Foundations chapter13 safety
A nurse is caring for a client on bedrest who repeatedly attempts to get out of bed without assistance. Which is the most therapeutic response by the nurse? 1. "Why do you keep trying to get out of bed?" 2. "Would you like me to give you a back rub?" 3. "I need for you to behave and stop trying to get out of bed." 4. "If you don't stop trying to get up, I will have to restrain you."
"Would you like me to give you a back rub?"
An instructor has been teaching nursing students about taking precautions to reduce the risk of exposure to blood and bodily fluids. Which actions performed by a student indicate teaching has been successful? Select all that apply.
-The student places a used syringe in a puncture-proof, labeled container. -The student washes his or her hands prior to contact with the client -The student wears gloves when carrying a urine sample from the client -The student washes his or her hands after contact with the client
A nurse educator is teaching a group of new graduate nurses about how to correctly apply restraints. The nurse educator recognizes that further instruction is warranted when a new graduate nurse states: 1. "I should never use restraints on a client." 2. "I should tie restraints in a quick-release knot." 3. "I should not use restraints for the convenience of the staff." 4. "I should be able to insert three fingers between the client's body and the restraint."
1. "I should never use restraints on a client."
The nurse is caring for a client who has been placed in restraints. Which statements made to the client by the nurse indicate an understanding of following restraint guidelines of the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission? Select all that apply. 1. "Would you like some water?" 2. "I'll check on you every 3 hours." 3. "Do you need help going to the bathroom?" 4. "Let's change the position you're lying in." 5. "We'll remove these in about an hour. "
1. "Would you like some water?" 3. "Do you need help going to the bathroom?" 4. "Let's change the position you're lying in." 5. "We'll remove these in about an hour. "
Which of the following clients are at highest risk for injury or death due to entrapment of the head and chest between side rails and the bed? Select all that apply. 1. 75-year-old client with chronic pain 2. 35-year-old client with a broken leg 3. 82-year-old client with dementia 4. 42-year-old client with type I diabetes 5. 65-year-old client with osteoporosis and fecal impaction
1. 75-year-old client with chronic pain 3. 82-year-old client with dementia 5. 65-year-old client with osteoporosis and fecal impaction
. A nurse is assessing a client who has been placed in restraints. Which tasks would be completed during this assessment? 1. Checking distal pulses 2. Resecuring restraints to the side rails 3. Checking the skin for warmth and color 4. Asking if the client feels numbness or tingling 5. Assisting the client with toileting
1. Checking distal pulses 3. Checking the skin for warmth and color 4. Asking if the client feels numbness or tingling 5. Assisting the client with toileting
A student nurse encounters an unresponsive client in a waiting room. The client is not breathing and has no pulse or respirations. What is the first step the student nurse should take? 1. Begin rescue breathing 2. Alert the emergency team. 3. Begin cardiopulmonary resuscitation (CPR). 4. Perform the Heimlich maneuver.
2. Alert the emergency team.
A fire breaks out in a hospital after a petroleum-based product catches on fire. The nurse makes sure that the fire extinguisher is designated with which letter? 1. A 2. B 3. C 4. D
2. B
Which of the following items increase a client's risk for falling, according to the Morse Fall Scale? Select all that apply. 1. History of falls within the last 2 years 2. Use of a cane 3. Has an IV/saline lock 4. Requires nurse-assisted ambulation 5. Has altered mental status
2. Use of a cane 3. Has an IV/saline lock 4. Requires nurse-assisted ambulation 5. Has altered mental status
A charge nurse supervises an unlicensed assistive personnel (UAP) while providing care to a client at risk for falls. The client repeatedly attempts to get out of bed without assistance. The charge nurse intervenes when observing which action by the UAP? 1. Placing the client's mattress on the floor 2. Having the client fold washcloths and towels 3. Having the client sit in a rocking chair near the nurses' station 4. Offering infrequent opportunities for the client to go to the bathroom
4. Offering infrequent opportunities for the client to go to the bathroom
The nurse is evaluating a client's understanding of teaching regarding home oxygen therapy. Which statement by the client indicates that teaching has been effective? 1. It is okay for me to burn candles near the oxygen source. 2. I should avoid wearing wool blankets or sweaters. 3. I should avoid moving around the house when using oxygen. 4. I can cook on my gas stove while using oxygen
2. I should avoid wearing wool blankets or sweaters.
An experienced nurse is teaching a nursing student about body mechanics. Which statement made by the experienced nurse is accurate? Select all that apply. 1. You'll primarily use this when moving clients. 2. It's important to understand that your center of gravity is your body's middle point. 3. Your base of support comes from your lower legs. 4. Hold heavy items close to your body when lifting. 5. You should always try to lift objects, rather than pull or push them
2. It's important to understand that your center of gravity is your body's middle point. 3. Your base of support comes from your lower legs. 4. Hold heavy items close to your body when lifting
. The nurse is extinguishing a fire that has broken out in the workplace. Which is the first step the nurse should take? 1. Squeeze the handles together. 2. Pull the pin found between the handles. 3. Aim the nozzle at the base of the flames. 4. Sweep the nozzle back and forth at the base of the flames.
2. Pull the pin found between the handles.
A nurse is caring for a client who has a history of falls due to getting up without assistance. The nurse selects a restraint alternative for this client. Restraint alternatives include which of the following? Select all that apply 1. Vests 2. Jackets 3. Leg monitors 4. Bed monitors 5. Chair monitors
3. Leg monitors 4. Bed monitors 5. Chair monitors
A student nurse has received a prescription for a narcotic pain reliever due to chronic back pain. Which action should the student nurse take? 1. Ask another student to monitor his or her behavior while working. 2. Switch time at the clinical facility with another student. 3. Speak confidentially with an instructor. 4. Increase the hours he or she sleeps per night
3. Speak confidentially with an instructor.
The charge nurse recognizes that a client with which score on the Morse Fall Scale is at the highest risk for falling? 1. 15 2. 25 3. 45 4. 55
4. 55
A member of the hospital maintenance staff is mopping when clients begin to complain about watery eyes and irritated throats. Which action should the nurse take? 1. Evacuate the area immediately. 2. Notify the Centers for Disease Control and Prevention (CDC). 3. Treat the clients for chemical exposure. 4. Identify the chemicals and consult the material safety data sheets (MSDSs).
4. Identify the chemicals and consult the material safety data sheets (MSDSs).
. When caring for a client with bilateral wrist restraints, a nurse can delegate which of the following to a certified nursing assistant (CNA)? 1. Educating the client on restraint alternatives 2. Checks and releases of the restraints 3. Assessment of bilateral radial pulses 4. Teaching of when restraints can be removed
Checks and releases of the restraints
The nurse is extinguishing a fire that has broken out in the workplace. Which is the first step the nurse should take? 1. Squeeze the handles together. 2. Pull the pin found between the handles. 3. Aim the nozzle at the base of the flames. 4. Sweep the nozzle back and forth at the base of the flames.
Pull the pin found between the handles
A nurse is caring for a female client who has been hospitalized for a right-sided cerebrovascular accident (CVA). The client is impulsive and confused. She has weakness on the left side of her body and requires assistance when ambulating. What is the nurse's highest priority when caring for this client? 1. Range-of-motion exercises 2. Performing a calorie count 3. Ordering a social service consult 4. Ensuring that the bed alarm is turned on
Ensuring that the bed alarm is turned on
The ____________________ establishes the national standards for client safety. The organization is also responsible for evaluating and accrediting health-care organizations and programs in the United States.
Joint Commission
A nursing instructor supervises a student nurse who is caring for a client who is on fall precautions. The nursing instructor would intervene if he or she observed the student nurse: 1. Keeping the bed at the highest position at all times. 2. Using furniture to block areas that are off-limits to the client. 3. Placing the client's bed at the lowest level when the client is sleeping. 4. Placing the overbed table across the wheelchair when the client is seated.
Keeping the bed at the highest position at all times
A pregnant nurse is assigned to a client undergoing internal radiation therapy for thyroid cancer. What precautions should the nurse take? 1. Wear a film badge. 2. Limit her amount of time around the client. 3. Wear a lead apron when near the client. 4. Request an alternative assignment.
Request an alternative assignment.
The nurse is placing a vest restraint on the client. The nurse knows that the crossover is appropriately placed when it is on the ____________________.
front
A nurse is working on a nursing unit when an electrical fire starts. Which action should the nurse take first? 1. Sound the fire alarm. 2. Obtain a fire extinguisher. 3. Confine the fire to one area. 4. Remove clients from immediate danger.
remove clients from immediate danger