RN Lesson 2 Safety & Infection Control Practice Test

The nurse is offering safety instructions to a parent with a 4 month-old infant and a 4 year-old child. Which statement by the parent indicates a correct understanding of the appropriate precautions to take with the children?

"I have the 4 year-old hold and help feed the 4 month-old a bottle with me." The infant seat should be placed on the rear seat. Small children and infants are not to be left unsupervised. Infants are to be placed on their back when they go to sleep or are lying in a crib. A four year-old could assist with the care of an infant such as feeding with proper direct supervision.

The parents of a toddler ask the nurse how long their child will have to sit in a car seat while in an automobile. What is the nurse's best response to the parents?

"Your child must use a car seat until he weighs at least 40 pounds." The guidelines for car seats depend on the child's weight, height, age and car type. Children should use car seats until they weigh 40 pounds (according to the U.S. National Highway Traffic Safety Administration).

Which situation requires handwashing or hand sanitation? (Select all that apply.)

1. After contact with inanimate objects in the immediate vicinity of the client 2. After cleaning a wound 3. Before having direct contact with a client 4. Prior to eating Handwashing is still the simplest and most effective strategy to prevent the spread of infection. It is necessary to wash one's hands to protect oneself prior to eating, after removing gloves following any client procedure, and even after having contact with intact skin or objects in the client's room. However, it is not necessary to wash hands after handling every chart (although using an alcohol-based hand rub would be advisable).

The nurse is providing burn prevention education to parents of a toddler and a school-age child. What safety measures should the nurse include in the teaching? (Select all that apply.)

1. Checks for hot straps or buckles before placing a child in a car seat 2. Cook with pot handles turned towards the center of the stove 3. Create an escape plan and practice it with the children To prevent burns at home, hot water heaters should be set to below 120 F (48.8 C) and parents and caregivers should test the bath water before placing a child in it. When possible, the back burners on the stove should be used and pot handles should be turned to the center or toward the back of the stove to prevent an item from being pulled down by a child. A parent or caregiver should check the straps and buckles placing a child in a car seat. Escape plans should be practiced and children should know what to do in case of a fire. Smoke detectors batteries should be replaced regularly (usually once a year); people should not wait until the alarm sounds to replace the batteries.

The medication benztropine mesylate (Cogentin) is ordered, but the nurse incorrectly administers carvedilol (Coreg). What are the most important actions the nurse should take after making this medication error? (Select all that apply.)

1. Monitor and document the client's blood pressure 2. Notify the nurse manager 3. Document the administration of carvedilol (Coreg) 4. Notify the health care provider When a nurse makes a medication error, the client's safety and well-being are the top priority. The nurse will document giving the beta-blocker carvedilol and as well as any effects the medication has on the client. The health care provider must be notified; the nurse will document that the provider was called and that orders were implemented. The nurse manager must also be notified. Once the client is stable, the nurse will complete an incident/variance/quality-assurance report (usually within 24 hours of the incident.) The initial disclosure of the medication error with the client should occur as soon as reasonably possible after the event (usually within 1-2 days after the event).

The nurse is caring for a client who is not oriented to time, place or person and has repeatedly attempted to pull out intravenous lines and a feeding tube. The nurse receives an order from the health care provider to apply a vest and soft wrist restraints. Which of the following actions by the nurse are appropriate? (Select all that apply.)

1. Tie the restraints using quick-release knots 2. Conduct a thorough assessment of the client 3. Document which alternative interventions were used or attempted 4. Explain the rationale for restraints to the client Prior to applying restraints, the nurse must first conduct a thorough assessment of the client and document the behavior and/or events leading to the use of the restraint. The nurse should also document which alternatives to restraints were tried and the client's response to those measures. Even though the client may be confused, the nurse must still explain the reason for applying restraints. A physician's order is required and the order must be renewed each calendar day of use. Many policies state that clients in restraints must be assessed every hour; care is given and documented at least every 2 hours.

The charge nurse is making client room assignments. In order to minimize the risk of a hospital acquired infection, which of these children would be the most appropriate roommate for a 3 year-old child diagnosed with minimal change disease?

4 year-old with bilateral inguinal hernia repair Minimal change disease is a kidney disorder that can lead to nephrotic syndrome. Corticosteroids can cure the disease in most children but cytotoxic therapy and other drugs may be needed, but this treatment can reduce the child's ability to fight infection. The charge nurse must select a roommate who does not have an infection, which is the child who just had surgery. The sickle cell crisis may have been triggered by an infection. The child who's sibling has a viral disease has the potential to develop an infection.

A nurse is conducting a community-wide seminar on childhood safety issues. Which of these children is at the highest risk for poisoning?

A 20 month-old who has just learned to climb stairs Toddlers, aged one to three years, are at the highest risk for poisoning because they are increasingly mobile, need to explore and engage in autonomous behavior.

The paramedics are transporting a poisoning victim to the local hospital. In which of these cases does the nurse anticipate that hyperbaric oxygen therapy will be used?

A 35 year-old found unconscious with suspected carbon monoxide poisoning Carbon monoxide (CO) poisoning is the leading cause of poisoning in the U.S. It causes severe hypoxia which is why treatment includes high-dose oxygen; in severe poisoning, hyperbaric oxygen therapy may be used. Treatment for crystal drain cleaner and diazepam may include gastric lavage and/or activated charcoal. Treatment for alcohol poisoning may include gastric lavage, IV fluids and supportive care.

The charge nurse on the evening shift is asked to determine which client is a candidate for discharge. Which of these clients should the nurse select as a potential candidate for discharge?

A middle-aged adult with a history of type 1 diabetes and one day post diabetic ketoacidosis The client selected to be discharged should be one whose condition is more stable than the others and where there's less of a risk for complications or instability after discharge. Although the client with asthma has a chronic condition, s/he was just admitted and is experiencing an acute exacerbation of the condition. The adolescent is experiencing an acute condition, probably brought on by his/her alcohol abuse. Neither of these clients are stable enough for discharge. It is a humane choice to allow the client who is in the process of dying to stay in the hospital.

The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the discharge list in order to make room for a new admission?

A middle-aged client with a seven-year history of being ventilator dependent and who was admitted with bacterial pneumonia eight days ago The best candidate for discharge is one who has a chronic condition and has an established plan of care. The client who has been on the ventilator for years is most likely stable and could continue medication therapy at home. The other clients have a risk for instability or are unstable.

A nurse is performing well-child assessments at a day care center when a staff member interrupts the examinations for assistance with another child. The nurse finds a crying 3 year-old child on the floor with bleeding gums and two unlabeled open bottles nearby. What should be the nurse's first action?

Ask the staff member about the contents of the bottles The nurse needs to assess the situation and determine what the child ingested. Once the substance is identified, the poison control center and emergency medical services should be called.

The nurse is setting up a client's dinner tray. When the nurse turns her back to the client, the client grabs the nurse's buttocks and states he is hungry for much more than dinner. Which of the following responses by the nurse is indicated?

Complete an incident report To keep the therapeutic relationship intact, a nurse needs to set limits on appropriate behavior and not ignore bad behavior. Sexual harassment is a form of violence and is never part of the job. The nurse should report the incident to her supervisor and complete an incident report. The nurse has the right to ask not to be assigned to this client.

A neonate is having difficulty maintaining a temperature above 98 F (36.6 C) and is placed in an infant warming system (IWS). Which of the following actions will ensure the safety of the neonate?

Monitor the neonate's temperature continuously When using a warming device, the neonate's temperature should be continuously monitored using a probe that's securely attached to the skin. Monitoring the neonate's temperature is the priority safety concern because skin burns, permanent brain damage or even death can result due to improper use or monitoring of equipment. No clothing or swaddling is needed in the IWS; usually babies are dressed only in a diaper (although bubble wrap blankets or plastic wrap blankets can be used to minimize heat loss in high risk newborns.) For healthy term newborns, nurses should warm their hands and stethoscopes prior to contact with the baby.

After an explosion at a factory, one of the employees approaches the nurse and says, "I am a certified nursing assistant (CNA) at the local hospital." Which of these tasks would be appropriate for the nurse to assign to this worker who is assisting in the care of the injured?

Palpate pulses The heart rate and regularity would indicate if the client is in shock or has potential for shock. If the pulses could not be easily palpated or are irregular, those clients would need to be seen first and further assessment by the nurse could be done (including measuring blood pressure). Taking temperatures is not a priority in this situation.

The school nurse is providing information for teachers at a school where a 10 year-old child with epilepsy attends. What is the most important action a teacher can take when the child experiences a tonic-clonic seizure in the classroom?

Place something soft and flat under the child's head During seizure activity, the priority would be to protect the child from physical injury. The teacher could place something soft and flat, like a folded jacket under the child's head to help prevent head trauma. After protecting the head, the prioritized sequence of the actions would be to move furniture away from the child, note movements and time, and then provide privacy, if possible, while reassuring the other students.

The nurse is to administer a new medication to a client. Which of the following actions best demonstrates an awareness of safe and proficient nursing practice?

Prior to administration of the medication, the nurse should ask: "What is your name? What allergies do you have?" and then check the client's name band and allergy band. A dual check is always done for a client's name. This would involve verbal and visual checks. Because this is a new medication an allergy check is appropriate. The other options have parts that might be correct actions. However, to be the correct answer all of the parts of an option need to be correct.

The nurse observes a nursing assistant using antiseptic hand rub and rubbing the hands vigorously after leaving the room of a client diagnosed with Clostridium difficile. Which action is most appropriate by the nurse?

Require the nursing assistant to wash hands again with soap and water Anyone who is hospitalized should be encouraged to ask caregivers if they washed their hands and to remind visitors to wash their hands. However, it is the nurse's responsibility to supervise the nurse assistant and to correct practice errors as needed. Clostridium difficile (C. diff) is one of the few pathogens that require soap and water for cleansing the hands. Since antiseptic hand rub is ineffective against the hardy spores produced by this bacterium, the nurse should require the nursing assistant to wash his/her hands with soap and water, especially after providing care for this client.

A client is admitted to an inpatient crisis unit with the diagnosis of acute mania and has been placed in seclusion. The nurse is assigned to observe the client at all times. It is now time for the client's dinner. What action should the nurse take next?

Serve the dinner in the seclusion room, maintaining observation Seclusion is ordered by a physician and requires continuous observation, unless the order is discontinued or amended. It is incorrect to amend the seclusion or mealtime. Meals can be eaten in the seclusion room with the nurse continuing the 1:1 observation. Meals must be offered on time and should not be withheld. Contracts for safe behavior are meaningless in the presence of psychotic behavior (mania).

A client is diagnosed with gastroenteritis, caused by a salmonella infection. Which of these actions is the primary nursing intervention designed to limit the transmission of salmonella?

Wash hands thoroughly with soap and water before and after client contact Salmonella is a bacteria and one of the causes of gastroenteritis. Gastroenteritis is characterized by acute onset of nausea, vomiting, abdominal cramps and/or diarrhea. The CDC recommends using standard precautions for this illness, which is why the primary nursing intervention is thorough handwashing before and after client contact using soap and water. Skin disinfectants can reduce the number of bacteria on the hands but cannot replace the importance of washing with soap and water. Clients do not need to be placed in isolation; symptomatic clients can be cohorted. Double-gloving can be effective in surgery, but it's probably not needed when changing contaminated linens.