chap. 27: safety, security, and emergency preparedness
Which safety tip could the nurse give to parents to help decrease the risk of the leading cause of injury or death in children 1 to 4 years of age?
"Always provide close supervision for young children when they are in or around pools and bathtubs."
The nurse is teaching an unlicensed assistive personnel (UAP) about fire safety. Which UAP statement demonstrates that teaching has been effective?
"I will rescue clients from harm before doing anything else."
A nurse is applying restraints to a confused client who has threatened the safety of a roommate. Which actions would the nurse perform when properly applying restraints to a client? Select all that apply.
- Check agency policy for the application of restraints and secure a physician's order. - Pad bony prominences. - Remove the restraint at least every 2 hours or according to agency policy and client need
The nurse is preparing to apply prescribed extremity restraints to a client's ankles. Place in order the steps of the procedure the nurse should perform. Use all options.
- Explain rationale for use to the client and family. - Pad bony prominences. - Wrap the restraint around the client's ankle and secure it with hook-and-loop fastener straps. - Ensure that two fingers fit between the restraint and the client's skin. - Position limbs in normal anatomic position. - Secure restraints to the bed frame with quick-release knots.
The community health nurse is talking with four clients. Who does the nurse identify that would most benefit from teaching about alcohol and drug use?
19-year-old male college student majoring in physics
Which nurse would be at the highest risk of causing a hazardous situation?
A nurse who has worked 32 hours of overtime this week
A home care nurse provides health education to parents regarding the care of their toddler. Which precaution should the nurse suggest the parents take to protect the toddler from drowning?
Avoid unattended baths for the toddler.
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
A health care provider orders extremity restraints for a confused client who is at risk for injury by pulling out her central venous catheter. What is the nurse's most appropriate action when carrying out this order?
Ensure that two fingers can be inserted between the restraint and the client's extremity.
A client has presented to the emergency department after splashing a chemical in the eyes. When managing the injury, what should be included in the plan of care?
Flush the eyes with water for 10 minutes.
A nurse working in a long-term care facility institutes interventions to prevent falls in the older adult population. Which intervention would be an appropriate alternative to the use of restraints for ensuring client safety and preventing falls?
Involve family members in the client's care.
What best describes the nurse's role in disaster preparedness?
Multiple roles, including triage and the distribution of resources
A nurse responds to the call bell and finds another nurse evacuating the client from the room, which has caught fire. Which action should the nurse take?
Pull the fire alarm lever.
The nurse is caring for a client who has been prescribed extremity restraints. Which action must be documented by the nurse?
The alternative measures attempted before applying the restraints
A staff development nurse is providing an in-service to a group of nurses on the use of restraints in health care facilities. What is an example of a chemical restraint?
a dose of an antipsychotic
A program has been introduced at a hospital with the goal of improving client safety. The nurses participating in the program should recognize what event as posing the most significant threat to a client's safety?
administering medications to the client
The nurse recognizes that assessment for sensory-perceptual alterations is a priority for which client?
an 84-year-old male with four recent driving violations
Which item would alert the home care nurse to a safety hazard threatening a young child?
dangling blind cords
A client went missing from a long-term care facility and an emergency code was called. After a search of 1 hour, the client was discovered in a utility room that should have been inaccessible. When responding to this event, staff should:
fill out an incident report, with the goal of preventing a similar event in the future
When educating families on fire safety in the home, which information is important for the nurse to emphasize?
Have a meeting place outside the home in case of fire.
The unlicensed assistive personnel (UAP) tells the nurse that a client is very confused and trying to get out of bed without assistance. What is the appropriate action by the nurse?
Initiate use of a bed alarm.
The nurse is providing discharge teaching to the family of an older adult client. Which teaching will the nurse include to decrease the risk for electric shock?
Refrain from using extension cords.
The nurse is caring for a young child in the hospital who is being discharged home with his grandmother, who has guardianship. When performing a risk assessment, the nurse identifies that his grandmother has one other adult living with her to help with the child, because the grandmother has congestive heart failure and diabetes mellitus. In addition, the financial situation is poor and she cannot afford to buy safety devices to safety-proof the house. What nursing diagnosis is most appropriate for this child based on these findings?
Risk for Poisoning related to medications in unlocked cabinets
A nurse is preparing to file a safety event report after a client experienced a fall. Which statement is correct regarding the filing of a safety event report?
The nurse should record the incident in the client's medical record and fill out a safety event report separately.
The nurse is caring for a client who has been repetitively pulling at IV lines and the urinary catheter. After other methods of diverting the client's behaviors fail, the health care provider orders chemical restraints. Which treatment does the nurse anticipate?
administration of an antipsychotic agent to alter the client's behavior
A 17-year-old is brought to the emergency department with a head injury. The nurse knows that adolescents are vulnerable to injuries related to:
automobile accidents
When educating families on fire safety, it is important to:
have a meeting place outside the home
Which topic should a public health nurse emphasize when educating older adults on reducing their risk of poisoning?
keeping medications in clearly labeled containers
Which level of health care provider may make the decision to apply physical restraints to a client?
nurse practitioner
A school nurse is providing information to a group of older adults during Fire Prevention Week. Which statement is correct regarding fires in the home?
Most people who die in house fires die of smoke inhalation rather than burns.
The poison control nurse receives a call from the parent of a 2-year-old child. The parent states, "I just took a quick shower, and when I finished, I walked into the kitchen and found my child with an open bottle of household cleaner." What is the poison control nurse's appropriate response?
"Is your child breathing at this time?"
A school-age child is admitted to the emergency room with the diagnosis of a concussion following a collision when playing football. After the collision, the parents state that he was "knocked out" for a few minutes before recognizing his surroundings. What is the priority assessment when the nurse first sees the client?
Assessment of vital signs and respiratory status