CHAPTER 27 Patient Safety and Quality

A patient reports difficulty seeing objects at a distance after a cerebrovascular accident. What would the nurse anticipate? 1 Risk of falls 2 Anxiety related to fear of falling 3 Unilateral neglect due to brain injury 4 Impaired physical mobility on one side of the body

1

Which is a serious reportable event included in the National Quality Forum List? 1 Immediate postoperative death 2 Hypothermia due to severe cold conditions 3 A fall associated with administration of diuretics 4 Injury resulting from physical assault that occurred at a patient's home

1

What are the changes observed upon exposure to severe heat? Select all that apply. 1)Irregular heartbeat 2) concentration 3)Decrease in oxygenation 4)Changes in electrolyte balance 5)Rise in core body temperature

4,5

A patient has a leg fracture. Which statement made by the patient about crutch safety requires further teaching by the nurse? 1 "I should lean on the crutches to support my body weight." 2 "I should regularly inspect the structural intactness of the crutches." 3 "I should dry the crutch tips using paper towels if they become wet." 4 "I should immediately replace any worn crutch tips to prevent slipping."

1

A patient who was admitted to the hospital receives a red-color wristband for identification purposes. What is the significance of the wristband? 1 The patient has allergies. 2 The patient is at risk for falling. 3 The patient should be treated immediately. 4 The patient is not indicated for resuscitation

1

At 12 noon the emergency department nurse hears that an explosion has occurred in a local manufacturing plant. Which action does the nurse take first? 1. Prepare for an influx of patients 2. Contact the American Red Cross 3. Determine how to resume normal operations 4. Evacuate patients per the disaster plan

1

The nursing assessment of an 80-year-old patient who demonstrates some confusion but no anxiety reveals that the patient is a fall risk because she continues to get out of bed without help despite frequent reminders. The initial nursing intervention to prevent falls for this patient is to: 1. Place a bed alarm device on the bed. 2. Place the patient in a belt restraint. 3. Provide one-on-one observation of the patient. 4. Apply wrist restraints

1

The registered nurse is teaching a group of student nurses about various problems faced by older adults and effective interventions to overcome those problems. Which patient information provided by the registered nurse needs correction?

1

A nurse is educating parents to look for clues in teenagers for possible substance abuse. Which environmental and psychosocial clues should the nurse include? (Select all that apply.) 1. Blood spots on clothing 2. Long-sleeved shirts in warm weather 3. Changes in relationships 4. Wearing dark glasses indoors 5. Increased computer use

1,2,3,4

What is the correct order of safety measures to be followed by the nurse in the event of a fire in a hospital area? 1. Activating the alarm 2. Rescuing and removing all patients 3. Extinguishing the fire with an appropriate extinguisher 4. Closing doors and windows and turning off electrical equipment

2,1,3,4

. A couple who is caring for their aging parents are concerned about factors that put them at risk for falls. Which factors are most likely to contribute to an increase in falls in the elderly? (Select all that apply.) 1. Inadequate lighting 2. Throw rugs 3. Multiple medications 4. Doorway thresholds 5. Cords covered by carpets 6. Staircases with handrails

1,2,3,4,5

A nurse is evaluating a patient who is in soft wrist restraints. Which of the following activities does the nurse perform? (Select all that apply.) 1. Check the patient's peripheral pulse in the restrained extremity 2. Evaluate the patient's need for toileting 3. Offer the patient fluids if appropriate 4. Release both limbs at the same time to perform range of motion (ROM) 5. Inspect the skin under each restraint

1,2,3,4,5

Which age group is at the highest risk for accidental poisoning at home? 1 Adults 2 Toddlers 3 Older adults 4 Adolescents

2

Which nursing process step is demonstrated when the nurse performs a visual examination on a patient who becomes too agitated when approached? 1 Planning 2 Evaluation 3 Assessment 4 Implementation

2

Which safety precaution should the nurse follow to reduce the risk of falls in a patient with hemiparesis? 1 Standing on the patient's unaffected side when using a walker. 2 Standing on the patient's affected side when using a cane and a gait belt. 3 Performing range-of-motion exercises before ambulating. 4 Having the patient frequently touch one hand with the other hand.

2

Which factors contribute to an increase in falls in older patients? Select all that apply. 1 Safety devices 2 Anticonvulsants 3 High bed position 4 Moderate lighting 5 Secure rugs and carpeting

2,3

The nurse assists a surgical technician in preparing a sterile field. Which action made by the nurse indicates a need for correction? 1 Allowing the flap to lie flat on the table's surface 2 Grasping the outer edge of the tip of the outermost flap 3 Standing close to the sterile field while opening the last flap 4 Opening the outermost flap of the sterile kit away from the body

3

Which intervention would be most appropriate to prevent a patient fall by reducing the risk of entanglement? 1 Cleaning all spills promptly and posting a sign indicating a wet floor 2 Removing excess equipment, supplies, and furniture from rooms and halls 3 Coiling and securing excess electrical, telephone, and any other cords or tubing 4 Keeping the floors clutter and obstacle free, particularly the path to the bathroom

3

Which intervention would the nurse employ to reduce the risk of falling in the health care setting due to tripping? 1 Cleaning all spills promptly 2 Ensuring adequate glare-free lighting 3 Keeping the floor free of clutter and obstacles 4 Having assistive devices on the exit side of the bed

3

You are caring for a patient who frequently tries to remove his intravenous catheter and feeding tube.You have an order from the health care provider to apply a wrist restraint. Place the steps for applying a wrist restraint in the correct order. 1. Be sure that patient is comfortable with arm in anatomic alignment. 2. Wrap wrist with soft part of restraint toward skin and secure snugly. 3. Identify patient using two identifiers. 4. Introduce self and ask patient about his feelings of being restrained. 5. Assess condition of skin where restraint will be placed

3,4,1,5,2

Which nursing interventions fall under the category of nurse-initiated interventions? Select all that apply . 1 Inserting a Foley catheter 2 Starting an intravenous infusion 3 Elevating an edematous extremity 4 Repositioning the patient to relieve pain 5 Informing about the side effects of medications

3,4,5

The family of a patient who is confused and ambulatory insists that all four side rails be up when the patient is alone. What is the best action to take in this situation? (Select all that apply.) 1. Contact the nursing supervisor. 2. Restrict the family's visiting privileges. 3. Ask the family to stay with the patient if possible. 4. Inform the family of the risks associated with side-rail use. 5. Thank the family for being conscientious and put the four rails up. 6. Discuss alternatives that are appropriate for this patient with the family.

3,4,6

In a pediatric ward, one of the newborns died of sudden infant death syndrome (SIDS). Which nursing measure lowers the risk of death due to SIDS? 1 Massaging the baby's heels 2 Attaching pacifiers with a string around the baby's neck 3 Gently rubbing the baby's back 4 Having the baby sleep on his or her back

4

The nursing assessment of a 78-year-old woman reveals orthostatic hypotension, weakness on the left side, and fear of falling. On the basis of the patient's data, which one of the following nursing diagnoses indicates an understanding of the assessment findings? 1. Activity Intolerance 2. Impaired Bed Mobility 3. Acute Pain 4. Risk for Falls

4

Which task related to use of patient restraints can be delegated to nursing assistive personnel (NAP)? 1 Checking on a restraint 2 Assessing a patient's behavior 3 Determining a patient's need for restraints 4 Orientating the patient to the environment

1

You are conducting an education class at a local senior center on safe-driving tips for seniors. Which of the following should you include? (Select all that apply.) 1. Drive shorter distances 2. Drive only during daylight hours 3. Use the side and rearview mirrors carefully 4. Keep a window rolled down while driving if has trouble hearing 5. Look behind toward the blind spot 6. Stop driving at age 75

1,2,3,4,5

. What is your role as a nurse during a fire? (Select all that apply.) 1. Help to evacuate patients 2. Shut off medical gases 3. Use a fire extinguisher 4. Single carry patients out 5. Direct ambulatory patients

1,2,3,5

A patient has delivered a baby at full term. What does the nurse teach the patient about protecting newborns from environmental temperature? Select all that apply. 1 Teach the importance of adequate clothing. 2 Emphasize covering the head of the baby with a cap. 3 Explain that extra care is not required for full-term babies. 4 Instruct the patient to avoid exposing infants to extreme temperatures. 5 Encourage the patient to keep the baby's body temperature above 99.5° F (37.5° C

1,2,4

To ensure safe use of oxygen in the home by a patient, which teaching points should the nurse include? Select all that apply. 1 Smoking is prohibited around oxygen. 2 Demonstrate how to adjust the oxygen flow rate based on patient symptoms. 3 Do not use electrical equipment around oxygen. 4 Special precautions may be required when traveling with oxygen. 5 It is safe to use oxygen around gas stoves, candles, or fireplaces that are in use

1,3,4

A nurse knows that the people most at risk for accidental hypothermia are: (Select all that apply.) 1. People who are homeless. 2. People with respiratory conditions. 3. People with cardiovascular conditions. 4. The very old. 5. People with kidney disorders

1,3,4,

A nurse cares for a patient who is diagnosed with tuberculosis. Which nursing interventions would be most appropriate to reduce the risk of transmission? Select all that apply. 1 Wearing an N95 respirator 2 Maintaining a positive airflow in the room 3 Wearing a surgical mask when the patient is 5 feet away or less 4 Wearing a mask while outside of the patient's room 5 Wearing gloves while performing a physical examination of the patien

1,5

The nurse is caring for a patient who has a lack of coordination and weakness of both lower limbs. The patient is able to bear weight on both limbs but is unable to walk independently. Which gait does the nurse teach the patient? 1 A two-point gait 2 A four-point gait 3 A three-point gait 4 A three-point alternating gait

2

. The nurse is caring for a patient who is having a seizure. Which of the following measures will protect the patient and the nurse from injury? (Select all that apply.) 1. If patient is standing, attempt to get him or her back in bed. 2. With patient on floor, clear surrounding area of furniture or equipment. 3. If possible, keep patient lying supine. 4. Do not restrain patient; hold limbs loosely if they are flailing. 5. Never force apart a patient's clenched teeth

2,4,5

The nurse is performing fall prevention measures for a patient. During which step of the nursing process does the nurse perform "Timed Get up and Go" (TUG) if a patient is able to ambulate? 1 Planning 2 Evaluation 3 Assessment 4 Implementation

3

The nurse is teaching the parent of a young child about car safety. Which statement by the parent indicates effective learning? 1 "I should secure my 6-month-old child in a forward-facing car seat." 2 "When my child is 1 year old, I can place his car safety seat in the front seat." 3 "I should place my 3-month old child in the back seat with a rear-facing convertible seat." 4 "I should not place my child in a front-facing seat before the age of 1."

3

Which is a serious reportable event included in the National Quality Forum list? 1)Discharging a patient with a cardiac condition 2)Severe bleeding while removing a foreign object during surgery 3)Disability associated with electric shock during care in a health care facility 4)Bruising associated with the use of bed rails during care in the health care facility

3

Which recommendation would be appropriate to reduce the risk of falls in a patient with hemiparesis? 1 "You should perform range-of-motion exercises." 2 "You should make use of coping skills that you have previously used." 3 "You should consult an ophthalmologist for a visual assessment." 4 "You should touch one side of your body frequently with the other hand."

3

While administering an intravenous medication, the patient develops adverse reactions. What is the priority nursing intervention in this situation? 1 Administering the antidote of the medication 2 Flushing the intravenous line with normal saline solution 3 Stopping the medication delivery immediately 4 Documenting the adverse reaction in the patient's medical record

3

.A patient has been newly admitted to a medicine unit with a history of diabetes and advanced heart failure. The nurse is assessing the patient's fall risks. Place the following steps for measuring the "Timed Get-up and Go Test" (TUG) in the correct order: 1. Have patient rise from straight-back chair without using arms for support. 2. Begin timing. 3. Tell patient to walk 10 feet as quickly and safely as possible to a line you marked on the floor, turn around, walk back, and sit down. 4. Check time elapsed. 5. Look for unsteadiness in patient's gait. 6. Have patient return to chair and sit down without using arms for support.

3,1,2,5,6

The nurse is changing the dressing of a patient at a bedside table. Which are the techniques of asepsis that the nurse should perform? Select all that apply. 1 Wearing a mask 2 Using protective eyewear 3 Using an instant alcohol hand antiseptic 4 Having well-manicured nails 5 Washing hands with soap and water followed by rinsing under a stream of water for 15 seconds

3,4,5

You are admitting Mr. Jones, a 64-year-old patient who had a right hemisphere stroke and a recent fall. His wife stated that he has a history of high blood pressure, which is controlled by an antihypertensive and a diuretic. Currently he exhibits left-sided neglect and problems with spatial and perceptual abilities and is impulsive. He has moderate left-sided weakness that requires the assistance of two and the use of a gait belt to transfer to a chair. He currently has an intravenous (IV) line and a urinary catheter in place. Which factors increase his fall risk at this time? (Select all that apply.) 1. Smokes a pack a day 2. Used a cane to walk at home 3. Takes antihypertensive and diuretics 4. History of recent fall 5. Neglect, spatial and perceptual abilities, impulsive 6. Requires assistance with activity, unsteady gait 7. IV line, urinary catheter

3,4,5,6,7

A parent calls the pediatrician's office to ask about directions for using a car seat. Which of the following is the most correct set of instructions the nurse gives to this parent? 1. Only infants and toddlers need to ride in the back seat. 2. All toddlers can move to a forward facing car seat when they reach age 2. 3. Toddlers must reach age 2 and the height/weight requirement before they ride forward facing. 4. Toddlers must reach age 2 or the height or weight requirement before they ride forward facing

4

Which suggestion would be appropriate to prevent unilateral neglect in a patient with hemiparesis? 1 "You should perform range-of-motion exercises." 2 "You should use a walker and cane around the home." 3 "You should consult with an ophthalmologist for visual assessment." 4 "You should touch one side of the body frequently with the other hand.

4

The registered nurse (RN) is teaching a nursing student about poisons. Which statements if made by the nursing student indicate effective learning? Select all that apply. 1 "Poisons mostly affect the liver." 2 "Household cleaning solutions do not cause poisoning." 3 "Older adults are at greater risk for accidental poisoning at home." 4 "A poison control center is the best resource for treating accidental poisoning." 5 "Emergency treatment is necessary when a poisonous substance comes into contact with the skin."

4,5