How is the information documented on incident reports used?
- A. to analyze risk categories
- B. to make sure procedures are in compliance with regulations
- C. to identify the educational needs of the staff
- D. all of the above
Correct Answer: D
Rationale: Risk management utilizes information from incident reports to perform all of the tasks identified.
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A nurse is returning phone calls in a pediatric clinic. Which of the following reports most requires the nurse's immediate attention and phone call?
- A. An untoward, adverse drug reaction associated with the quinolones is tendon rupture.
- B. Electrolyte imbalance has not been associated with the group, and antibiotic-associated colitis is most common in augmentin and penicillin groups.
- C. A 7 year-old boy has been having a low fever and headache for the past 3 days that has history of an anterior knee wound.
- D. A 7 year-old girl that had a cast on her right ankle is complaining of itching.
Correct Answer: B
Rationale: An untoward, adverse drug reaction associated with the quinolones is tendon rupture. Electrolyte imbalance has not been associated with the group, and antibiotic-associated colitis is most common in augmentin and penicillin groups.
A nurse from the maternity unit is floated to the critical care unit because of staff shortage on the evening shift. Which client would be appropriate to assign to this nurse? A client with
- A. a Dopamine drip IV with vital signs monitored every 5 minutes
- B. a myocardial infarction that is free from pain and dysrhythmias
- C. a tracheotomy of 24 hours in some respiratory distress
- D. a pacemaker inserted this morning with intermittent capture
Correct Answer: B
Rationale: This client is the most stable with minimal risk of complications or instability. The nurse can utilize basic nursing skills to care for this client, making it suitable for a nurse from another unit.
The nurse is demonstrating the use of a fire extinguisher during a fire drill. Place the steps for using a fire extinguisher in the correct order.
- A. Squeeze the handle
- B. Sweep from side to side
- C. Pull the pin
- D. Aim at the base of the fire
Correct Answer: C,D,A,B
Rationale: The PASS technique is: Pull the pin (C), Aim at the base (D), Squeeze the handle (A), Sweep side to side (B).
The new NA is caring for the client who is at risk for a fall. Which statement by the nurse to the new NA is most important?
- A. "Remind the client to call for assistance before getting out of bed."
- B. "Clip the call light to the bedcovers so the client can find it easily."
- C. "Be sure the bed is in the lowest position when you leave the room."
- D. "Check that you have all four side rails up after you provide care."
Correct Answer: C
Rationale: Ensuring the bed is in the lowest position is critical to minimize injury from a fall, which poses a greater risk than other options. Four side rails (D) are considered a restraint and should be avoided.
Which statement by the nurse is appropriate when directing an unlicensed assistive personnel (UAP) to assist a 69 year-old surgical client to ambulate for the first time?
- A. Have the client sit on the side of the bed for at least 2 minutes before helping him stand.
- B. If the client is dizzy on standing, ask him to take some deep breaths.
- C. Assist the client to the bathroom at least twice on this shift.
- D. After you assist him to the chair, let me know how he feels.
Correct Answer: A
Rationale: Give clear information to the UAP about what is expected for client safety. This instruction ensures the client is assessed for orthostatic hypotension before ambulating, reducing the risk of falls.