Chapter 27: Safety, Security, and Emergency Preparedness

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." "If your clothes should catch on fire, go to an open area as quickly as possible." "Make sure that your family's microwave oven was made after 1999; otherwise, it may be a fire risk." "A wood-burning fireplace is a major fire risk, and it shouldn't be used unless necessary."

"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.

A hospital is introducing a program that has the goal of aligning practices more closely with the Quality and Safety Education for Nurses (QSEN) project. What initiative best exemplifies QSEN competencies? A. New systems are introduced to increase communication between nurses and the members of other health disciplines. B. Systems are reviewed with the goal of achieving the best client outcomes at the lowest cost. C. Hiring practices are reviewed to maximize the proportion of nurses who possess baccalaureate or graduate degrees. D. New partnerships are established between the hospital and local schools of nursing.

A. New systems are introduced to increase communication between nurses and the members of other health disciplines.

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. A. Obtain order from a licensed provider within minutes of restraint application. B. Withhold information from family regarding restraints due to HIPAA. C. Check circulation and skin condition every 2 hours. D. Offer regular, frequent opportunities for toileting. E. Maintain restraints until discharge.

A. Obtain order from a licensed provider within minutes of restraint application. C. Check circulation and skin condition every 2 hours. D. 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.

A client has frequent readmissions for fall-related injuries. Which is the most appropriate intervention by the nurse? A. Perform a vision test with Snellen chart B. Arrange an audiology consult to evaluate hearing C. Assess the client for signs and symptoms of osteoporosis D. Arrange for a skilled home care assessment

D. Arrange for a skilled home care assessment The client's home should be evaluated for potential hazards and risks. There is no indication of vision or hearing issues. It is uncommon for falls to be directly attributable to osteoporosis.

An older adult is admitted to the hospital with a fractured hip. The client suddenly develops acute onset of confusion and hallucinations. Which action should the nurse implement first? A. Leave to notify the health care provider concerning a change in client status B. Apply limb restraints to ensure client safety C. Promptly document the change in client status D. Reduce distressing environmental stimuli to maximize client safety

D. Reduce distressing environmental stimuli to maximize client safety Added stimulation can increase the maladaptive behaviors of the client; therefore, the nurse should first reduce the distressing environmental stimuli. Proper communication of client status change is a legal requirement of nurses, and documentation provides a means of communication between interdisciplinary teams and provides continuing of care. However, notifying the health care provider and documenting the change in status are not the priority action. Restraints are to be used as a last resort in client care.

Which item would alert the home care nurse to a safety hazard threatening a young child? Three blankets in a crib A gated stairway Padded child safety seat Dangling blind cords

Dangling blind cords

Which topic should a public health nurse emphasize when educating older adults on reducing their risk of poisoning? a. keeping medications in clearly labeled containers b. alternatives to chemical-based cleaning supplies c. hidden sources of lead in the household environment d. avoiding the use of alternative and complementary therapies

a. 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.