Chpt 10

The home health nurse is visiting an older adult patient and her husband. What safety concern is the highest priority when the nurse is assessing this patient's home environment?

Accidental poisoning

While reviewing fire safety, a type C fire extinguisher can only be used on which type of fire?

An electrical fire

CDC

Centers for Disease Control and Prevention

RACE

rescue, alarm, contain, extinguish

The nurse is talking to a young mother who has an infant who has just started to crawl. Based on knowledge of growth and development, which safety issue is currently the most important to discuss with the mother?

How to manage electrical sockets and cords

A patient has a wrist safety Remind her device on for the last two hours. What is the nurse highest priority intervention?

Remove the safety reminder device and assess circulation and skin integrity.

The nurse is providing home poison control instructions to the parent of a two-year-old boy. Which statement by the parent indicates a need for further teaching?

I will give my child syrup ipecac if he ingest a poisonous substance that is not Caustic

An older adult patient in a long-term care facility has been wandering around outside of the room during the late evening hours. The patient has a history of falls. How should the nurse intervene?

Obtain an order for a bed and chair alarm

The LPN/LVN is reviewing the care plan of the patient who has an SRD applied for personal safety. Which is the highest priority goal for this patient?

Patient will remain free of injury

The LPN is reinforcing discharge teaching with parents of a small child regarding poisoning. Which statement by the parents would indicate the need for further teaching?

"We have some empty food containers that we can use for storing anything dangerous."

When the staffs knowledge of the fire safety precaution is assessed, which action indicates a need for further fire safety instruction? Select all that apply

-A heating pad cord is taped win afraid area is noted -A UAP evacuated critically ill patients on the elevator during a fire drill

The nurse is caring for a patient on a ventilator and reads the order restrain PRN. The nurse considers which factor when caring for this patient? Select all that apply

-Allow as much freedom of movement as possible when applying SRDs -Ensure that the nurse two fingers can be inserted between the SRD and the patient skin

The LPN is caring for a patient who has a safety reminder device. What are the most appropriate points that need to be included in the documentation?

-Duration of the use of physical restraint -Explanation given to the patient and family -Reason for the physical restraint -Type of safety reminder used

The nurse is conducting a fall risk assessment on an older adult patient who is moving into an assisted living center. Which question with a nurse ask? Select all that apply

-Have you had any falls in the past year? -Do you feel unsteady when you stand up? -Are you able to independently walk from room to room? -Have you ever lost consciousness before or after a fall -Do you use a cane or other assistive devices

The older adult residents in a nursing home must be evacuated because the facility is at risk for flooding and damage due to a hurricane that will pass through the area in several days. The nurses assigned to keep a log to document the events. What information is most important to record? Select all that apply

-How each resident was transported -Name of the resident -Where the residents were sent -Who transported each resident -Notification of family members and healthcare providers

When caring for the patient who requires the use of an SRT, what should be included in the patient's plan of care? Select all that apply

-Monitor the skin for signs of impairment -Remove the SRD once every two hours -Reevaluate the need for the SRT frequently

The nurse is planning to teach a community group about fire safety in the home.What information should be included in the presentation? Select all that apply

-No smoking by patient, family, Or visitors in the area where oxygen is used -install fire alarms, smoke detectors, and carbon monoxide detectors -Practice fire escape routes from each room and practice exit drills

The nurse is considering the use of an SRD to prevent patient from self injury. When using an SRT what should the nurse do? Select all that apply

-Obtain a providers order for the SRD -Explain the purpose of the SRD to the patient -Explain the purpose of the SRD to the family -Exhaust all alternatives before using an SRD

The nurse is reviewing the disaster preparedness plan for a small nursing home. What should be included in the plan? Select all that apply

-Possible admission to a hospital or transferred to a temporary shelter -Log to document residents names and locations -System to notify families and providers -Method of patient identification such as bracelet or a picture ID

The nurses observing the UAP who is assisting the resident in a long-term care facility ambulate with a gait belt. Which action by the UAP indicates to the nurse that further instruction is necessary? Select all that apply

-The UAP loosely fast since the gate belt around the patients waste -The UAP fast since the bell around the arm of the chair to prevent the resident from slipping out of the chair

A patient has a care plan with A patient problem of risk for injury. Which intervention would be most appropriate? Select all that apply

-keypad in low position except when Care is given. -instruct in the use of a cowbell and keep in reach at all times -orient patient the room and environment to provide a familiarity -assisted patient to the bathroom frequently

The patient reports dizziness when standing up too fast. Which over-the-counter medication is most likely to be contributing to the patient's orthostatic hypotension?

Anti-histamine

The nurse is teaching a new group of UAP how to evacuate residence from a long-term care facility in case of fire or other emergency. What piece of equipment for the universal carry method does the nurse need to teach about?

A blanket

Which newly admitted patient would be at the greatest risk for an injury?

A patient who has a history of falls

During the 7 AM to 3 PM shift on the adult surgical unit, the code is an ounce for an external disaster emergency. Which event best represents this type of situation?

A school bus accident

Which occurrence is most likely to be investigated as a sentinel event?

An older patients sustains a broken arm related to the use of an SRD

An adult patient is brought to the emergency department for treatment for an unintentional poisoning. Where is the nurse first action in caring for this patient?

Assess the patient

The home health nurse is assessing a child for the risk of injury. Which factor place as a child at greatest risk for specific types of injuries?

Developmental level

The postoperative patient demonstrate some mild dizziness and mild shortness of breath when moving from sitting to standing position. What action should the nurse perform first?

Assist patient to sit back down

Before the nurse can intervene, a UAP pushes contaminated material into an overfilled sharps container and sustains a puncture wound. What should the nurse do first?

Assist the UAP to scrub the wound with copious amounts of soap and water

The nurse is sitting at the front desk at a walk-in clinic. A patient comes in and reports fever, malaise, and muscle aches with a rash on the tongue, mouth and throat. The nurse notes pustules on the patient palm. What should the nurse to first?

Call the provider to try edge the patient.

A confused patient is yelling at the unlicensed assistive personnel. As the nurse enters the room, the patient processed food tray at the UAP. What should the nurse do first?

Calmly talk to the patient and respectfully addressed him by name

For the care of a patient who has an SRT in place, which task can be delegated to a UAP?

Change position every two hours

A nurse is working in a long-term care facility caring for older adults. What type of accident is most often experience by an older adult?

Falls

In the event of a mercury's spill, what is the priority nursing action?

Evacuate everyone in the room

The nurse is giving instructions to a UAP about patient safety and fall prevention. What should the nurse tell the UAP about helping the patient to go to the bathroom?

Have her sit ups slowly and dangle her legs before standing

A mother brings her alert and playful child to the clinic because she found him playing with this empty bottle of baby aspirin. Which question is the most important to ask the mother?

How many pills do you think we're in the container?

The nurse is working in a local health department and the nurse there has been An unusually large number of phone calls about foodborne illness. Which question is the nurse most likely to ask callers to differentiate the possible involvement of bioterrorist agent that causes botulism from other more common causes of foodborne illnesses?

In addition to Gastro intestinal symptoms, have you had drooping eyelids or difficulty swallowing or speaking?

A patient with the latex allergy is exposed to Lake Tex. Which sign or symptom is the cost for the greatest concern?

Laryngeal Edema

In which clinic setting is the nurse most likely to need knowledge of how to apply safety reminder devices and manage the care of these patients?

Mental health walk in clinic

A patient begins to have a grand mal seizure. What is the priority action?

Monitor the patency of the airway

Finally admitted patient appears to be disoriented and the nurses considering using a safety reminder device. What is the nurse next intervention for this patient?

Obtain a healthcare providers order

OSHA

Occupational Safety and Health Administration

The nurse supplies the gate belt to a male patient of average build who has some weakness on the left side. How does the nurse position herself before assisting the patient to ambulate down the hall?

On the patient's left side and holding the back of the gait belt

Which newly obtain piece of equipment creates the greatest risk for falls for an older adult?

Prescription lenses

PASS

Pull, Aim, Squeeze, Sweep

Which pneumonic is used most often to set priorities in case of a fire?

RACE (Rescue, Activate, Confine, Extinguish)

The nurse notices smoke coming from the wastebasket in a patient room. Upon entering the room, the nurse is a fire that is starting to flare up. What should the nurse do first?

Remove the patient from the room

What is the first measure for the nurse to carry out in the event of a fire in the workplace?

Remove the people from the room with the fire.

It is suspected that the patient has been exposed to cyanide gas. The nurse is alert for which symptom?

Respiratory distress

The nurse started a new job in a small long-term care facility in a rural area. The back exit hallway is being used as storage area while a new storage area is being planned. What should the nurse to first?

Review the facilities policies / procedures for emergencies

An infant has a wound with the dressing on the left upper arm. He repeatedly attempts to remove the dressing. Which SRD with the nurse select?

Right elbow SRD

SRD

Safety Reminder Device

The nurse discover smoke in a soiled utility room across the hall from a patient room. What should the nurse initial action be?

Sound the fire alarm

The older adult tells the nurse that he is having trouble reading the labels on his medication bottles. What is the best Strategy that the nurse could suggest to reduce the risk of an accidental medication error?

Teach the patient to use a medication organizer to manage the medication

The occupational health nurse learns of a mercury spell that occurred in a factory in which she is employed. Which action by the nurses correct?

The nurse evacuate the area context trained personnel to clean up the spell

The LPN is reviewing the admission information of a patient. Which information is most concerned to the nurse that this patient is at risk for falling?

The patient wears glasses and hearing aid

The nurse is documenting on a patient with an SRD. what information with the nurse include in this documentation?

The specific type of SR do used and assessment of the patient

The nurse is caring for a patient who relies on mechanical ventilation. The nurse here is a fire alarm and flames are visible in the back Corridor. What should the nurse do?

Till I get to UAP to move ambulatory patients toward the exit

Which instructions should be given to the UAP who is assigned to assist in the care of a patient who is being treated with internal radiation?

Where are your personal Docimeter during care or when handling patient items