CHAPTER 27: PATIENT SAFETY AND
QUALITY (TESTBANK) CLINICAL
SKILLS EXAM QUESTIONS AND
ANSWERS
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. - Answer-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
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." - Answer-ANS: C
Restraint alternatives include more frequent observations, social interaction such as
involvement of family during visitation, frequent reorientation, regular exercise, and
the introduction of familiar and meaningful stimuli (e.g., involve in hobbies such as
knitting or crocheting or looking at family photos) within the environment or folding
washcloths. Getting up constantly can be cause for concern. Apologizing is not an
alternative to restraints. Getting restless when the sitter leaves indicates the
alternative is not working.
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: Evaluation
MSC: Safety and Infection Control
The nurse is caring for a patient who suddenly becomes confused and tries to
remove an intravenous (IV) infusion. Which priority action will the nurse take?
a.
Assess the patient.
b.
Gather restraint supplies.
c.
Try alternatives to restraint.
d.
Call the health care provider for a restraint order. - Answer-ANS: A
When a patient becomes suddenly confused, the priority is to assess the patient, to
identify the reason for change in behavior, and to try to eliminate the cause. If
,interventions and alternatives are exhausted, the nurse working with the health care
provider may determine the need for restraints.
DIF:Apply (application)REF:380 | 403
OBJ: Describe assessment activities designed to identify a patient's physical,
psychosocial, and cognitive status as it pertains to his or her safety. TOP:
Implementation
MSC: Reduction of Risk Potential
18. The nurse is monitoring for the four categories of risk that have been identified in
the health care environment. Which examples will alert the nurse that these safety
risks are occurring?
a.
Tile floors, cold food, scratchy linen, and noisy alarms
b.
Dirty floors, hallways blocked, medication room locked, and alarms set
c.
Carpeted floors, ice machine empty, unlocked supply cabinet, and call light in reach
d.
Wet floors unmarked, patient pinching fingers in door, failure to use lift for patient,
and alarms not functioning properly - Answer-ANS: D
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 - Answer-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.
QUALITY (TESTBANK) CLINICAL
SKILLS EXAM QUESTIONS AND
ANSWERS
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. - Answer-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
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." - Answer-ANS: C
Restraint alternatives include more frequent observations, social interaction such as
involvement of family during visitation, frequent reorientation, regular exercise, and
the introduction of familiar and meaningful stimuli (e.g., involve in hobbies such as
knitting or crocheting or looking at family photos) within the environment or folding
washcloths. Getting up constantly can be cause for concern. Apologizing is not an
alternative to restraints. Getting restless when the sitter leaves indicates the
alternative is not working.
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: Evaluation
MSC: Safety and Infection Control
The nurse is caring for a patient who suddenly becomes confused and tries to
remove an intravenous (IV) infusion. Which priority action will the nurse take?
a.
Assess the patient.
b.
Gather restraint supplies.
c.
Try alternatives to restraint.
d.
Call the health care provider for a restraint order. - Answer-ANS: A
When a patient becomes suddenly confused, the priority is to assess the patient, to
identify the reason for change in behavior, and to try to eliminate the cause. If
,interventions and alternatives are exhausted, the nurse working with the health care
provider may determine the need for restraints.
DIF:Apply (application)REF:380 | 403
OBJ: Describe assessment activities designed to identify a patient's physical,
psychosocial, and cognitive status as it pertains to his or her safety. TOP:
Implementation
MSC: Reduction of Risk Potential
18. The nurse is monitoring for the four categories of risk that have been identified in
the health care environment. Which examples will alert the nurse that these safety
risks are occurring?
a.
Tile floors, cold food, scratchy linen, and noisy alarms
b.
Dirty floors, hallways blocked, medication room locked, and alarms set
c.
Carpeted floors, ice machine empty, unlocked supply cabinet, and call light in reach
d.
Wet floors unmarked, patient pinching fingers in door, failure to use lift for patient,
and alarms not functioning properly - Answer-ANS: D
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 - Answer-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.
