Craven Ch. 17: Safety

A nurse has applied restraints to a client as ordered at 9 p.m. The nurse adheres to the guidelines for restraint use by removing them at which time? - 9:30 p.m. - 10 p.m. - 10:30 p.m. - 11 p.m.

- 11 p.m. Explanation: When a restraint is applied, it should be removed, one at a time, at least every 2 hours.

A grade school nurse is addressing parents regarding car safety. What is a recommended safety guideline for this age group? - All school-age children need to be secured in safety seats. - Booster seats should be used for children until they are 4'9" (1.43 m) tall or at least 8 years of age. - Children under 8 years old should ride in the back seat. - All school-age children need to be secured in lap seat belts.

- Booster seats should be used for children until they are 4'9" (1.43 m) tall or at least 8 years of age. Explanation: 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.

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 - Smoking cessation - Safety equipment for playing sports - Back to sleep guidelines

- Childproofing the house Explanation: 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.

A nurse is providing an in-service program for staff on fire safety and is reviewing the types of fire extinguishers available. Which class of fire extinguisher would the nurse describe as appropriate for use on an electrical fire? - Class A - Class B - Class C - Class D

- Class C Explanation: A Class C fire extinguisher is used for electrical fires. A Class A extinguisher is used for paper, wood, or cloth fires. A Class B extinguisher is used for flammable liquid or gas fires. A Class D extinguisher is used for combustible material fires.

The nurse is conducting a community education program on bike helmet safety. The nurse determines additional information is needed when a participant states: - "I should be able to fit two fingers between my chin and the chin strap." - "The helmet should rest 1 in (2.5 cm) above the eyebrows." - "My child needs a helmet if in a secured passenger bike seat." - "My child should wear a helmet every time he rides a bike."

- "I should be able to fit two fingers between my chin and the chin strap." Explanation: The nurse should determine that additional information is needed when the participant states that the chin strap should fit two fingers underneath the chin. The chin strap needs to be snug, and the ability to fit two fingers between the strap and the chin indicates it is not snug enough. The helmet should rest 1 in (2.5 cm) above the eyebrows. Children should wear a helmet every time they ride a bike or are strapped into a bike seat as a passenger.

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." Explanation: 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 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)." - "It is advisable to use a head support in the car seat of a newborn to maintain neck stability." - "You can use a second-hand care seat if you have it inspected and installed by the fire or police department." - "When strapping the newborn into the car seat, you should allow a four finger width between the chest and strap so the child can breathe."

- "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)." Explanation: 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.

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. - Withhold information from family regarding restraints due to HIPAA. - Check circulation and skin condition every 2 hours. - Offer regular, frequent opportunities for toileting. - Maintain restraints until discharge.

- 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. Explanation: 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.

An older adult client is planning to move with the son and daughter-in-law into a bigger apartment. The son asks the nurse for some tips to keep the parent safe. Which safety principles should the nurse include in the client teaching? - Combine medications into a few pill bottles for ease of use. - Put a small nightlight in the hall and stairway. - Decorate the parent's room with small rugs and wall hangings. - Locate the parent in a room near the kitchen.

- Put a small nightlight in the hall and stairway. Explanation: The nurse should suggest that the client put nightlights in the hallway or stairway to illuminate the area during the night. Medicines should not be combined for ease of use, but kept in original bottles for easy identification and use. Small rugs can be a fall hazard and should be eliminated. While the parent may enjoy a room near the kitchen, choosing a room near the bathroom would be more beneficial in case of the need for use at night.

A nurse is making a home visit for a client with several home safety concerns. On which safety concept(s) would the nurse advise the client? Select all that apply. - Remove extension cords from open spaces. - Check the batteries in all smoke detectors. - Store prescription medications on the counter. - Ensure appropriate lighting in hallways and entrances to the home. - Remove throw rugs from high traffic areas.

- Remove extension cords from open spaces. - Check the batteries in all smoke detectors. - Ensure appropriate lighting in hallways and entrances to the home. - Remove throw rugs from high traffic areas. Explanation: Nursing assessment includes identifying individuals at risk and recognizing unsafe situations in the environment. Assessment includes an awareness of risk factors in the home. The nurse would advise the client to remove extension cords from open spaces, check the batteries in smoke detectors, remove throw rugs, and ensure appropriate lighting in hallways and entrances to the home. The nurse would not advise the client to place prescription medications on the counter as anyone could access these. It is recommended that medication be kept in a place that is easy for the client to access, but still should be kept out of the reach of children or others who may take them.

A father asks the nurse who is caring for his 13-year-old daughter why his daughter could be performing poorly in school lately, and why she is distancing herself from friends and family. Which of these possibilities would the nurse consider as the priority risk? - She may be the victim of cyber-bullying. - She has lost interest in academics because she has a boyfriend now. - She may be beginning her menses. - She may be developing nutritional deficiencies from poor dietary habits.

- She may be the victim of cyber-bullying. Explanation: Symptoms of cyber-bullying include faltering school achievement, absenteeism, health concerns, isolating oneself from peers/friends, and increased anxiety and depression symptoms. Adolescents may neglect academics when involved in personal relationships, but that is a common milestone of the age group. Achieving menarche may alter mood, but it is not a risk concern. Nutritional deficits can be seen in adolescence and may need to be investigated with this client, but it is not the priority at this time.

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 adds the information in the safety event report to the client health record. - The nurse calls the primary health care provider to fill out and sign the safety event report. - The nurse provides an opinion of the physical and mental condition of the client that may have precipitated the incident. - The nurse details the client's response and the examination and treatment of the client after the incident.

- The nurse details the client's response and the examination and treatment of the client after the incident. Explanation: 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. - Increased sleep is the result of boredom. - Adolescents require less sleep than adults; this is clearly an underlying medical concern. - Increased sleep guarantees adolescents will behave in a safe manner.

- Trying to balance too many activities can result in sleep deprivation. Explanation: 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 is caring for an older adult client at risk of injury due to confusion. The client has a stable gait. Which method of restraining should the nurse use? - waist restraint - locking lap tray chair - alarm-activating bracelet - vest restraint

- alarm-activating bracelet Explanation: The nurse should use an alarm-activating bracelet for the client because the client has a stable gait. This prevents unnecessary confinement to bed, and the client can move freely without getting off the premises. Waist restraints, vest restraints, and chair restraints are restrictive, and their use should be minimal.

The residential home nurse is caring for a client who lives in an assisted living unit. In designing a plan of care to prevent fires, the nurse identifies which as the highest risk to the client? - clothes dryer - gas stove - electrical sockets - cigarette smoking

- gas stove Explanation: Fire, injury from fire, and fire-related deaths all decreased significantly between 2004 and 2013. Based on data collected by the United States Fire Administration, residential fires (31.7%) are second in prevalence only to outdoor fires (39.3%). It is important to note that 80% of all fire deaths occur in the home. Cooking is the cause of fire in 29.3% of residential cases; some of the other causes include carelessness (9.2%), heating (9%), electrical malfunction (7.9%), appliances (5%), and smoking (2.3%).

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? - placing the client in a bed with a bed alarm - providing a bed that is low to the floor - raising one bed rail to offer stabilization when standing - raising all side rails while the client is in bed

- raising all side rails while the client is in bed Explanation: 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.

Which nursing concern is appropriate for designing educational interventions for a single parent who leaves their toddler unattended in the bathtub? - not compliant - suffocation risk - falls risk - altered body temperature risk

- suffocation risk Explanation: Death from drowning occurs from suffocation. Nearly half of all drowning victims are children under the age of 5. Most drowning deaths in young children occur because of inadequate supervision of a bathtub or pool.

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 - ensuring a good ventilation system at the workplace - educating the workers about signs of the presence of CO gas - keeping the resuscitation equipment ready at hand

- using carbon monoxide detectors and alarms Explanation: 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 charge nurse is observing a new nurse care for a client who is at high risk for falls. Which action by the new nurse would require the charge nurse to intervene? - waiting outside of the closed bathroom door while the client uses the toilet - transferring the client to a room that can be visualized from the nursing station - applying an electronic personal alarm - placing a "high fall risk" designation on the outside of the client's room

- waiting outside of the closed bathroom door while the client uses the toilet Explanation: The nurse should remain with a client who is at high risk for falls.

A nurse is making a visit to a client's home and, during the assessment, the nurse notices some possible hazards. What would the nurse identify as potential hazards? Select all that apply. - wall-to-wall carpeting - clutter on the stairs - nonworking smoke detector - electrical outlet with several extension cords - evidence of mice droppings - hair dryer stored in hall cabinet

clutter on the stairs - nonworking smoke detector - electrical outlet with several extension cords - evidence of mice droppings Explanation: Potential hazards in the home include clutter on the stairs, nonworking smoke detectors, overloaded electrical outlets, and evidence of rodents (such as mice droppings). Loose, unsecure carpeting (not wall-to-wall carpeting) and electrical appliances such as hair dryers stored near the tub or sink (and not in a hall cabinet) would be problematic.