Chapter 27: Safety

A school nurse is conducting a safety seminar with students in 6th grade. Which teaching point is most important?

"Make sure that you have smoke detectors in your house and that they're in working order." A paramount fire-safety issue is smoke detectors, since approximately half of home fire deaths occur in a home without a smoke detector. This risk far exceeds that of fireplaces, even though these must be used with caution. Individuals should stop, drop and roll if clothing catches on fire. Old microwaves do not constitute a significant fire risk.

The nurse is teaching an unlicensed assistive personnel (UAP) about fire safety. Which UAP statement requires immediate nursing intervention?

"Only certain members of the health care team can extinguish a fire." All members of the health care team are educated about how to extinguish a fire. Therefore, the UAP's statement about certain members being taught how to use the fire extinguisher requires correction. The other statements are appropriate.

A new mother inquires about the use of a car seat for her infant. Which information provided by the nurse is most accurate regarding the use of a rear-facing safety seat for an infant?

A rear-facing safety seat should be used for infants and toddlers younger than 2 years old or up to the maximum weight for the seat. Infants and toddlers up to 2 years of age (or up to the maximum height and weight for the seat) should remain in a rear-facing safety seat.

The nurse manager is reviewing the QSEN quality and safety competencies for nurses. Which competencies are included in this initiative? Select all that apply.

Client-centered care Teamwork and collaboration Quality improvement (QI) The Quality and Safety Education for Nurses (QSEN) project has been designed to provide a framework for the knowledge, skills, and attitudes necessary for future nurses. The six competencies include client-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. Requirements for foreign-educated nurses and the establishment of clinical career ladders are not explicit focuses of the QSEN competencies.

Which actions should the nurse perform to help prevent occupational safety hazards? Select all that apply.

-Use equipment only for the use for which it was intended. -Only operate equipment the nurse is familiar with. -Use three-pronged electric plugs whenever possible Nurses work with mechanical and electrical equipment on a daily basis. Proper care to avoid injury and damage to these items includes using them only for the specific purpose, using three-pronged plugs, and having working knowledge of the correct procedures for safety. Bending cords can cause internal wire damage. Many types of sensitive technical equipment can be damaged if cleaned with soap and water.

A client has frequent readmissions for fall-related injuries. Which is the most appropriate intervention by the nurse?

Arrange for a skilled home care assessment The client's home should be evaluated for potential hazards and risks. There is no indication of vision or hearing issues. It is uncommon for falls to be directly attributable to osteoporosis.

A confused client is pulling at the IV line. When considering alternatives to restraints, which nursing intervention would be used first?

Conceal IV tubing with gauze wrap Wrapping the IV line provides protection for the site. Medications used to control behavior can be considered a chemical restraint that is an intervention of last resort. The presence of a family member may assure client safety and alleviate client anxiety, but would not necessarily protect the IV site. As well, it is inappropriate to delegate client safety observation to family members. Bed alarms alert the nurse to the client leaving his or her bed, but not interference with the IV site.

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. If poisonous substances have been instilled into the eye, immediate irrigation with lukewarm water for 10 to 15 minutes may reduce harmful effects.

An older adult is admitted to the hospital with a fractured hip. The client suddenly develops acute onset of confusion and hallucinations. Which action should the nurse implement first?

Reduce distressing environmental stimuli to maximize client safety Added stimulation can increase the maladaptive behaviors of the client; therefore, the nurse should first reduce the distressing environmental stimuli. Proper communication of client status change is a legal requirement of nurses, and documentation provides a means of communication between interdisciplinary teams and provides continuing of care. However, notifying the health care provider and documenting the change in status are not the priority action. Restraints are to be used as a last resort in client care.

An older adult client has developed diabetic neuropathy. What would be the most important education intervention for the client and family?

Reduce the temperature on the water heater. The principles of a safe environment for older adults follow the same general guidelines as those for all ages: comfortable temperature range, adequate clothing, bath water of the right temperature (the setting on the hot water heater may need to be reduced), adequate ventilation, and lighting that allows for safe navigation throughout the house at all times of day. Clients with neuropathy will definitely need the hot water heater temperature reduced.

The nurse typically delegates a situational assessment to the unlicensed assistive personnel (UAP) for the home care client with heart failure. Which finding causes the nurse to perform this assessment rather than delegate it?

The client went to the emergency department to be evaluated after a fall. The nurse must validate, analyze, document, communicate, and act on the findings, as appropriate. The nurse performs the assessment because there has been a change in the client's condition. Any acute change warrants an assessment by the registered nurse. This change indicates that there may need to be additional changes to the client's environment to prevent injury, too. The decision to delegate must be based on careful analysis of the client's needs and circumstances, as well as the qualifications of the person to whom the task is being delegated. Depending on the state's Nurse Practice Act and the facility's policies and procedures, the unlicensed assistive personnel (UAP) may perform some or all of the parts of a situational assessment. Workload or lack of experience will not be factors in the delegation decision, because this is part of the job requirement upon hire. Parts of the assessment, such as whether the client is safe or what the client may need, can be done by the UAP.

A client who is enrolled in Medicare and who has been recovering in the hospital from a stroke has developed a pressure injury on the coccyx, an event that the Centers for Medicare & Medicaid Services (CMS) has identified as a "never event." The nurse should recognize what implication of this CMS designation?

The hospital must bear any costs incurred for treating the client's injury. If "never events" occur while a client is hospitalized, the cost of the care associated with that event will not be paid by CMS, but will be borne by the hospital. Fines are not levied against the hospital, however, and CMS does not actively divert clients to other facilities. CMS does not pay damages on behalf of hospitals.

A nurse is filing a safety event report for an older adult client who tripped and fell when getting out of bed. Which action exemplifies an accurate step of this process?

The nurse details the client's response and the examination and treatment of the client after the incident. An unintentional injury or incident that compromises safety in a health care agency requires the completion of a safety event report (incident report). The nurse completes the event report immediately after the incident and is responsible for recording the circumstances and the effect on the client in the medical record. The safety event report is not a part of the medical record and should not be mentioned in the documentation. The physician is not responsible for filling out or signing the safety report unless she witnessed the incident. The nurse reports factual information, not opinions.

A nurse was injured when a client with Alzheimer disease struck the nurse on the side of the head during a transfer. The nurse has completed an incident report. Which statement about an incident report is most accurate?

The report provides a detailed and objective account of the circumstances before, during, and after the event. Incident reports are used for internal review and improvements to systems. They include detailed descriptions of the event in question. They do not become part of the client's health record. They are often provided to outside agencies, but they do not bypass the institution where the event occurred. Clients and their families do not sign incident reports.

The nurse is performing a safety belt fit test for a young client at a well-child check-up. What criteria confirms that the child may sit in the back seat of a vehicle with a lap and shoulder belt in place?

The seat belt stays low on the hips and is not resting on the soft part of the stomach. The child must meet all of the following criteria to be allowed to sit in the back of a vehicle with a lap and shoulder belt:• The child must sit in the back seat with the entire back against the vehicle's seat back.• The buckled seat belt must stay low on the hips and is not resting on the soft part of the stomach.• The shoulder belt must lay on the collarbone and shoulder.• The child must maintain the correct seating position with the shoulder belt on the shoulder and the lap belt low across the hips.

A client has been discharged from the hospital after being treated for a myocardial infarction. The client has been asked to evaluate the care received by completing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The results of this survey may affect:

the amount of money the hospital receives from the Centers for Medicare & Medicaid Services. A portion of the value-based purchasing program is based on clients' responses to satisfaction surveys such as HCAHPS. This survey is irrelevant to the client's enrollment in Medicare or Medicaid. OSHA is not privy to HCAHPS results. HCAHPS results are not used in the determination of Magnet designation.