28Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 28 Safety, Security, and Emergency Preparedness

The nurse manager and nurses in an acute care hospital are participating in a safety huddle to identify patients at risk for falling. Which patients will the nurses determine require follow-up? Select all that apply.

a Age >50 years

b History of falling

c Taking antibiotics

d Presence of postural hypotension

e Nausea from chemotherapy

f Transferred from long-term care

b, d, f.

Risk factors for falls include age >65 years, documented history of falls, postural hypotension which can cause dizziness, and unfamiliar environment. A medication regimen that includes diuretics creating urinary urgency and tranquilizers, sedatives, hypnotics, or analgesics causing altered mental status and impaired judgment are also risks. Chemotherapy or antibiotics are not included as factors leading to falls.

A school nurse is teaching parents about home and fire safety. What information will be included 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.

Eighty percent of fire deaths in the United States occur in the home. Most fatal home fires occur while people are sleeping, and most deaths result from smoke inhalation rather than burns. The widespread availability and use of home smoke alarms is considered the primary reason for the decline in fire-related injury and death. People with limited financial resources may use space or kerosene heaters, wood stoves, or a fireplace as the sole source of heat if utilities are turned off. Bedroom doors should be kept closed when sleeping and monitors used to listen for children.

A community health nurse is providing education on child safety. Who does the nurse identify as at highest risk for choking and suffocation?

a A toddler playing with his older brother’s wooden blocks

b A 4-year-old eating yogurt and strawberries for lunch

c An infant sleeping in the prone position

d A 3-year-old drinking a glass of juice

c. Infants should be placed on their backs to sleep. A young child may place small or loose parts in the mouth. Anything that will fit through the average toilet paper roll is not safe for a toddler. A 3-year-old and a 4-year-old drinking juice and eating yogurt are developmentally appropriate.

While discussing home safety with the nurse, a patient admits that they smoke a cigarette in bed before falling asleep at night. Which health problem is the priority for this patient?

a Impaired gas exchange: etiology, cigarette smoking

b Acute anxiety: etiology, inability to stop smoking

c Nonadherence: etiology, nonadherence to recommendation to stop smoking

d Knowledge deficiency: etiology, risk for burn and suffocation in a house fire

c. Because the patient is not aware or denies that smoking in bed poses a danger for fire and toxic fumes, education about the risk for burns and suffocation is needed. 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 a toxic substance from under the sink. How will the nurse advise the parents?

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 tells the parents to call the PCC immediately, before attempting a home remedy. Parents may be instructed to bring the child to an emergency facility for immediate treatment. Activated charcoal is not appropriate to use at home but under medical supervision, after the risks and benefits have been assessed. Syrup of ipecac is no longer recommended because vomiting may exacerbate the hazard as it vomited up. 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. What should be the focus of this education?

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 age 2 years (or the maximum height and weight for the seat) should be in a front-facing safety seat.

d Children age 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 age 2 years (or up to the maximum height and weight for the seat) should be in a rear-facing safety seat. Many children older than age 6 years should still be in a booster seat.

A nurse in a long-term care facility is on an interprofessional safety committee focusing on protecting older adults from injury and trauma. Which action does the nurse suggest they prioritize?

a Ensuring proper function of fire alarms

b Preventing exposure to temperature extremes

c Screening for partner or elder abuse

d Maintaining clutter free rooms and hallways

d. Falls among older adults are the most common cause of hospital admissions for trauma, therefore rooms and hallways 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.

An experienced nurse and new graduate nurse are caring for a confused older adult who gets out of bed and wanders. The preceptor intervenes when observing which action by the graduate nurse?

a Raising all four side rails to keep the patient in bed

b Performing documentation in the patient’s room

c Suggesting obtaining a patient “sitter”

d Using a bed alarm to alert staff the patient leaving the bed

a. The desire to prevent a patient from wandering is not sufficient reason for the use of side rails. People of small stature are more likely to be injured slipping through or between the side rails. A history of falls from a bed with raised side rails carries a significant risk for a serious incident. The nurse uses creative measures while promoting safety and respect for the patient’s dignity.

The hospital’s fire alarm sounds, and an announcement is made that there is a fire in a patient room. What is the priority for nurses on the unit?

a Removing patients from the room or vicinity

b Attempting to put out the fire with water or appropriate extinguishers

c Closing all the doors on the unit to contain the fire

d Running to the closest unit and requesting help

a. The nurse uses the acronym RACE and rescues and/or removes the patient and those in nearby rooms as the safety priority. Sounding the alarm and extinguishing the fire are important after the patient is safe. Remaining on the unit allows you to assist patients and is more appropriate; assistance can be summoned by phone.

A nurse is filing a safety event report for a confused patient who fell while getting out of bed. Which action is most appropriate during documentation?

a Including suggestions on how to prevent the incident from recurring

b Providing minimal information about the incident

c Discussing the details with the patient before documenting them

d Recording the circumstances and effect on the patient in the health 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.

Nursing students are invited to participate in the clinical agency’s annual disaster drill, simulating the release of an airborne infectious agent and ensuing panic. Which assignment is most appropriate for the students?

a Cleansing and dressing wounds sustained during the panic

b Triaging patients with respiratory symptoms and traumatic injuries

c Providing information to families of missing loved ones

d Ensuring everyone entering and working has an N95 mask

d. Rapid assessment and triage are essential during a disaster. Delegating tasks appropriate to students are based on skill level and ability to complete skills independently. Ensuring masks are worn and the education for this, if needed, are within the educational and clinical skills of nursing students.

A disoriented older resident likes to wander the halls of their long-term care facility but becomes agitated when they cannot find their room. Which action is most appropriate as an alternative to restraints?

a Placing them in a geriatric chair near the nurses’ station

b Using the sheets to secure them snugly in the bed

c Keeping the bed in the high position

d Identifying their door with his photograph and a balloon

d. This allows the resident to be on the move and be more likely to find their room when they want to return. Many facilities use this kind of approach, rather than restrict patients’ movements. Identifying the patient’s door with their photo and a balloon may resolve the issue without 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 likely result in a fall.

A nurse has exhausted every effort to keep a confused, postoperative patient safe and in bed. Following The Joint Commission guidelines for use of restraints, which nursing action reflects safe practice?

a Positioning the patient in the supine position prior to applying wrist restraints

b Ensuring that two fingers can be inserted between the restraint and patient’s wrist

c Applying a cloth restraint to the left hand of the patient with an IV catheter in the right wrist

d Tying an elbow restraint to the raised side rail of the patient’s bed

b. The nurse should be able to place two fingers between the restraint and a patient’s wrist or ankle. Restraining the patient in a supine position increases the 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.

During the admission process, a nurse orients an older adult to their hospital room. What is the current safety priority?

a Explaining how to use the telephone

b Introducing the patient to their roommate

c Reviewing the hospital policy on visiting hours

d Demonstrating how to operate the call bell

d. Teaching the patient 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 works in a facility stating they support a culture of safety. What will the nurse expect to find operationalized in this culture? Select all that apply.

a Support for reporting errors and near misses without blame

b Nurses being the employees responsible for safety in the organization

c Commitment of resources to address actual/potential safety issues

d Emphasis placed on individuals, their departments, and resources

e Promotion of teamwork and collaboration throughout the organization

f Administrators’ and managers’ commitment to safe operations

a, c, e, f.

The key features of a culture of safety include: (1) acknowledging the high-risk nature of health care and the commitment to safe operations, (2) maintaining a blame-free environment where reporting is protected and expected, (3) promoting teamwork and collaboration to prevent and seek solutions to patient safety issues, and (4) valuing safety as a focus in all health care facilities, the home, workplace, and community.

A school nurse is teaching about adolescent safety with students entering high school. What will the nurse include in the discussion about the major causes of death in this group? Select all that apply.

a Choking

b Diving accidents

c Car accidents

d Suicide

e Intimate partner violence

f Cigarette smoking

c, d.

Car accidents and suicide are common causes of death in adolescents. Choking is more typical in children younger than age 3 years. While diving accidents can occur in adolescents due to poor judgment, this is not as common. Intimate partner violence is more common in adults. Smoking, while ill advised, takes many years or decades to become a cause of death.