PrepU ch.27 safety, security, and emergency preparedness

Unintentional injuries are a major cause of disability and death in the United States. For adults, where do unintentional injuries fall on the list of leading causes of death? a.Fifth b.Tenth c.First d.Eighth

a. Fifth Unintentional injuries are the fifth leading cause of deaths behind heart disease, cancer, stroke, and chronic obstructive lung disease. Listed are the top 3 leading causes of death in the US: Heart disease, cancer, and chronic lower respiratory diseases.

The nurse is discussing car safety with the mother of a 6-year-old child. The child's mother questions the need for the use of special car seats for her child. What information can be provided to her? a."Car seats are only recommended until children are 3 years old." b."At the age of 6 your child should be using a booster seat." c."Car seats are recommended until children are at least 10 years old." d."Your child will be safe in the car using the provided shoulder harness and lap belts."

b. "At the age of 6 your child should be using a booster seat." When children outgrow standard car seats, parents and caregivers should use booster seats, preferably those that use combination shoulder and lap belts, until the car seat belt fits appropriately (typically when they have reached 4 ft, 9 in [1.43 m] in height and are between 8 and 12 years of age).

The nurse is providing safety teaching to the family of an older adult client. Which finding in the client's home will the nurse teach the family to address? a.Outlets and switches have cover plates. b.Machines used infrequently are unplugged. c.A hair dryer is placed next to the sink. d.No extension cords are being used.

c. A hair dryer is placed next to the sink. Electrical shock can result if appliances such as a hair dryer come in contact with water. The hair dryer should be removed away from the sink. Other findings reflect appropriate safety measures.

The health department is reviewing community health initiatives for the year. During the summer, the health department focuses infection control implementation activities on which program? a.administering influenza immunizations b.administering free antibiotics c.using pesticides for mosquitoes d.delivering fans to older adult residents

c. using pesticides for mosquitoes Community problems such as water supply contaminated with sewage or tick infestations near residential areas also can result in infection. Influenza immunization is concentrated in the fall and winter. Antibiotic administration is not a prevention program but one geared to disease treatment. Fans may be delivered to older adults but this intervention will not reduce infection.

x The nurse is teaching the caregiver of an adolescent child about safety. Which teaching will the nurse include? a.Supervise your child on the changing table. b.Place all household cleaners out of reach. c.Buy protective sporting equipment. d.Peer pressure causes children of this age to take risks.

d. Peer pressure causes children of this age to take risks. Adolescents tend to be impulsive and take risks as a result of peer pressure, so this is important for the nurse to teach the adolescent. Buying protective sporting equipment, placing household cleaners out of reach, and supervising the child on the changing table are not age-appropriate teachings to include.

The nurse is caring for an adult who requires IV fluids but continues to pull at the IV site and tubing. The adult child tries to calm the client, without success. Which short-term restraints should the nurse use to control the adult's movement during the procedure? a.Mummy restraint b.Elbow restraint c.Waist restraint d.Extremity restraint

d. Extremity restraint The extremity restraint is appropriate during an accidental removal of therapeutic devices, because it provides short-term restraint designed to control all movement. The vest restraint, mummy restraint, and elbow restraint are not appropriate in this situation.

The poison control nurse receives a call from the caregiver of a young school-age child who may have ingested a poisonous substance. Which is the priority response by the nurse? a."Check breathing and heart rate." b."What do you think that the child might have ingested?" c."At what time did the child ingest the substance?" d."Induce vomiting while you wait for emergency personnel to arrive."

a. "Check breathing and heart rate." Initial treatment for a victim of suspected poisoning involves maintaining breathing and cardiac function. After that, rescuers attempt to identify what was ingested, how much, and when. Definitive treatment depends on the substance, the client's condition, and if the substance is still in the stomach.

The nurse is caring for a client that is disoriented. The nurse places the client in soft wrist restraints to discourage pulling at a nasogastric tube. Which nursing action(s) is appropriate? Select all that apply. -Obtain order from a licensed provider within minutes of restraint application. -Withhold information from family regarding restraints due to HIPAA. -Check circulation and skin condition every 2 hours. -Offer regular, frequent opportunities for toileting. -Maintain restraints until discharge.

-Obtain order from a licensed provider within minutes of restraint application. -Check circulation and skin condition every 2 hours. -Offer regular, frequent opportunities for toileting. An order for restraints from the licensed health care provider must be obtained within minutes after the restraint is applied. Frequent and regular nursing assessments are required of the restrained client's vital signs; circulation; skin condition or signs of injury; psychological status and comfort; and readiness for discontinuing the restraint. The nurse must explain the need for restraints with the family. When the assessment findings indicate that the client has improved, restraints must be removed.

The nurse is performing an assessment on an older adult. From which data does the nurse deduce that the client is at high risk for falls in the home? Select all that apply. -Takes furosemide daily -Admits to drinking wine through the evening -Shares a one floor living space with a spouse -Has history of diabetic neuropathy -Participates in a walking club

-Takes furosemide daily -Admits to drinking wine through the evening -Has history of diabetic neuropathy The acronym DAME (Drug/alcohol use, Age-related physiologic status, Medical problems, Environmental) assists the nurse to asses fall risk at home. The diuretic furosemide may cause the client to fall during frequent and possibly urgent trips to the toilet. Furosemide may also cause volume depletion and dizziness in standing. Diabetic neuropathy contributes to falls because of loss of normal sensation in feet and lower extremities. Consuming alcohol contributes to loss of balance, volume depletion and urinary urgency. Living on one floor and performing regular exercise describe positive characteristics for fall prevention.

The nurse is preparing an education session on injury prevention for parents with toddlers. What will the nurse prioritize during this session to help parents to reduce the risk of injury for toddler, given their developmental stage? Select all that apply. -safety with stairs -water safety -electric outlet safety -childproof latches -bike safety

-safety with stairs -water safety -electric outlet safety -childproof latches Infants and toddlers are vulnerable and often the victims of accidental poisoning, falls from stairs or high chairs, burns, electrocution from exploring outlets or manipulating electric cords, and drowning. As children do not begin to learn how to ride a bike independently until at least the preschool age (more commonly during the school-aged years), the nurse will not prioritize teaching the parents about bike helmet safety.

The nurse is making the initial assessment of a client following a surgical procedure with sedation. Place in order the nurse's assessment actions. Use all options. -intravenous access and IV fluids -level of consciousness and orientation -items within the client's reach -airway, breathing, and circulation -wounds and tubes

1-airway, breathing, and circulation 2-level of consciousness and orientation 3-intravenous access and IV fluids wounds and tubes 4-items within the client's reach The nurse is performing an assessment following a surgical procedure. The most important assessment is the client's airway, breathing, and circulation. A problem with any of these would indicate a situation requiring immediate action. The nurse would then assess the client's level of consciousness and orientation. Again, an abnormality in these areas could indicate the need for immediate action. Next, the nurse checks the IV site and fluids infusing for patency, solution, and rate. Then the nurse would assess the client for wounds and the tubes for presence, patency, and fluid color and amount. The paramount concern is for the client. After client assessments are completed, then the nurse checks for the call bell, water if allowed, and other personal items within reach of the client.

The nurse is conducting a community education program on bike helmet safety. The nurse determines additional information is needed when a participant states: a."I should be able to fit two fingers between my chin and the chin strap." b."The helmet should rest 1 in (2.5 cm) above the eyebrows." c."My child needs a helmet if in a secured passenger bike seat." d."My child should wear a helmet every time he rides a bike."

a. "I should be able to fit two fingers between my chin and the chin strap." The nurse should determine that additional information is needed when the participant states that the chin strap should fit two fingers underneath the chin. The chin strap needs to be snug, and the ability to fit two fingers between the strap and the chin indicates it is not snug enough. The helmet should rest 1 in (2.5 cm) above the eyebrows. Children should wear a helmet every time they ride a bike or are strapped into a bike seat as a passenger.

Which statement indicates that a family understands the teaching that has been provided by the nurse related to car seat safety for their 3-year-old child who weighs 31 lb (14 kg)? a."We place our child in a front-facing car seat in the back seat of the car." b."We place our child in a front-facing car seat in the front of the car." c."We place our child in a rear-facing car seat in the back seat of the car." d."We place our child in a rear-facing car seat in the front of the car."

a. "We place our child in a front-facing car seat in the back seat of the car." Explanation: Infants and toddlers should ride in a rear-facing car safety seat as long as possible, until they reach the highest weight or height allowed by their seat. Most convertible seats have limits that will allow children to ride rear-facing for 2 years or more with weight limits averaging 35 to 40 lb (15.5 to 18 kg).

The nurse is educating health care providers on implementation of a hospital disaster plan. What consideration should the nurse prioritize? a.Establish the nurse's role during a disaster b.Provide simple explanations to maximize client safety c.Identify the resources available for the nursing unit d.Notify the organization's leader that a disaster has been called

a. Establish the nurse's role during a disaster During a disaster nurses will have multiple roles. In addition to their clinical knowledge, they may be responsible for triage, counseling and various other duties. Fear, panic, anger, and exaggerated concerns are expected. Disaster preparedness is imperative, as well as knowledge of resources. Communication with leadership should be established and sources for reliable information monitored. However, none of the necessary actions can be performed if the nurse lacks clarity on his or her role.

A hospital is introducing a program that has the goal of aligning practices more closely with the Quality and Safety Education for Nurses (QSEN) project. What initiative best exemplifies QSEN competencies? a.New systems are introduced to increase communication between nurses and the members of other health disciplines. b.Systems are reviewed with the goal of achieving the best client outcomes at the lowest cost. c.Hiring practices are reviewed to maximize the proportion of nurses who possess baccalaureate or graduate degrees. d.New partnerships are established between the hospital and local schools of nursing.

a. New systems are introduced to increase communication between nurses and the members of other health disciplines. Teamwork and collaboration is one of the core QSEN competencies, and is exemplified by increasing communication between different disciplines. The six QSEN competencies do not explicitly address financial costs of care, higher levels of education for nurses, or increased partnership between hospitals and educational institutions.

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? a.Open doors and windows. b.Wait inside until emergency personnel arrive. c.Allow emergency personnel to apply oxygen. d.Recommend that carbon monoxide detectors be installed in the home.

a. Open doors and windows. Carbon monoxide (CO) is extremely lethal because it is colorless, odorless, and tasteless. The nurse recognizes symptoms of bright cherry red skin color, nausea, headache, and inability to move. The initial direction will be for the caller to open doors and windows to reduce the level of toxic gas and provide adequate ventilation. If, while waiting for emergency personnel to arrive, the family members gain the ability to move, they can evacuate outdoors. After having the caller open doors and windows, the nurse can then provide instructions about emergency personnel and further discuss CO detectors.

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? a.Provide a bedside commode and ensure adequate lighting. b.Obtain an order for insertion of an indwelling urinary catheter. c.Limit the client's fluid intake during the evening. d.Accompany the client to the bathroom every 4 hours around the clock.

a. 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 smells smoke and subsequently discovers a fire in a garbage can in a common area on the hospital unit. What is the nurse's priority action in this situation? a.Rescue anyone who is in immediate danger. b.Evacuate clients and staff. c.Activate the fire alarm on the unit. d.Attempt to extinguish the fire.

a. Rescue anyone who is in immediate danger. The acronym "RACE" can be used as a guide to the immediate response to fire. This involves rescuing anyone in immediate danger (R); pulling the alarm, calling "code red," and alerting appropriate personnel (A); confining the fire by closing doors and windows (C); evacuating clients and other people to a safe area (E). Extinguishing the fire is not part of the immediate response.

During a course on terrorism, a group of emergency room nurses learns about terrorists who use bombs or other explosives to inflict injury on numerous people and cause multiple fatalities. This is an example of: a.mass trauma terrorism. b.chemical terrorism. c.bioterrorism. d.nuclear terrorism.

a. mass trauma terrorism. Mass trauma terrorism is caused by bombs and other explosives that are used to inflict mass trauma and cause multiple fatalities. Bioterrorism involves the deliberate spread of pathogenic organisms into the community. Chemical terrorism involves the deliberate release of a chemical compound for the purpose of causing mass destruction. Nuclear terrorism involves the dispersal of radioactive materials into the environment for the purpose of causing injury and death.

The nurse is assessing a client's mental health competence and decision-making ability. Which activity will best provide the needed information to the nurse? a.Ask the client to read and discuss a passage from a pamphlet. b.Ask the client "what if" questions to determine level of thought organization. c.Ask the client to review his medical health history to assess for the level of organization of his thought processes. d.Discuss with the client's family any concerns about his mental stability.

b. Ask the client "what if" questions to determine level of thought organization. When reviewing mental health and level of decision-making ability, the best method is to ask the client "what if" type of questions. Assessing the client's reading ability and understanding of passages read will not provide the needed information. Asking the client to discuss his medical history will provide some information but will not provide information on his ability to reason and make clear decisions. Questioning the family provides only a secondary source of information and will not be as effective.

A client is brought to the emergency department after inhaling a substance suspected to be anthrax from the contents of an envelope. What symptoms experienced by the client would the nurse correlate with this substance? a.Nausea, vomiting, and diarrhea b.Cough, dyspnea, and fatigue c.Abdominal pain and hematemesis d.Ulcerated skin lesions

b. Cough, dyspnea, and fatigue The symptoms of exposure to anthrax present differently based on the means of transmission. Contact with cutaneous absorption of anthrax can be indicated by skin lesion with local edema that progresses, enlarges, ulcerates, and becomes necrotic. Gastrointestinal exposure can be indicated by nausea, vomiting, fever, abdominal pain, hematemesis, and severe diarrhea. Inhalation exposure can be indicated by fever, fatigue, cough, dyspnea, and pain; exposure of this type may progress to meningitis, septicemia, shock, and death.

The nurse is teaching the caregiver of a 3-year-old about safety. Which teaching will the nurse include? a.Supervise your child on the changing table. b.Place all household cleaners out of reach. c.Buy protective sporting equipment. d.Peer pressure causes children of this age to take risks.

b. Place all household cleaners out of reach. Household chemicals, which are associated with a risk for poisoning, should be placed out of the toddler's reach. Infants should be supervised on a changing table. Protective sporting gear should be purchased for school-age children who are physically active. Adolescents tend to be impulsive and take risks as a result of peer pressure.

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? a.She may be the victim of cyber-bullying. b.She has lost interest in academics because she has a boyfriend now. c.She may be beginning her menses. d.She may be developing nutritional deficiencies from poor dietary habits.

b. She may be the victim of cyber-bullying. 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.

What is the primary role of the nurse in the care of clients who experience domestic violence? a.Calling the police b.Identifying health education and counseling measures for the family c.Providing prompt recognition of the potential or actual threat to safety d.Serving as a witness in court

c. Providing prompt recognition of the potential or actual threat to safety The nurse is often the initial health care provider in contact with an abused child or a battered woman or man. Prompt recognition of the potential or actual threat to safety is crucial, and the nursing assessment may play a vital role in identifying a harmful environment.

A client has frequent readmissions for fall-related injuries. Which is the most appropriate intervention by the nurse? a.Perform a vision test with Snellen chart b.Arrange an audiology consult to evaluate hearing c.Assess the client for signs and symptoms of osteoporosis d.Arrange for a skilled home care assessment

d. 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.

What is the rationale for health care personnel to orient clients to rooms and equipment when they are admitted to the hospital? a.It is hospital policy. b.It is part of the routine and is included on the admission checklist. c.It allows time for the health care provider to write admission orders. d.Orienting clients to the surroundings decreases the potential for injury.

d. Orienting clients to the surroundings decreases the potential for injury. Orienting the client to unfamiliar surroundings will decrease the risks for unintentional injury.

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? a.Leave to notify the health care provider concerning a change in client status b.Apply limb restraints to ensure client safety c.Promptly document the change in client status d.Reduce distressing environmental stimuli to maximize client safety

d. 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.

The nurse begins a shift and finds that the wrong medication has been administered to a client. After completing a safety event report, what should the nurse do next? a.File the safety event report in the appropriate file and document in the nurse's notes the date and time that it was filed. b.Make a copy of the safety event report for the client. c.Place the safety event report in the client's medical record for future reference. d.Submit the safety report to the appropriate department within the facility so that it can be reviewed.

d. Submit the safety report to the appropriate department within the facility so that it can be reviewed. When an adverse event occurs, a safety event report should be filed and submitted according to facility policy. Safety event reports should not become a part of the client's medical record, nor should they be mentioned in documentation or copied and given to the client.

A health care provider has ordered restraints for an older adult client who is delirious from the pain medication she was administered. Which guideline is appropriate for utilizing restraints? a.Chemical restraints should be tried before using physical restraints. b.The restraints can be ordered by the nursing supervisor in emergency situations. c.The client's vital signs must be assessed every hour. d.The client's order for restraints must be renewed by the health care provider every 4 hours.

d. The client's vital signs must be assessed every hour. The client's vital signs must be assessed every hour when restrained. Restraints must be ordered by a health care provider. Orders for restraints may be renewed every 4 hours for adults 18 years of age or older but must be renewed every 24 hours. Chemical restraints do not necessarily have to precede the use of physical restraints.

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

d. 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.

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? a.the use of skid-proof mats for the bath tub b.safety of guns in the home c.correct placement of booster seats for the car d.Use of blankets, pillows, and stuffed animals in the crib

d. Use of blankets, pillows, and stuffed animals in the crib 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 likely to be physically able to access guns in the home. Infants should not have pillows, stuffed animals, or blankets in the bed due to the risk of suffocation.