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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
- D. round battery just out of arm's reach
- E. A 1-month-old infant with a pacifier that has no string around the baby's neck
Correct Answer: B
Rationale: The nurse will see patient B first because using an electric razor near oxygen can lead to a fire hazard due to the presence of flammable gases. Patient A with a lighter poses a similar risk, but using an electric razor is more immediate. Patient C and D present no immediate danger. Patient E is safe as there is no strangulation risk with the pacifier. Prioritizing safety is crucial in patient care.
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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.
Correct Answer: D
Rationale: The correct answer is D. Using a nonvented furnace can lead to carbon monoxide poisoning, posing a significant safety risk. This choice stands out as it directly contradicts safety measures by using a potentially hazardous heating source. Choice A demonstrates awareness of changing carbon monoxide detector batteries timely. Choice B indicates proactivity in chimney maintenance. Choice C shows understanding of seeking help if necessary. Choices E, F, and G are irrelevant. In summary, choice D is the only one that poses a direct safety concern, making it the correct answer.
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
Correct Answer: B
Rationale: The correct answer is B: 65° to 75° F. This temperature range is ideal for a patient with respiratory issues experiencing shortness of breath. Lower temperatures can exacerbate breathing difficulties, while higher temperatures may cause discomfort. Maintaining a moderate temperature helps improve air quality and makes it easier for the patient to breathe. Choice A is too cold and could potentially worsen the patient's condition. Choices C and D are in Celsius and are not in the appropriate range for comfort.
A home health nurse is assessing the home for fire safety. Which information from the family will cause the nurse to intervene? (Select all that apply.)
- A. Smoking in bed helps me relax and fall asleep.
- B. We never leave candles burning when we are gone.
- C. We use the same space heater my grandparents used.
- D. We use the RACE method when using the fire extinguisher.
- E. There is a fire extinguisher in the kitchen and garage workshop.
Correct Answer: A,C,D
Rationale: Correct Answer: A, C, D
Rationale:
A: Smoking in bed is a significant fire hazard as it can lead to accidental fires if the individual falls asleep without extinguishing the cigarette. Intervening is crucial to prevent potential disasters.
C: Using an old space heater may pose a safety risk due to outdated technology and potential malfunctions, making it unsafe to use. Intervening is necessary to ensure the safety of the family.
D: Using the RACE method (Rescue, Alarm, Contain, Extinguish) during a fire emergency is important for effective response. Confirming that the family is aware of this method ensures proper handling of fire situations.
Summary:
B: Leaving candles burning unsupervised is a safety concern, but the family's practice of not doing so mitigates the risk.
E: Having fire extinguishers in accessible locations is a good practice for fire safety, indicating preparedness and prevention.
Overall, choices A, C, and D require
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
Correct Answer: D
Rationale: The correct answer is D because it includes examples of safety risks that directly impact patient well-being. Wet floors unmarked can lead to slips and falls. Patient pinching fingers in the door is a physical hazard. Failure to use a lift for a patient can cause injury to both the patient and staff. Alarms not functioning properly can delay response to emergencies.
Explanation for other choices:
A: Tile floors, cold food, scratchy linen, and noisy alarms are not direct safety risks that pose immediate harm to patients.
B: Dirty floors, blocked hallways, and alarms set are not specific examples of patient safety risks.
C: Carpeted floors, ice machine empty, and call light in reach are not significant safety risks compared to the examples in choice D.
A patient may need restraints. Which task can the nurse delegate to a nursing assistive personnel?
- A. Determining the need for restraints
- B. Assessing the patient's orientation
- C. Obtaining an order for a restraint
- D. Applying the restraint
Correct Answer: D
Rationale: The correct answer is D: Applying the restraint. The rationale is that nursing assistive personnel can perform tasks that involve direct patient care under the supervision of a nurse. Applying restraints is a task that involves following specific guidelines and does not require critical thinking or decision-making skills. Tasks A, B, and C involve assessing, determining the need, and obtaining orders for restraints, which require nursing judgment and cannot be delegated to nursing assistive personnel. Other choices are left blank as they are not relevant to the question.