Fundamentals of Nursing 2nd Edition Yoost Test Bank Chapter 25: Safety Yoost & Crawford: Fundamentals of Nursing: Active Learning for Collaborative Practice, 2nd Edition MULTIPLE CHOICE 1. The nursing instructor asks the student nurse to identify what Robert Wood Johnson Foundation funded project that focuses on nurses’ increased attention to patient safety? a. OSHA (Occupational Safety and Health Agency) b. MSDS (material safety data sheets) c. QSEN (Quality and Safety Education for Nurses) d. ADA (Americans with Disability Act) ANS: C QSEN, or the Quality and Safety Education for Nurses, was funded by the RWJ to focus on preparing nurses of the future with the knowledge, skills, and attitudes to advance quality and safety on the job. MSDS are material safety data sheets, OSHA is the Occupational Safety and Health Agency, and ADA is the Americans with Disability Act. DIF: Remembering OBJ: 25.1 MSC: NCLEX Client Needs Category: Safe and Effective Care TOP: Implementation NOT: Concepts: Safety 2. The nurse knows changes in which body system affect overall mobility increasing the propensity of falling? a. Neurologic b. Hepatic c. Cardiopulmonary d. Musculoskeletal NURSINGTB.COM ANS: D Impairments in the musculoskeletal system can impact mobility through restrictions of range of motion and strength, increasing the chances of falling. Changes to the neurologic system can impair cognitive functioning, changes to the hepatic system can affect mental status, and changes to the cardiopulmonary system can affect activity tolerance. DIF: Understanding OBJ: 25.2 MSC: NCLEX Client Needs Category: Safe and Effective Care TOP: Assessment NOT: Concepts: Safety 3. The nurse is visiting a patient with cardiac disease who has been experiencing increased episodes of shortness of breath when exercise is attempted. The nurse is concerned that the patient’s decrease in activity may lead to which outcome? a. Orthostatic hypotension b. Increase risk of heart disease c. Loss of short-term memory d. Worsening shortness of breath ANS: A NURSINGTB.COM Fundamentals of Nursing 2nd Edition Yoost Test Bank Inactivity in patients with cardiopulmonary disease can lead to an unsafe drop in blood pressure with position changes, or orthostatic hypotension. The patient already has heart disease. Loss of short-term memory is not related to the shortness of breath. The lack of activity is not likely to worsen the shortness of breath; improving activity level may help things eventually. DIF: Applying OBJ: 25.2 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 4. The nurse recognizes conversations about safe sexual practices, including the consequences of unprotected sex such as pregnancy and sexually transmitted infections, are important to begin in what patient population? a. Adults b. School-aged children c. Adolescents d. Older adults ANS: C Sexual curiosity and experimentation occur in the adolescent patient population. Conversations about safe sexual practices, including the consequences of unprotected sex, such as pregnancy and sexually transmitted infections, are important. These conversations are also important for adults and older adults but are handled differently in context with their age-related needs. School-aged children may be too young depending on their age and their environment. The nurse must use judgment on when to have the conversation. DIF: Understanding OBJ: 25.4 MSC: NCLEX Client Needs Category: Safe and Effective Care NURSINGTB.COM TOP: Implementation NOT: Concepts: Safety 5. The nurse manager is developing a training guide and identifies which organization that is the best for resources to help develop guidelines to prevent exposure to hazardous situations and decrease the risk of injury in the workplace? a. OSHA (Occupational Safety and Health Administration) b. CDC (Centers for Disease Control and Prevention) c. QSEN (Quality and Safety Education for Nurses) d. NIOSH (National Institute for Occupational Safety and Health) ANS: A Occupational Safety and Health Administration (OSHA) was established in 1970 to provide employers with guidelines for preventing exposure to hazardous chemicals and hazardous situations and reducing the risk of injury in the workplace. The CDC is the Centers for Disease Control and Prevention and provides information to address exposure to infectious diseases. QSEN, or the Quality and Safety Education for Nurses, was funded by the RWJ to focus on preparing nurses of the future with the knowledge, skills, and attitudes to advance quality and safety on the job. NIOSH, or the National Institute for Occupational Safety and Health, is a federal agency within the CDC that was established to conduct research and recommend interventions for the prevention of work-related injury and illness. DIF: Understanding OBJ: 25.7 MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Health Care Organizations NURSINGTB.COM TOP: Implementation Fundamentals of Nursing 2nd Edition Yoost Test Bank 6. The nurse is educating parents about firearm safety. Which parent statement indicates to the nurse a need for further education? a. “I should make sure I obtain the proper permits.” b. “It is okay to store firearms with ammunition loaded.” c. “I should store all firearms without ammunition.” d. “I should make sure all firearms have trigger locks in place.” ANS: B Firearms should be stored in a secure location with trigger locks in place. Ammunition should be stored in a separate location also locked. Proper permits should be obtained as appropriate. Loaded firearms should never be stored where children can access them. DIF: Applying OBJ: 25.4 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 7. The nurse recognizes that a patient is using a portable generator in the house as a power source. What source of poisoning does the nurse appropriately identify? a. Lead b. Carbon monoxide c. Antifreeze d. Pesticide ANS: B Sources of carbon monoxide include automobiles, stoves, gas ranges, portable generators, lanterns, the burning of charcoal and wood, and heating systems. Lead is found in lead-based paints in toys, buildings, and ceramic dishes; sources of lead include water from lead pipes or pipes soldered with lead, gasoline or soil contaminated by gasoline, and household dust that RnStiIfrN may contain paint chips or soNilU .A eeG zeTaB n. dC peO stM icides are liquids. DIF: Applying OBJ: 25.4 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 8. The nurse is educating the patient about the proper disposal of medications in the home. Which statement by the patient indicates a good understanding of the information? a. “Remove the label from the bottle and throw in the trash.” b. “Flush the medication down the disposal.” c. “Mix the medications with kitty litter, place the mixture in a jar, and put the jar in the trash.” d. “Dissolve the medication in water and pour down the drain.” ANS: C Flushing or pouring the medication down the drain can contaminate the water system. Throwing the medication in the trash poses potential for someone to remove the medication and use it. This can be avoided by mixing it with an undesirable substance like kitty litter or coffee grounds. DIF: Applying OBJ: 25.7 TOP: Intervention MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 9. The nurse knows that which patient has a teaching need based on statements by the patient’s parents? a. “My 6-month-old daughter only sleeps with me when she’s ill.” NURSINGTB.COM Fundamentals of Nursing 2nd Edition Yoost Test Bank b. “I do not put pillows in the bed with my 3-month-old son.” c. “I do not feed popcorn to my 2-year-old.” d. “I have discussed the risks of the ‘choking game’ with my 16-year-old.” ANS: A Small children should never sleep in the bed with others because of the risk of suffocation. The rest of the statements are appropriate. Pillows do present a hazard to a 3-month-old, and popcorn is a choking risk for a 2-year-old. The choking game is a risk to any adolescent. DIF: Applying OBJ: 25.4 TOP: Intervention MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Patient Education 10. The nurse is teaching a student nurse about restraint use in patients. Which statement by the student nurse indicates a learning need regarding restraints? a. “Having all four side rails up on the bed is considered a restraint.” b. “The use of restraints has been shown to decrease fall-related injuries.” c. “Death has been associated with the use of restraints.” d. “Medications administered to control behavior are considered a chemical restraint.” ANS: B Restraints may be physical or chemical. A physical restraint is a mechanical or physical device, such as material or equipment attached or adjacent to the patient’s body, used to restrict movement. Examples of physical restraints are wrist or ankle restraints, a jacket or vest, and side rails. A medication that is administered to a patient to control behavior is a chemical restraint. The use of restraints has been associated with patient injury including death and does not prevent patient falls. NURSINGTB.COM DIF: Applying OBJ: 25.4 TOP: Intervention MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 11. The nurse displays an understanding of high-risk populations for MRSA when identifying which group as the lowest risk? a. Prison inmates b. College dorm residents c. Team athletes d. Food service workers ANS: D High-risk populations for MRSA include those living in close quarters or those who have frequent skin-to-skin contact, including prison inmates, college dorm residents, and team athletes. Food service workers work together but do not generally live in close quarters or have skin-to-skin contact frequently. DIF: Understanding OBJ: 25.1 TOP: Assessment MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Infection 12. The nurse knows that which assessment tool is not used to assess fall risk? a. Glasgow Falls Scale b. Johns Hopkins Hospital Fall Assessment Tool c. Morse Fall Scale d. Hendrich II Fall Risk Model NURSINGTB.COM Fundamentals of Nursing 2nd Edition Yoost Test Bank ANS: A The Glasgow is a coma scale used to measure level of consciousness, not falls. The rest are scales used to assess the risk for falls in patients. DIF: Remembering OBJ: 25.4 MSC: NCLEX Client Needs Category: Safe and Effective Care TOP: Assessment NOT: Concepts: Safety 13. The patient has a nursing diagnosis of Risk for Falls. The nurse identifies which goal to be most important? a. Patient will ambulate twice a day. b. Patient will have no symptoms of infection. c. Patient will perform activities of daily living. d. Patient will have no injuries during hospital stay. ANS: D All the goals except lack of infection are appropriate for a patient with a Risk for Falls diagnosis; however, the most important goal is for the patient to have no injuries during the hospitalization. DIF: Applying OBJ: 25.5 TOP: Planning MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 14. Which collaborative team member would be most effective in assisting the nurse to identify medication alternatives that are less likely to cause drowsiness and dizziness to reduce the risk of falls in the elderly patient? a. Nursing case manager b. Charge nurse NURSINGTB.COM c. Physical therapist d. Pharmacist ANS: D The nurse collaborates with the pharmacist and health care provider to identify and implement safe medication alternatives for older adults to minimize side effects such as drowsiness, dizziness, and orthostatic hypotension, which can increase fall risk. Although case managers and charge nurses might have some experience in this area, pharmacists are educated to focus on medication. Physical therapists evaluate the patient’s ability to perform and maintain balance during routine activities such as sitting, standing, and walking. DIF: Applying OBJ: 25.6 TOP: Planning MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 15. The nurse is concerned about helping the patient find resources to obtain assistive equipment to be used in the home. Which team member should the nurse contact first? a. Occupational therapist b. Physical therapist c. Health care provider d. Social worker ANS: D NURSINGTB.COM Fundamentals of Nursing 2nd Edition Yoost Test Bank The nurse should collaborate with the social worker to identify community resources for obtaining assistive equipment. The social worker facilitates contact with insurance companies or other agencies to assist with the financing of recommended therapeutic assistive and specialty devices. Occupational therapists evaluate the patient for safe performance of activities of daily living (ADLs) such as bathing, dressing, and grooming, and they make recommendations to enhance safe performance of these activities, such as the use of specialty equipment (e.g., grippers for pants, oversized shoehorns). Physical therapists evaluate the patient’s ability to perform and maintain balance during routine activities such as sitting, standing, and walking. They make recommendations for assistive devices such as canes and walkers to promote safe performance of these activities. Health care providers order the equipment. DIF: Understanding OBJ: 25.6 MSC: NCLEX Client Needs Category: Safe and Effective Care TOP: Planning NOT: Concepts: Collaboration 16. Which statement by the patient indicates to the nurse a teaching need regarding safety in the home? a. “I will put a night-light in every room.” b. “I will not use an extension cord to plug in multiple items.” c. “I will wash my throw rugs in the bathroom regularly.” d. “I will keep all cleaning supplies out of reach of children.” ANS: C Throw rugs present a fall or tripping hazard. Night-lights help light halls to prevent falls, extension cords can present a trip hazard, and cleaning supplies can contain poisonous materials. N R I G B.C M DIF: Applying OBJ: 25.6U S N TT OP: PlO anning MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 17. The ER nurse is triaging a patient with suspected poisoning. Who should the nurse anticipate contacting first? a. Family services b. Radiology c. Poison Control Center d. Respiratory ANS: C If poisoning is suspected, the National Poison Control Center should be contacted immediately. This information will be needed to determine treatment. Respiratory may be needed, and radiology and family services may also be needed, but that will be determined after the treatment plan is determined. DIF: Applying OBJ: 25.3 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Caring Behaviors 18. The staff nurse knows that many health care facilities use the fire emergency response defined by which acronym? a. RACE b. PASS c. PACE NURSINGTB.COM Fundamentals of Nursing 2nd Edition Yoost Test Bank d. QSEN ANS: A RACE stands for rescue, alarm, contain, and extinguish. QSEN is the Quality and Safety Education for Nurses. PASS is pull, aim, squeeze, and sweep for fire extinguishers. PACE is not a health care acronym. DIF: Understanding OBJ: 25.4 MSC: NCLEX Client Needs Category: Safe and Effective Care TOP: Implementation NOT: Concepts: Safety 19. The nurse is ambulating a patient back from the bathroom when the patient begins to have a seizure. Which action should the nurse do first? a. Lower the patient to the floor if standing. b. Move sharp or hard objects away from the patient. c. Turn the patient’s head to the side to prevent aspiration. d. Attempt to place a tongue blade to prevent choking. ANS: A During a seizure, a patient should be protected from injury by first lowering the patient to the ground if standing. The nurse should then place the head on a soft surface and turn it to the side to prevent aspiration and move sharp or hard objects out of the way. The nurse should never attempt to force any object into a seizing patient’s mouth. DIF: Applying OBJ: 25.7 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 20. The nurse is caring for a confused, combative patient. Which action would be considered last by the nurse to control behavN ior R of the client? U SING TB.C OM a. Orient the patient frequently. b. Apply restraints. c. Move the patient to a room close to the nurse’s station. d. Encourage the family to spend time with the patient. ANS: B All alternatives to physical restraints should be considered prior to their use. DIF: Applying OBJ: 25.7 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 21. The nurse knows which method to be an appropriate way to tie restraints? a. Knot tied to the bed frame b. Quick-release knot tied to the side rail c. Bow tied to the bed rail d. Quick-release ties attached to the bed frame ANS: D Restraints should never be tied in a knot because the knot may prohibit a quick exit in the event of an emergency requiring evacuation. Instead, use quick-release ties or mechanisms such as buckles. Restraints are never be tied to side rails because injuries may result when they are raised or lowered. They should be tied to a stable part of the bed such as the frame. DIF: Understanding OBJ: 25.7 NURSINGTB.COM TOP: Implementation Fundamentals of Nursing 2nd Edition Yoost Test Bank MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 22. Which statement by the nurse correctly identifies the UAP role in patient restraint use? a. “The UAP can perform initial assessment.” b. “The UAP can apply a restraint.” c. “The UAP can assist with applying and monitoring of a physical restraint.” d. “The UAP can contact the health care provider and request an order for restraints.” ANS: C The UAP cannot perform the initial assessment, and most facilities require that a registered nurse or licensed practical nurse. Applying a restraint. The health care provider should be contacted by the nurse, not the UAP. The UAP can assist with applying the restraint and can perform monitoring checks under the direction of a Registered Nursing. DIF: Applying OBJ: 25.7 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety MULTIPLE RESPONSE 1. The nurse is explaining the National Patient Safety Goals (NPSG) to the student nurse. Which answers indicate that the student has a good understanding of these goals? (Select all that apply.) a. The NPSG’s focus on treating chronic infections quickly b. The NPGS’s focus on improving staff communication c. The NPGS’s focus on using medications safely d. The NPGS’s focus on identifying patients correctly ANS: B, C, D NURSINGTB.COM The NPSG focus on specific goals each year. The goals for 2018 included: identify patients correctly, improve staff communication, improve the safety of using medications, reduce harm associated with clinical alarm systems, reduce risk of health care–associated infections and the hospital identifies safety risks inherent in its patient population. Although treating chronic infections quickly is important, it is not an NPSG. DIF: Applying OBJ: 25.1 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety 2. The nurse is providing education to a cardiac patient who has multiple life stressors that are impacting the patient’s health. Which statements by the patient indicate a good understanding of actions that can be taken to reduce stressors? (Select all that apply.) a. “I should change my job.” b. “I should plan some downtime.” c. “I should meet with a financial counselor.” d. “I should talk with my family about my situation.” e. “I should make my family go to counseling with me.” ANS: B, C, D NURSINGTB.COM Fundamentals of Nursing 2nd Edition Yoost Test Bank In adulthood, life stressors such as financial concerns, work-related demands, and efforts to balance work with family life are common challenges that can take a physical toll on the body. Individuals should plan relaxation periods or vacations. Meeting with financial counselors and talking with family can help to achieve that balance. Changing jobs may be beneficial but could also create more stress and forcing family to go to counseling may also not be a wise choice. DIF: Applying OBJ: 25.7 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Patient Education 3. The nurse is providing education to a community group on environmental safety. Which safety measures are effective in improving their environmental safety? (Select all that apply.) a. Use of night-lights throughout the home b. Illumination of stairwells and pathways c. Installation of motion-activated lighting on the exterior of the home d. Application of wax to all floors to increase shine e. Staying indoors when air pollution is high ANS: A, B, C, E Inadequate lighting presents safety concerns in home, work, community, and health care environments. For an individual to safely and successfully navigate pathways and perform various activities while avoiding potential obstacles and hazards, the environment must be well illuminated. Well-lit, glare-free halls, stairways, rooms, and work spaces help to reduce the risk of tripping, slipping, and falling. Night-lights reduce the risk of injuries to children, guests, and older adults. Lighting the exterior of the house will also reduce the risk of falling. Staying indoors during episodes when air pollution is high can help prevent chronic lung disease. Waxed floors are slipper N Ry. I G B.C M U S N T O DIF: Applying OBJ: 25.7 TOP: Implementation MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Patient Safety NURSINGTB.COM