Chapter 26, Safety, Security, and Emergency Preparedness

The clinical nurse educator at a long-term care facility is responsible for organizing and carrying out staff education

sessions. Which of the following topics for staff education is most likely to benefit the greatest number of residents?

A) Educating nurses on how to prevent falls

B) Reviewing safe medication administration

C) Educating nurses on how to prevent wandering by confused residents

D) Reviewing resuscitation for cardiac and respiratory arrest

Ans: A

Feedback:

Falls remain the leading cause of death among older adult Americans. Education that aims to reduce the incidence of

falls is likely to be of more benefit than measures that address medication administration, prevention of wandering, or

resuscitation procedures, even though such topics may be of importance.

Which of the following measures should nurses implement in a hospital setting in order to identify intimate partner

violence (IPV)?

A) Routine screening of newly admitted clients

B) Focused physical assessment for IPV for all new clients

C) Involvement of a social worker in the admission assessment of all new female clients

D) Review of the definition and legal repercussions of IPV with all new female clients

Ans: A

Feedback:

Practices related to the identification of IPV vary, but it is generally agreed that a simple screening tool can be an

effective strategy. A focused physical assessment and the involvement of social work are not warranted for all clients. A

review of the definition and repercussions of IPV is likely not as effective as a simple and direct screening tool.

A nurse is admitting a client to a geriatric medicine unit following the client's recent diagnosis of acute renal failure.

Which of the following nursing actions is most likely to reduce the client's chance of experiencing a fall while on the

unit?

A) Orient the client to the room and environment thoroughly upon admission.

B) Provide the client with a bedpan to reduce the need to transfer to a commode or washroom.

C) Administer pain medications sparingly in order to minimize cognitive or musculoskeletal side effects.

D) Place the client in a shared room with a client who is stable and oriented.

Ans: A

Feedback:

A person who is familiar with his or her surroundings is less likely to experience an accidental injury. As part of the

hospital admission routine, it is important to orient the client to the safety features and equipment in the room. A bedpan

should not be used for the sole reason of reducing the risk of falls, and pain medication should be provided in doses

sufficient to treat the client's pain. A client should never be charged with supervising the safety of another client.

Which of the following clients is most likely to face an increased risk of falls due to his or her medication regimen?

A) A female client age 77 years who has received a benzodiazepine to minimize her anxiety

B)

A male client age 79 years whose recent high blood pressure has required a PRN dose of an angiotensin-converting

enzyme (ACE) inhibitor

C) A woman age 81 years who has required a blood transfusion to treat a gastrointestinal bleed

D) A man 90 years of age whose venous ulcer has required the administration of intravenous antibiotics

Ans: A

Feedback:

While all drugs carry some risk of adverse effects, the use of benzodiazepines and antiepileptics are more predicative of

falls than are other drug families.

A girl age 4 years has been admitted to the emergency department after accidently ingesting a cleaning product. Which

of the following treatments is most likely appropriate in the immediate treatment of the girl's poisoning?

A) Administration of activated charcoal

B) Inducing vomiting

C) Gastric lavage

D) Intravenous rehydration

Ans: A

Feedback:

Activated charcoal is the most common treatment for many poisonings and is more effective and safe than induced

vomiting or gastric lavage. Rehydration is likely necessary, but this does not actively treat the girl's poisoning.

In light of the failure of alternatives, a nurse has been forced to physically restrain an agitated client. Which of the

following actions should the nurse perform when applying and maintaining the restraints?

A) Tie the client's hand restraint to the bed frame rather than the side rail.

B) Obtain a physician's order for the restraints within 24 hours.

C) Ensure the client is under continuous surveillance while restrained.

D) Choose a restraint device that best minimizes the client's mobility.

Ans: A

Feedback:

Restraints should be tied to the frame of the bed rather than to the side rails. A physician's order is needed for restraints,

except in emergencies when an order must be obtained within one hour of application. Frequent assessment of the client

is needed, but continuous surveillance is not necessarily required. The least restrictive type of device that allows the

greatest mobility, while still ensuring safety, is chosen.

A client is very anxious and states, "I am so stressed." Why do these factors affect the client's safety?

A) Stress increases retention of information

B) Stress affects interpersonal relationships

C) Stress increases concern about hazards

D) Stress tends to narrow the attention span

Ans: D

Feedback:

Stressful situations tend to narrow a person's attention span and make him or her more prone to accidents. Stress does

not increase retention of information or concern about hazards. Although stress may affect interpersonal relationships,

that is not the same as safety.

A client with diabetes has impaired sensation in her lower extremities. What education would be necessary to reduce her

risk of injury?

A) "Always test the temperature of bath water before stepping in."

B) "Take your insulin twice a day as we have discussed."

C) "Remember to follow your diet so you lose weight this month."

D) "Rub lotion on the skin of your legs and feet twice a day."

Ans: A

Feedback:

Alterations in sensory perception can have a serious effect on safety. A client whose tactile sense is impaired may not

perceive temperature extremes that are a threat to safety. Although all the other statements may be necessary, they do

not promote safety.

Which of the following people has the greatest risk for accidental injury?

A) An infant just learning to crawl

B) An older adult who walks two miles a day

C) An athlete who exercises on a regular basis

D) A worker who operates industrial machines

Ans: D

Feedback:

Certain occupations, lifestyles, and environments place people in more hazardous situations. A worker who operates

industrial machines is at greater risk for accidental injury as well as for hearing loss.

What age group is most vulnerable to toxic fumes or asphyxiation?

A) Young children

B) Adolescents

C) Toung adults

D) Middle adults

Ans: A

Feedback:

Most exposure to toxic fumes, such as carbon monoxide, occurs in the home. Young children and older adults are more

vulnerable to toxic fumes. Suffocation, or asphyxiation, can occur at any age, but the incidence is greater in children.

What safety device for children is mandated by law in all 50 states?

A) Bumper pads in baby cribs

B) Infant car seats and carriers

C) Automatic hot water heater controls

D) Parental controls for Internet access

Ans: B

Feedback:

All 50 states mandate the use of infant car seats and carriers when transporting a child in a motor vehicle.

An emergency room nurse is assessing a toddler with multiple bruises and burns. The nurse suspects the toddler has

been abused. What is legally required of the nurse?

A) Nothing; the nurse has no control over the toddler's home.

B) Refer the caregivers of the toddler to a home health nurse.

C) Verbally confront the caregivers about the suspicions.

D) Report suspicions about the abuse to proper authorities.

Ans: D

Feedback:

Nurses are both legally and ethically obligated to report abuse, either suspected or confirmed. In many states, the failure

to report actual or suspected abuse is a crime. The role of the nurse does not include confrontation.

A grade school nurse is addressing parents at a PTA meeting regarding car safety. Which of the following is a

recommended safety guideline for this age group?

A) All school-age children need to be secured in safety seats.

B) Booster seats should be used for children until they are 4 feet 9 inches tall or at least 8 years of age.

C) Children under 8 years old should ride in the back seat.

D) All school-age children need to be secured in lap seat belts.

Ans: B

Feedback:

All school-age children need to be secured in safety seats, belt-positioning booster seats, or shoulder lap belts for their

size. The National Highway Traffic Safety Administration recommends booster seats for children until they are 4 feet 9

inches tall or at least 8 years of age, and all children 12 and under should ride in the back seat to eliminate the risk of

injury from airbag deployment (National Highway Traffic Safety Administration [NHTSA], 2008).

An adolescent has recently had a ring inserted into her navel. Which of the following is the greatest risk facing the

adolescent as a result of this activity?

A) A scar over the navel

B) A local and/or systemic infection

C) A greater acceptance by peers

D) A strained relationship with parents

Ans: B

Feedback:

Body piercing is a quick procedure that does not require anesthesia, but the risk for infection is great. This risk includes

local infection, hepatitis B virus, and HIV.

Nurses provide many interventions to prevent falls in health care settings. Which of the following would be an

appropriate intervention to prevent falls?

A) Keep bed in the high position.

B) Keep side rails up at all times.

C) Apply restraints to all confused clients.

D) Lock wheels on beds and wheelchairs.

Ans: D

Feedback:

Locking wheels on beds and wheelchairs prevents them from rolling and precipitating a fall. Beds should be kept in low

positions with the side rails down in most situations; restraints should be applied only as a last resort.

A nurse makes a medication error and fills out an incident report. What will the nurse do with the incident report once it

is filled out?

A) Place it in the client's medical record.

B) Take it home and keep it locked up.

C) Maintain it according to agency policy.

D) Include it with documentation of the error.

Ans: C

Feedback:

An accident in a health care agency requires filling out an incident report, a confidential document that objectively

describes the circumstances of the accident. The incident report is not a part of the medical record and should not be

mentioned in the documentation. The report is maintained by the agency.

In what situation would the use of side rails not be considered a restraint?

A) The nurse keeps them raised at all times.

B) The institution's policies mandate using side rails.

C) A visitor requests their use.

D) A client requests they be up at night.

Ans: D

Feedback:

It is now recognized that side rails can pose serious risks for some clients. However, side rails are not considered

restraints if the client requests they be put up at night to increase feelings of security while asleep. Agency policies help

nurses determine when to apply restraints and what type to use.

Bioterrorism has become a commonly used term. What is the definition of bioterrorism?

A) A verbal threat by those wishing to harm specific individuals

B) A written threat calculated to produce terror in a family

C) The deliberate spread of pathogens into a community

D) A worldwide plan to produce illness and injury

Ans: C

Feedback:

Bioterrorism involves the deliberate spread of pathogenic organisms into a community.

A client arrives at the emergency department with nausea, hematemesis, fever, abdominal pain, and severe diarrhea.

There is a suspicion the client has been exposed to the anthrax bacillus. What category of medications will be

administered?

A) Antimicrobials

B) Narcotics

C) Antihistamines

D) Antacids

Ans: A

Feedback:

Anthrax is a potentially fatal bacterial infection. The recommended treatment for exposure to, as well as symptoms of,

an anthrax infection is with rapid administration of antimicrobial therapy. Narcotics are administered to manage pain.

Antihistamines are prescribed to manage allergy conditions. Antacids are prescribed to manage gastrointestinal

disorders.

What statement by a client would indicate that a nurse had successfully implemented a educating/learning strategy to

prevent injury in the home?

A) "I will turn off the outside lights and lock the doors every night."

B) "Do you think it would be best for me to buy a gun?"

C) "I am going to remove all those throw rugs on the floor."

D) "Well, I always let the boys play in the bathtub; they love it."

Ans: C

Feedback:

Nurses must evaluate the effectiveness of their interventions to promote safety and prevent injury. If the expected client

outcomes have been met and evaluative criteria satisfied, the client should be able to correctly identify real and potential

unsafe environmental situations, and implement safety measures in the environment.

A nurse is caring for a stable toddler diagnosed with accidental poisoning, due to the ingestion of cleaning solution.

What must be included in educating parents about how to protect a toddler from accidental poisoning?

A) Closely monitor the toddler's activity.

B) Label poisonous solutions.

C) Keep cleaning solutions locked up.

D) Do not leave the toddler alone.

Ans: C

Feedback:

The parents should keep cleaning solutions locked up to protect the toddler from accidental poisoning. Accidental

poisonings usually occur among toddlers and commonly involve substances located in bathrooms or kitchens. Labeling

poisonous substances may not help as toddlers are unable to read. Not leaving the child alone and closely monitoring the

child are important, but not feasible all the time.

When educating parents of preschoolers, what is most important to include in your presentation?

A) Use wrist guards with rollerblades

B) Teach preschoolers to tread water

C) Keep chemicals in a locked cabinet

D) Strict discipline with potty training

Ans: C

Feedback:

Increasing mobility, lack of life experience and judgment, and immature musculoskeletal and neurologic systems lead to

potentially hazardous encounters for toddlers and preschoolers.

The facility risk management team is preparing an in-service to nursing staff members. The presentation will highlight

risk factor increase related directly to the type of clientele on a nursing unit. The presenter will correctly explain that

which of the following risks is increased for female nurses who work on an oncology care unit?

A) Back injuries

B) Bloodborne pathogens

C) Adverse reproduction

D) Neurologic disorders

Ans: C

Feedback:

Common risks in health care facilities are exposure to bloodborne pathogens from stick injuries via used needles, back

injuries caused by heavy lifting, and potential adverse reproductive outcomes as a result of overexposure to

antineoplastic medications. On oncology divisions, the nurse is continually exposed to antineoplastic agents.

The nurse is caring for a client who has prescribed extremity restraints. The nurse is required to document which of the

following?

A) Alternative measures attempted before applying the restraints

B) A verbal order for renewal of the restraints every 48 hours

C) Detailed description of the restraint application process

D) Type of personal protective equipment (PPE) used by the nurse during restraint application

Ans: A

Feedback:

This is not typically documented.

A nurse enters a client's room and finds that the client has fallen on her way to the bathroom. Which of the following is

a prudent nursing intervention for this client?

A) Briefly leave the client in order to call the primary physician to assess the client's condition.

B) Order x-rays or CT scans for the client, as needed.

C) Document the incident, assessment, and interventions in the client's medical record.

D) Do not file an event report unless the client is seriously injured in the fall.

Ans: C

Feedback:

The nurse is responsible for documenting the incident in the client's record. Assess the patient immediately and provide

appropriate care and interventions based on client status, and ensure prompt follow-through for any physician orders for

diagnostic tests. An event report should be filed in the case of a fall, as per facility policy.

A doctor orders restraints for an older adult client who is disoriented from the pain medication she is taking. Which of

the following is an appropriate guideline for applying these restraints?

A) Chemical restraints should be tried before using physical restraints.

B) The restraints can be ordered by the nursing supervisor in emergency situations.

C) The client's vital signs must be assessed every hour.

D)

Adults must be reassessed within 4 hours; children age 9 to 17 years within two hours; and children under 9 years within

one hour.

Ans: D

Feedback:

Client with restraints must be monitored and reassessed as described in answer D. Restraints must be ordered by a

physician, and client vital signs must be assessed every two hours.

A physician orders restraints for a confused client who is at risk for injury by pulling out tubes necessary to sustain her

life. Which of the following statements describes an accurate action to take when applying these restraints?

A) Apply restraints to the hands or wrists, never to the ankles.

B) Ensure that two fingers can be inserted between the restraint and the client's extremity.

C) Use a quick-release knot to tie the restraint to the side rail.

D) Remove the restraint at least every four hours, or according to agency policy.

Ans: B

Feedback:

Restraints should be sufficiently loose for two fingers to be inserted between the restraint and the extremity. Restraints

can be placed on ankles; quick-release knots should be tied to the bed frame, not the side rail. Restraints should be

removed every two hours.

Which of the following populations, based on their development stage, would benefit from strategies to prevent falls?

Select all that apply.

A) Newborns

B) Toddlers

C) Adolescents

D) Adults

E) Older Adults

Ans: A, B, E

Feedback:

Educate parents never to leave newborns alone on a changing table, and also teach parents of toddlers to childproof the

home. Parents of preschoolers should make sure their children wear proper safety equipment when riding bicycles or

scooters. Adolescents and adults are not at high risk for falls. Older adults, however, are at risk for falls due to the effects

of aging on the body systems.

After a client falls out of bed, the nurse completes which of the following?

A) Safety event report (incident report)

B) Telephone call to hospital's attorney

C) Progress note stating event report was completed

D) Malpractice report

Ans: A

Feedback:

An accident or incident that compromises safety in a health care agency requires the completion of a safety event report.

This is a confidential document, formerly referred to as an incident report. The safety event report is not a part of the

medical record and should not be mentioned in the documentation.

The nurse knows that a health care facility should determine its disaster-preparedness plan for delivering care in the

event of an emergency or disaster?

A) As soon as the disaster is announced publicly

B) When officially informed that a disaster has occurred

C) After the first disaster has been experienced

D) In advance of a possible emergency or disaster

Ans: D

Feedback:

Each health care facility should determine in advance how to deliver care, if an emergency or disaster occurs. This

involves collaboration with internal committees and external agencies.

A nurse is assessing a client who recently had a stroke. What is one area of assessment necessary to promote safety?

A) Neuromuscular

B) Respiratory

C) Gastrointestinal

D) Genitourinary

Ans: A

Feedback:

Anything that affects a patient's health state potentially can affect the safety of the environment. For example, a nurse

who is assessing a patient with a recent stroke would assess neuromuscular impairment to prevent falls.

A nurse specializes in caring for victims of domestic violence. Which of the following statements accurately describes

domestic violence in the United States? (Select all that apply.)

A) Studies indicate that each year, more than 12 million adults in the United States are victims of intimate partner violence.

B) Intimate partner violence is domestic violence or battering between two people in a close relationship.

C) Many men who batter their spouses also batter their children.

D) There is no evidence linking childhood sexual abuse to adult physical symptoms or substance abuse.

E) Domestic violence is not seen in a cycle.

Ans: A, B, C

Feedback:

Studies indicate that each year, more than 12 million adults in the United States are victims of intimate partner violence.

Intimate partner violence is domestic violence or battering between two people in a close relationship. Many men who

batter their spouses also batter their children. Recent evidence suggests a relationship between childhood sexual abuse

and certain physical symptoms in adulthood, such as gastrointestinal symptoms, eating disorders, and substance abuse.

The nurse may be involved directly in health education and counseling measures, or may suggest other resources to the

family as additional support for safety, well-being and to interrupt the cycle of violence.

Prior to inserting a nasogastric tube, the nurse correctly verifies the client's identity through which of the following

methods?

A) Ask the client: "Is your name___?"

B) Check the client's identification bracelet.

C) Verify the client's room number.

D) Call the client by his or her first name.

Ans: B

Feedback:

The Joint Commission's National Patient Safety Goals include improving the accuracy of client identification. The nurse

should check the client's identification bracelet to verify the client's identity.

Which of the following nursing diagnoses would be appropriate for teaching interventions for a single mother who

leaves her toddler unattended in the bathtub?

A) Noncompliance

B) Risk for Suffocation

C) Risk for Falls

D) Risk for Imbalanced Body Temperature

Ans: B

Feedback:

Death from drowning occurs from suffocation. Nearly half of all drowning victims are children under the age of 5. Most

drowning deaths in young children occur because of inadequate supervision of a bathtub or pool.

The nurse conducting a community emergency preparedness education class includes which of the following as an

example of a natural disaster?

A) Toxic spill

B) Earthquake

C) War

D) Terrorist event

Ans: B

Feedback:

A disaster is broadly defined as a tragic event of great magnitude that requires the response of people outside the

involved community. Disasters can be categorized as natural (e.g., massive flooding following a hurricane or an

earthquake) or man-made (e.g., a toxic spill, war, or a terrorist event).