Safety Practice Questions PDF

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Safety KEYWORDS The following words include nursing/medical terminology, concepts, principles, and information relevant to content specifically addressed in the chapter or usually associated with topics presented in it. English dictionaries, nursing textbooks, and medical dictionaries, such as Taber’s Cyclopedic Medical Dictionary, are resources that can be used to expand your knowledge and understanding of these words and related information. Abdominal thrust (Heimlich maneuver) Allergies: Food Latex Medication Aspiration Call bell Cardiopulmonary resuscitation Child-proof devices Dysphagia Electrical: Grounding Hazards Surge Falls Fire safety: Fire extinguishers—A, B, C Rescue, Alarm, Confine, RACE Model (R Extinguish)

Functional alignment Incident report Knots: Clove hitch Half bow Slip Restraints: Belt Elbow Jacket Mitt Mummy Poncho Vest Side rails

QUESTIONS 1. What is an appropriately worded goal for a patient who is at risk for falling? “The patient will be: 1. Taught how to call for help to ambulate.” 2. Kept on bed rest when dizzy.” 3. Restrained when agitated.” 4. Free from trauma.” 2. A resident brings several electronic devices to a nursing home. One of the devices has a two-pronged plug. What rationale should the nurse provide when explaining why an electrical device must have a three-pronged plug? 1. Controls stray electrical currents 2. Promotes efficient use of electricity 3. Shuts off the appliance if there is an electrical surge 4. Divides the electricity among the appliances in the room 3. A nurse is caring for a patient with Parkinson’s disease who is experiencing difficulty swallowing. What potential problem associated with dysphagia has the greatest influence on the plan of care? 1. Anorexia 2. Aspiration 3. Self-care deficit 4. Inadequate intake 191

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4. The nurse is caring for a confused patient. What should the nurse do to prevent this patient from falling? 1. Encourage the patient to use the corridor handrails 2. Place the patient in a room near the nurses’ station 3. Reinforce how to use the call bell 4. Maintain close supervision 5. A school nurse is teaching children about fire safety procedures. What is the first thing they should be taught to do if their clothes catch on fire? 1. Yell for help 2. Roll on the ground 3. Take their clothes off 4. Pour water on their clothes 6. The practitioner orders a vest restraint for a patient. What should the nurse do first when applying this restraint? 1. Perform an inspection of the patient’s skin where the restraint is to be placed 2. Ensure that the back of the vest is positioned on the patient’s back 3. Permit four fingers to slide between the patient and the restraint 4. Secure the restraint to the bed frame using a slipknot 7. An unconscious patient begins vomiting. In which position should the nurse place the patient? 1. Supine 2. Side-lying 3. Orthopneic 4. Low Fowler 8. The nurse is assisting a patient to use a bedpan. What is the most important nursing intervention? 1. Dusting powder on the rim before placing the bedpan under the patient 2. Positioning the rounded rim of the bedpan toward the front of the patient 3. Ensuring that the bedside rails are raised once the patient is on the bedpan 4. Encouraging the patient to help as much as possible when using the bedpan 9. A toaster is on fire in the pantry of a hospital unit. What should the nurse do first? 1. Unplug the toaster 2. Activate the fire alarm 3. Put out the fire with an extinguisher 4. Evacuate the patients from the room next to the kitchen 10. The risk management coordinator is preparing a program on the factors that contribute to falls in a hospital setting. Which factor that most often contributes to falls should be included in the program? 1. Wet floors 2. Frequent seizures 3. Advanced age of patients 4. Misuse of equipment by nurses 11. What clinical manifestation indicates that a further nursing assessment is necessary to determine if the patient is having difficulty swallowing? 1. Debris in the buccal cavity 2. Abdominal cramping 3. Epigastric pain 4. Constipation

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12. The nurse is assessing a patient who is being admitted to the hospital. Which is the most important information collected by the nurse that indicates whether the patient is at risk for physical injury? 1. Weakness experienced during a prior admission 2. Medication that increases intestinal motility 3. Two recent falls that occurred at home 4. The need for corrective eyeglasses 13. What should the nurse do to best prevent a patient from falling? 1. Provide a cane 2. Keep walkways clear of obstacles 3. Assist the patient with ambulation 4. Encourage the patient to use the handrails in the hall 14. What is the last step in making an occupied bed that the nurse should teach a nursing assistant? 1. Raising both the side rails on the bed 2. Lowering the height of the bed toward the floor 3. Ensuring that the patient is in a comfortable position 4. Elevating the head of the bed to a semi-Fowler position 15. The nurse is caring for a patient with a nasogastric tube for gastric decompression. Which nursing action takes priority? 1. Discontinuing the wall suction when providing care 2. Positioning the patient in the semi-Fowler position 3. Instilling the tube with 30 mL of air every 2 hours 4. Caring for the nares at least every 8 hours 16. A patient states that when turning on an electric radio a strong electrical shock was felt. What should the nurse do first? 1. Arrange for the maintenance department to examine the radio 2. Disconnect the radio from the source of energy 3. Check the skin for electrical burns 4. Take the patient’s apical pulse 17. A nurse educator is teaching a group of newly hired nursing assistants. Which patient should they be taught is at the greatest risk for injury? 1. School-aged child 2. Comatose teenager 3. Postmenopausal woman 4. Confused middle-aged man 18. The nurse is planning care for a patient who requires bilateral arm restraints. Which information is important to consider when planning care for this patient? 1. Their use adequately prevents injuries 2. They require a practitioner’s order to be applied 3. Reasons for their use must be clearly documented 4. Most patients recognize that they contribute to their safety 19. A nurse in the nursing education department of a community hospital is planning an inservice education class about injury prevention. Which factor that most commonly causes injuries in hospitalized patients should be included in the teaching plan? 1. Malfunctioning equipment 2. Failure to use restraints 3. Visitors 4. Falls

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20. What is the priority nursing intervention to prevent patient problems associated with latex allergies? 1. Use nonlatex gloves 2. Identify persons at risk 3. Keep a latex-safe supply cart available 4. Administer an antihistamine prophylactically 21. Which nursing intervention enhances an older adult’s sensory perception and thereby helps prevent injury when walking from the bed to the bathroom? 1. Providing adequate lighting 2. Raising the pitch of the voice 3. Holding onto the patient’s arm 4. Removing environmental hazards 22. Which human response to illness alerts the nurse that a patient has the greatest risk for aspiration during meals? 1. Bulimia 2. Lethargy 3. Anorexia 4. Stomatitis 23. The nurse is preparing a patient for a physical examination. What is most important for the nurse to do in this situation? 1. Identify the positions that may be contraindicated for the patient during the examination 2. Explore the patient’s attitude toward health-care providers 3. Inquire about the other professionals caring for the patient 4. Ask when the patient last had a physical examination 24. A patient has dysphagia. Which nursing action takes priority when feeding this patient? 1. Ensuring that dentures are in place 2. Medicating for pain before providing meals 3. Providing verbal cueing to swallow each bite 4. Checking the mouth for emptying between every bite 25. A 3-year-old child is admitted to the pediatric unit. What is the best way for the nurse to maintain the safety of this preschool-aged child? 1. Teaching the child how to use the call bell 2. Placing the child in a crib with high side rails 3. Keeping the child under constant supervision 4. Having the child stay in the playroom most of the day 26. Which time of day is of most concern for the nurse when trying to protect a patient with dementia from injury? 1. Afternoon 2. Morning 3. Evening 4. Night 27. A patient consistently tries to pull out a urinary retention catheter. As a last resort to maintain integrity of the catheter and patient safety, the nurse obtains an order for a restraint. Which type of restraint is most appropriate in this situation? 1. Mummy restraint 2. Elbow restraint 3. Jacket restraint 4. Mitt restraint

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28. The nurse is orienting a newly admitted patient to the hospital. It is most important for the nurse to teach the patient how to: 1. Notify the nurse when help is needed 2. Get out of the bed to use the bathroom 3. Raise and lower the head and foot of the bed 4. Use the telephone system to call family members 29. Profuse smoke is coming out of the heating unit in a patient’s room. What should the nurse do first? 1. Open the window 2. Activate the fire alarm 3. Move the patient out of the room 4. Close the door to the patient’s room 30. The nurse must apply a hospital gown that does not have snaps on the shoulders to a patient receiving an intravenous infusion in the forearm. What should the nurse do? 1. Insert the IV bag and tubing through the sleeve from inside of the gown first 2. Disconnect the IV at the insertion site, apply the gown, and then reconnect the IV 3. Close the clamp on the IV tubing no more than 15 seconds while putting on the gown 4. Don the gown on the arm without the IV, drape the gown over the other shoulder, and adjust the closure behind the neck 31. The nurse is planning care for a patient with a wrist restraint. How often should a restraint be removed, the area massaged, and the joints moved through their full range? 1. Once a shift 2. Once an hour 3. Every 2 hours 4. Every 4 hours 32. Which is the first action the home care nurse should employ to prevent falls by an older adult living at home? 1. Conduct a comprehensive risk assessment 2. Encourage the patient to remove throw rugs in the home 3. Suggest installation of adequate lighting throughout the home 4. Discuss with the patient the expected changes of aging that place one at risk 33. The nurse is preparing a bed to receive a newly admitted patient. Which action is most important? 1. Place the patient’s name on the end of the bed 2. Ensure that the bed wheels are locked 3. Position the call bell in reach 4. Raise one side rail 34. The nurse identifies the presence of a fire in the dirty utility room. Place the nurse’s actions in order of priority using the RACE model. 1. Pull the fire alarm 2. Close unit doors and windows 3. Shut the door to the utility room 4. Provide emotional support to agitated patients Answer: 35. Which actions are important when the nurse uses a stretcher? Select all that apply. 1. _____ Lowering the bed below the level of the stretcher when transferring a patient from the stretcher to a bed 2. _____ Guiding the stretcher around a turn leading with the end with the patient’s head 3. _____ Ensuring the patient’s head is at the end with the swivel wheels 4. _____ Pulling the stretcher on the elevator with the patient’s feet first 5. _____ Pushing the stretcher from the end with the patient’s head

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ANSWERS AND RATIONALES 1. 1. This is a planned intervention, not a goal. 2. This is a planned intervention, not a goal. 3. This is a planned intervention, not a goal. In addition, it is inappropriate to restrain a person automatically for agitation. A restraint should be used as a last resort to prevent the patient from self-injury or injuring others. 4. This is an appropriate goal. It is realistic, specific, and measurable and has a time frame. It is realistic to expect that all patients be safe. It is specific and measurable because safety from trauma can be compared with standards of care within the profession of nursing. It has a time frame because the words free from reflect the time frames of always, constantly, and continuously. 2. 1. A three-pronged plug functions as a ground to dissipate stray electrical currents. 2. This is not the purpose of a three-pronged plug. 3. A surge protector performs this function. 4. A multiple outlet plug performs this function. 3. 1. Although lack of an appetite (anorexia) can occur with dysphagia, it is not the most serious associated risk. 2. When a person has difficulty with swallowing (dysphagia), food or fluid can pass into the trachea and be inhaled into the lungs (aspiration) rather than swallowed down the esophagus. This can result in choking, partial or total airway obstruction, or aspiration pneumonia. 3. Dysphagia is unrelated to self-care deficit. Feeding self-care deficit occurs when a person is unable to cut food, open food packages, or bring food to the mouth. 4. Inadequate intake of food and fluid can result with dysphagia because of fear of choking. However, it is not the most serious associated risk. 4. 1. A confused patient may not be able to follow directions or understand cause and effect. 2. This may be impossible and impractical. 3. A confused patient may not be able to follow directions or understand cause and effect. 4. Maintaining safety of the confused patient is best accomplished through close or direct supervision. Confused 196

patients cannot be left on their own because they may not have the cognitive ability to understand cause and effect, and therefore their actions can result in harm. 5. 1. This may eventually be done, but the child must do something immediately without waiting for help to arrive. 2. Rolling on the ground will smother the flames and put the fire out. Children should be taught to: “Stop, drop, and roll.” 3. This may be impossible. In addition, it will take time and the clothing and skin will continue to burn. 4. Finding and obtaining water will take too much time and the clothing and skin will continue to burn. Something must be done immediately. 6. 1. Even when applied correctly, restraints can cause pressure and friction. A baseline assessment of the skin under the restraint should be made. In addition, the presence of a dressing, pacemaker, or subclavian catheter may influence the type of restraint to use. 2. Although this is done, it is not the first intervention. 3. This will result in the jacket being too loose. The jacket should be applied so that two, not four, fingers can slide between the patient and the restraint. 4. Although this is done, it is the last, not the first, intervention of the options offered. 7. 1. The supine position will promote aspiration and should be avoided in this situation. 2. The side-lying position prevents the tongue from falling to the back of the oropharynx, allowing the vomitus to flow out of the mouth by gravity and thus preventing aspiration. 3. The orthopneic is an unsafe, impossible position in which to maintain an unconscious patient. 4. The low-Fowler position will allow the tongue to fall to the back of the oropharynx, promoting aspiration. This position should be avoided in this situation. 8. 1. The use of powder should be avoided because it is a respiratory irritant. 2. The rounded rim of a bedpan should be placed under the patient’s buttocks, not toward the front of the patient.

CHAPTER 4 SAFETY

3. Patient safety is a priority. A bedpan is not a stable base of support and the effort of elimination may require movements that alter balance. Side rails provide a solid object to hold while balancing on the bedpan and supply a barrier to prevent falling out of bed. 4. Although this is done to promote independence and limit strain on the nurse, it is not the most important factor to consider when maintaining safety of a patient on a bedpan. 9. 1. This is unsafe because it places the nurse in jeopardy. The nurse may be exposed to an electrical charge or become burned. 2. Because no patient is in jeopardy, the nurse’s initial action should be to activate the alarm. The sooner the alarm is set, the sooner professional firefighters will reach the scene of the fire. 3. The nurse may not be capable of containing or fighting the fire. Not calling for professional firefighting help first places the nurse, staff, and patients in jeopardy. 4. This is premature at this time, but it may become necessary eventually. 10. 1. Although wet floors can contribute to falls, they are not the most common factor that contributes to falls in the hospital setting. 2. Although seizures can contribute to falls, most patients do not experience seizures. 3. Older adults who are hospitalized frequently have multiple health problems, are frail, and lack stamina. All of these factors contribute to the inability to maintain balance and ambulate safely. 4. Although this occasionally happens and is negligence, it is not the most common factor that contributes to falls in the hospital setting. 11. 1. Stasis of food in the oral cavity indicates that the patient is not swallowing ingested food completely. Food collects in the buccal cavity because the area between the teeth and cheek forms a pocket that traps the food. 2. Abdominal cramping is related to problems such as flatus, malabsorption, and increased intestinal motility, not difficulty swallowing. 3. Epigastric pain is related to problems, such as gastritis, cholecystitis, and angina, not difficulty swallowing.

4. Although constipation may result from not eating foods high in fiber because of difficulty with chewing and swallowing, this adaptation is not as directly related to difficulty swallowing as another option. 12. 1. Although this is important information, it is not the most important factor of the options offered in this question. In addition, the prior admission may have been too long ago to have any current relevance. 2. A patient with increased intestinal motility may experience diarrhea, which may place the patient at risk for a fluid and electrolyte imbalance, not a physical injury. Although a person with diarrhea may need to use the toilet more frequently, a bedside commode or bedpan can be used to reduce the risk of falls. 3. This is significant information that must be considered because if falls occurred before, then they are likely to occur again. When a risk is identified, additional injury prevention precautions can be implemented. 4. Although this is important information, it is not the most important factor of the options offered in this question. 13. 1. The patient may or may not need a cane. An unnecessary cane may actually increase the risk of a fall. 2. Although this should be done, it is not the best intervention of the options presented. 3. This widens the patient’s base of support, which improves balance and decreases the risk of a fall. 4. Although this should be done, it is not the best intervention of the options presented. 14. 1. This may or may not be necessary. This action should be based on the individual needs of the patient. 2. It is safer if the bed is in the lowest position because a greater risk for injury to a patient occurs when the mattress of the bed is further from the floor. 3. This should be done while the bed is at a comfortable working height for the caregiver. 4. This may or may not be necessary. This action should be based on the individual needs of the patient. 15. 1. This is unnecessary and can result in vomiting and aspiration. 2. A nasogastric (NG) tube for gastric decompression passes down the esophagus, through the cardiac

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sphincter, and into the stomach. The cardiac sphincter remains slightly open because of...