Ch. 27 Safety, Security, & Emergencies Flashcards
The nurse caring for patients in a long-term care facility knows that there are factors that place certain patients at a higher risk for falls. Which patients would the nurse consider to be in this category? Select all that apply.
A) A patient who is older than 50
B) A patient who has already fallen twice
C) A patient who is taking antibiotics
D) A patient who experiences postural hypotension
E) A patient who is experiencing nausea from chemotherapy
F) A 70-year-old patient who is transferred to long-term care
b, d, f.
Risk factors for falls include age over 65 years, documented history of falls, postural hypotension, and unfamiliar environment. A medication regimen that includes diuretics, tranquilizers, sedatives, hypnotics, or analgesics is also a risk factor, not chemotherapy or antibiotics.
A school nurse is teaching parents about home safety and fires. What information would be accurate to include in the teaching plan? Select all that apply.
A) Sixty percent of U.S. fire deaths occur in the home.
B) Most fatal fires occur when people are cooking.
C) Most people who die in fires die of smoke inhalation.
D) Fire-related injury and death have declined due to the availability and use of smoke alarms.
E) Fires are more likely to occur in homes without electricity or gas.
F) Fires are less likely to spread if bedroom doors are kept open when sleeping.
c, d, e.
Of all fire deaths in the United States, 80% occur in the home. Most fatal home fires occur while people are sleeping, and most people who die in house fires die of smoke inhalation rather than burns. The widespread availability and use of home smoke alarms is considered the primary reason for the significant decline in fire-related injury and death. People with limited financial resources should be asked about how they heat their house because the electricity or gas may have been turned off and space or kerosene heaters, wood stoves, or a fireplace may be the sole source of heat. Bedroom doors should be kept closed when sleeping and monitors used to listen for children.
A nurse is assessing the following children. Which child would the nurse identify as having the greatest risk for choking and suffocating?
A) A toddler playing with his 9-year-old brother’s construction set
B) A 4-year-old eating yogurt for lunch
C) An infant covered with a small blanket and asleep in the crib
D) A 3-year-old drinking a glass of juice
a.
A young child may place small or loose parts in the mouth; a toy that is safe for a 9-year-old could kill a toddler. An infant sleeping in a crib without a pillow or large blanket and a 3-year-old and a 4-year-old drinking juice and eating yogurt are not particular safety risks.
While discussing home safety with the nurse, a patient admits that she always smokes a cigarette in bed before falling asleep at night. Which nursing diagnosis would be the priority for this patient?
A) Impaired gas exchange related to cigarette smoking
B) Anxiety related to inability to stop smoking
C) Risk for suffocation related to unfamiliarity with fire prevention guidelines
D) Deficient knowledge related to lack of follow-through of recommendation to stop smoking
c.
Because the patient is not aware that smoking in bed is extremely dangerous, she is at risk for suffocation from fire. The other three nursing diagnoses are correctly stated but are not a priority in this situation.
A nurse working in a pediatrician’s office receives calls from parents whose children have ingested toxins. What would be the nurse’s best response?
A) Administer activated charcoal in tablet form and take child to the ED.
B) Administer syrup of ipecac and take child to the ED.
C) Bring the child in to the primary care provider for gastric lavage.
D) Call the PCC immediately before attempting any home remedy.
d.
The nurse should tell the parents to call the PCC immediately, before attempting any home remedy. Parents may be instructed to bring the child immediately to an emergency facility for treatment. Activated charcoal is considered the most effective agent for preventing absorption of the ingested toxin. It is not recommended for storage or use at home. Activated charcoal can be administered through a nasogastric tube in the ED for serious poisonings after the risks and benefits have been determined. Syrup of ipecac is no longer recommended because vomiting may be dangerous. A toxic substance may prove more hazardous coming up rather than when it was swallowed. Gastric lavage is no longer prescribed routinely for the treatment of ingestion of a toxic substance because it may propel the poison into the small intestine, where absorption will occur. The amount of toxin removed by gastric lavage is relatively small.
A nurse is teaching parents in a parenting class about the use of car seats and restraints for infants and children. Which information is accurate and should be included in the teaching plan?
A) Booster seats should be used for children until they are 4′9″ tall and weigh between 80 and 100 lb.
B) Most U.S. states mandate the use of infant car seats and carriers when transporting a child in a motor vehicle.
C) Infants and toddlers up to 2 years of age (or up to the maximum height and weight for the seat) should be in a front-facing safety seat.
D) Children older than 6 years may be restrained using a car seat belt in the back seat.
a.
Booster seats should be used for children until they are 4′9″ tall and weigh between 80 and 100 lb. All 50 U.S. states mandate the use of infant car seats and carriers when transporting a child in a motor vehicle. Infants and toddlers up to 2 years of age (or up to the maximum height and weight for the seat) should be in a rear-facing safety seat. Many children older than 6 years should still be in a booster seat.
Based on the statistics for the leading cause of hospital admission for trauma in older adults, what would be the nurse’s priority intervention to prevent trauma when caring for older adults in a nursing home?
A) Checking to make sure fire alarms are working properly.
B) Preventing exposure to temperature extremes.
C) Screening for partner or elder abuse.
D) Making sure patient rooms are decluttered.
d.
Falls among older adults are the most common cause of hospital admissions for trauma, therefore rooms should be free of clutter. Elder abuse, fires, and temperature extremes are also significant hazards for older adults but are not the most common cause of trauma admissions. IPV occurs more frequently in adults as opposed to older adults.
What consideration should the nurse keep in mind regarding the use of side rails for a patient who is confused?
A) They prevent confused patients from wandering.
B) A history of a previous fall from a bed with raised side rails is insignificant.
C) Alternative measures are ineffective to prevent wandering.
D) A person of small stature is at increased risk for injury from entrapment.
d.
Studies of restraint-related deaths have shown that people of small stature are more likely to slip through or between the side rails. The desire to prevent a patient from wandering is not sufficient reason for the use of side rails. Creative use of alternative measures indicates respect for the patient’s dignity and may in fact prevent more serious fall-related injuries. A history of falls from a bed with raised side rails carries a significant risk for a future serious incident.
When a fire occurs in a patient’s room, what would be the nurse’s priority action?
A) Rescue the patient.
B) Extinguish the fire.
C) Sound the alarm.
D) Run for help.
a.
The patient’s safety is always the priority. Sounding the alarm and extinguishing the fire are important after the patient is safe. Calling for help, if possible, rather than running for assistance, allows you to remain with your patient and is more appropriate.
A nurse is filing a safety event report for a confused patient who fell when getting out of bed. What action is performed appropriately?
A) The nurse includes suggestions on how to prevent the incident from recurring.
B) The nurse provides minimal information about the incident.
C) The nurse discusses the details with the patient before documenting them.
D) The nurse records the circumstances and effect on the patient in the medical record.
d.
A safety event report objectively describes the circumstances of the accident or incident. The report also details the patient’s response and the examination and treatment of the patient after the incident. The nurse completes the event report immediately after the incident, and is responsible for recording the circumstances and the effect on the patient in the medical record. The safety event report is not a part of the medical record and should not be mentioned in the documentation. Because laws vary in different states, nurses must know their own state law regarding safety event reports.
When discussing emergency preparedness with a group of first responders, what information would be important to include about preparation for a terrorist attack?
A) Posttraumatic stress disorders can be expected in most survivors of a terrorist attack.
B) The FDA has collaborated with drug companies to create stockpiles of emergency drugs.
C) Even small doses of radiation result in bone marrow depression and cancer.
D) BLI is a serious consequence following detonation of an explosive device.
d.
BLI is a recognized consequence following exposure to an explosive device. The CDC is the federal facility that has collaborated with the pharmaceutical companies to stockpile drugs for an emergency. A high dose of radiation exposure can result in bone marrow depression and cancer. Most survivors of a terrorist event will experience stress and some (possibly one third of survivors) may exhibit posttraumatic stress disorder.
An older resident who is disoriented likes to wander the halls of his long-term care facility. Which action would be most appropriate for the nurse to use as an alternative to restraints?
A) Sitting him in a geriatric chair near the nurses’ station
B) Using the sheets to secure him snugly in his bed
C) Keeping the bed in the high position
D) Identifying his door with his picture and a balloon
d.
This allows the resident to be on the move and be more likely to find his room when he wants to return. The alternative would be to not allow him to wander. Many facilities use this kind of approach. Identifying his door with his picture and a balloon may work as an alternative to restraints. Using the geriatric chair and sheets are forms of physical restraint. Leaving the bed in the high position is a safety risk and would probably result in a fall.
The Joint Commission issues guidelines regarding the use of restraints. In which case is a restraint properly used?
A) The nurse positions a patient in a supine position prior to applying wrist restraints.
B) The nurse ensures that two fingers can be inserted between the restraint and patient’s ankle.
C) The nurse applies a cloth restraint to the left hand of a patient with an IV catheter in the right wrist.
D) The nurse ties an elbow restraint to the raised side rail of a patient’s bed.
b.
The nurse should be able to place two fingers between the restraint and a patient’s wrist or ankle. The patient should not be put in a supine position with restraints due to risk of aspiration. Due to the IV in the right wrist, alternative forms of restraints should be tried, such as a cloth mitt or an elbow restraint. Securing the restraint to a side rail may injure the patient when the side rail is lowered.
A nurse orients an older adult to the safety features in her hospital room. What is a priority component of this admission routine?
A) Explain how to use the telephone.
B) Introduce the patient to her roommate.
C) Review the hospital policy on visiting hours.
D) Explain how to operate the call bell.
d.
Knowing how to use the call bell is a safety priority; knowing how to use the phone, meeting the roommate, and knowledge of visiting hours will not necessarily prevent an accidental injury.
A nurse is caring for a client who fell at a nursing home. The client is oriented to person, place, and time and can follow directions. Which of the following actions should the nurse take to decrease the risk of another fall? (Select all that apply.)
A. Place a belt restraint on the client when they are sitting on the bedside commode.
B. Keep the bed in its lowest position
with all side rails up.
C. Make sure that the client’s call light is within reach.
D. Provide the client with nonskid footwear.
E. Complete a fall‑risk assessment.
C. CORRECT: Making sure that the call light is within reach enables the client to contact the nursing staff to ask for assistance and prevents the client from falling out of bed while reaching for the call light.
D. CORRECT: Nonskid footwear keeps the client from slipping.
E. CORRECT: A fall‑risk assessment serves as the basis for a plan of care that can then individualize for the client.
