Chapter 25 - Safety

What are Unintentional Injuries?

"Accidents" - occur at random and may be unavoidable. Injuries that result from incidents such as falls, motor vehicle crashes, poisonings, drownings, fire-associated injuries, suffocation by ingested objects, and firearms.

What are the four major types of abuse?

1. Physical 2. Psychological/Emotional 3. Sexual 4. Financial

What are the six rights of medication that should always be double-checked?

1. Right drug 2. Right dose 3. Right time 4. Right patient 5. Right route 6. Right documentation

What are Individual Factors that affect safety?

A person's physical condition and age or developmental level. Functioning of body systems and those associated with an individual's lifestyle.

When working with radiation diagnostics or treatments, which preventive measures should be followed to avoid exposure? (Select all that apply.) a. Using lead shielding of patients and staff b. Keeping staff at the farthest distance possible from the radiation source c. Limiting the length of exposure d. Wearing a badge to monitor the length of exposure e. Following procedures and safety checks

All of the above

What is abuse?

Anything offensive, harmful, or injurious to an individual that can pose a direct safety threat.

What is the leading cause of unintentional poisoning deaths in the United States?

Carbon monoxide

Patients are assessed for safety hazards and potential sources of injury as the first step in the nursing process. While performing this assessment, the nurse should focus on:

Collecting subjective data related to the patient's symptoms and chief complaint. Reviewing the patient's history of exposures to environmental hazards. Forming an objective assessment focusing on the affected body systems.

Who created the National Center for Injury Prevention and Control and what is its purpose?

Created by the CDC. Works to reduce injury, disability, death and the costs associated with injuries.

What are symptoms of Carbon Monoxide poisoning?

Dizziness, light-headedness, and nausea. Death can occur with prolonged exposure in an enclosed area.

What are unique risks for toddlers?

Drowning Poisoning by accidental ingestion of medications or chemicals Choking on small toys or pieces of food such as grapes and hot dogs Strangulation by crib slats or cords from blinds Electrocution by electrical outlets Injury on sharp corners of furniture Falling on stairways Overheating and dehydration in hot environments

What are common safety concerns in health care environments?

Falls Restraints Medication administration errors Radiation exposure Drug-resistant microorganisms Procedural errors

What are some major safety concerns in home and community settings?

Food safety Injuries related to motorized and nonmotorized means of transportation Household equipment safety Poisoning Fires and Electrical Hazards Abuse Bioterrorism Suffocation and Drowning

What are unique risks for school-age children?

Head and limb injuries related to skating, skateboarding, sledding, and bicycling Head and neck injuries related to trampoline use Drowning in swimming pools

Where do we experience Environmental Factors that affect safety?

Home, outdoors, workplace, community, and settings in which care is provided.

What are Healthcare-associated infections?

Infections acquired during a hospital stay after the patient was admitted for an alternative illness.

What are unique risks for adults?

Injury from work-related hazards Overdoses from illegal and prescription drugs Sexually transmitted diseases due to multiple partners Motor vehicle accidents related to impaired driving

What are some examples of potentially toxic substances found in the home?

Lead Carbon monoxide Plants Medications (prescription, over-the-counter, and illicit drugs) Household chemicals

What are unique risks for older adults?

Medication errors related to confusion or sensory deficits Falls related to limited mobility Hyperthermia or hypothermia

What are unique risks for teenagers?

Motor vehicle accidents related to distracted driving Sexual transmitted diseases or unplanned pregnancy due to unprotected sex Depression and self-harm Violence Poisoning from tobacco, alcohol, or illegal or prescription drugs

What are some well-documented areas of occupational health and safety in nursing?

Needle-stick injuries Back and neck injuries resulting from lifting Patient-on-nurse violence

What organization was established in 1970 to address safety concerns by providing employers with guidelines for preventing exposure to hazardous chemicals and hazardous situations and reducing risk of injury in the workplace?

OSHA The Occupational Safety and Health Administration

What is lead poisoning?

Occurs when levels build up in the blood over months or years and it can affect all body systems. When lead levels are greater than 5 µg lead/dL of blood, the CDC recommends initiation of public health actions Lead-based paint is the most common and dangerous exposure for young children

What are some examples of Environmental Factors that affect safety?

Pollution Lighting Communicable Diseases Workplace Hazards

What is the goal of QSEN?

Preparing nurses of the future with knowledge, skills and attitudes needed to advance quality and safety on the job in their health care settings.

What is QSEN?

Quality and Safety Education for Nurses

What does R.A.C.E stand for?

R: Rescue all patients in immediate danger, and move them to safe areas. A: Activate the manual-pull station or fire alarm, and have someone call 911 C: Contain the fire by closing doors, confining the fire, and preventing the spread of smoke E: Extinguish the fire if possible after all patients are removed from the area

What are Intentional Injuries?

Result from deliberate acts of violence or abuse and often have fatal consequences -- such as suicide and homicide.

Who created the The National Patient Safety Goals that are reevaluated every year?

The Joint Commission (TJC)

What is the definition of Safety?

The condition of being free from physical and psychological harm and injury.

How do nurses play a central role in promoting safety for patients in health care settings and homes?

Through: 1. Assessment of risk 2. Patient education 3. Environmental management

The nurse is teaching a group of parents about strategies to minimize lead exposure in children. Which statement made by a parent indicates the need for further teaching? a. "I will arrange yearly checks for the heaters that we use." b. "I will use a filter for all sources of water in our home." c. "I will wash and peel vegetables before eating them." d. "I will teach my children to frequently wash their hands."

a. "I will arrange yearly checks for the heaters that we use." Rationale: Lead poisoning occurs when lead accumulates in the body over a period of months to years and causes serious health problems. Children under the age of 6 are more prone to lead poisoning. Scheduling yearly checks of the heating equipment is done to prevent carbon monoxide poisoning or fires. This measure would not be helpful to prevent lead poisoning in children. Tap water may contain lead, so filtering water at home is helpful in preventing lead exposure. Many pesticides and insecticides contain lead. Therefore fruits and vegetables should be washed well and peeled before using. Lead particles also get settled in soil, so children should wash their hands frequently after playing in the dirt to prevent lead exposure.

A patient sustained minor burns in a fire at home. After stabilizing the patient, the nurse asks the patient to obtain a fire extinguisher at home. Which instructions does the nurse provide to the patient? Select all that apply. a. "Make it inaccessible to the children." b. "Place it on each level near an exit." c. "Keep it at a low level (height) in the room." d. "Place it in clear view." e. "Keep it away from stoves and heating appliances."

a. "Make it inaccessible to the children." b. "Place it on each level near an exit." d. "Place it in clear view." e. "Keep it away from stoves and heating appliances." Rationale: Fire extinguishers should be placed where they are inaccessible to children. Children may play with this equipment, which may lead to accidents. To enhance fire safety, a fire extinguisher has to be placed on each level of the home and near the exit doors so that it is reachable when required. The extinguishers should be easily visible so that they can be accessed when required. They should be placed away from stoves and heating appliances to prevent explosion of the equipment. They should not be placed at a low level in a room. If one is placed at a low level, it would be accessible to children, and this can lead to accidents.

A nurse is teaching a student nurse about toxins in the home. Which statement shows a need for further teaching? a. "Mix household chemicals in a well ventilated area." b. "Wear protective clothing when spraying pesticides." c. "Open the windows when using household chemicals." d. "Poisonous chemicals should always be kept in their original containers."

a. "Mix household chemicals in a well ventilated area." This statement shows a need for additional teaching. Mixing household chemicals can result in toxic fumes.

A nurse is teaching a student nurse what The Joint Commission (TJC) might do while at a hospital renewing their accreditation. Which statements made by the student nurse demonstrates that the teaching has been effective? Select all that apply. a. "The surveyor may observe and talk to patients." b. "It is likely that the surveyor will interview the staff." c. "During an on-site survey, the surveyor will trace patient care." d. "A hospital's information and documentation is reviewed during accreditation." e. "The surveyor will provide a final accreditation decision at the closure of the on-site

a. "The surveyor may observe and talk to patients." b. "It is likely that the surveyor will interview the staff." c. "During an on-site survey, the surveyor will trace patient care." d. "A hospital's information and documentation is reviewed during accreditation.

A nurse is caring for a child who unintentionally came in contact with a poisonous plant. Which findings would be concerning during her assessment? Select all that apply a. A red, itchy rash b. Nausea and vomiting c. Swollen lips and tongue d. No urine output for 2 hours e. Crying when the nurse walks into the room

a. A red, itchy rash b. Nausea and vomiting c. Swollen lips and tongue

Which statements are true about unintentional and intentional injuries? Select all that apply a. Accidents are also referred to as unintentional injuries. b. Unintentional injuries typically result from deliberate acts of violence. c. Unintentional injuries are the second leading cause of death in the United States. d. The risk factors for intentional injuries are better understood than those of unintentional injuries. e. Patterns of unintentional injuries are often predictable and preventable.

a. Accidents are also referred to as unintentional injuries. d. The risk factors for intentional injuries are better understood than those of unintentional injuries. e. Patterns of unintentional injuries are often predictable and preventable.

Who is at greatest risk for drowning? a. Children between 1 and 4 years of age b. Children between 5 and 10 years of age c. Adults who do not use approved life jackets d. Teenagers who are under the influence of alcohol

a. Children between 1 and 4 years of age

A nurse works in a psychiatric unit. The nurse understands that the use of restraints may be useful for ensuring a patient's safety. Which complications would the nurse be aware of when using physical restraints? Select all that apply. a. Compromised circulation b. Incontinence c. Pressure ulcers d. Increased appetite e. Improved alertness

a. Compromised circulation b. Incontinence c. Pressure ulcers Rationale: Compromised circulation can result from improperly applied physical restraints. Incontinence can occur due to the inability to get out of bed on time to use the toilet. Pressure ulcers can result from pressure caused on the bony prominence due to immobility. Increased appetite is generally not a complication and may not be related to the use of restraints. Improved alertness is a good sign and is not a complication of the use of restraints.

A nurse is using physical restraints for a patient in the medical surgical unit. For which possible reasons would the nurse use restraints on the patient? Select all that apply. a. Confused and disoriented b. Trying to remove medical devices c. Verbally aggressive to the nurse d. Sedated and needs to be protected from falling out of bed e. Being prepared for a routine physical assessment

a. Confused and disoriented b. Trying to remove medical devices Rationale: Physical restraints are used (temporarily) when the patient is confused and disoriented to prevent the risk of falls. Some patients are extremely irritated as they are connected to many medical devices (such as ECG leads, pulse oximeter, and intravenous lines). They tend to remove the devices repeatedly. The nurse should use restraints for avoiding the removal of such devices. If the patient is verbally aggressive to the nurse, the nurse should make the patient realize that the behavior is inappropriate. Physical restraints should not be used in such a situation. The side rails of the bed can be raised for prevention of falls in a sedated patient. When used in this way, they are not considered a restraint.

1. When teaching a patient about fire safety, which activity does the nurse know is the leading cause of fire-related death? a. Cooking b. Playing with matches c. Smoking d. Heating with kerosene heaters

a. Cooking

Which assessment data would support the inclusion of Risk for fall into a patient's plan of care? Select all that apply a. Experiencing confusion after surgery b. Being diagnosed with cognitive impairment c. Having access to unlabeled household chemicals d. Using a walker after a total hip replacement e. Lacking knowledge related to safety precautions

a. Experiencing confusion after surgery d. Using a walker after a total hip replacement

Which are examples of unintentional injuries? Select all that apply a. Falls b. Suicide c. Drowning d. Homicide e. Fire-associated injuries

a. Falls c. Drowning e. Fire-associated injuries

Of which common causes of death in the elderly population would a nurse working in a nursing home be aware? Select all that apply. a. Falls b. Poisoning c. Hypothermia d. Heat stroke e. Motor vehicle accident

a. Falls c. Hypothermia d. Heat stroke Rationale: Falls are a very common cause of accidental death in elderly patients due to poor vision, gait and balance problems, and effects of various medications. Hypothermia and heat stroke are also common causes of death in the elderly as they are more vulnerable to temperature changes. Poisoning is more common in toddlers and small children as they have a habit of ingesting chemicals such as cleaning solutions and medicines found in the house. Motor vehicle accidents are more of a major cause of death in younger adults than in the elderly.

Which factor would the nurse evaluate when assessing an elderly patient using the Morse Fall Scale? a. Gait pattern b. Use of antiepileptics c. Get-Up-and-Go test d. Dizziness or vertigo

a. Gait pattern Rationale: The Morse Fall Scale is a tool used to assess fall risk in patients. Improper gait pattern is an important factor that may result in falls in a patient. The Morse Fall Scale considers the gait pattern as an individual factor for the assessment of risk of falls. The Hendrich II Fall Risk Model evaluates the effect of antiepileptic drugs, because these drugs may increase the fall risk. The Get-Up-and-Go test is a simple test used to assess a person's mobility. This test is also used in the Hendrich II Fall Risk Model. Dizziness or vertigo is evaluated in the Hendrich II Fall Risk Model.

Which factors would the nurse assess using the Johns Hopkins Hospital Fall Assessment Tool? Select all that apply. a. History of falls b. Dizziness or vertigo c. Specific medications d. Secondary diagnosis e. Patient care equipment

a. History of falls c. Specific medications e. Patient care equipment Rationale: The Johns Hopkins Hospital Fall Assessment Tool is used to screen patients for the risk of falls. This tool focuses on factors such as history of falls, advanced age, mobility, and cognitive and elimination functions. This tool also focuses on the medications used by the patient and equipment used for patient care that increase the risk of falls. Dizziness or vertigo is assessed in the Hendrich II Fall Risk Model. Presence of a secondary diagnosis is assessed in the Morse Falls Scale.

What is true regarding safety promotion? Select all that apply a. Implementing community outreach programs that provide instruction about safety, aids the nurse in promoting safety. b. Nurses must protect their own safety first, then that of their patients. c. Nurses must use strategies to reduce the risk of harm to others. d. Valuing their role in preventing errors in the health care setting is important for nurses in promoting safety. e. Assisting the patient, the patient's family, and the community is important in promoting

a. Implementing community outreach programs that provide instruction about safety, aids the nurse in promoting safety. c. Nurses must use strategies to reduce the risk of harm to others. d. Valuing their role in preventing errors in the health care setting is important for nurses in promoting safety. e. Assisting the patient, the patient's family, and the community is important in promoting

A patient has accidentally consumed kerosene. Which nursing intervention complicates the patient's condition further? a. Inducing vomiting b. Maintaining the airway c. Administering oxygen d. Measuring oxygen saturation

a. Inducing vomiting Rationale: Kerosene is a poisonous substance. Inducing vomiting in a patient who has consumed kerosene is dangerous as it can cause aspiration. Maintaining the airway is the primary measure to reduce the risk of aspiration and is thus important in cases of kerosene poisoning. Oxygen administration is helpful in kerosene poisoning. Measuring oxygen saturation is an important intervention for this patient as it helps identify the need for intubation and other assistive measures.

Which measures can the nurse teach to prevent poisoning of children? Select all that apply. a. Install safety latches on reachable cabinets. b. Keep syrup of ipecac on hand. c. Use childproof caps on medications. d. Use a plunger rather than a chemical drain cleaner. e. Keep cleaning supplies under the kitchen sink.

a. Install safety latches on reachable cabinets. c. Use childproof caps on medications. d. Use a plunger rather than a chemical drain cleaner.

Which fall risk assessment tool would the nurse employ for the patient using a walker? a. Morse Falls Scale b. Hendrich II Fall Risk Model c. New York-Presbyterian Fall and Injury Risk Tool d. Johns Hopkins Hospital Fall Assessment Tool

a. Morse Falls Scale Rationale: Ambulatory aids include walkers, crutches, and wheelchairs. The Morse Falls Scale assesses six items: history of falls, presence of a secondary diagnosis, use of an ambulatory aid, presence of an intravenous or a saline lock, gait, and mental status. The Hendrich II Fall Risk Model, the New York-Presbyterian Fall and Injury Risk Tool, and the Johns Hopkins Hospital Fall Assessment Tool do not consider the use of an ambulatory aid as a separate factor for the assessment of fall risk. The Hendrich II Fall Risk Model focuses on eight factors: impulsivity, symptomatic depression, altered elimination, dizziness or vertigo, male gender, use of antiepileptics, use of benzodiazepines, and performance on the "Get-Up-and-Go" test. The New York-Presbyterian Fall and Injury Risk Tool assesses fall history, gender, mental status, gait, and the use of sedatives. The Johns Hopkins Hospital Fall Assessment Tool focuses on the history of falls, influence of age, patient care equipment, mobility, cognitive, and elimination functions.

The nurse is planning to discharge a patient home on a new medication. Which statements are important to emphasize in the discharge paperwork? Select all that apply a. Never take larger or more frequent doses of medications. b. Do not refer to medication as "candy" which can entice children. c. Read over directions in direct light, and follow all directions on medication label. d. Dispose of used needles in a plastic container to avoid needlestick injuries. e. Make sure the primary care provider sets refill orders for the medication.

a. Never take larger or more frequent doses of medications. b. Do not refer to medication as "candy" which can entice children. c. Read over directions in direct light, and follow all directions on medication label.

A nurse working at a rehabilitation center has a patient who is paralyzed from the waist down. The patient needs assistance with mobility, bathing, and other activities of daily living (ADLs). Which helpful resources related to safety and injury prevention will the nurse coordinate? a. Obtaining a health aide when family members are not available to assist to the patient b. Ordering assistive devices such as a bath stool, hand held shower nozzle and grab bars for the patient c. Discussing options available for handicap transportation services so that the patient can get to physical therapy and other appointments d. Helping the family find a therapist to assist in the adjustment to the patient's injury e. Preventing the patient from using anything that is sharp

a. Obtaining a health aide when family members are not available to assist to the patient b. Ordering assistive devices such as a bath stool, hand held shower nozzle and grab bars for the patient

What other health care professional should the nurse consult first when a patient has difficulty with activities of daily living (ADLs) such as bathing and dressing and why? a. Occupational therapist to evaluate the ability to perform ADLs b. Physical therapist to evaluate the patient's need for assistive devices c. Social worker to arrange for needed assistive devices d. Area agency on aging to arrange for Meals on Wheels

a. Occupational therapist to evaluate the ability to perform ADLs

A patient is being provided artificial respiration through ventilators in an intensive care unit. Unfortunately there has been a fire in the ward. Which intervention should the nurse perform in this situation? a. Provide manual respiration via an Ambu bag. b. Make arrangement to shift the patient along with ventilators. c. Remove ventilator support and wait until the fire is under control. d. Make arrangements to provide oxygen until the fire is under control.

a. Provide manual respiration via an Ambu bag. Rationale: The most appropriate nursing action is to provide manual respiration via an Ambu bag until the fire is brought under control. This would help prevent hypoxia in the patient. It is difficult to shift the patient and ventilator setup during a fire. Taking the patient off ventilator support may prove fatal. Providing oxygen without ventilator support is not useful for patients who are on ventilators.

Which are examples of external factors which may affect safety? Select all that apply a. Residing in a high-crime area b. Living with an abusive, alcoholic father c. Developmentally performing below one's age level d. Being diagnosed with a disease at a very young age e. Becoming a member of a gang in your neighborhood

a. Residing in a high-crime area b. Living with an abusive, alcoholic father e. Becoming a member of a gang in your neighborhood

To assist with determining the patient's risk for injury and issues requiring further evaluation, the patient assessment should include which items? Select all that apply a. Subjective data related to the patient's symptoms b. Patient's family history c. Focused assessment of the affected body systems. d. Patient's history of exposures to environmental hazards. e. Subjective data related to the patient's chief complaint

a. Subjective data related to the patient's symptoms c. Focused assessment of the affected body systems. d. Patient's history of exposures to environmental hazards. e. Subjective data related to the patient's chief complaint

Which organization accredits hospitals while focusing on patient safety? a. The Joint Commission b. World Health Organization c. Center for Disease Control d. National Institute of Health

a. The Joint Commission

A patient has recovered from seizures in a postoperative ward. Which action by the nurse would ensure continued safety of the patient? Select all that apply. a. The side rails of the bed should be raised. b. The patient should be placed in the supine position. c. The call light and intercom should be kept near the patient. d. The use of pillows should be avoided. e. The bed should be placed in the highest position.

a. The side rails of the bed should be raised. c. The call light and intercom should be kept near the patient. Rationale To ensure continued safety of the patient following seizures, the side rails of the bed should be raised to prevent a fall. Placing the call light and intercom within reach of the patient would help in receiving assistance, if needed. The patient should be positioned in a side-lying position, not in the supine position. The side-lying position prevents the tongue from falling back and obstructing the airway. A pillow should be used for supporting the head now that the seizure is over. The bed should be lowered to the lowest position to prevent a fall and risk of injury.

The senior nurse is teaching a group of nursing students about the prevention of hospital fires. Which activities should be performed during a fire? Select all that apply. a. Use fire extinguisher. b. Open all doors and windows. c. Turn off sources of oxygen. d. Close all doors and windows. e. Pour water everywhere.

a. Use fire extinguisher. c. Turn off sources of oxygen. d. Close all doors and windows. Rationale: A fire can be extinguished if the oxygen supply to the fire is cut off. Therefore the important measures to extinguish the fire include using a fire extinguisher, turning off sources of oxygen, and closing all doors and windows. Opening all doors and windows would increase the oxygen supply and fuel the fire. Water should not be poured as it leads to unnecessary waste and only helps in fires that involve paper, wood, or cloth.

Which restraint-free alternative is best for the nurse to use for an 84-year-old patient after hip replacement who has confusion and incontinence? a. A room near the nurses' station and decreased sensory stimuli b. A pressure sensor alarm and a room near the nurses' station c. Side rails up and decreased sensory stimuli d. A 24-hour sitter and the patient's favorite TV program

b. A pressure sensor alarm and a room near the nurses' station

An elderly client residing in the community with cardiopulmonary compromise and impaired ability to perform activities of daily living (ADLs) presents safety concerns to the nurse. Which is the greatest concern? a. Ability to obtain and take medications correctly b. Ability to safely get on and off a toilet c. Ability to safely procure food and prepare meals d. Ability to safely eat without choking

b. Ability to safely get on and off a toilet

Which individuals are more likely to be involved in an intentional injury? a. A young female with a history of falling b. An adolescent female with severe depression c. A young adult male with a history of violence d. An older adult male diagnosed with dementia e. A middle-aged female who is a known child abuser

b. An adolescent female with severe depression c. A young adult male with a history of violence e. A middle-aged female who is a known child abuser

A new nurse is caring for an uncooperative patient who has undergone cardiac bypass surgery and needs restraints. Which restraint applied by a new nurse would require correction? a. Applying mitt restraint b. Applying vest restraint c. Applying wrist restraint d. Applying ankle restraint

b. Applying vest restraint Rationale: A restraint inhibits a patient from moving freely. A patient who had undergone cardiac bypass surgery would have surgical incisions on the chest; therefore vest restraints should not be used because they may cause pain at the incision site. Mitt, wrist, and ankle restraints would not cause undue discomfort to the patient and thus can be used. Mitt restraints are used to restrict movement of a hand or finger. Limb restraints, such as wrist and ankle restraints, are applied to prevent patients from pulling on tubes.

An 18-year-old patient is brought to the emergency department following a motor vehicle accident. Which factors would be the causes of a motor vehicle accident in this age group? Select all that apply. a. Reduced vision b. Drunken driving c. Driving too fast d. Careless about road hazards e. Not properly trained to drive

b. Drunken driving c. Driving too fast d. Careless about road hazards Rationale: Motor vehicle accidents are commonly seen in teenage drivers between 16 and 19 years. In this age group, alcohol, drugs, and high speeds are the major causes of accidents. Dangerous or hazardous situations are not always considered in this age group. Reduced vision is a common cause of accidents in an older or elderly population. Proper training to drive is always given before issuing a valid license.

Which factors would the nurse evaluate using the Hendrich II Fall Risk Model? Select all that apply. a. History of falls b. Get-Up-and-Go test c. Presence of intravenous lines d. Use of benzodiazepines e. Use of ambulatory aids

b. Get-Up-and-Go test d. Use of benzodiazepines Rationale: The Hendrich II Fall Risk Model is a tool used to screen the factors that increase the risk of falling in patients. The Get-Up-and-Go test is a simple test used to assess the mobility of a person. This tool evaluates the effect of certain medications such as benzodiazepines and antiepileptics that may increase the risk of falls in people. Fall history is assessed in the Johns Hopkins Hospital Fall Assessment Tool and the Morse Falls Scale. The presence of an intravenous line and the use of an ambulatory aid are factors in the Morse Falls Scale.

A nurse is caring for an older adult in his home. The nurse is concerned about infection control in this patient. About which practices would the nurse inquire when assessing the risk of food poisoning in this patient? Select all that apply. a. Daily water intake b. Handwashing practices c. Knowledge about food storage practices d. Monthly consumption of fruits and vegetables e. Practice of checking expiration dates on milk products

b. Handwashing practices c. Knowledge about food storage practices e. Practice of checking expiration dates on milk products Rationale: Good handwashing practices include washing hands before and after handling food items. Proper knowledge about food storage practices ensures that the food consumed is safe and free of contamination. A regular practice of checking expiration dates on milk products ensures that the products are safe for consumption. Knowledge of daily water intake does not help in assessing the risk of food poisoning. Knowledge of monthly consumption of fruits and vegetables is not related to the risk of food poisoning.

What is safety? Select all that apply a. Resistance against attack b. Having no physical harm or injury c. Being comfortable in an environment d. Being free from psychological harm and injury e. Having the ability to speak and act without hindrance

b. Having no physical harm or injury d. Being free from psychological harm and injury

An agitated patient has been physically restrained for 2 hours. Which interventions would the nurse include in the plan of care as alternatives to using restraints? Select all that apply. a. Take the patient to a brightly lit room. b. Include the use of aromatherapy. c. Use gentle massage for relaxation. d. Let the patient listen to music. e. Keep the patient in isolation.

b. Include the use of aromatherapy. c. Use gentle massage for relaxation. d. Let the patient listen to music. Rationale: Aromatherapy uses the sense of smell by using strong-smelling plant oils to reduce a patient's anxiety and improve mood. Incorporate gentle massage techniques to promote patient relaxation. Listening to music or watching television may relieve stress. The patient may be oversensitive to bright light; therefore the patient should not be taken to a bright place. Isolating the patient from family members may aggravate the patient's agitation. Therefore the nurse should encourage family and significant others to spend time with the patient.

Which measure would ensure normal breathing and reduced risk of musculoskeletal injury to a patient having seizures? Select all that apply. a. Tighten the waist belt. b. Loosen the collar. c. Restrain the patient. d. Turn the patient's head to the side. e. Place a soft pillow under head.

b. Loosen the collar. d. Turn the patient's head to the side. Rationale: Loosening the patient's collar facilitates breathing movements by reducing the effort required for chest expansion. During a seizure, a patient should be protected from injury by placing the head on a soft surface and turned to the side to prevent aspiration and by moving sharp or hard objects out of the way. Tightening the waist belt restricts abdominal expansion, further aggravating respirations in the patient. The patient should not be restrained during seizures, as this increases the chance of musculoskeletal injury. Pillows should be removed to prevent suffocation.

Which initial nursing intervention should the nurse employ for a patient who has inhaled poisonous fumes? a. Call the Poison Control Center. b. Move the patient to obtain fresh air. c. Summon an ambulance immediately. d. Perform cardiopulmonary resuscitation.

b. Move the patient to obtain fresh air. Rationale: A patient who has inhaled poisonous gas should first be moved to a place that has fresh air as soon as possible, so that the patient is not further exposed to poisonous fumes. After moving the patient to a safe area, the nurse should call the Poison Control Center to obtain first aid instructions. If the victim is not breathing and has no pulse, an ambulance should be called and cardiopulmonary resuscitation should be performed.

The Institute of Medicine published To Err is Human more than a decade ago and we still use this document to guide our safety practices within the hospital setting. What performance standards has The Joint Commission developed from this? a. NCLEX Assessments b. National Patient Safety Goals c. Employer's Annual Performance Review d. Advanced Cardiac Life Support (ACLS)

b. National Patient Safety Goals

A nurse is caring for an older adult in his home and is concerned about his infection control and his risk of injury. Which activities should the nurse perform to assess this patient's risk of injury? Select all that apply. a. Inspect the patient's food. b. Perform a home hazard appraisal. c. Inquire about the patient's visual acuity. d. Observe the patient's posture and balance. e. Assess the patient's gastrointestinal system.

b. Perform a home hazard appraisal. c. Inquire about the patient's visual acuity. d. Observe the patient's posture and balance. Rationale: A home hazard appraisal may reveal issues like poor lighting, small items, or excessive furniture in the house that can increase the risk of injury. Inquiring about the patient's visual acuity helps assess the risk of falling or tripping over objects at home. Assessing patient's posture and balance reveals any balance, coordination, or movement-related issues. Inspecting the patient's foods does not help in assessment of risk. Assessing the patient's gastrointestinal system does not affect the risk of injury.

The nurse is providing care to a child who is the victim of physical abuse. When planning collaborative care for this patient to enhance safety, which providers should the nurse include? a. Pharmacist b. Psychologist c. Social worker d. Physical therapist e. Occupational therapist

b. Psychologist c. Social worker

Which is the priority nursing diagnosis related to safety when planning care for a pediatric patient with burns on over 50 percent of the body? a. Acute Pain b. Risk for Infection c. Disturbed Body Image d. Risk for Ineffective Renal Perfusion

b. Risk for Infection The patient is at Risk for Infection due to the burn injury threatening the patient's safety; therefore, this is the priority nursing diagnosis for this situation.

The nurse is performing a fall risk assessment on a newly admitted patient. Which finding is a greater known risk factor for falls? a. Taking aspirin b. Urinary incontinence c. Multiple comorbidities d. Malnutrition

b. Urinary incontinence

A parent calls the pediatrician's office frantic about the bottle of cleaner that her 2-year-old son drank. Which instruction would the nurse give to this parent? a. "Give the child milk." b. "Give the child syrup of ipecac." c. "Call the poison control center." d. "Take the child to the emergency department."

c. "Call the poison control center." Rationale: A poison control center is the best resource for patients and parents needing information about the treatment of an accidental poisoning. The parent should not be instructed to give the child milk to drink. Syrup of ipecac may induce vomiting that may further injure the child. Taking the child to the emergency department will waste valuable time; the child will receive prompt attention by calling the poison control center.

Which activity would be most appropriate for the registered nurse (RN) to delegate to unlicensed assistive personnel (UAP)? a. Assessing the patient for fall risk and complications of restraint use b. Evaluating the patient's ability to perform activities of daily living (ADLs) c. Assisting with or performing the patient's ADLs d. Teaching the patient use of assistive devices

c. Assisting with or performing the patient's ADLs

Which pertinent patient information should the nurse consider prior to goal setting when planning care related to injury prevention and safety promotion? a. Family structure b. Level of education c. Developmental level d. Family medical history e. Cultural background

c. Developmental level The nurse must be aware of the patient's developmental level in order for the plan of care to be discussed in appropriate terms to facilitate understanding. e. Cultural background The patient's cultural background and beliefs are important when planning care because interventions must align with the patient's cultural values and beliefs otherwise the patient will be reluctant to follow the care plan.

Which should the nurse consider related to patient understanding when planning care related to injury prevention and safety promotion? a. Aligning the patient's goals with the cultural values b. Determining the patient's beliefs for goal statements c. Ensuring the patient has necessary support to meet goals d. Considering the patient's developmental level for goal statements

c. Ensuring the patient has necessary support to meet goals Ensuring the patient has the necessary support to meet goals is a nursing consideration related to patient understanding when planning care related to injury prevention and safety promotion.

A patient suffers a cerebrovascular accident. On assessment, the nurse learns that gait and vision are normal, but the patient is anxious and has a fear of falling. How should the nurse help the patient in managing anxiety? Select all that apply. a. Refer the patient for an ophthalmologic assessment. b. Suggest the elimination of obstacles in the home. c. Establish a therapeutic relationship with the patient. d. Encourage the use of effective coping skills. e. Remind the patient to scan the surrounding environment.

c. Establish a therapeutic relationship with the patient. d. Encourage the use of effective coping skills. Rationale: A patient who has anxiety related to a fear of falling benefits from a therapeutic relationship with the nurse and encouragement to use coping skills effectively. These measures help reduce the patient's anxiety and cope better with the fear of falling. The ophthalmologist's opinion will not help the patient as the patient does not have a visual impairment. Elimination of obstacles at home reduces the risk of falling in cluttered homes, but not the anxiety related to the potential for falls. Scanning the entire environment is useful only if the patient has unilateral neglect. Unilateral neglect is a sign related to brain injury where a person lacks awareness of one side of the body or one side of the surrounding environment.

Which provides specific performance-related patient safety outcomes? a. NCLEX b. Health Care provider on the unit for the day c. National Patient Safety Goals (NPSGs) d. Hospital policies about standards of care

c. National Patient Safety Goals (NPSGs)

Which measure should the nurse take while restraining a patient using a vest strap? a. Attach the straps to the side rails of the bed. b. Tie the straps securely with a square knot. c. Secure the straps with a quick-release knot. d. Fasten the straps allowing one finger width.

c. Secure the straps with a quick-release knot. Rationale: While using a vest strap to restrain a patient, the nurse should tie the straps with quick-release knots so that the patient can be freed quickly in case of emergency. The straps should not be tied to side rails because that may cause injury when the side rails or bed are lowered or raised. Straps should not be tied with a square knot because it will take more time to untie the straps in an emergency. Wrap the strap to ensure that two fingers, side by side, fit between the restraint and the patient's skin.

A couple states they are worried about the safety risks affecting their adolescent daughter. Which option presents the greatest risk for injury for an adolescent? a. Home accidents b. Physiological changes of aging c. Poisoning and child abduction d. Automobile accidents and substance abuse

d. Automobile accidents and substance abuse Rationale: Risks to the safety of adolescents involve many factors outside the home because much of their time is spent away from home and with their peer group. According to the Centers for Disease Control and Prevention, the risk of motor vehicle accidents is higher among 16- to 19-year-old drivers than any other age group. In an attempt to relieve the tensions associated with physical and psychosocial changes and peer pressures, some adolescents engage in risk-taking behaviors such as smoking, drinking alcohol, and using drugs. Home accidents, physiological changes of aging, poisonings, and child abductions are not among the greatest risks for safety in adolescents.

How does QSEN ensure that nurses advance quality and safety in future health care settings? a. By opening new nursing schools b. By starting legislation to keep the project going c. By providing safety goals and hospital accreditation d. By preparing nurses with knowledge, skills, and a positive attitude

d. By preparing nurses with knowledge, skills, and a positive attitude

A 56-year-old man who has been staying at a cabin while hunting arrives at the emergency department with complaints of dizziness, light-headedness, and nausea. What does the nurse initially suspect? a. Lead poisoning b. Radon exposure c. Food poisoning d. Carbon monoxide poisoning

d. Carbon monoxide poisoning

Which national organization categorizes injuries as intentional or unintentional? a. The Joint Commission (TJC) b. Center for Disease Control (CDC) c. American Nursing Association (ANA) d. National Center for Health Statistics (NCHS)

d. National Center for Health Statistics (NCHS) The National Center for Health Statistics categorizes as intentional or unintentional, because they track statistics of health.

The emergency department nurse is caring for a patient who recently had a stroke, has been stumbling often and has a large cut on his head. Who would be appropriate to consult with in order to get assistance for this patient? a. Pharmacist b. Acute stroke team c. Social worker d. Physical therapy team

d. Physical therapy team

A patient gets poison on the skin. Which nursing intervention is priority? a. Administer an oral antihistamine tablet. b. Apply cool compresses to the contaminated area. c. Take the patient outside for fresh air as soon as possible. d. Remove clothing that was in contact with the chemical.

d. Remove clothing that was in contact with the chemical. Rationale: While caring for a patient who has been exposed to poison on the skin, the nurse should first remove the clothing that was in contact with the poison and rinse the skin with water for at least 15 minutes. If itching or inflammation still persists, an antihistamine tablet can be administered to the patient on the health care provider's prescription. Using cool compresses is not appropriate at this time. Taking the patient outside for fresh air occurs if the poison has been inhaled.

The nursing assessment of a 78-year-old woman reveals shuffling gait, decreased balance, and instability. Which nursing diagnosis is best supported by these findings? a. Activity intolerance (ICNP) b. Impaired mobility in bed (ICNP) c. Arthritis pain (ICNP) d. Risk for fall (ICNP)

d. Risk for fall (ICNP) Rationale: Risk for fall (ICNP) is the nursing diagnosis best supported by the observations of shuffling gait, decreased balance, and instability; these conditions place the patient at high risk for a fall. There is no evidence in the findings to suggest activity intolerance (ICNP). With decreased balance and instability, the patient may experience impaired mobility in bed (ICNP), but the findings better support a nursing diagnosis related to risk for an injury or fall. None of the clinical findings described specifically support the diagnosis of pain due to arthritis.

Quality and Safety Education for Nurses (QSEN) project is increasing emphasis for patient safety. In what way has it impacted actual initiatives and regulations? a. Implementing new job descriptions for safety nurses b. Requiring all newly licensed RN's to take a safety test c. Requiring newly licensed nurses to petition their senator for support on patient safety d. Using national resources for professional development to focus attention on safety in hospital settings

d. Using national resources for professional development to focus attention on safety in hospital settings