Taylor's Fundamental PrepU Ch. 27 Safety

The nurse is preparing to discuss safety with a group of parents of infants. When planning the program, which topic would be most important to include? The use of skid-proof mats for the bath tub Gun safety in the home Correct placement of booster seats for the car Appropriate positioning in a crib

Appropriate positioning in a crib Explanation: Infant safety education should include use of approved car seats and not booster seats. Booster seats are used for the pre-school child with recommended height and weight. The use of skid-proof mats in the bathtub are topics more suited to the parents of preschool children. Infants are not physically able to access guns in the home so gun safety is a lower priority. Infants should be placed on their back to sleep to prevent sudden infant death.

A school-age child is admitted to the emergency room with a possible 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 head circumference Assessment of vital signs and respiratory status Evaluation of all of his cranial nerves Initiation of a peripheral intravenous (IV) line for fluid administration

Assessment of vital signs and respiratory status Explanation: Assessment after a head injury includes immediate evaluation of airway, breathing, and circulation. Therefore, assessment of vital signs and respiratory status is a priority for this client. Head circumference is only beneficial in children less than 2 years old and/or with open fontanels. Evaluation of all of his cranial nerves does not take priority over cardiopulmonary assessment. Assessment comes before intervention in the nursing process and more assessment is needed for this client before the need for an IV line is determined.

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 Smoking cessation Safety equipment for playing sports Back to sleep guidelines

Childproofing the house Explanation: To prevent accidental injury and death in toddlers and preschoolers, parents need to childproof the home environment. Play areas should allow for exploration but still provide for safety. Safety equipment for sports should be taught to school-age and older children. Drug and alcohol education is also typical for school-age and older children. Back to sleep guidelines are relevant for neonates unable to roll independently.

The community health nurse is performing a home visit to a family with a toddler. Which observation should prompt the nurse to perform safety education? Three blankets in the child's crib Absence of pads on the stairs Use of an electric heater in the house Dangling blind cords

Dangling blind cords Explanation: As babies gain neurologic and musculoskeletal functions, they learn and explore by pulling objects to themselves. Dingling cords can present a strangulation hazard. Electric heaters must be out of reach but their use is not prohibited. The presence of three blankets does not pose a significant safety risk. Access to stairs must be controlled but there is no recommendation for padding stairs.

The older adult client was admitted to the emergency department for accidentally overdosing on a prescribed medication. The client is prescribed several medications that have varying frequencies for administration. The nurse is providing tips to the client to prevent such an occurrence from happening again. What instructions would the nurse provide to the client? Select all that apply. Place pills in a pill dispenser that provides for separate dosing throughout the day. Maintain a list of medications with dosages and frequencies, and share it at each primary care provider visit. Contact the pharmacist or primary care provider about questions regarding medications. Request large-print medication labels on each of the prescribed medication bottles. Keep discontinued medications in case the health care provider prescribes the medication again.

Place pills in a pill dispenser that provides for separate dosing throughout the day. Maintain a list of medications with dosages and frequencies, and share it at each primary care provider visit. Contact the pharmacist or primary care provider about questions regarding medications. Request large-print medication labels on each of the prescribed medication bottles. Explanation: The nurse would instruct the client to place medications in the appropriate square of a medication dispenser. This is a reminder to the client about taking medications at the appropriate time and helps to prevent overdoses. Keeping a list of medications with dosage and frequency assists the health care provider in not prescribing a medication the client may already be taking. The client should contact the pharmacist or health care provider about questions regarding the prescribed medications. Large-print labels allow the older client who may be visually impaired to see what is in the medication bottle. The client should not keep medications that have been discontinued. The client may accidentally take the discontinued medication.

An older adult client with an unsteady gait has been experiencing urinary urgency after being diagnosed with a urinary tract infection. What is the nurse's best action for reducing the client's risk of falls? Provide a bedside commode and ensure adequate lighting. Obtain an order for insertion of an indwelling urinary catheter. Limit the client's fluid intake during the evening. Accompany the client to the bathroom every 4 hours around the clock.

Provide a bedside commode and ensure adequate lighting. Explanation: The use of a commode can often reduce the risk of falls that is associated with ambulating to the bathroom. Falls reduction is not considered a justifiable rationale for catheter insertion. Toileting every 4 hours may or may not be adequate for the client's needs. Fluid intake should never be reduced for the sole purpose of reducing urine output.

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? Evacuate the unit. Pull the fire alarm lever. Confine the fire. Extinguish the fire.

Pull the fire alarm lever. Explanation: The nurse should pull the fire alarm lever. As per the RACE principle of fire management, the flow of activities should be rescue, alarm, confine, and extinguish. The client had already been evacuated by another nurse, so the next action should be to pull the fire alarm lever, followed by confinement of the fire and extinguishing.

The nurse is meeting with a group of concerned parents of school-aged children about recent events in the community involving guns. What information will the nurse include in the education of the parents about gun safety? Select all that apply. Reinforce to children to never touch a gun. Instruct children to leave a friend's home in which a gun is accessible. Keep guns and ammunition together in a locked container. Install a trigger lock on every gun in the home. Place the key to the locked gun storage area in a place inaccessible to children.

Reinforce to children to never touch a gun. Instruct children to leave a friend's home in which a gun is accessible. Install a trigger lock on every gun in the home. Place the key to the locked gun storage area in a place inaccessible to children. Explanation: Information that the nurse would include about gun safety include reinforcing to the child to never touch a gun, instructing the child to leave a home where a gun is accessible, and installing trigger locks on all guns. Guns and ammunition are to be kept in separate locked containers, not together. Parents should place the key to the locked gun storage area in a place that is inaccessible to children.

A nurse is preparing discharge education for a client with a newborn infant. What is the highest priority item that must be included in the education plan? Lock all cabinets that contain cleaning supplies. Keep all pots and pans in lower cabinets. Give warm bottles of formula to the infant. Restrain the infant in a car seat.

Restrain the infant in a car seat. Explanation: The client should restrain the infant in a car seat when driving. Infants are especially vulnerable to injuries resulting from falling off changing tables or being unrestrained in automobiles. Locking the cabinets, giving warm bottles of formula to the infant, and keeping all pots and pans in lower cabinets are secondary teachings.

A father asks the nurse who is caring for his 13-year-old daughter why his daughter could be performing poorly in school lately, and why she is distancing herself from friends and family. Which of these possibilities would the nurse consider as the priority risk? She may be the victim of cyber-bullying. She has lost interest in academics because she has a boyfriend now. She may be beginning her menses. She may be developing nutritional deficiencies from poor dietary habits.

She may be the victim of cyber-bullying. Explanation: Symptoms of cyber-bullying include faltering school achievement, absenteeism, health concerns, isolating oneself from peers/friends, and increased anxiety and depression symptoms. Adolescents may neglect academics when involved in personal relationships, but that is a common milestone of the age group. Achieving menarche may alter mood, but it is not a risk concern. Nutritional deficits can be seen in adolescence and may need to be investigated with this client, but it is not the priority at this time.

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 verbal prescription for the restraints, renewed every 48 hours A detailed description of the restraint application process The type of personal protective equipment used by the nurse during restraint application

The alternative measures attempted before applying the restraints Explanation: Reasonable measures to avoid the use of restraints must be attempted before implementation; these measures must be documented. Verbal restraint prescriptions must be renewed every 24 hours, not every 48 hours. Neither a detailed description of the restraint application process nor the type of personal protective equipment used by the nurse during restraint application are required to be documented.

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 adds the information in the safety event report to the client health record. The nurse calls the primary health care provider to fill out and sign the safety event report. The nurse provides an opinion of the physical and mental condition of the client that may have precipitated the incident. The nurse details the client's response and the examination and treatment of the client after the incident.

The nurse details the client's response and the examination and treatment of the client after the incident. Explanation: 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 health care provider is not responsible for filling out or signing the safety report unless she witnessed the incident. The nurse reports factual information, not opinions.

The nurse is providing safety education to a group of adolescents. What teaching point should the nurse prioritize? Fire prevention and fire safety The obligation to report any unsafe actions to authorities The value of not giving into social pressure to perform unsafe acts Infection control and strategies for breaking the chain of infection

The value of not giving into social pressure to perform unsafe acts Explanation: As adolescents explore opportunities, they may know that certain behaviors are unsafe, but social pressure can persuade them to act against their better judgment. This social pressure underlies many of the risks that adolescents face. Fire safety and infection control are also valid teaching points, but social pressure is particularly significant for adolescents.