Test Bank Patient Safety and Quality Potter et al.: Fundamentals of Nursing, 9th Edition, Exams of Nursing

Download Test Bank Patient Safety and Quality Potter et al.: Fundamentals of Nursing, 9th Edition and more Exams Nursing in PDF only on Docsity! Test Bank Patient Safety and Quality Potter et al.: Fundamentals of Nursing, 9th Edition MULTIPLE CHOICE 1. A home health nurse is performing a home assessment for safety. Which comment by the patient will cause the nurse to follow up? a. “Every December is the time to change batteries on the carbon monoxide detector.” b. “I will schedule an appointment with a chimney inspector next week.” c. “If I feel dizzy when using the heater, I need to have it inspected.” d. “When it is cold outside in the winter, I will use a nonvented furnace.” ANS: D Using a nonvented heater introduces carbon monoxide into the environment and decreases the available oxygen for human consumption and the nurse should follow up to correct this behavior. Checking the chimney and heater, changing the batteries on the detector, and following up on symptoms such as dizziness, nausea, and fatigue are all statements that are safe and appropriate and need no follow-up. DIF: Analyze (analysis) REF: 374 OBJ: Describe environmental hazards that pose risks to a person’s safety. TOP: Assessment MSC: Safety and Infection Control 2. The nurse is caring for an older-adult patient admitted with nausea, vomiting, and diarrhea due to food poisoning. The nurse completes the health history. Which priority concern will require collaboration with social services to address the patient’s health care needs? a. The electricity was turned off 3 days ago. b. The water comes from the county water supply. c. A son and family recently moved into the home. d. This home is not furnished with a microwave oven. ANS: A Electricity is needed for refrigeration of food, and lack of electricity could have contributed to the nausea, vomiting, and diarrhea due to food poisoning. This discussion about the patient’s electrical needs can be referred to social services. Foods that are inadequately prepared or stored or subject to unsanitary conditions increase the patient’s risk for infections and food poisoning, and an assessment should include storage practices. The water supply, the increased number of individuals in the home, and not having a microwave may or may not be concerns but do not pertain to the current health care needs of this patient. DIF: Analyze (analysis) REF: 374 | 381 | 388 OBJ: Describe environmental hazards that pose risks to a person’s safety. TOP: Planning MSC: Management of Care TOP: Teaching/Learning MSC: Safety and Infection Control 6. The nurse is monitoring for Never Events. Which finding indicates the nurse will report a Never Event? a. No blood incompatibility occurs with a blood transfusion. b. A surgical sponge is left in the patient’s incision. c. Pulmonary embolism after lung surgery d. Stage II pressure ulcer ANS: B The Centers for Medicare and Medicaid Services names select serious reportable events as Never Events (i.e., adverse events that should never occur in a health care setting). A surgical sponge left in a patient’s incision is a Never Event. No blood incompatibility reaction is safe practice. Pulmonary embolism after certain orthopedic procedures is like a total knee and hip replacement. Stage III and IV pressure ulcers are Never Events. DIF: Understand (comprehension) REF: 377-378 OBJ: Discuss the importance of consensus standards for public reporting of patient safety events. TOP: Implementation MSC: Management of Care 7. The nurse discovers a patient on the floor. The patient states that he fell out of bed. The nurse assesses the patient and places the patient back in bed. Which action should the nurse take next? a. Do nothing, no harm has occurred. b. Notify the health care provider. c. Complete an incident report. d. Assess the patient. ANS: B Report immediately to physician or health care provider if the patient sustains a fall or an injury. The nurse must provide safe care, and doing nothing is not safe care. The scenario indicates the nurse has already assessed the patient. After the patient has stabilized, completing an incident report would be the last step in the process. DIF: Apply (application) REF: 399 OBJ: Define the knowledge, skills, and attitudes necessary to promote safety in a health care setting. TOP: Implementation MSC: Safety and Infection Control 8. When making rounds the nurse observes a purple wristband on a patient’s wrist. How will the nurse interpret this finding? a. The patient is allergic to certain medications or foods. b. The patient has do not resuscitate preferences. c. The patient has a high risk for falls. d. The patient is at risk for seizures. ANS: B In 2008 the American Hospital Association issued an advisory recommending that hospitals standardize wristband colors: red for patient allergies, yellow for fall risk, and purple for do not resuscitate preferences. Purple does not indicate seizures. DIF: Understand (comprehension) REF: 390 OBJ: Define the knowledge, skills, and attitudes necessary to promote safety in a health care setting. TOP: Assessment MSC: Safety and Infection Control 9. A nurse reviews the history of a newly admitted patient. Which finding will alert the nurse that the patient is at risk for falls? a. 55 years old b. 20/20 vision c. Urinary continence d. Orthostatic hypotension ANS: D Numerous factors increase the risk of falls, including a history of falling, being age 65 or over, reduced vision, orthostatic hypotension, lower extremity weakness, gait and balance problems, urinary incontinence, improper use of walking aids, and the effects of various medications (e.g., anticonvulsants, hypnotics, sedatives, certain analgesics). DIF: Understand (comprehension) REF: 375 | 388 OBJ: Describe assessment activities designed to identify a patient’s physical, psychosocial, and cognitive status as it pertains to his or her safety. TOP: Assessment MSC: Safety and Infection Control 10. The nurse is assessing a patient for lead poisoning. Which patient is the nurse most likely assessing? a. Young infant b. Toddler c. Preschooler d. Adolescent ANS: B The incidence of lead poisoning is highest in late infancy and toddlerhood. Children at this stage explore the environment and, because of their increased level of oral activity, put objects in their mouths. Young infant is too young. A preschooler and an adolescent are too old. DIF: Understand (comprehension) REF: 375-376 OBJ: Discuss the specific risks to safety related to developmental age. TOP: Assessment MSC: Health Promotion and Maintenance does not consume alcohol, beer, or wine. Sleep is important no matter the age of the individual and is important for rest and integration of learning. DIF: Apply (application) REF: 376 | 387 OBJ: Discuss the specific risks to safety related to developmental age. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 14. The nurse is teaching a group of older adults at an assisted-living facility about age- related physiological changes affecting safety. Which question would be most important for the nurse to ask this group? a. “Are you able to hear the tornado sirens in your area?” b. “Are you able to read your favorite book?” c. “Are you able to taste spices like before?” d. “Are you able to open a jar of pickles?” ANS: A The ability to hear safety alerts and seek shelter is imperative to life safety. Decreased hearing acuity alters the ability to hear emergency vehicle sirens. Natural disasters such as floods, tsunamis, hurricanes, tornadoes, and wildfires are major causes of death and injury. Although age-related changes may cause a decrease in sight that affects reading, and although tasting is impaired and opening jars as arthritis sets in are important to patients and to those caring for them, being able to hear safety alerts is the most important. DIF: Apply (application) REF: 375 OBJ: Discuss the specific risks to safety related to developmental age. TOP: Assessment MSC: Health Promotion and Maintenance 15. The nurse is caring for a hospitalized patient. Which behavior alerts the nurse to consider the need for a restraint? a. The patient refuses to call for help to go to the bathroom. b. The patient continues to remove the nasogastric tube. c. The patient gets confused regarding the time at night. d. The patient does not sleep and continues to ask for items. ANS: B Patients who are confused, disoriented, and wander or repeatedly fall or try to remove medical devices (e.g., oxygen equipment, IV lines, or dressings) often require the temporary use of restraints to keep them safe. Restraints can be used to prevent interruption of therapy such as traction, IV infusions, NG tube feeding, or Foley catheterization. Refusing to call for help, although unsafe, is not a reason for restraint. Getting confused at night regarding the time or not sleeping and bothering the staff to ask for items is not a reason for restraint. DIF: Apply (application) REF: 391 OBJ: Describe assessment activities designed to identify a patient’s physical, psychosocial, and cognitive status as it pertains to his or her safety. TOP: Assessment MSC: Safety and Infection Control 16. The nurse is trying to use alternatives rather than restrain a patient. Which finding will cause the nurse to determine the alternative is working? a. The patient continues to get up from the chair at the nurses’ station. b. The patient gets restless when the sitter leaves for lunch. c. The patient folds three washcloths over and over. d. The patient apologizes for being “such a bother.” ANS: C Specific risks to a patient’s safety within the health care environment include falls, patient- inherent accidents, procedure-related accidents, and equipment- related accidents. Wet floors contribute to falls, pinching finger in door is patient inherent, failure to use the lift is procedure related, and an alarm not functioning properly is equipment related. Tile floors and carpeted or dirty floors do not necessarily contribute to falls. Cold food, ice machine empty, and hallways blocked are not patient-inherent issues in the hospital setting but are more of patient satisfaction, infection control, or fire safety issues. Scratchy linen, unlocked supply cabinet, and medication room locked are not procedure-related accidents. These are patient satisfaction issues and control of supply issues and are examples of actually following a procedure correctly. Noisy alarms, call light within reach, and alarms set are not equipment- related accidents but are examples of following a procedure correctly. DIF: Apply (application) REF: 379 OBJ: Describe the four categories of safety risks in a health care agency. TOP: Evaluation MSC: Safety and Infection Control 19. Which activity will cause the nurse to monitor for equipment-related accidents? a. Uses a patient-controlled analgesic pump b. Uses a computer-based documentation record c. Uses a measuring device that measures urine d. Uses a manual medication-dispensing device ANS: A Accidents that are equipment related result from the malfunction, disrepair, or misuse of equipment or from an electrical hazard. To avoid rapid infusion of IV fluids, all general-use and patient-controlled analgesic pumps need to have free-flow protection devices. Measuring devices used by the nurse to measure urine, computer documentation, and manual dispensing devices can break or malfunction but are not used directly on a patient and are considered procedure-related accidents. DIF: Understand (comprehension) REF: 379 OBJ: Describe the four categories of safety risks in a health care agency. TOP: Assessment MSC: Reduction of Risk Potential 20. A patient is admitted and is placed on fall precautions. The nurse teaches the patient and family about fall precautions. Which action will the nurse take? a. Check on the patient once a shift. b. Encourage visitors in the early evening. c. Place all four side rails in the “up” position. d. Keep the patient on fall risk until discharge. ANS: D A fall-reduction program includes a fall risk assessment of every patient, conducted on admission and routinely (see hospital policy) until a patient’s discharge. The timing of visitors would not affect falls. All four side rails are considered a restraint and can contribute to falling. Individuals on high risk for fall alerts should be checked frequently, at least every hour. DIF: Understand (comprehension) REF: 390-391 OBJ: Describe the four categories of safety risks in a health care agency. TOP: Implementation MSC: Safety and Infection Control 21. A nurse is inserting a urinary catheter. Which technique will the nurse use to prevent a procedure-related accident? a. Pathogenic asepsis b. Medical asepsis c. Surgical asepsis d. Clean asepsis ANS: C The potential for infection is reduced when surgical asepsis is used for sterile dressing changes or any invasive procedure such as insertion of a urinary catheter. Pathogenic and clean asepsis are not types of asepsis. Medical asepsis is not sterile. DIF: Understand (comprehension) REF: 379 OBJ: Discuss methods to reduce physical hazards and the transmission of pathogens. TOP: Implementation MSC: Safety and Infection Control 22. A nurse is providing care to a patient. Which action indicates the nurse is following the National Patient Safety Goals? a. Identifies patient with one identifier before transporting to x-ray department b. Initiates an intravenous (IV) catheter using clean technique on the first try c. Uses medication bar coding when administering medications d. Obtains vital signs to place on a surgical patient’s chart ANS: C One of the National Patient Safety Goals is to use medicines safely. For example, proper preparation and administration of medications, use of patient and medication bar coding, and “smart” intravenous (IV) pumps reduce medication errors. Identifying patients correctly is a national patient safety goal, and two identifiers are needed, not one. Another goal is to prevent infection; starting an IV should be a sterile technique, not a clean technique. While obtaining vital signs is a component of safe care, it does not meet a national patient safety goal. DIF: Apply (application) REF: 377 OBJ: Define the knowledge, skills, and attitudes necessary to promote safety in a health care setting. TOP: Implementation MSC: Safety and Infection Control restraint is removed. DIF: Apply (application) REF: 403 OBJ: Identify the factors to assess when a patient is in restraints. TOP: Implementation MSC: Safety and Infection Control 26. The emergency department has been notified of a potential bioterrorism attack. Which action by the nurse is priority? a. Monitor for specific symptoms. b. Manage all patients using standard precautions. c. Transport patients quickly and efficiently through the elevators. d. Prepare for post-traumatic stress associated with this bioterrorism attack. ANS: B Manage all patients with suspected or confirmed bioterrorism-related illnesses using standard precautions. For certain diseases, additional precautions may be necessary. The early signs of a bioterrorism-related illness often include nonspecific symptoms (e.g., nausea, vomiting, diarrhea, skin rash, fever, confusion) that may persist for several days before the onset of more severe disease. Limit the transport and movement of patients to movement that is essential for treatment and care. Psychosocial concerns (post-traumatic stress) are important but are not the first priority at this moment. DIF: Apply (application) REF: 381 | 394 OBJ: Discuss methods to reduce physical hazards and the transmission of pathogens. TOP: Implementation MSC: Safety and Infection Control 27. The patient is confused, is trying to get out of bed, and is pulling at the intravenous infusion tubing. Which nursing diagnosis will the nurse add to the care plan? a. Impaired home maintenance b. Deficient knowledge c. Risk for poisoning d. Risk for injury ANS: D The patient’s behaviors support the nursing diagnosis of Risk for injury. The patient is confused, is pulling at the intravenous line, and is trying to climb out of bed. Injury could result if the patient falls out of bed or begins to bleed from a pulled line. Nothing in the scenario indicates that this patient lacks knowledge or is at risk for poisoning. Nothing in the scenario refers to the patient’s home maintenance. DIF: Apply (application) REF: 381-382 OBJ: Identify relevant nursing diagnoses associated with risks to safety. TOP: Diagnosis MSC: Management of Care 28. A confused patient is restless and continues to try to remove the oxygen cannula and urinary catheter. What is the priority nursing diagnosis and intervention to implement for this patient? a. Risk for injury: Check on patient every 15 minutes. b. Risk for suffocation: Place “Oxygen in Use” sign on door. c. Disturbed body image: Encourage patient to express concerns about body. d. Deficient knowledge: Explain the purpose of oxygen therapy and the urinary catheter. ANS: A DIF: Apply (application) REF: 392 OBJ: Define the knowledge, skills, and attitudes necessary to promote safety in a health care setting. TOP: Implementation MSC: Safety and Infection Control 31. The nurse is providing information regarding safety and accidental poisoning to a grandparent who will be taking custody of a 1-year-old grandchild. Which comment by the grandparent will cause the nurse to intervene? a. “The number for poison control is 800-222-1222.” b. “Never induce vomiting if my grandchild drinks bleach.” c. “I should call 911 if my grandchild loses consciousness.” d. “If my grandchild eats a plant, I should provide syrup of ipecac.” ANS: D The administration of ipecac syrup or induction of vomiting is no longer recommended for routine home treatment of poisoning. The nurse must intervene to provide additional teaching. All the rest are correct and do not require follow up. The poison control number is 800-222- 1222. After a caustic substance such as bleach has been drunk, do not induce vomiting. This can cause further burning and injury as the substance is eliminated. Loss of consciousness associated with poisoning requires calling 911. DIF: Apply (application) REF: 390 OBJ: Describe nursing interventions specific to a patient’s age for reducing risks of falls, fires, poisonings, and electrical hazards. TOP: Teaching/Learning MSC: Health Promotion and Maintenance 32. A home health nurse is assessing a family’s home after the birth of an infant. A toddler also lives in the home. Which finding will cause the nurse to follow up? a. Plastic grocery bags are neatly stored under the counter. b. Electric outlets are covered in all rooms. c. No bumper pads are in the crib. d. Crib slats are 5 cm apart. ANS: A Plastic grocery bags increase the risk for suffocation. The nurse will follow up with instructions to remove or keep locked or out of reach. All the rest are correct and do not require follow-up. Electrical outlets should be covered to reduce electrical shock. Bumper pads are not used in the crib to prevent suffocation, strangulation, or entrapment. Crib slats should be less than 6 cm apart. DIF: Apply (application) REF: 385-386 OBJ: Discuss the specific risks to safety related to developmental age. TOP: Assessment MSC: Reduction of Risk Potential 33. Which patient will the nurse see first? a. A 56-year-old patient with oxygen with a lighter on the bedside table b. A 56-year-old patient with oxygen using an electric razor for grooming c. A 1-month-old infant looking at a shiny, round battery just out of arm’s reach d. A 1-month-old infant with a pacifier that has no string around the baby’s neck ANS: B The nurse will see the patient shaving with an electric razor first as this is an actual problem. Do not use oxygen around electrical equipment or flammable products. A lighter on the bedside table and a shiny, round battery are potential problems, not actual. Plus, it would be hard, almost impossible, for a 1 month old to actually grab the battery when it is out of arm’s reach. A baby should use a pacifier without strings. DIF: Analyze (analysis) REF: 387-388 OBJ: Describe environmental hazards that pose risks to a person’s safety. TOP: Assessment MSC: Management of Care 34. A home health nurse is teaching a family to prevent electrical shock. Which information will the nurse include in the teaching session? a. Run wires under the carpet. b. Disconnect items before cleaning. c. Grasp the cord when unplugging items. d. Use masking tape to secure cords to the floor. ANS: B A guideline to prevent electrical shock is to disconnect items before cleaning. Do not run wires under carpeting. Grasp the plug, not the cord, when unplugging items. Use electrical tape to secure the cord to the floor, preferably against baseboards. DIF: Understand (comprehension) REF: 389 OBJ: Describe nursing interventions specific to a patient’s age for reducing risks of falls, fires, poisonings, and electrical hazards. TOP: Teaching/Learning MSC: Reduction of Risk Potential 35. The nurse has placed a yellow armband on a 70-year-old patient. Which observation by the nurse will indicate the patient has an understanding of this action? a. The patient removes the armband to bathe. b. The patient wears the red nonslip footwear. c. The patient insists on taking a “water” pill in the evening. d. The patient who is allergic to penicillin asks the name of a new medicine. ANS: B A yellow armband is an alert for high risk of falls. Red nonslip footwear helps to grip the floor and decreases the chance of falling. The communication armband should stay in place and should not be removed, so that all members of the a. Water outdoor plants with a nozzle and hose. b. Walk to the mailbox in the summer. c. Encourage yearly eye examinations. d. Use bathtubs without safety strips. e. Keep pathways clutter free. ANS: B, C, E Walking to the mailbox in summer provides exercise when pathways are not icy and slick. Encourage annual vision and hearing examinations. Pathways that are clutter free reduce fall risk. Using a hose to water plants and using tubs without safety strips are all items the patient should avoid to help in the prevention of falls in the home. DIF: Apply (application) REF: 377 | 387 OBJ: Describe nursing interventions specific to a patient’s age for reducing risks of falls, fires, poisonings, and electrical hazards. TOP: Teaching/Learning MSC: Safety and Infection Control 3. A patient requires restraints after alternatives are not successful. The nurse is reviewing the orders. Which findings indicate to the nurse the order is legal and appropriate for safe care? (Select all that apply.) a. Health care provider orders restraints prn (as needed). b. Health care provider writes the type and location of the restraint. c. Health care provider renews orders for restraints every 24 hours. d. Health care provider performs a face-to-face assessment prior to the order. e. Health care provider specifies the duration and circumstances under which the restraint will be used. ANS: B, D, E A physician’s/health care provider’s order is required, based on a face-to-face assessment of the patient. The order must be current, state the type and location of restraint, and specify the duration and circumstances under which it will be used. These orders need to be renewed within a specific time frame according to the policy of the agency. In hospital settings each original restraint order and renewal is limited to 8 hours for adults, 2 hours for ages 9 through 17, and 1 hour for children under age 9. Restraints are not to be ordered prn (as needed). DIF: Understand (comprehension) REF: 391-392 OBJ: Identify the factors to assess when a patient is in restraints. TOP: Evaluation MSC: Management of Care 4. The nurse is performing the “Timed Get Up and Go (TUG)” assessment. Which actions will the nurse take? (Select all that apply.) a. Ranks a patient as high risk for falls after patients takes 18 seconds to complete b. Teaches patient to rise from straight back chair using arms for support c. Instructs the patient to walk 10 feet as quickly and safely as possible d. Observes for unsteadiness in patient’s gait e. Begins counting after the instructions f. Allows the patient a practice trial ANS: C, D, F The nurse instructs the patient to walk 10 feet (3 m) as quickly and safely as possible and observes for unsteadiness in the patient’s gait. For accuracy, a patient should have one practice trial that is not included in the score. Patient taking less than 20 seconds to complete TUG is adequate for independent mobility. Score over 30 seconds is dependent and at risk for fall. Counting does not begin after instructions. The patient rises from a straight back chair without using arms for support. cognitive status as it pertains to his or her safety. TOP: Assessment MSC: Safety and Infection Control 7. The nurse is caring for a group of medical-surgical patients. The unit has been notified of a fire on an adjacent wing of the hospital. The nurse quickly formulates a plan to keep the patients safe. Which actions will the nurse take? (Select all that apply.) a. Close all doors. b. Note evacuation routes. c. Note oxygen shut-offs. d. Move bedridden patients in their bed. e. Wait until the fire department arrives to act. f. Use type B fire extinguishers for electrical fires. ANS: A, B, C, D Closing all doors helps to contain smoke and fire. Noting the evacuation routes and oxygen shut-offs is important in case evacuation is needed. You will move bedridden patients from the scene of a fire by a stretcher, bed, or wheelchair. The nurse cannot wait until the fire department arrives to act. Type C fire extinguishers are used for electrical fires; type B is used for flammable liquids. DIF: Understand (comprehension) REF: 392-393 OBJ: Describe the knowledge, skills, and attitudes necessary to promote safety in a health care setting. TOP: Implementation MSC: Safety and Infection Control 8. The nurse is caring for a patient in restraints. Which essential information will the nurse document in the patient’s medical record to provide safe care? (Select all that apply.) a. One family member has gone to lunch. b. Patient is placed in bilateral wrist restraints at 0815. c. Bilateral radial pulses present, 2+, hands warm to touch d. Straps with quick-release buckle attached to bed side rails e. Attempts to distract the patient with television are unsuccessful. f. Released from restraints, active range-of-motion exercises completed ANS: B, C, E, F Proper documentation, including the behaviors that necessitated the application of restraints, the procedure used in restraining, the condition of the body part restrained (e.g., circulation to hand), and the evaluation of the patient response, is essential. Record nursing interventions, including restraint alternatives tried, in nurses’ notes. Record purpose for restraint, type and location of restraint used, time applied and discontinued, times restraint was released, and routine observations (e.g., skin color, pulses, sensation, vital signs, and behavior) in nurses’ notes and flow sheets. Straps are not attached to side rails. Comments about the activities of one family member are not necessarily required in nursing documentation of restraints. DIF: Apply (application) REF: 392 | 403 OBJ: Identify the factors to assess when a patient is in restraints. TOP: Communication and Documentation MSC: Safety and Infection Control