FUNDAMENTA MSN5320 Chapter 27: Patient Safety and Quality Potter et al.: Fundamentals of Nursing, 9th Edition

FUNDAMENTA MSN5320 Chapter 27: Patient Safety and Quality Potter et al.: Fundamentals of Nursing, 9th Edition Chapter 27: 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 3. The patient has been diagnosed with a respiratory illness and reports shortness of breath. The nurse adjusts the temperature to facilitate the comfort of the patient. At which temperature range will the nurse set the thermostat? a. 60° to 64° F b. 65° to 75° F c. 15° to 17° C d. 25° to 28° C ANS: B A person’s comfort zone is usually between 18.3° and 23.9° C (65° and 75° F). The other ranges are too low or too high and do not reflect the average person’s comfort zone. DIF: Understand (comprehension) REF: 374 OBJ: Describe environmental hazards that pose risks to a person’s safety. TOP: Implementation MSC: Basic Care and Comfort 4. A homeless adult patient presents to the emergency department. The nurse obtains the following vital signs: temperature 94.8° F, blood pressure 106/56, apical pulse 58, and respiratory rate 12. Which vital sign should the nurse address immediately? a. Respiratory rate b. Temperature c. Apical pulse d. Blood pressure ANS: B The temperature indicates the patient is experiencing hypothermia. Homeless individuals are more at risk for hypothermia. While all the vital signs are low, the most critical vital sign at this time is the temperature. DIF: Analyze (analysis) REF: 374 OBJ: Describe environmental hazards that pose risks to a person’s safety. TOP: Assessment MSC: Reduction of Risk Potential 5. A nurse is teaching the patient and family about wound care. Which technique will the nurse teach to best prevent transmission of pathogens? a. Wash hands b. Wash wound c. Wear gloves d. Wear eye protection ANS: A One of the most effective methods for limiting the transmission of pathogens is the medically aseptic practice of hand hygiene. The most common means of transmission of pathogens is by the hands. While washing the wound is needed, the best method to prevent transmission is hand hygiene. Wearing gloves and possibly eye protection help protect the nurse, but handwashing is best for limiting the transmission of pathogens. DIF: Understand (comprehension) REF: 375 OBJ: Discuss methods to reduce physical hazards and the transmission of pathogens. 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 11. A nurse is teaching a community group of school-aged parents about safety. Which safety item is most important for the nurse to include in the teaching session? a. Proper fit of a bicycle helmet b. Proper fit of soccer shin guards c. Proper fit of swimming goggles d. Proper fit of baseball sliding shorts ANS: A