Chapter 27: Patient Safety and Quality

You are caring for a patient in an intensive care unit (ICU) who has pulled out his own IV line.You have tried restraint alternatives.Which of the following would you assess to determine appropriateness or reason to physically restrain the patient? (Select all that apply.)

1. Health care provider's order

2. Patient's current behavior

3. Current medications

4. Health literacy

5. Presence of fever

6. Serum electrolytes

7. Age

1, 2, 3, 5, 6

You complete a fall risk assessment on your assigned patient, who is 45 years old and has a history of cocaine use and liver failure. His laboratory results show an elevated prothrombin time.You determine that the patient is at high risk for falling. Which of the following measures are targeted to his fall risk status? (Select all that apply.)

1. Using skid-proof footwear

2. Scheduling any oral medications at least 2 hours before bedtime

3. Placing a low bed in room

4. Placing the nurse call system within patient's reach

5. Using a bed exit alarm

6. Providing patient with a protective head helmet when in chair or walking

2, 3, 5, 6

During a home health visit a nurse observes a patient preparing lunch. Which of the following are safe practices to follow in the safe preparation and storage of food? (Select all that apply.)

1. Always use a single cutting board to prepare foods for cooking.

2. Refrigerate leftovers as soon as possible.

3. Always buy vegetables in packages marked "prewashed."

4. Cook meats to the proper temperature.

5. Wash hands thoroughly before food preparation

2, 4, 5

A nurse enters the hospital room of a patient who had a total knee replacement the day before and is sitting in a chair. The nurse is preparing to return the patient to bed. Which of the following pose potential safety risks? (Select all that apply.)

1. A current safety inspection sticker is on the IV fluid pump.

2. A walker is positioned near the patient's bedside.

3. The hospital bed is in the high position.

4. There is no gait belt at the bedside.

5. The overbed table with the patient's glasses is positioned against the wall opposite the end of the bed.

3, 4, 5

Match the patient fall risks on the left with the correct risk factor category on the right.

___1. A 42-year-old patient who is recovering from anesthesia refuses assistance with walking to the bathroom.

___2. A 60-year-old patient with a history of falling in the last 6 months.

___3. A patient's walking path has spilled fruit juice on the floor.

___4. A 68-year-old patient recovering from a colon resection uses an IV pole to walk.

___5. Patient is unable to identify own fall risks.

___6. The physical therapist has not yet fitted a 62-year-old patient for a prescribed walker.

A. Intrinsic risk

B. Extrinsic risk

1A

2A

3B

4B

5A

6B

A nurse working on a surgery floor is assigned four patients. The nurse assesses each patient, noting behaviors and physical signs and symptoms.Which of the following patientsis more likely to be violent toward the nurse?

1. The first patient maintains eye contact with the nurse, is calm during the nurse's assessment, and asks questions frequently.

2. The second patient is very drowsy, loses attention when the nurse asks questions, and mumbles when speaking.

3. The third patient moves nervously in bed, swears and grimaces when trying to cough, and speaks in a low volume.

4. The fourth patient speaks in a loud voice and becomes irritable when the nurse arrives to help walk the patient.

4

Match the intervention for promoting child safety on the left with the correct developmental stage on the right.

1. Teach children proper bicycle and skateboard safety.

2. Teach children how to cross streets and walk in parking lots.

3. Teach children proper techniques for specific sports.

4. Teach children not to operate electric toothbrushes while unsupervised.

5. Teach children not to talk to or go with a stranger.

6. Teach children not to eat items found in the grass.

A. School-age child

B. Preschooler

A: 1, 2, 3

B: 4, 5, 6

The nurse finds a 68-year-old woman wandering in the hallway and exhibiting confusion. The patient says she is looking for the bathroom. Which interventions are appropriate for this patient? (Select all that apply.)

1. Ask the health care provider to order a restraint.

2. Recommend insertion of a urinary catheter.

3. Provide scheduled toileting rounds every 2 to 3 hours.

4. Institute a routine exercise program for the patient.

5. Keep the bed in high position with side rails down.

6. Keep the pathway from the bed to the bathroom clear

3, 4, 6

Place the following steps for applying a wrist restraint in the correct order:

1. Pad the skin overlying the wrist.

2. Insert two fingers under the secured restraint to be sure that it is not too tight.

3. Be sure that the patient is comfortable and in correct anatomical alignment.

4. Secure restraint straps to bedframe with quick-release buckle.

5. Wrap limb restraint around wrist or ankle with soft part toward skin and secure snugly.

3, 1, 5, 2, 4

Match the fall prevention intervention on the left with the scientific rationale on the right.

___1. Prioritize nurse call system responses to patients at high risk.

___2. Place patient in a wheelchair with wedge cushion.

___3. Establish elimination schedule with bedside commode.

___4. Use a low bed for patient.

___5. Provide a hip protector.

___6. Place nonskid floor mat on floor next to bed.

A. Maintains comfort and makes exit difficult

B. Makes it difficult for patients with lower extremity weakness to stand

C. Reduces slipping when walking

D. Reduces fall impact

E. Ensures rapid response for help

F. Reduces chance of patient trying to get out of bed on own

1E

2A

3F

4B

5D

6C