review questions Safety, security, and Emergency Preparedness

A nurse is preparing to file a safety event report after a client experienced a fall. Which statement is correct regarding the filing of a safety event report? A. The nurse should record the incident in the client's medical record and fill out a safety event report separately. B. The nurse should include a note on the client's chart that mentions the report. C. The nurse should make a copy of the safety event report and place it in the client's medical record. D. The nurse should await results of the x-ray before filing the report.

A. The nurse should record the incident in the client's medical record and fill out a safety event report separately. Explanation: The nurse completes the safety event report immediately after an unintentional injury and is responsible for recording the incident and its 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 nurse should not wait until after the x-ray to complete the form.

The older adult will have an increased risk for developing which of the following? A. Gunshot wounds B. Fire hazards C. Poisoning D. Heatstroke

Heatstroke Explanation: The ability to thermoregulate may become impaired; older adults are at higher risk than younger adults for hypothermia and heatstroke.

Which safety tip could the nurse give to parents to help decrease the risk of the leading cause of injury or death in children 1 to 4 years of age? A. "Never keep firearms in the home with young children." B. "Always provide close supervision for young children when they are in or around pools and bathtubs." C. "Never smoke in the bed in the house when young children are present." D. "Store medications in a locked area to prevent children from getting into them."

"Always provide close supervision for young children when they are in or around pools and bathtubs." Explanation: The leading cause of injury and death in children 1 to 4 years of age is drowning. Therefore, providing close supervision when children are in or around tubs and pools will help decrease and/or prevent this injury.

Which action directly addresses one of the Joint Commission 2015 Hospital National Safety Goals? A. A nurse has committed to exceeding the required amount of continuing education required for license renewal. B. A hospital has set ambitious targets for reducing the incidence of catheter-related urinary tract infections. C. A long term care facility has put new measures in place to identify residents who may be aggressive. D. A public health agency has changed its policies so that two nurses are always present during a home visit.

A hospital has set ambitious targets for reducing the incidence of catheter-related urinary tract infections. Explanation: Reducing the rates of health care-associated infections is among the 2015 goals. Actions such as identifying aggressive clients, pairing nurses during home visits, and continuing education are beneficial, but none directly address the 2015 goals set out by the Joint Commission.

Which action directly addresses one of the Joint Commission 2015 Hospital National Safety Goals? A. A public health agency has changed its policies so that two nurses are always present during a home visit. B. A long term care facility has put new measures in place to identify residents who may be aggressive. C. A hospital has set ambitious targets for reducing the incidence of catheter-related urinary tract infections. D. A nurse has committed to exceeding the required amount of continuing education required for license renewal.

A hospital has set ambitious targets for reducing the incidence of catheter-related urinary tract infections. Explanation: Reducing the rates of health care-associated infections is among the 2015 goals. Actions such as identifying aggressive clients, pairing nurses during home visits, and continuing education are beneficial, but none directly address the 2015 goals set out by the Joint Commission.

Which nurse would be at the highest risk of causing a hazardous situation? A. A nurse who is transferred to another unit to assist with care B. A nurse who has worked 32 hours of overtime this week C. A nurse who has placed a client in the bed with three side rails up D. A nurse who is administering medications to four clients

A nurse who has worked 32 hours of overtime this week Explanation: Health care staff who suffer sleep deprivation due to extended work hours and variable shift assignments are more likely to commit errors and be a factor in adverse events. A nurse transferring to another unit is able to provide care to clients within the scope of practice; this does not present a hazardous situation. Placing three side rails up assists with prevention of falls and is not classified as a restraint. Administering medications to four clients is not a risk factor for hazardous situations.

A nurse is educating parents of preschoolers on appropriate safety measures for this age group. What might be a focus of the education plan? A. Gun safety B. Childproofing the house C. Fire safety D. Smoking cessation

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. Smoking cessation and gun safety should be taught to adolescents. Fire safety is typically taught to school age children.

The nurse is reviewing a healthcare provider's orders in the electronic health record (EHR) and notices several abbreviations. What is the appropriate nursing action? A. Fix the abbreviations in the EHR. B. Administer medications as ordered. C. Confirm abbreviations with another nurse. D. Contact healthcare provider to clarify order.

Contact healthcare provider to clarify order. Explanation: Before treatments can safely be carried out and medications safely given, the nurse must contact the healthcare provider to clarify the orders. Many abbreviations and symbols are not permitted for use in healthcare records. The nurse should never alter documentation, nor it is appropriate to confirm abbreviations with another nurse.

Which item would alert the home care nurse to a safety hazard threatening a young child? A. Padded child safety seat B. A gated stairway C. Dangling blind cords D. Three blankets in a crib

Dangling blind cords Explanation: As babies gain neurologic and musculoskeletal functions, they learn and explore by pulling objects to themselves and placing almost everything in their mouths. Cords, tablecloths, plastic bags, bottles, and cans are tempting, dangerous objects that caregivers must strive to keep out of reach.

A child is playing soccer and is involved in a head-to-head collision with another player. Which assessment findings should the nurse be alert to that may indicate a concussion? Select all that apply. A. Vomiting B. Drowsiness C. Headache D. Increased thirst E. Fever

Drowsiness Headache Vomiting Explanation: Concussions are a frequently seen sports injury in school-age children. Nurses should be aware of symptoms that may indicate that a concussion or more serious head injury is present. Symptoms of a concussion include headache, vomiting, problems with balance, fatigue, dazed or stunned appearance, difficulty concentrating and remembering, confusion, forgetfulness, irritability, nervousness, very emotional behavior, drowsiness, difficulty falling asleep, and sleeping more or less than usual. Fever and increased thirst are not symptoms usually seen with a concussion.

A nurse is using the DAME acronym to perform fall assessments on older adults in a home health care setting. Which examples of nursing actions follow this guideline? (Select all that apply.) A. M—A nurse reviews patient charts for medical problems affecting falls. B. D—A nurse assesses drug and alcohol use of the patients. C. A—A nurse assesses the age-related physiologic status of the patients. D. E—A nurse assesses the energy level of patients prior to scheduling activities. E. D—A nurse decreases the amount of pain killers administered to patients. F. M—A nurse manages the amount of time patients spend alone.

D—A nurse assesses drug and alcohol use of the patients. A—A nurse assesses the age-related physiologic status of the patients. M—A nurse reviews patient charts for medical problems affecting falls. Explanation: Home health care nurses frequently use the acronym DAME to assess the risk for falling in older adults at home. The D stands for drug and alcohol use; the A stands for age-related physiologic status; the M is for medical problems; and the E represents environment.

An older adult woman in a long-term care facility has fallen and sustained several injuries. Which of her injuries would be the most serious fall-related injury?

Fractured hip Explanation: Falls can occur at any age, but a large percentage of older adults in long-term settings suffer a fall. Hip fractures are among the most serious fall-related injuries. Fractures can cause pain, permanent disability, and even death. A fractured ulna may be painful but would not cause the same potential for complications as a hip fracture. Lacerations and contusions may be uncomfortable for the client but will heal with limited risk for further complications.

What best describes the nurse's role in disaster preparedness? A. Multiple roles, including triage and the distribution of resources B. Performance of all of the skills such as IV insertion and wound care C. Counseling the victims and families D. Administration of all of the medications

Multiple roles, including triage and the distribution of resources Explanation: Nurses will perform multiple roles when assisting with a disaster, including triage, procedures, counseling, and distribution of resources.

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 partnerships are established between the hospital and local schools of nursing. B. Systems are reviewed with the goal of achieving the best client outcomes at the lowest cost. C. New systems are introduced to increase communication between nurses and the members of other health disciplines. D. Hiring practices are reviewed in order to maximize the proportion of nurses who possess baccalaureate or graduate degrees.

New systems are introduced to increase communication between nurses and the members of other health disciplines. Explanation: 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.

Which level of health care provider may make the decision to apply physical restraints to a client? A. Nurse practitioner B. Senior personal care assistant C. RN nurse manager D. LPN team leader

Nurse practitioner Explanation: Current evidence-based research has shown that physical restraints should only be used as a last resort, and only used to prevent injury to staff, clients, or others. Federal and state guidelines, as well as accrediting bodies, such as The Joint Commission, require that restraints be applied only when ordered by a prescriber such as a physician, nurse practitioner, or physician assistant.

A nurse is caring for a client who is receiving an intravenous therapy through an IV pump. Which intervention should the nurse implement to ensure electrical safety? A. Run the electrical cord of the pump under the carpet. B. Tape the electrical cord of the pump to the floor. C. Obtain a three-prong grounded plug adapter. D. Use an extension cord to provide freedom of movement.

Obtain a three-prong grounded plug adapter. Explanation: The nurse should obtain a three-prong grounded plug adapter, as it carries any stray electricity back to the ground. Using an extension cord may be an electrical hazard. Taping the electrical cord to the ground and running the electrical cord under the carpet are not appropriate actions for electrical safety.

The nurse is teaching the caregiver of an adolescent child about safety. Which teaching will the nurse include? A. Buying protective sporting equipment, B. placing household cleaners out of reach C. supervising the child on the changing table D. Peer pressure causes children of this age to task risks.

Peer pressure causes children of this age to task risks. Explanation: 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.

A client in a long-term care facility has become increasingly unsteady. The nurses are worried that the client will climb out of bed and fall. Which measure would be a priority recommendation for this client? A. Providing a bed that is elevated from the floor B. Placing the client in a bed with a bed alarm C. Using restraints on the client to prevent a fall D. Raising all the side rails of the bed

Placing the client in a bed with a bed alarm Explanation: Raising all side rails on the bed would be a restraint, and may increase the client's risk of a fall if he or she climbs out of bed. Providing a bed that is elevated would put the client at a greater risk for a fall. Using restraints are not an option at this time, but placing the client in a bed with a bed alarm would help to prevent a fall.

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

Providing prompt recognition of the potential or actual threat to safety Explanation: 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 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? A. Pull the fire alarm lever. B. Confine the fire. C. Extinguish the fire. D. Evacuate the unit.

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.

A nurse visits an older adult client at home and assesses the safety of the client's environment. Which article can be a threat to the client's safety? A. skid-resistant small area rugs on the floor B. a laundry bag at the corner of the room C. carpet on the floor of the living room D. area rugs kept on the stairs without carpet

area rugs kept on the stairs without carpet Explanation: The area rugs kept on the stairs are a health hazard and may cause falls. The older adult client should remove the area rugs from the stairs to prevent accidental injury. Laundry bags, skid-resistant small area rugs, and carpets are not harmful.

An 17-year-old is brought to the emergency department with a head injury. The nurse knows that adolescents are vulnerable to injuries related to: A. automobile accidents. B. falls from staircases. C. falls from beds. D. play-related injuries.

automobile accidents. Explanation: Adolescents are prone to injuries related to activities that involve high risk, such as driving. Adolescents tend to be impulsive and take unnecessary risks as a result of peer pressure. Falling from the bed is common in infants. Play-related injuries are commonly seen in school-age children, and falling from staircases is a common injury among toddlers.

An administrative assistant at a large factory visits the medical unit and tells the nurse she is having pain in the right wrist, numbness in the index finger, and decreased mobility of the right hand. The nurse suspects the client has: A. carpal tunnel syndrome. B. a fracture of the hand. C. a herniated cervical disc. D. an infection in the bone.

carpal tunnel syndrome. Explanation: Adults with jobs that require repetitive movement (typists, assembly line workers, supermarket checkers, computer operators) may develop carpal tunnel syndrome, a compression of the median nerve that causes pain and decreases hand mobility. A fracture would most likely be accompanied by symptoms including pain, swelling, and an inability to use the extremity. A herniated cervical disk would likely be accompanied by symptoms involving numbness and discomfort of the neck and arms. There are no manifestations consistent with an infection in the bone.

A client went missing from a long-term care facility and an emergency code was called. After a search of one hour, the client was discovered in a utility room that should have been inaccessible. When responding to this event, staff should: A. complete an incident report in order to determine who was primarily responsible for the event. B. document strategies in the client's health record for preventing future incidents. C. fill out an incident report, with the goal of preventing a similar event in the future. D. hold a facility-wide meeting to identify strategies for making improvements to the safety of residents.

fill out an incident report, with the goal of preventing a similar event in the future. Explanation: Incident reports are primarily used to facilitate improvements, not to determine culpability. A client's health record is not the appropriate place for documenting strategies for future care. Holding a meeting does not replace the need to document the event in the form of an incident report.

A client went missing from a long-term care facility and an emergency code was called. After a search of one hour, the client was discovered in a utility room that should have been inaccessible. When responding to this event, staff should: A. hold a facility-wide meeting to identify strategies for making improvements to the safety of residents. B. complete an incident report in order to determine who was primarily responsible for the event. C. document strategies in the client's health record for preventing future incidents. D. fill out an incident report, with the goal of preventing a similar event in the future.

fill out an incident report, with the goal of preventing a similar event in the future. Explanation: Incident reports are primarily used to facilitate improvements, not to determine culpability. A client's health record is not the appropriate place for documenting strategies for future care. Holding a meeting does not replace the need to document the event in the form of an incident report.

When educating families on fire safety, it is important to: A. have a meeting place outside the home. B. use extension cords to prevent shock. C. keep a fire extinguisher in a closet. D. account for all members and then exit.

have a meeting place outside the home. Explanation: The whole family should regularly practice crawling on the floor, using escape routes, and having a meeting place outside the home in case of fire. Attempting to account for all family members before exiting the burning structure is dangerous and may result in the loss of life. Shock is possible with extension cords. Having a fire extinguisher is important but it should be kept in a area with access and not a closet.

A large health care organization has committed to promoting a just culture when adverse events and near misses take place. Which question will guide the organization's response when a nurse commits an error? A. "How have other organizations responded to nurses in events like this?" B. "What is the organization's legal liability in this matter?" C. "How did the nurse's actions contribute to this error?" D. "Have the client and the family been informed about this?"

"How did the nurse's actions contribute to this error?" Explanation: Key to the establishment of a just culture is a recognition that not all errors are the same, and that nurses' contributions to errors vary greatly. Legal liability, the response of other organizations, and communication with the client are valid considerations, but none directly promote the establishment of a just culture.

The nurse is conducting a community education program on bike helmet safety. The nurse determines additional information is needed when a participant states: A. "My child should wear a helmet every time he rides a bike." B. "I should be able to fit two fingers under the chin strap." C. "The helmet should rest 1 inch above the eyebrows." D. "My child needs a helmet if he is in a secured passenger bike seat."

"I should be able to fit two fingers under the chin strap." Explanation: The nurse should determine that additional information is needed when the participant states that the chin strap should fit two fingers underneath. The chin strap needs to be snug, and the ability to fit two fingers indicates it is not snug enough. The helmet should rest 1 inch above the eyebrows. The child should wear a helmet every time he rides a bike or is strapped into a bike seat as a passenger.

The poison control nurse receives a call from the parent of a 2-year-old child. The parent states, "I just took a quick shower, and when I finished, I walked into the kitchen and found my child with an open bottle of household cleaner." What is the poison control nurse's appropriate response? A. "Did you leave the household chemical in reach of your child?" B. "Is your child breathing at this time?" C. "You should not have left your child alone while you showered." D. "Induce vomiting and call 9-1-1 right away."

"Is your child breathing at this time?" Explanation: Initial treatment for a victim of suspected poisoning involves maintaining breathing and cardiac function, so the nurse will ask about the child's respiratory status. Definitive treatment depends on the substance, the client's condition, and if the substance is still in the stomach; vomiting should not be induced until more information is gathered. Instructing the parent about leaving the child alone is not therapeutic at this time.

An 8-year-old boy fell off his bicycle. He was not wearing a helmet and has sustained a concussion. What information should the nurse teach the parents about concussions? A. "It is important to monitor frequently for headache, vomiting, visual disturbances, and changes in alertness." B. "Concussions happen often in children of this age group, and they always bounce back fine." C. "Wearing bicycle helmets will keep your child safe from head injuries." D. "Try to keep him resting for a few days at home using the television and his video games."

"It is important to monitor frequently for headache, vomiting, visual disturbances, and changes in alertness." Explanation: Frequent neurologic assessments are crucial after a traumatic brain injury, to assess for subtle changes as they begin. Helmets are meant to protect the wearer, but head injury can still occur. "Passing off" an injury as something that kids get and "bounce back" from is wrong and potentially harmful. Watching TV and video games stimulates brain activity and may worsen the child's symptoms and the injury itself.

A school nurse is conducting a safety seminar with students in 6th grade. Which teaching point is most important? A. "Make sure that your family's microwave oven was made after 1999; otherwise, it may be a fire risk." B. "Make sure that you have smoke detectors in your house and that they're in working order." C. "A wood-burning fireplace is a major fire risk, and it shouldn't be used unless necessary." D. "If your clothes should catch on fire, go to an open area as quickly as possible."

"Make sure that you have smoke detectors in your house and that they're in working order." Explanation: 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? A. "Only certain members of the healthcare team can extinguish a fire." B. "I will rescue clients from harm before doing anything else." C. "I will close the door to the room where the fire is, after clients have been removed." D. "After clients are evacuated from the room with the fire, the alarm can be sounded."

"Only certain members of the healthcare team can extinguish a fire." Explanation: All members of the healthcare 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.

Which statement indicates that a family understands the teaching that has been provided by the nurse related to car seat safety for a 9-month-old infant? A. "We place our baby in a rear-facing car seat in the back seat of the car." B. "We place our baby in a front-facing car seat in the middle of the back seat of the car." C. "We place our baby in a front-facing car seat in the front of the car so that he doesn't cry." D. "We place our baby in a rear-facing car seat in the front of the car so that we can see him in case he chokes."

"We place our baby in a rear-facing car seat in the back seat of the car." Explanation: Children from birth to 2 years of age should remain in a rear-facing infant seat in the back seat of the car until they reach the maximum height and weight for a front-facing child car seat.

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? A. "We place our child in a rear-facing car seat in the back seat of the car." B. "We place our child in a rear-facing car seat in the front of the car." C. "We place our child in a front-facing car seat in the back seat of the car." D. "We place our child in a front-facing car seat in the front of the car."

"We place our child in a front-facing car seat in the back seat of the car." Explanation: Children over the age of 2 should be placed in a front-facing car seat based on the child's weight and height.

The nurse is caring for four clients. Which does the nurse anticipate may have a latex sensitivity? A. 43-year old who avoids nuts due to diverticulitis B. 21-year old who cannot eat bananas C. 55-year old who does not drink orange juice due to gastroesophageal reflux disease (GERD) D. 30-year old who is lactose intolerant

21-year old who cannot eat bananas Explanation: The molecular structure of latex is similar to avocados, bananas, almonds, peaches, kiwi, and tomatoes. The nurse will anticipate that the client who cannot eat bananas may have a latex sensitivity. The other options do not relate to latex sensitivity.

The community health nurse is talking with four clients. Who does the nurse identify that would most benefit from teaching about alcohol and drug abuse? A. 19-year-old male college student majoring in physics B. 34-year-old male who does not use a seat belt C. 25-year-old female who just accepted her first job D. 40-year-old female who is working two jobs

19-year-old male college student majoring in physics Explanation: Young adults, particularly those who just became emancipated from parental supervision, are at highest risk for alcohol and drug abuse. Other clients may have other safety risk factors, but are not at a proportionately higher risk for alcohol and drug abuse.

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. A rear-facing safety seat should be used for infants and toddlers younger than 2 years old and weighing less than 20 lb (9 kg). B. 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. C. A rear-facing safety seat should be used for infants younger than 1 year old and weighing more than 20 lb (9 kg). D. A rear-facing safety seat should be used for infants younger than 1 year old or up to the maximum weight for the seat.

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. Explanation: 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.

An acronym RACE is commonly taught as a means for remembering priorities for action during a fire. The "A" in this acronym stands for which of the following? A. Activate the fire alarm and notify the appropriate person. B. Attempt to extinguish the fire. C. Alert the local fire department. D. Answer all telephone calls and call bells.

Activate the fire alarm and notify the appropriate person. Explanation: RACE stands for Rescue - Alarm - Contain - Extinguish. The "A" in the acronym RACE stands for "activate the fire alarm and notify the appropriate person."

The nurse has just admitted a client with a latex allergy to the medical-surgical nursing floor. Which is the priority nursing intervention? A. Notify the interdisciplinary healthcare team to use nonlatex equipment. B. Apply an allergy-alert identification bracelet on the client. C. Teach client to wear Medic-Alert bracelet. D. Flag the room door.

Apply an allergy-alert identification bracelet on the client. Explanation: The priority is to apply an allergy-alert bracelet to the client so that any member of the interdisciplinary team can quickly identify the latex allergy. All other actions can take place immediately thereafter.

The nurse overhears an older adult client's son talking to her in a very aggressive and violent way. When the nurse walks into the room, the son changes and speaks kindly to his mother and the health care providers. What should the nurse do about this observation? A. Document the observed behaviors in the client's chart. B. Report the suspicions to to the authorities. C. Ask to examine the client alone in order to speak to her privately. D. Nothing, as it is none of the nurse's concern.

Ask to examine the client alone in order to speak to her privately. Explanation: In 90% of elder abuse cases that are reported, the person doing the abusing is a family member. The best thing to do would be for the nurse to get the client alone so that she can discuss the relationship that was observed. Documenting the behaviors is appropriate, but not enough. More assessment is needed to prevent possible injury to the client. The nurse must address what could be a sign of elder abuse, and reporting it to authorities may be appropriate after more assessment and following protocols.

The nurse is caring for an adult client on prescribed bed rest who repeatedly attempts to get out of bed, despite instructions to remain there. Which initial intervention is appropriate? A. Administer a prescribed dose of lorazepam. B. Assess for the need to urinate. C. Raise the side rails. D. Contact the physician for an order to apply a waist restraint.

Assess for the need to urinate. Explanation: Client needs should be assessed before considering physical or pharmacologic restraint. Confused clients may need to urinate and not urinate in a bed. A nurse should assess to determine why the client is attempting to get out of bed. A chemical restraint is the use of a medication. Raise the side rails is considered a restraint as well as apply a waist restraint.

The nurse is teaching the caregiver of a school-age child about safety. Which teaching will the nurse include? A. Peer pressure causes children of this age to task risks. B. Place all household cleaners out of reach. C. Buy protective sporting equipment. D. Supervise your child on the changing table.

Buy protective sporting equipment. Explanation: School-age children are physically active, which makes them prone to play-related injuries. Therefore, the nurse teaches the caregiver about buying protective sporting equipment. Telling the caregiver to supervise the child on the changing table is appropriate for infants, not school-age children. Placing household cleaners out of reach is appropriate for toddlers. Teaching about peer pressure risks is appropriate for adolescents.

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

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.

What is the most important safety concept that a nurse should include in the teaching plan for a family with a newborn infant in the household? A. Include safeguards to prevent falls in the home. B. Avoid stuffed animals and blankets in the crib. C. Teach seat belt safety. D. Educate about, and be aware of, signs of risky behaviors.

Avoid stuffed animals and blankets in the crib. Explanation: Suffocation is a hazard for infants, especially before the age of 4 months. Toddlers and older children are more at risk for falls, and adolescents tend to engage in risky behaviors. Therefore, education about, and awareness of, these behaviors is important in this age group, but not for an infant. Seat belt safety is more appropriate to teach older children and adults. Car seat safety would be important for families with a newborn infant.

A home care nurse provides health education to parents regarding the care of their toddler. Which precaution should the nurse suggest the parents take to protect the toddler from drowning? A. Avoid unattended baths for the toddler. B. Instruct the toddler not to go near the pool. C. Monitor the activities of the toddler. D. Allow the child to swim with friends.

Avoid unattended baths for the toddler. Explanation: The parents should not leave the toddler for an unattended bath. Toddlers are naturally inquisitive, and instructing them to stay away from the pool may make them more curious. Monitoring the activities of the toddler is not always feasible. Allowing the child to swim with friends does not ensure safety.

When educating families on fire safety in the home, which information is important for the nurse to emphasize? A. Account for all members and then exit together. B. Use extension cords to prevent shock. C. Have a meeting place outside the home in case of fire. D. Keep a fire extinguisher in a closet.

Have a meeting place outside the home in case of fire. Explanation: The whole family should regularly practice a fire escape plan, such as crawling on the floor, using escape routes, and having a meeting place outside the home in case of fire. Attempting to account for all family members before exiting the burning structure is dangerous and may result in the loss of life. Shock is possible with extension cords. Having a fire extinguisher is important, but it should be kept in an area with access and not a closet.

One of the leading causes of death in the United States, particularly in southwestern states, is drowning. How can the nurse assist in lowering this statistic? A. Begin swim lessons with toddlers. B. Implement drowning-prevention strategies. C. Educate children in cardiopulmonary resuscitation. D. Require fencing around all pools.

Implement drowning-prevention strategies. Explanation: The principles of injury control have interventions centered at three primary levels: the individual level, providing education about safety hazards and prevention strategies; the design phase, using engineering and environmental controls; and the regulatory level, creating, monitoring, and enforcing regulations to ensure safe products and environments among manufacturers, retailers, employers, workers, and product users.

The unlicensed assistive personnel (UAP) tells the nurse that a client is very confused and trying to get out of bed without assistance. What is the appropriate action by the nurse? A. Administer the client's sedative as ordered. B. Initiate use of a bed alarm. C. Put up all four side rails on the bed. D. Contact the physician for a restraint order.

Initiate use of a bed alarm. Explanation: To prevent a fall, the nurse should attempt to prevent the confused client from getting out of bed by himself by using the least restrictive action first. In this case, it would be to initiate the use of a bed alarm. Putting up all four side rails and use of a sedative are considered forms of restraints, and restraints should be used only as a last resort when the client is in danger of harming himself or others. Contacting the physician for a restraint order or sedative is appropriate if the least restrictive measures do not work.

A nurse is providing instructions to the mother of a toddler regarding the prevention of burn injuries in the toddler. Which instruction is the priority to provide to the mother? A. Teach the toddler about fire safety. B. Instruct the toddler about the consequences of burns. C. Cool hot liquids before giving them to the child. D. Keep coffee cups on the counter above the child's reach.

Keep coffee cups on the counter above the child's reach. Explanation: The mother should be told to always keep her coffee cup on the counter so that it is out of reach of the toddler. Toddlers are naturally inquisitive and more mobile than infants, and they fail to understand the dangers of looking into a cup, which can have hot contents. Consequently, they are often the victims of accidental poisoning, falls down stairs or from high chairs, burns, electrocution from exploring outlets or manipulating electric cords, and drowning. The toddler may not understand fire safety or the consequence even after he has been given instructions. A parent feeding the child is not a usual cause of accidental thermal injury.

A school nurse is providing information to a group of older adults during Fire Prevention Week. Which statement is correct regarding fires in the home? A. Most home fires are caused by children playing with matches. B. Most fatal home fires occur while people are cooking. C. About 10% of home fire deaths occur in a home without a smoke detector. D. Most people who die in house fires die of smoke inhalation, rather than burns.

Most people who die in house fires die of smoke inhalation, rather than burns. Explanation: Most people who die in house fires die of smoke inhalation, rather than burns. About 50% of home fire deaths occur in a home without a smoke detector. Many home fires are started because someone fell asleep smoking in bed or on a sofa, and most fatal home fires occur while people are sleeping.

An older adult client has developed diabetic neuropathy. What would be the most important education intervention for the client and family? A. Reduce the temperature on the water heater. B. Obtain a carbon monoxide detector in the home C. Increase the amount of ventilation in the house. D. Keep the environment warmer in winter.

Reduce the temperature on the water heater. Explanation: 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 is providing discharge teaching to the family of an older adult client. Which teaching will the nurse include to decrease the risk for electric shock? A. All machines that are used infrequently to remain plugged in. B. Refrain from using extension cords. C. Leave outlets and switches open so air circulates through them. D. Remove the plug from the wall by pulling the electric cord.

Refrain from using extension cords. Explanation: Extension cords should not be used, so that overload is not placed on electric wires and circuits. For safest practices that decrease risk for electric shock, outlets and switches should be covered, machines that are used infrequently should be unplugged, and plugs should be removed from the wall by grasping the actual plug (not the cord).

The nurse is admitting a client to a medical-surgical unit who states, "If someone brings balloons to me, I might have trouble breathing." What is the appropriate nursing action? A. Remind client that oranges and spinach can cause a cross-reaction. B. Assure client that balloons do not cause breathing difficulties. C. Keep balloons on opposite side of the client's room. D. Replace common healthcare items with latex-free equipment.

Replace common healthcare items with latex-free equipment. Explanation: The client has described a reaction to latex, so the environment should be as free from latex as possible. The nurse will replace all health care equipment with latex-free versions. The molecular structure of latex is similar to avocados, bananas, almonds, peaches, kiwi, and tomatoes; not oranges and spinach.

A client who was receiving care on a psychiatric unit committed suicide at a time when nurses are known to be handing off to nurses on the next shift. What is a responsibility of the organization when responding to this sentinel event? A. Appropriately discipline the nurses who were participating in the shift change. B. Change the institution's policies regarding supervision of clients. C. Inform local health care institutions about the event in order to promote safety. D. Report the event to the Joint Commission.

Report the event to the Joint Commission. Explanation: Hospitals are required to report serious safety events to regulatory agencies such as the Joint Commission and to state health agencies. There is no formal responsibility to inform other local institutions. There is no obvious need for discipline, though education may be needed. Policies and procedures would be reviewed, but may not need to be changed.

A client on a hospital unit has been infected with hepatitis C virus (HCV) because a nurse mistakenly connected an HCV-positive client's intravenous pump and tubing. What is an appropriate response by the hospital to this incident? A. Report this sentinel event to the Joint Commission and to relevant state agencies B. File an incident report with the American Nurses Association describing plans for preventing similar events in the future. C. Inform the public that the incident occurred, while protecting the confidentiality of the clients. D. Offer compensation to the affected client in a timely manner, while maintaining the client's confidentiality.

Report this sentinel event to the Joint Commission and to relevant state agencies Explanation: Sentinel events must be reported to the Joint Commission and to relevant state agencies. Sentinel events are not normally publicized, and incident reports are not provided to the ANA. Matters related to financial compensation would likely involve the courts, not the Joint Commission or health agencies.

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. Attempt to extinguish the fire. D. Activate the fire alarm on the unit.

Rescue anyone who is in immediate danger. Explanation: 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.

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

Restrain the baby in a car seat. Explanation: The client should restrain the baby 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 baby, and keeping all pots and pans in lower cabinets are secondary teachings.

The nurse is caring for a young child in the hospital who is being discharged home with his grandmother, who has guardianship. When performing a risk assessment, the nurse identifies that his grandmother has one other adult living with her to help with the child, because the grandmother has congestive heart failure and diabetes mellitus. In addition, the financial situation is poor and she cannot afford to buy safety devices to safety-proof the house. What nursing diagnosis is most appropriate for this child based on these findings? A. Risk for Contamination related to flaking or peeling of paint B. Risk for Suffocation related to child left unattended in the bathtub C. Risk for Poisoning related to medications in unlocked cabinets D. Risk for Injury related to substance abuse

Risk for Poisoning related to medications in unlocked cabinets Explanation: Because this child lives with his grandmother, who has a diagnosis that requires multiple medications, and because the family cannot purchase safety devices to safety-proof the house, this child is most at risk for poisoning related to medications in unlocked cabinets. There is no evidence that there is peeling paint in the home, or substance abuse, or that the child is being left unattended.

The nurse is creating a plan of care for the older adult who has multiple medications and a difficult time reading medication labels due to poor eyesight. What is the most appropriate nursing diagnosis to include in this client's plan of care? A. Risk for Injury related to substance abuse B. Altered Sensory Perception related to decreased visual acuity C. Risk for Falls related to immobility D. Risk for Poisoning related to poor eyesight and the inability to read medication labels

Risk for Poisoning related to poor eyesight and the inability to read medication labels Explanation: Older adults are at an increased risk for falls and can have an altered sensory perception. However, neither of those diagnoses address this client's lack of vision, causing difficulty in reading the labels of his multiple medications and thereby causing a risk for injury by overdose. There is no indication of substance abuse in this client.

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

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.

A nurse is assessing a client who was exposed to botulism from contaminated food supplies. Which symptom would the nurse expect to find in this client? A. Flu-like symptoms B. Skeletal muscle paralysis that progresses symmetrically and in a descending manner C. Skin lesion with local edema that progresses, enlarges, ulcerates, and becomes necrotic D. Petechial hemorrhages

Skeletal muscle paralysis that progresses symmetrically and in a descending manner Explanation: Exposure to botulism results in skeletal muscle paralysis that progresses symmetrically and in a descending manner. Muscle weakness often occurs, which can abruptly result in respiratory failure. One of the common symptoms of smallpox infection is flu-like symptoms. Skin lesions with local edema that worsens is associated with anthrax. Petechial hemorrhages result from viral hemorrhagic fevers.

Which reason best explains why adolescents behave in an unsafe manner despite knowledge of a particular activity's risk? A. Poor judgment B. Normal rebellion C. Social pressure D. Past experience

Social pressure 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.

The nurse is reading another nurse's notes that were recorded in the electronic health record (EHR) during the previous shift. What is the appropriate nursing action when numerous unapproved abbreviations are noticed in the previous nurse's notes? A. Correct the abbreviations in the EHR. B. Contact the facility's information technology department to delete abbreviations. C. Suggest to the nurse manager that an in-service on abbreviation use would be helpful. D. Ask another nurse to fix the abbreviations.

Suggest to the nurse manager that an in-service on abbreviation use would be helpful. Explanation: Many abbreviations and symbols are not permitted for use in healthcare records. The nurse should never alter documentation, nor it is appropriate to ask another nurse, nor the IT department, to do so. The nurse should talk to the nurse manager about an in-service on appropriate abbreviation use.

The nurse is teaching the caregiver of an infant 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 task risks.

Supervise your child on the changing table. Explanation: Infants are especially vulnerable to injuries resulting from falling off changing tables or being unrestrained in automobiles. Therefore, the nurse teaches the caregiver to supervise the child on the changing table. Placing household cleaners out of reach, buying protective sporting equipment, and teaching about peer pressure risks are appropriate for older children, not infants.

The nurse is caring for an 80-year-old client who was admitted to the hospital in a confused and dehydrated state. After the client got out of bed and fell, restraints were applied. She began to fight and was rapidly becoming exhausted. She has black-and-blue marks on her wrists from the restraints. What would be the most appropriate nursing intervention for this client? A. Talk with the client's family about taking her home because she is out of control. B. Leave the restraints on and talk with her, explaining that she must calm down. C. Sedate her with sleeping pills and leave the restraints on. D. Take the restraints off, stay with her, and talk gently to her.

Take the restraints off, stay with her, and talk gently to her. Explanation: Physical restraints increase the possibility of the occurrence of falls, skin breakdown and contractures, incontinence, depression, delirium, anxiety, aspiration respiratory difficulties, and even death. The best action in this situation is for the nurse to remove the restraint, stay with the client and gently talk to her. Sedating her with sleeping pills is a chemical form of restraint. Leaving the restraints on the client to talk to her is going to cause further agitation and bruising of her wrists. The client's condition—not confusion and agitation—dictates when the client is discharged.

A client who is enrolled in Medicare and who has been recovering in the hospital from a stroke has developed a pressure injury on his 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? A. CMS will bear the hospital's costs if the client chooses to sue the hospital. B. The hospital will be fined by CMS because the client developed a pressure injury. C. The hospital must bear any costs incurred for treating the client's injury. D. CMS may choose to divert clients to other health care facilities in the future.

The hospital must bear any costs incurred for treating the client's injury. Explanation: 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.

The school nurse is preparing a presentation about safety promotion for middle school students. Which topic should the nurse plan to include? A. The importance of consistent seat belt use B. Avoiding workplace injury C. Identification of hazards associated with falls D. The importance of practicing moderation when consuming alcohol

The importance of consistent seat belt use Explanation: Seat belt use is an important safety precaution to teach audiences of all ages. Improper seat belt use (or lack of seat belt use) increases the risk for injury. It is not appropriate to teach middle school children about moderation with alcohol, workplace injury, or falls.

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

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 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 follows the universal client compact principles for partnership when providing care for clients. Which nursing action reflects this philosophy? A. The nurse makes health care decisions for a client who is uncooperative. B. The nurse includes the client as a member of the health care team. C. The nurse does not allow the client to review his or her own medical information. D. The nurse confers with members of the health care team but does not ask for family input from the assigned advocate of the client.

The nurse includes the client as a member of the health care team. Explanation: The National Patient Safety Foundation's Principles for Partnership represent a concerted effort to demonstrate a health care organization's commitment to respect the rights of clients and incorporate these beliefs into their mission. Including the client and family as a member of the health care team reflects these principles. The other answer choices do not demonstrate these principles.

A nurse is using the QSEN competency of evidence-based practice when caring for clients. What is an example of this competency? A. The nurse works with other health care team members to provide care for a client diagnosed with Alzheimer's disease. B. The nurse researches best current practices for prevention of the spread of infection in physician offices. C. The nurse uses computer-generated care plans for client care. D. The nurse manager holds an in-service for staff to teach them the safe operation of a new piece of equipment.

The nurse researches best current practices for prevention of the spread of infection in physician offices. Explanation: The QSEN model specifies the integration of best current evidence with clinical expertise, along with client and family preferences and values, for delivery of optimal health care. Researching current practices for prevention of the spread of infection demonstrates this competency. Working with others to provide care demonstrates collaboration of care. The nurse manager holding an in-service demonstrates education of the staff. Use of computer-generated plans for client care demonstrates the use of nursing informatics.

A nurse was injured when a client with Alzheimer's 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? A. The incident report is reviewed by state agencies and the Occupational Safety and Health Administration rather than by hospital administration. B. The report provides a detailed and objective account of the circumstances before, during, and after the event. C. The report becomes a confidential part of the client's health record once it is reviewed by hospital administration. D. The client and the client's family will be required to sign the report, acknowledging that they read it before it was filed.

The report provides a detailed and objective account of the circumstances before, during, and after the event. Explanation: 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 school nurse is educating 7th grade children about safety. Which recommendation is most appropriate for this age group? A. Do not text while driving. B. Use protective sporting equipment. C. Be cautious of electrical outlets. D. Use caution when descending stairs.

Use protective sporting equipment. Explanation: School-age children in the 7th grade are physically active, which makes them prone to play-related injuries. Therefore, protective sporting equipment should be used. Information about not texting while driving is more appropriate for teenagers and adults who drive. Using caution around electrical outlets and stairs is more appropriate for parents of toddlers.

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:

You Selected: nuclear terrorism. Correct response: mass trauma terrorism. Explanation: 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.

A program has been introduced at a hospital with the goal of improving client safety. The nurses participating in the program should recognize what event as posing the most significant threat to a client's safety? A. admitting the client to the health care facility B. transferring the client from one location in the hospital to another C. electronically reporting the results of diagnostic testing to the client's primary care provider D. administering medications to the client

administering medications to the client Explanation: A large proportion of adverse events in hospital settings involves medication administration. It is generally accepted that medication administration is more risky than communication of testing results, client transfers, or client admissions.

The nurse is caring for a client who has been repetitively pulled at IV lines and the urinary catheter. After other methods of diverting the client's behaviors fail, the healthcare provider orders chemical restraints. Which treatment does the nurse anticipate? A. asking the unlicensed assistive personnel (UAP) to sit with the client B. application of devices that reduce the client's ability to move arms C. administration of an antipsychotic agent to alter the client's behavior D. articulating the reason for use of a physical restrictive device to the client's spouse

administration of an antipsychotic agent to alter the client's behavior Explanation: Chemical restraints are medications, such as an antipsychotic, that are used to manage a client's behavior or freedom of movement. These are generally used to manage violent or self-destructive behavior that jeopardizes the immediate physical safety of the client, staff, or others. Physical restraints are devices that immobilize or reduce the ability of a client to freely move his or her arms, legs, body, or head. Asking the UAP to sit with the client is a diversion method. Articulation of rationale for using a physical restraint is part of nursing teaching.

The nurses on a critical care unit can utilize the safety strategy of redundancy by: A. having two nurses independently check the dosage of high-risk medications. B. introducing a brief waiting period between the time that a medication is ordered and the time that it is administered. C. ensuring the antidotes are readily available for certain high-risk medications. D. introducing equipment that makes it more difficult for a nurse to commit an error.

having two nurses independently check the dosage of high-risk medications. Explanation: Successive checks for certain high risk procedures or events add needed safety redundancy. For example, two registered nurses check the information about the client, and about a blood product about to be administered, to ensure the blood product is the correct one and is safe for the client. The use of antidotes and waiting periods is unrelated to redundancy. Equipment that makes it difficult to commit an error is an example of mistake-proofing.

A near miss has taken place on a medical unit in which a client nearly received a unit of packed red blood cells of an incompatible blood type. In the follow up to this event, which action should be prioritized? A. identifying systemic factors on the unit that may have contributed to the event B. reinforcing the standards for nursing care to staff members who were involved C. communicating the potential consequences of the near miss to the client involved D. ensuring that the client's nurse is held accountable and educated about best practice

identifying systemic factors on the unit that may have contributed to the event Explanation: Central to creating a culture of safety is the need to identify systemic factors that may contribute to errors or near misses. Communicating with the client is necessary, but identifying systemic factors is a priority because of the implications for future clients. Focusing on the nurses who were directly involved demonstrates a narrow and short term perspective of safety, which may be perceived as punitive.

A nurse is providing care for a client whose blood pressure has been gradually dropping over the course of a shift. The nurse has decided to inform the client's primary care provider by telephone using the SBAR tool. The nurse will end this communication by: A. describing the main assessment results that have been gathered during the shift. B. identifying the desired outcomes. C. making a suggestion about what she believes to be the best action. D. reviewing the main events that she has described to the care provider.

making a suggestion about what she believes to be the best action. Explanation: In the SBAR tool, the "R" denotes a recommendation, not a review. Assessment results are shared earlier. The desired outcomes are not necessarily part of the recommendation.

The nurse educator has just completed a lecture regarding older adults and hazards in the home. The nurse educator recognizes that the education was effective when the students state that common dangers in the home setting of an older adult include: A. household cleaners stored under the sink and hanging cords on window blinds. B. risky behaviors and cyber-bullying. C. polypharmacy and use of multiple extension cords. D. peeling paint and easy access to the backyard pool.

polypharmacy and use of multiple extension cords. Explanation: Older adults have significant risk of falls at home, due to aging changes such as diminished cognition, vision, hearing, and balance. Multiple medications, especially those altering level of consciousness, and household objects that challenge safe mobility, are common dangers. Cleaners, hanging cords, peeling paint, and bodies of water are dangers to young children due to the potential for accidental poisoning, drowning, asphyxiation, and lead toxicity. Risky behaviors and cyber-bullying are common issues in the adolescent and young adult age groups.

A client is being treated for community-acquired pneumonia and has experienced respiratory distress and hypoxia on several occasions since being admitted. The nurse can best prevent adverse outcomes during this client's care by: A. collaborating closely with members of the interdisciplinary team. B. vigilantly monitoring the client's oxygenation status. C. educating the client about self-care as it relates to respiratory health. D. involving the client when identifying goals for care.

vigilantly monitoring the client's oxygenation status. Explanation: All of the listed actions are appropriate to the care of this client. However, close monitoring and early detection of changes are paramount in the prevention of adverse outcomes. Frequent and careful assessment is a priority.