Chapter 20: Patient Environment and Safety Study Guide

22. Material safety data sheets (MSDS) are required by the Occupational Safety and Health Administration (OSHA). The nurse must: a. have a copy of all MSDS on the unit to safely handle biohazards. b. know the location of the MSDS and comply with their guidelines. c. not handle biohazards identified in the MSDS. d. keep the MSDS confidential and not discuss them outside the agency.

ANS: B MSDS are consulted for recommended methods of storage, labeling, handling spills, and disposal of biohazards.

5. The best way to maintain safety measures relative to helping a patient get into bed is to: a. set the bed height at the nurse's waist level. b. make sure that the bed wheels are locked. c. place the bed against the wall. d. insist that the patient stays in bed.

ANS: B The goal is to provide safety when getting a patient into or out of bed. Locking the wheels to the bed is one way to ensure this safety measure.

12. An agitated resident who is seated in his wheelchair calls the nurse because the bed linens are smoldering. After moving the patient to the hall, the nurse should: a. close the door to the room to confine the fire. b. assess the patient for burns. c. extinguish the flames with an appropriate extinguisher. d. activate the fire alarm system immediately.

ANS: D RACE is used as an acronym to respond to fire. "RACE" represents Rescuing the patient from immediate danger, Activating the fire alarm system, Containing the fire by closing doors and windows, and Extinguishing the flames with an appropriate extinguisher.

4. A patient complains of not being able to sleep because of the noise in the hall at night. The nurse should: a. move the patient to the far end of the hall. b. ask the doctor for a sleeping medication for the patient. c. tell the patient to close the door. d. request that co-workers limit hallway conversations.

ANS: D The main cause of noise is people. Encourage the staff to limit conversations in the hallway and speak in lowered voices.

24. A nurse caring for a patient with a chair alarm will do which of the following interventions as recommended by the 2016 National Safety Goals to prevent alarm fatigue. a. Respond promptly to alarm. b. Educate patient to turn off alarm when it goes off. c. Check alarm volume each hour. d. Monitor functionality of alarm each morning.

ANS: A Bed and chair alarms along with cardiac and oxygen sensor alarms are among the alarms specified in the 2015 National Patient Safety Goal of improving the safety of medical alarms. All medical equipment alarms need to be closely monitored and checked for functionality and volume at the start of the shift and frequently throughout the shift. Steps need to be taken to prevent the catastrophic outcomes of alarm fatigue (Box 20-4). Alarm fatigue occurs when nurses become desensitized to patient care alarms and then either miss or delay response to an alarm. These absent or delayed responses have resulted in adverse patient outcomes (Sendelback, S. and Funk 2013).

6. When the nurse is making an occupied bed, back safety indicates that the nurse should initially: a. raise the bed to the proper working height before starting. b. encourage the patient to use the side rail to help turn side to side. c. keep one side rail up at all times to keep the patient from falling. d. complete the linen change on one side before moving to the other side.

ANS: A Bringing the bed to height appropriate working level can prevent a back injury. Although other options are part of the occupied bed skill, they are not directed at preventing back strain.

18. The health care provider orders wrist protective devices for an agitated patient. To safely use this protective device, the nurse: a. checks that circulation is not impaired by evaluating color, warmth, and pulses distal to the device. b. secures the ties of the device to the side rails of the bed to allow for easy access by the nurse. c. draws the protective device tightly to prevent the patient's hands from slipping out. d. uses a knot that is not easily undone for patient security.

ANS: A Checking for signs indicating that circulation has been impaired or skin abraded or for evidence of nerve impairment is part of the nurse's responsibility in upholding the principles of the use of protective devices.

19. The home health nurse assessing the home for safety hazards notes a hazard that should be remedied is: a. an extension cord lying across the floor. b. nonskid bath mats on the bathroom floor and in the shower. c. night lights high on the wall in the bathroom. d. lack of scatter rugs on the wooden floor.

ANS: A Extension cords pose a hazard for falls. The rest of the items assist in the prevention of falls.

13. When caring for a patient with acute radiation sickness (ARS) after an accident at an atomic power plant, the nurse should: a. wear a paper gown and boots, gloves, and a mask. b. stay in the room and talk to the patient to alleviate anxiety. c. decrease the amount of time spent in the room. d. wear a chemical mask with a filtered respirator.

ANS: A For prolonged periods in caring for a patient with ARS, the nurse should use the barrier protection of gown, boots, a mask, and gloves.

8. An older adult patient is discharged home after hip surgery. The statement that indicates a family member understands discharge safety instructions given by the nurse is: a. "I will install grab bars in the bathroom for both the toilet and bathtub." b. "I will put all personal items away to prevent my mother from dropping things." c. "I will dim the lights at night to prevent wakefulness." d. "I will ensure that my mother takes naps during the day to prevent tiredness."

ANS: A Grab bars in the tub and at the toilet help the person with joint impairment to bathe and toilet safely. Using well-lit areas during the day and night lights at night is helpful to avoid falls. Daytime napping may cause restlessness at night.

16. A patient is agitated and confused and keeps getting out of bed and needs to be observed constantly. The best initial nursing intervention is to: a. have a family member or friend sit with the patient. b. obtain an order for a sedative from the health care provider. c. instruct the nurse's aide to apply a vest protective device. d. make sure the side rails are up and close the door.

ANS: A Local and federal laws prohibit the use of physical and chemical restraints except those authorized by a health care provider. Health care workers are encouraged to find other alternatives such as asking a family member to supervise the patient before resorting to the use of protective devices.

23. A nurse is instructing a nursing student about protective device use. The nurse recognizes the need for further instruction when the nursing student states, "I will: a. tie the protective device to the side rails to ensure the protective devices are secure." b. use a half bow knot to secure the protective devices to the bed frame." c. check the area distal to the protective devices every 15 to 30 minutes." d. observe for signs of adequate circulation, including distal pulses."

ANS: A Protective device ties should be secured to an immovable part of the bed frame. They should not be tied to the side rails because lowering the rails may cause the device to be pulled too tightly around the patient or cause strain on a joint of an immobilized extremity. A half bow knot should be used to secure the device to the bed frame or chair. The area distal to the protective device should be checked every 15 to 30 minutes and should be observed for signs of adequate circulation, including pulses distal to the device.

21. The nurse clarifies to the worried family that the guiding principle for using protective devices is: a. to use the least amount of immobilization needed for the situation. b. to use only immobilization techniques necessary to keep the patient safe. c. that protective devices are mandated for behavioral use only. d. that protective devices must be applied by qualified personnel.

ANS: A The principle is derived from local and federal laws and endorsed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which supports protective devices only as a last resort. This is because of previous misuse and abuse of these devices by health care personnel.

2. Legal implications for using a protective device require thorough documentation and require that the nurse include: (Select all that apply.) a. alternative methods and actions used. b. medications that the patient is taking. c. education done for patient and family. d. the patient's medical diagnosis. e. type of device and placement.

ANS: A, C, E The nurse should document alternative methods and actions taken before placing the device, the education done for both patient and family, and the type of device used and where it was placed. Remember, if it is not documented, it was not done.

2. An appropriate environmental nursing intervention for a patient with respiratory congestion is to: a. maintain the room temperature slightly cooler to decrease congestion. b. moisten the respiratory passages with the use of an air humidifier. c. order a large floor fan to make it easier to breathe. d. open the windows to encourage air circulation.

ANS: B A very low humidity will dry respiratory passages. Vaporizers or humidifiers may be ordered for a patient with a respiratory condition. Small table fans may help some persons to breathe more easily.

17. The doctor has written an order to place a resident in the nursing home in a vest protective device. It is the nurse's responsibility to: a. check with the nursing supervisor about the legality of the order. b. remove the device every 2 hours and change the patient's position. c. remove the device every 4 hours to toilet the patient. d. apply the device loosely to prevent circulation impairment.

ANS: B Changing position helps prevent other complications such as skin decubiti.

14. There is evidence that a resident in a home care environment might have accidentally ingested gasoline left by the gardeners. The nurse should first: a. call the family members to notify them of the incident. b. call the poison control center and describe the situation. c. induce the patient to vomit. d. place the gasoline can in a safe place.

ANS: B If a nurse suspects gasoline poisoning, it is important to call the poison control center to obtain further instructions. It is also important to prevent vomiting, because this may cause respiratory problems.

1. The certified nursing assistant (CNA) places a confused, weak patient in a wheelchair and applies a vest protective device. The nurse should instruct the CNA to: (Select all that apply.) a. secure the ties in the front to prevent the patient from falling. b. secure the ties in the back to prevent the patient from falling. c. use a double knot to prevent the patient from undoing the tie. d. use a half bow knot to secure the device to a chair. e. provide passive range of motion to the upper extremities as needed.

ANS: B, D, E Placing the ties under the armrests and securing at the back will keep the patient from sliding. The half bow knot makes it difficult for the patient but easy for the health care worker to undo.

3. Each resident admitted must have a fall risk assessment performed so that appropriate actions to prevent falls can be included in the nursing care plan. The items are considered when doing a fall risk assessment on a newly admitted resident include: (Select all that apply.) a. gender. b. age. c. weight. d. medications. e. balance.

ANS: B, D, E The common factors that predispose a person to falls may include age, the type of medications the resident is taking, and physical mobility.

10. A patient who has right-sided weakness following a stroke is admitted to a long-term care facility and exhibits increasing wandering and inability for self-care. To protect the patient from the most frequent cause of injury among the older adult, the nurse's most efficient intervention would be: a. provide a night light in the bathroom. b. keep pathways clear of paper, shoes, and equipment. c. apply a personal alarm. d. provide hip protectors.

ANS: C Because falls are the most common accidents among residents, the provision of a personal alarm to sound when the person attempts to get out of bed is the most efficient intervention. Keeping the pathways clear, provision of adequate light, and provision of hip protectors are all safety oriented but do not prevent falls.

3. The patient complains of an odor in his room that smells like something is rotting. The nurse makes an assessment of the room and: a. changes the linens, which are wrinkled and rumpled from 24-hour use. b. rinses out the emesis basin of used dry tissues. c. removes an old flower arrangement. d. heavily sprays room deodorant around the patient's bed.

ANS: C Odors in health care facilities are frequently unpleasant. The odor from a deteriorating flower arrangement is offensive. The arrangement should be discarded in a container outside the patient's room.

1. An older adult patient who is unable to get out of bed complains that the room is too cold because of the air-conditioning and asks the nurse to open the window. The nurse's best reply is: a. "Certainly, that will let in warm air from outside and should make you warmer." b. "The air conditioner is set to keep the most comfortable temperature in the room." c. "I'll adjust the thermostat in your room and get a blanket for you." d. "Agency policy prevents me from opening the window."

ANS: C Older inactive people need a warmer environment because of their poor thermoregulation. Rooms should be kept at a comfortable 68° to 74° F. Most health care facilities prohibit the opening of windows for safety reasons.

15. A nursing assistant on the day shift reports that he has raised the bed rails to keep an agitated patient from climbing out of bed. The nurse's best response to this information is: a. "Good idea. Be sure to check on the patient every hour to assess the patient's comfort." b. "A vest protective device will work better; put one on the patient, please." c. "The rails won't prevent falling; bring the patient out to sit by the nurses' station where we can watch her." d. "You'll need to check the patient every 15 minutes and reorient the patient as to why the rails are up."

ANS: C Seating the patient close to the nurses' station will allow the nurse to check on the patient frequently. The nurse needs to get an order for a vest protective device.

25. A fire has started in a work area on the unit. Which of the following is the response which demonstrates correctly using a fire extinguisher? a. Aim the stream to the top of the flames. b. Squeeze the pin to activate the extinguisher. c. Move the extinguisher in a sweeping, side to side motion. d. Call 911.

ANS: C The acronym PASS can be used to correctly use a fire extinguisher: Pull the pin, Aim at the base of the fire, Squeeze the trigger, and Sweep side to side.

9. The nurse in a long-term facility who is making a fall assessment would identify the person most at risk for a fall to be a resident who: a. paces all day in the halls and sleeps well at night. b. had knee replacement surgery 2 days ago and wears a knee brace. c. had a stroke with right-sided weakness 2 weeks ago and is confused. d. uses a walker to ambulate both indoors and outdoors.

ANS: C The most common factors predisposing a person to falls are impaired physical mobility, altered mental status, and unavailability of assistance.

11. A diabetic patient has chronic peripheral vascular disease, which results in edema and poor circulation to her feet. She constantly complains of cold legs. The best nursing action is to provide: a. a heating pad and place it under the patient's feet. b. an electric blanket to increase warmth to legs at night. c. a hot shower to increase circulation to legs. d. additional blankets and encourage the use of warm bed socks.

ANS: D Extra blankets and bed socks will reduce the sense of cold. A person with diabetes or impaired circulation is more easily burned than a person in good health.

7. A patient has left sided paralysis following a right-sided cerebrovascular accident (CVA). After completing a bed bath, the nurse should begin to change the sheets by: a. lowering both side rails and rolling the patient to the side of the bed. b. asking the patient to roll to his right and hold on to the side rail for support. c. positioning the patient in a supine position with both side rails raised. d. positioning the patient in a side lying position on his left side with the near side rails raised.

ANS: D Moving the patient to the left side lying position provides safety for the patient and allows the patient to use his good (right) hand to hold the rail.

20. A resident is confused and teary. She is threatening to leave the facility to return home. The nurse should: a. call her family immediately and notify them of the problem. b. have the nurse's aide place a vest protective device on the patient. c. call the doctor immediately and get an order for a protective device. d. stay with the patient and attempt to determine the cause of the problem.

ANS: D Protective devices may not be used without an order or to punish or discipline a patient. Talking to the patient is an excellent strategy to determine the cause of the problem. Medications may also cause mood alterations. Stay with the patient who is confused or unsteady. Second action would be to determine if there is family members that might be able to stay with the patient.