Chapter 27 Prep U
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)
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 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 vital signs and respiratory status
The nurse is caring for an older adult client who has a cognitive impairment and frequently wanders. The nurse will implement which action(s) into the client's plan of care? Select all that apply.
Check that all exit doorways have a STOP sign posted. Place a bell over the client's room and other facility doors.
A nurse visits an older adult client at home and assesses the safety of the client's environment. Multiple small rugs are located in the home. Which statement by the nurse is appropriate when addressing the client's safety?
I am concerned that the small rugs in your home can be a tripping hazard.
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
The telehealth nurse receives a call stating that upon entering a family member's home, two people have been found semi-conscious with a bright cherry red skin color. They are reporting nausea and headache, and are unable to move. Which initial direction will the nurse provide?
Open doors and windows.
What is the primary role of the nurse in the care of clients who experience domestic violence?
Providing prompt recognition of the potential or actual threat to safety
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?
Restrain the infant in a car seat.
The nurse has completed a comprehensive assessment of a client who has been admitted to the hospital experiencing acute withdrawal from alcohol. What nursing diagnosis would provide the clearest justification for the use of physical restraints during this client's care?
Risk for Injury Related to Agitation
Which reason best explains why adolescents behave in an unsafe manner despite knowledge of a particular activity's risk?
Social pressure
A nurse is completing an intake assessment. The nurse notes that an older adult male client appears to have bruises in varying stages of healing. Which action by the nurse indicates an understanding of her responsibilities?
The nurse should question the client about the source of the bruises.
The nurse cares for a client who is postoperative after an abdominal surgery. Which is the most important statement for the nurse to use in teaching this client?
Use the call bell for any needs and wear nonslip footwear.
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
The school nurse is providing education on poisoning risks to adolescent students. Which topic does the nurse include in the teaching?
experimentation with drugs and inhalants
Which level of health care provider may make the decision to apply physical restraints to a client?
nurse practitioner
The nurse has provided a family with education related to car seat safety for a 9-month-old infant. Which statement indicates an understanding of the teaching?
We place our infant in a rear-facing car seat in the back seat of the car.