completion of a safety event report (incident report). The nurse completes the event report immediately after the incident and is responsible for recording the circumstances and the effect on the client in the medical record. The safety event report is not a part of the medical record and should not be mentioned in the documentation. The physician is not responsible for filling out or signing the safety report unless she witnessed the incident. The nurse reports factual information, not opinions.
A 14-year-old boy is in the clinic for his well-child exam. When the client asks his mother if she has any questions for the practitioner, she states "He sleeps so much. I am worried about how lazy he is." What does the nurse know to be true about sleep in adolescents?
Trying to balance too many activities can result in sleep deprivation. Adolescence is a time of rapid physical growth and more sleep is required. Many adolescents try to balance afterschool activities with jobs and school, resulting in sleep deprivation. This, in turn, poses a safety risk as adolescents have increased freedoms, such as driving.
A nurse working in the intensive care unit begins to realize the potential fire hazards in a hospital setting. When should the nurse demonstrate how to function during an emergency?
in advance of an actual emergency Each health care facility should determine in advance how to deliver care if an emergency or disaster occurs. This involves collaboration with internal committees and external agencies. Nurses are responsible for knowing such disaster plans for where they work. Understanding and practicing the plan helps nurses remain calm during an emergency.
Which topic should a public health nurse emphasize when educating older adults on reducing their risk of poisoning?
keeping medications in clearly labeled containers Medication overdoses are among the more common sources of poisoning in older adults, a phenomenon that can be reduced by ensuring that medications are in clearly labeled containers to avoid administration errors. Cleaning supplies and lead are more significant sources of poisoning in infants and children. Alternative and complementary therapies carry risks, but it would be unnecessary to recommend complete avoidance of all such therapies.
A nurse is assessing a client who recently had a stroke. Which assessment would the nurse prioritize to promote client safety?
neuromuscular status Anything that affects a client's health state potentially can affect the safety of the environment. For example, a nurse who is assessing a client with a recent stroke would assess neuromuscular impairment to prevent falls. Skin integrity, hygiene, and abdominal integrity would be important to prevent infection and promote bowel function.
A school nurse is preparing an education session on safety for parents of school-age children. What would be an appropriate topic for this age group?
providing drug, alcohol, and sexuality education The school-age child should be taught drug, alcohol, and sexuality education. Selecting toys for the developmental level applies to infants. Teaching stress reduction techniques applies to adults. Providing close supervision to prevent injuries applies to toddlers.
A nurse responds to the call bell and finds another nurse evacuating the client from the room, which has caught fire. Which action should the nurse take?
pull the fire alarm lever The nurse should pull the fire alarm lever. As per the RACE principle of fire management, the flow of activities should be rescue, alarm, confine, and extinguish. The client had already been evacuated by another nurse, so the next action should be to pull the fire alarm lever, followed by confinement of the fire and extinguishing.
Over the past few weeks, a client in a long-term care facility has become increasingly unsteady. The nurses are worried that the client will climb out of bed and fall. Which measure does not comply with a least restraint policy?
raising all side rails while the client is in bed Raising all side rails on the bed would be a restraint and may increase the client's risk of falling if he climbs out of bed. All the other options would comply with a least restraint policy.
There is a fire in the neurology unit of a health care facility. What would be most appropriate to avoid in this situation?
use of elevators The nurses should avoid the use of elevators in a case of fire. They should not avoid the use of wheelchairs and stretchers, as these can be used to evacuate nonambulatory clients. The nurses should clamp the suction tubes of clients before disconnecting them from the suction apparatus; this helps in transporting the clients faster. The nurses should close doors and windows to reduce the fire's oxygen supply. Reference:
A nurse is working as an industrial nurse. Which activity would the nurse suggest that the employers adopt to prevent carbon monoxide (CO) inhalation by the workers?
using carbon monoxide detectors and alarms The nurse should suggest the use of carbon monoxide detectors and alarms to prevent carbon monoxide inhalation. Ensuring good ventilation is important at the workplace, but it may not be helpful in preventing CO poisoning. The CO gas is odorless; therefore, its presence cannot be detected. Keeping the resuscitation equipment ready is not a preventive measure.
The nurse is assessing clients for risk factors in the workplace. Which clients would be at risk for injury due to the environment of the workplace? Select all that apply.
worker who operates equipment in an automobile assembly plant gardener who mows and places fertilizer on lawns nursing assistant who lifts clients in a nursing home Rick factors for injury in the workplace include those occupations in which the client operates dangerous machinery such as in an automobile assembly plant, is exposed to noise and chemicals such as the gardener, and lifts heavy objects such as when the nursing assistant lifts clients in the nursing home. People in the fitness field tend to have low risk of injury and stress. The owner of a fitness center who teaches one yoga class a day has a low-risk factor for injury. The medical records technician, according to CareerCast.com, who works in a doctor's office has low-risk factors for injury.
The nurse is providing safety teaching to the family of an older adult client. Which finding in the client's home will the nurse teach the family to address?
A hair dryer is placed next to the sink. Electrical shock can result if appliances such as a hair dryer come in contact with water. The hair dryer should be moved away from the sink. Other findings reflect appropriate safety measures.
The acronym RACE is commonly taught as a means for remembering priorities for action during a fire. The "A" in this acronym stands for which of the following?
Activate the fire alarm and notify the appropriate person. RACE stands for Rescue - Alarm - Contain - Extinguish. The "A" in the acronym RACE stands for "activate the fire alarm and notify the appropriate person."
The nurse is teaching an unlicensed assistive personnel (UAP) about fire safety. Which UAP statement demonstrates that teaching has been effective?
"I will rescue clients from harm before doing anything else. The RACE acronym should be used when managing a fire: Rescue, Alarm, Confine, and Extinguish. Teaching has been effective when the UAP knows to rescue patients first. RACE
A home care nurse provides health education to parents regarding the care of their toddler. Which precaution should the nurse suggest the parents take to protect the toddler from drowning?
Avoid unattended baths for the toddler. The parents should not leave the toddler for an unattended bath. Toddlers are naturally inquisitive, and instructing them to stay away from the pool may make them more curious. Monitoring the activities of the toddler is not always feasible. Allowing the child to swim with friends does not ensure safety.
A school nurse is conducting a safety seminar with students in 6th grade. Which teaching point is most important?
Make sure that you have smoke detectors in your house and that they're in working order. A paramount fire-safety issue is smoke detectors, since approximately half of home fire deaths occur in a home without a smoke detector. This risk far exceeds that of fireplaces, even though these must be used with caution. Individuals should stop, drop and roll if clothing catches on fire. Old microwaves do not constitute a significant fire risk.
Use of which restraint requires the nurse to stay with the client until the restraint is discontinued?
Mummy restraint A mummy restraint restricts all movement.
A nurse is caring for a client who is receiving an intravenous therapy through an IV pump. Which intervention should the nurse implement to ensure electrical safety?
Obtain a three-prong grounded plug adapter. The nurse should obtain a three-prong grounded plug adapter, as it carries any stray electricity back to the ground. Using an extension cord may be an electrical hazard. Taping the electrical cord to the ground and running the electrical cord under the carpet are not appropriate actions for electrical safety.
A nurse is educating parents of preschoolers on appropriate safety measures for this age group. What might be a focus of the education plan?
childproofing the house To prevent accidental injury and death in toddlers and preschoolers, parents need to childproof the home environment. Play areas should allow for exploration but still provide for safety. Safety equipment for sports should be taught to school-age and older children. Drug and alcohol education is also typical for school-age and older children. Back to sleep guidelines are relevant for neonates unable to roll independently.
The clinical nurse educator at a long-term care facility is responsible for organizing and carrying out staff education sessions. Which topic for staff education is most likely to benefit the greatest number of residents?
educating nurses on how to prevent falls Falls remain the leading cause of death among older adults. Education that aims to reduce the incidence of falls is likely to be of more benefit than measures that address medication administration, prevention of wandering, or resuscitation procedures, even though such topics may be of importance.
A nurse finds that a fire has broken out in a client's room at the health care facility. Which intervention is the priority?
evacuate the client. The first priority in case of fire is to evacuate the client. As per the RACE principle of fire management, the rescue of the client is the first step, followed by raising an alarm, confining the fire, and finally, extinguishing the fire. RACE
A school nurse is aware of poisoning risks in the adolescent population. Poisoning in this age group is most often related to:
experimentation with drugs and inhalants. Adolescents and young adults who experiment with drugs may suffer unintentional poisoning and death. The ready availability of inhalants on store shelves and in the home may provide the opportunity for children to sniff or huff these dangerous substances. Adolescents may also swallow medications in a suicide attempt. Ingestion of substances containing lead occurs in the preschool population. Exposure to toxic fumes (cleaning agents) and carbon monoxide affects individuals of all age groups.
