A night shift nurse has a patient who is confused and withdrawing from alcohol. He is currently in 4 point restraints after attempting to attack one of the nurses.
What is the most appropriate action for the nurse to take during his shift?
A. Release the leg restraints to give the patient a break and see if combative behavior has gotten better.
B. Have the attending physician discontinue the restraints to give the patient a chance to behave more appropriately.
C. Assess the patient's skin integrity around the restraints hourly.
D. Ensure the physician has renewed the order for restraints, as this should be done every 12 hours.
A gunshot wound victim has been brought to your unit. He has chosen to be marked as confidential due to safety concerns.
Which of these actions would be inappropriate for you to do as the nurse?
A. Tell the patient's mother he is okay when she calls to ask about him being on the unit.
B. Keep the patient's name/information out of public areas such as the nurses' station.
C. Remove the patient from confidential status when he asks to be removed.
D. Deny that the patient is on the unit when visitors come or call.
When caring for a patient with known IV drug use, which statement should the nurse discuss to highlight the risk factors of this behavior?
A. The use of these drugs can increase the risk of contracting diseases due to immunosuppression.
B. The risk of contracting and/or spreading blood borne pathogens such as HIV, which can progress to AIDS, is a huge risk factor with this activity.
C. Drug use can lead to unsafe sex practices, increasing the risk of the transmission of sexually transmitted diseases.
D. IV drug use can lead to skin infections at the injection sites and poor health.
A nurse is in the operating room where x-rays are being taken during the procedure.
What is the best way to use this equipment safely?
A. Ensure the equipment being used to take x-rays has sterile drapes and covers on it to prevent contamination of the sterile field.
B. Have a lead apron and thyroid shield on when being exposed to active radiation, such as x-rays.
C. Make sure the patient does not have any metal in their body which could cause the machine to malfunction.
D. Ensure the time out has been done prior to any x-ray imaging being taken.
Which of these patients could most safely share a room?
A. a 30-year-old patient positive for the flu and a 75-year-old patient positive for MRSA infection
B. a patient positive for C. Difficile and an elderly patient who is suspected to have a C. Difficile infection
C. a 28-year-old male with blood-tinged sputum and night sweats and an 18-year-old male with the flu
D. an elderly woman with Hepatitis A and a 50-year-old woman with the measles
A patient comes into the Emergency Department with symptoms of chest tightness, difficulty breathing, blood tinged purulent sputum, and night sweats.
What is the best action for the nurse to take?
A. Review admission criteria, cohort patient with a patient positive for the flu, and draw blood for full work up blood panel.
B. Get the patient in a negative air pressure room and alert the attending of active tuberculosis
C. Arrange for a chest x-ray and private room, then wait for results.
D. Implement airborne precautions, arrange for a chest x-ray of the patient, and get the patient to negative air pressure, private room.
The nurse is educating adult patients on safety and injury prevention.
Which statement would be inaccurate?
A. "Using your safety belt when driving or riding the car prevents injury in the event of an accident."
B. "Working fire extinguishers and smoke alarms are extremely important to have in the home."
C. "Having taken a gun safety class to learn the basics and following those guidelines decreases the chances of injury."
D. "Use condoms when implementing birth control."
New parents ask their newborn's neonatal nurse about safety tips for their home with their new baby.
Which statement by the nurse is most appropriate?
A. "Have a blanket and a bumper in the crib for warmth and injury prevention."
B. "Keep all stuffed animals, pillows, blankets, bumpers, etc. out of the crib."
C. "Mattresses should be tight-fitting and crib bars should have at least 3 inches of space between each bar."
D. "Do not smoke in the baby's room. Other rooms are okay as long as the baby isn't in them."
Which of these scenarios would be incorrect when practicing aseptic technique?
A. Apply sterile gloves by touching the inside only when applying both gloves.
B. If anything on the sterile field is contaminated, dispose of everything and start over.
C. Do not touch the sterile field unless only touching 1 inch or less of the edges.
D. Open sterile supplies or instrument away from your body to make sure contamination does not occur.
Which statement would be the most accurate in safety education for injury prevention in the home of elderly adults?
A. Use the handrail when going up and down the stairs, ensure robes or pants are held up if flowy, and wear comfortable, non-skid footwear.
B. Use solid chairs without armrests, remove anything in walkways, and use cordless phones.
C. Have raised toilet seats, ensure all throw rugs have gripping material on the floor side, and use grab bars in the shower/bathroom.
D. Remove all throw rugs, remove furniture from all pathways, and wear comfortable, non-skid footwear.
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