Deck 37: Quality and Patient Safety

Question 1

The nurse is caring for an elderly patient admitted with nausea,vomiting,and diarrhea.Upon completing the health history,which priority concern would require collaboration with social services to address the patient's health care needs?

A)The electricity was turned off 2 days ago.
B)The water comes from the county water supply.
C)A son and family recently moved into the home.
D)The home is not furnished with a microwave oven.

Answer 1

The electricity was turned off 2 days ago.

Question 2

A nurse is teaching a community group of school-aged parents about safety.The most important item to prioritize and explain is how to check the proper fit of which of the following?

A)A bicycle helmet.
B)Swimming goggles.
C)Soccer shin guards.
D)Baseball sliding shorts.

Answer 2

A bicycle helmet.

Question 3

A visiting nurse completes an assessment of the ambulatory patient in the home and determines the nursing diagnosis of Risk for injury related to decreased vision.On the basis of this assessment,the patient will benefit the most from which of the following actions?

A)Installing fluorescent lighting throughout the house.
B)Evaluating the need to reposition furniture.
C)Maintaining complete bed rest in a hospital bed with side rails.
D)Applying physical restraints.

Answer 3

Evaluating the need to reposition furniture.

Question 4

A homeless adult patient presents to the emergency department.The nurse obtains the following vital signs: temperature 34.9°C (94.8°F),blood pressure 100/56,apical pulse 56,respiratory rate 12.Which of the vital signs should be addressed immediately?

A)Respiratory rate.
B)Temperature.
C)Apical pulse.
D)Blood pressure.

Question 5

According to the Hendrich II Fall Risk Model,a patient with a risk score of 6 is considered to be at which risk level?

A)No risk.
B)Low risk.
C)Medium risk.
D)High risk.

Question 6

The nurse is discussing with a patient's physician the need for restraint.The nurse indicates that alternatives have been utilized.What behaviours would indicate that the alternatives are working?

A)The patient continues to get up from the chair at the nurses' station.
B)The patient apologizes for being "such a bother."
C)The patient folds three washcloths over and over.
D)The sitter leaves the patient alone to go to lunch.

Question 7

The nurse is discussing measures to minimize the risk of injury from an automobile accident with an 84-year-old independent woman who lives alone and claims to drive only to church,to the doctor's office,and for groceries.What change has the greatest potential for affecting the patient's safety?

A)Taking public transportation whenever it is available.
B)Planning all trips around church and doctor appointments.
C)Planning to drive for short trips and only during daylight hours.
D)Arranging for family and friends to drive the patient whenever possible.

Question 8

Equipment-related accidents are risks in the health care agency.The nurse assesses for this risk when using which of the following?

A)IV pumps.
B)A measuring device that measures urine.
C)Computer-based documentation.
D)A manual medication-dispensing device.

Question 9

The nurse is caring for a hospitalized patient.Which of the following behaviours alerts the nurse to consider the need for restraint?

A)The patient refuses to call for help to go to the bathroom.
B)The patient continues to remove the nasogastric tube.
C)The patient gets confused regarding the time at night.
D)The patient does not sleep and continues to ask for items.

Question 10

The nurse is caring for a patient who suddenly becomes confused and tries to remove an intravenous infusion.The nurse begins to develop a plan to care for the patient.Which nursing intervention should take priority?

A)Gather restraint supplies.
B)Try alternatives to restraint.
C)Assess the patient.
D)Call the physician for a restraint order.

Question 11

A home health nurse is performing a home assessment for safety.Which of the following comments by the patient would indicate a need for further education?

A)"I will schedule an appointment with a chimney inspector next week."
B)"Daylight savings is the time to change batteries on the carbon monoxide detector."
C)"If I feel dizzy when using the heater,I need to have it inspected."
D)"If I'm cooking for only myself,I don't need to wash my hands."

Question 12

An older patient presents to the emergency department after stepping in front of a car at a crosswalk.After the patient has been examined in triage,the nurse interviews the patient.Which of the following comments would necessitate follow-up by the nurse?

A)"I try to exercise,so I walk that block almost every day."
B)"I waited and stepped out when the traffic sign said go."
C)"The car was going too fast;the speed limit is 20."
D)"I was so surprised;I didn't see or hear the car coming."

Question 13

The nurse is presenting an educational session on safety for parents of adolescents.The nurse should include which of the following teaching points?

A)Adolescents need unsupervised time with friends two to three times a week.
B)Parents and friends should teach adolescents how to drive.
C)Adolescents need information about the effects of beer on the liver.
D)Adolescents need to be reminded to use seatbelts on long trips.

Question 14

A 1-year-old child is scheduled to receive an intravenous (IV)line.The most appropriate type of restraint to use for this patient to prevent removal of the IV line is which of the following?

A)A wrist restraint.
B)A jacket restraint.
C)An elbow restraint.
D)A mummy restraint.

Question 15

An ambulatory patient is admitted to the extended-care facility with a diagnosis of Alzheimer's disease.In the Hendrich II Fall Risk Model,what is the most significant indicator of risk for falls?

A)Confusion/disorientation/impulsivity.
B)Dizziness/vertigo.
C)Symptomatic depression.
D)Altered elimination.

Question 16

A confused patient needs to have restraints applied to prevent him from pulling out his Foley catheter.Which of the following options can the nurse delegate to an unregulated care provider (UCP)?

A)Applying restraints.
B)Obtaining a physician's order to restrain the patient.
C)Documenting the events that led to restraining the patient.
D)Evaluating the effectiveness of the restraints.

Question 17

The nurse knows that children in late infancy and toddlerhood are at risk for injury from which of the following?

A)Learning to walk.
B)Trying to pull up on furniture.
C)Being dropped by a caregiver.
D)Growing ability to explore and oral activity.

Question 18

The nurse discussed threats to adult safety with a college group.Which of the following statements would indicate understanding of the topic?

A)"Our campus is safe;we leave our dorms unlocked all the time."
B)"As long as I have only two drinks,I can still be the designated driver."
C)"I am young,so I can work nights and go to school with 2 hours' sleep."
D)"I guess smoking even at parties is not good for my body."

Question 19

When teaching a parent about interventions for accidental poisoning,what instruction should be included regarding flushing a child's eye,in relation to the water temperature?

A)Cold.
B)Lukewarm.
C)Room temperature.
D)Above room temperature.

Question 20

A patient with an intravenous infusion requests a new gown after bathing.Which of the following actions is most appropriate?

A)Disconnect the intravenous tubing,thread the end through the sleeve of the old gown and through the sleeve of the new gown,and reconnect.
B)Thread the intravenous bag and tubing through the sleeve of the old gown and through the sleeve of the new gown without disconnecting.
C)Inform the patient that a new gown is not an option while receiving an intravenous infusion in the hospital.
D)Call the charge nurse for assistance because linen use is monitored and this is not a common procedure.

Question 21

Which of the following assessment findings is most critical for a patient who is currently being restrained with mechanical wrist restraints?

A)Angry,loud crying
B)Urinary incontinence
C)Reddened areas on wrists
D)Hands cool to the touch

Question 22

The nurse determines that the patient may need a restraint and recognizes which one of the following?

A)An order for a restraint may be implemented indefinitely until it is no longer required by the patient.
B)Restraints may be ordered on an as-needed basis.
C)No order or consent is necessary for restraints in long-term care facilities.
D)Restraints are to be periodically removed to have the patient re-evaluated.

Question 23

The nurse is providing information regarding safety and accidental poisoning to a grandmother who will be taking custody of a 1-year-old grandchild.Which of the following comments would indicate that the grandmother needs further instruction?

A)"If I think my grandchild has come into contact with a poison,I will call my local poison control centre."
B)"Never induce vomiting if my grandchild drinks bleach."
C)"I should call 911 if my grandchild loses consciousness."
D)"If my grandchild eats a plant,I should provide syrup of ipecac."

Question 24

An age-related musculoskeletal change that predisposes the older person to accidents is which of the following?

A)Increase in muscle function.
B)Increase in joint mobility.
C)Increase in nocturia.
D)Decrease in muscle strength.

Question 25

An elderly patient presents to the hospital with a history of falls,confusion,and stroke.The nurse determines that the patient is at high risk for falls.Which of the following interventions is most appropriate for the nurse to take?

A)Place the patient in restraints.
B)Lock beds and wheelchairs when transferring.
C)Place a bath mat outside the tub.
D)Silence fall alert alarm upon request of family.

Question 26

The patient is confused,is trying to get out of bed,and is pulling at the IV infusion tubing.These data would help to support which nursing diagnosis?

A)Risk for poisoning.
B)Knowledge deficit.
C)Impaired home maintenance.
D)Risk for injury.

Question 27

The nurse has been called to a hospital room where a patient was using a hair dryer from home.The patient received an electrical shock from the dryer and is now unconscious and not breathing.What is the best next step?

A)Ask the family to leave the room.
B)Check for a pulse.
C)Begin compressions.
D)Defibrillate the patient.

Question 28

The nurse is caring for a patient in restraints.Which of the following pieces of information about restraints must be documented by the nurse in the medical record? (Select all that apply. )

A)The patient states that her gown is soiled and needs changing.
B)Previous attempts to distract the patient with television were unsuccessful.
C)The patient was placed in bilateral wrist restraints at 0815.
D)One family member has gone to lunch.
E)Bilateral radial pulses present,2+,hands warm to touch.
F)Released from restraints,active range-of-motion exercises complete.

Question 29

A confused patient is restless and continues to try to remove his oxygen and urinary catheter.What are the priority nursing diagnosis and intervention to implement for this patient?

A)Risk for injury: Prevent harm to patient;use restraints if alternative strategies fail.
B)Deficient knowledge: Explain the purpose of oxygen therapy and the urinary catheter.
C)Disturbed body image: Encourage patient to express concerns about body.
D)Caregiver role strain: Identify resources to assist with care.