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1. A nurse reviews the history of a newly admitted patient. Which finding will
alert the nurse that the patient is at risk for falls?
18/20 vision
Continence of bowel and bladder
67 years old
Orthostatic hypotension
2. Why is it important for a nurse to notify the health care provider after a
patient falls?
Notifying the health care provider ensures that the patient receives
appropriate medical evaluation and intervention.
It helps the nurse to shift responsibility for the incident.
It is a requirement for all incidents regardless of severity.
It allows the nurse to avoid completing paperwork.
3. What is the first step a nurse should take when a patient exhibits sudden
confusion?
Call the health care provider for a restraint order.
Assess the patient.
Gather restraint supplies.
Try alternatives to restraint.
,4. What type of device requires the nurse to monitor for equipment-related
accidents?
Patient-controlled analgesic pump
Computer-based documentation record
Manual medication-dispensing device
Measuring device for urine
5. In a scenario where a nurse discovers a surgical sponge left in a patient's
incision post-operation, what immediate action should the nurse take?
Inform the patient and allow them to decide the next steps.
Document the finding and wait for the surgeon to return.
Report the incident according to hospital policy and ensure the
patient is assessed for any complications.
Remove the sponge without notifying anyone.
6. Describe how medication bar coding contributes to patient safety in nursing
practice.
Medication bar coding helps prevent medication errors by ensuring
the right patient receives the right medication.
Medication bar coding is a method for tracking patient vitals.
Medication bar coding is primarily used for inventory management in
pharmacies.
Medication bar coding is only relevant in surgical settings.
7. If a nurse finds a patient who has fallen and is unresponsive, what should the
nurse do immediately after notifying the health care provider?
, Complete an incident report before assessing.
Perform a quick assessment of the patient's condition.
Leave the patient to wait for help.
Call for additional staff without assessing.
8. If a patient insists on using a nonvented furnace during winter, what should
the nurse recommend to ensure safety?
Use the furnace only when someone is home.
Install a carbon monoxide detector and ensure proper ventilation.
Switch to a wood-burning stove instead.
Limit the use of the heater to daytime hours.
9. In a scenario where a patient is at high risk for falls, how might a nurse
implement walking as a safety measure?
Encourage the patient to walk alone without supervision.
Limit the patient's mobility to prevent falls.
Advise the patient to avoid walking altogether.
Develop a structured walking program tailored to the patient's
abilities.
10. Why is it important for a nurse to assess a patient before taking further action
when they become confused?
Assessing the patient is unnecessary if they are trying to remove an
IV.
Assessing the patient delays necessary interventions.
Assessing the patient is only needed after restraints are applied.
, Assessing the patient helps determine the cause of confusion and
appropriate interventions.
11. A nurse is preparing to place a urinary catheter prior to surgery into a client.
Which technique is appropriate for the procedure?
Clean technique
Surgical asepsis
Medical asepsis
Disinfection
12. What is the priority concern that requires collaboration with social services
for the patient in the scenario?
This home is not furnished with a microwave oven.
The water comes from the county water supply.
The electricity was turned off 3 days ago.
A son and family recently moved into the home.
13. A nurse is discussing home safety with a patient. Which statement indicates
that the patient has a lack of safety awareness?
"I use my walker every time I get out of bed".
"I have stopped smoking cigars".
"I need to change positions slowly when getting up".
"I should have multiple throw rugs in my home".
14. A newly admitted patient has a purple wristband on. What is your primary
concern with the patient?
Fall risk