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QUESTIONS: Safe and Effective Care Environment2

1.    Which of the following ethnic groups is at higher risk for pesticide-related injury?

a.    Native American

b.    Asian-Pacific

c.    Norwegian

d.    Hispanic

2.    Nurse Helena will teach parents of small children that the most common type of first-degree burn is:

a.    scalding from hot bath water or spills

b.    contact with hot surfaces such as stoves, fireplaces

c.    contact with flammable liquids and/or gases resulting in flash burns

d.    sunburn from lack of protection and overexposure

3.    Nurse George will teach the community-based client that the most common cause of injury from a house fire is:

a.    Explosion

b.    falls from second-story windows

c.    thermal damage to skin and body surfaces

d.    inhalation thermal injury

4.    Acute hyphema is associated with what type of injury?

a.    Orthopedic

b.    Eye

c.    insect sting or snakebite

d.    gynecological trauma

5.    The patient has sustained a hyphema, what intervention should nurse Adrian take?

a.    Have client wear ear protectors in the future

b.    Keep the client at bed rest typically with head of bed up

c.    Apply atropine eye drops

d.    Apply an ice pack to the site of injury

6.    Nurse Hyacnth first action upon discovery of an electrical fire is which of the following?

a.    Disconnect the electrical power if this can be done safely

b.    Smother the source with an object such as a blanket

c.    Saturate the source with water or other liquid readily available

d.    Activate the fire alarm immediately

7.    How many feet should separate nurse Gabriel and the source when extinguishing a small, waste basket fire with an appropriate extinguisher?

a.    1 foot

b.    2 feet

c.    4 feet

d.    6 feet

8.    While repositioning a comatose client, nurse Alexandra senses a tingling sensation as she lowers the bed. What action should she take?

a.    Unplug the bed’s power source

b.    Remove the client from the bed immediately

c.    Notify the biomedical department at once

d.    Turn off the oxygen

9.    After securing the client’s safety from a faulty grounded electric bed, nurse Irina will take which action?

a.    Discuss the matter with the client’s significant others

b.    Document the incident in the client’s record in detail

c.    Notify the physician

d.    Prepare an incident report

10.    Nurse Isabela is documenting a H-E-A-D-D-S-S inventory on the client. In which age group does the client fit?

a.    Preschool

b.    middle childhood

c.    adolescence

d.    college age

11.    One afternoon, an adult male with no history of past medical conditions arrives by ambulance in cardiac arrest after being discovered unconscious in his backyard. Nurse John notes his skin to be warm and moist to touch, diffusely swollen with multiple punctate lesions of the lower extremities. A likely cause of the emergency is:

a.    pulmonary embolus

b.    head trauma

c.    envenomation

d.    myocardial infarction

12.    To ensure patient safety when making an occupied bed, nurse Joseph will place the side rails in which of the following positions?

a.    both side rails in the lowered position

b.    the side rail opposite the nurse’s working area in the lowered position

c.    both side rails in the raised position

d.    the side rail opposite the nurse’s working area in the raised position

13.    Which of the following indicators increases the elderly client’s risk for falls?

a.    cranial nerve five dysfunction

b.    negative orthostatic vital signs

c.    negative Romberg’s sign

d.    diagnosis of urinary tract infection

14.    Which of the following risk factors is significant for predicting domestic violence in the adult population?

a.    married individuals

b.    lower socioeconomic status

c.    history of domestic violence in childhood

d.    no professional education or vocational training

15.    While assessing a Vietnamese child in the emergency department, the nurse notes erythematous, linear markings on the torso. As the caregiver explains how she put them there to treat fever, nurse Joanna suspects:

a.    Cupping

b.    Coining

c.    accidental trauma or child abuse

d.    chelation

16.    During a well infant check-up, the RN notes ecchymotic, bluish markings across the buttocks and sacral region of a dark-skinned infant. The markings most likely represent what skin condition?

a.    child abuse pattern injury or soft tissue trauma

b.    petechiae

c.    Mongolian spots

d.    Koplik’s spots

17.    During a well infant check-up, the RN notes a religious amulet around the client’s neck. What is the best response to the caregiver?

a.    Can you tell me about the necklace?

b.    This is a choking hazard

c.    Let me get this off

d.    Why did you put this around the baby’s neck?

18.    The RN is developing a community accident prevention program related to older adult premature death. Which of the following topics will be presented?

a.    Drowning

b.    Burns

c.    Influenza

d.    Motor vehicle accidents

19.    Nurse Julian instructing a new parent on the proper positioning of the infant car seat will explain that the infant or child may be positioned forward facing in an automobile at what weight?

a.    6 kg (12 lbs)

b.    7.5 kg (15 lbs)

c.    9 kg (20 lbs)

d.    10 kg (22 lbs)

20.    A lifeless child is brought unconscious to ER with resuscitative efforts in progress. In considering the etiology of childhood deaths, which of the following is the most likely cause?

a.    Poisoning

b.    congenital defects

c.    accidents

d.    influenza

21.    Community accident prevention education will include which of the following facts regarding the most prevalent cause of accidental death from age 1-44?

a.    Drowning

b.    Burns

c.    motor vehicle accidents

d.    Firearms

22.    Nurse Justin providing safety instruction to a local daycare explains that the leading cause of death for preschool children is:

a.    Drowning

b.    Burns

c.    Falls

d.    Motor vehicle accidents

23.    Nurse Camille teaching a parenting class instructs that the hot water temperature in the home should be at what degree to prevent thermal burns?

a.    100ºF

b.    120ºF

c.    140ºF

d.    150ºF

24.    Which of the following is the leading cause of accidental injury in the elderly?

a.    Falls

b.    motor-vehicle accidents

c.    firearm related trauma

d.    unintentional overdose

25.    While eating in the hospital cafeteria, nurse Carol sees a visitor display the “universal sign of choking.” Her first action is:

a.    page a “Code Blue” emergency

b.    immediately perform the Heimlich maneuver

c.    assess for ineffective breathing by asking, “Are you choking

d.    deliver four sharp back blows between the scapulae

ANSWERS: Safe and Effective Care Environment2

1.    Answer D. Because of the predilection toward outside and agricultural jobs, migrant workers, made up mostly of Hispanic people, this group is at higher risk for exposure.

2.    Answer D. The most common type of first-degree burn is sunburn underscoring the need for education regarding the use of sunscreens and avoiding exposure.

3.    Answer D.  Inhalation thermal injury is associated with significant morbidity and mortality. Manifestations might not show up until 24 hours post exposure.

4.    Answer B. An acute hyphema occurs as a result of a blunt injury to the eye and is manifested by a horizontal line of demarcation across the globe when the patient is upright. The manifestation occurs due to blood collected in the anterior chamber.

5.    Answer B. Initial care of the patient involves preventing further damage and rebleeding. Patients are kept at bed rest if possible and usually with the head of bed raised. TV watching is permitted but not reading. The use of atropine, ice, and eye shields are controversial, and a nurse would not prescribe a pharmacologic agent or thermal therapy although the nurse may administer a physician’s or a nurse practitioner’s order.

6.    Answer A. If safe to do so, the nurse should disconnect electrical devices from the power source. Smothering with a blanket is not indicated in an electrical fire and might serve to fuel the fire just as water or other liquids may incite an explosion or flames. The fire alarm should be activated promptly and would be the next action after disconnecting the electrical powered equipment.

7.    Answer D. The nurse should stand about 6 feet from the source of the fire. Getting much closer might put the nurse in danger.

8.    Answer A. Shutting off the bed’s electricity should be the initial step. The nurse should not touch the client until the bed is checked for faulty grounding. An electrician should assess the equipment. Oxygen should be discontinued until the equipment is cleared.

9.    Answer D. When the situation is safe for the client, the nurse should record the occurrence on an incident form according to the agency protocol.

10.    Answer C. The HEADDSS (home, education, activities, drugs, driving, sex, suicide) assessment acronym applies primarily to adolescents, although it might be used in the middle-childhood and college-age categories if deemed appropriate.

11.    Answer C. Hymenoptera (bees, wasps, ants) envenomation can cause local and systemic allergic reactions including anaphylaxis, shock, and cardiac arrest. The history of being found outdoors suggest the possibility of an insect or viper bite(s).

12.    Answer D. Placing the side rail up on the side opposite the nurse will prevent the patient from falling. While raising both side rails would also prevent a fall, the nurse would place the client and herself at greater risk for injury by attempting to work over a raised side rail.

13.    Answer D. Urinary tract infections in the elderly are associated with sensorium changes that increases the risk of falls. Canial nerve eight (not five) dysfunction would indicate equilibrium changes as a positive Romberg sign and orthostatic vital signs.

14.    Answer C. Domestic violence strikes all social and educational strata and includes dating and intimate partner violence. The strongest predictor of adult domestic violence is a history of observing or being victimized in childhood.

15.    Answer B. Certain Asian groups practice the technique of coining, rubbing the skin vigorously with a coin until a red mark occurs. Cupping is treatment for arthritis practiced in some cultures. Coining may be mistaken for child abuse if cultural practice is not assessed. Chelation is a medical technique of removing iron and heavy metals from the body in poisoning.

16.    Answer C. Mongolian spots are a normal skin variation often seen in dark-skinned newborns and infants. Petechiae is a red, punctate lesion associated with capillary breakage while Koplik’s spots are associated with strep and found in the pharynx.

17.    Answer A. Asking about the significance of the amulet in a nonthreatening manner is the first step in conveying respect for the client’s religion/culture. Immediately passing judgment and instructing against the use of the necklace rejects the individuality of the client and their ethnic diversity. Asking why as the initial response does not convey acceptance and might impair communication and incite client defensiveness.

18.    Answer D. Motor vehicle accidents pose the greatest risk for death of the listed options. Burns and drownings are much less frequent in the older adult, although they can occur, and influenza is a medical illness.

19.    Answer C. Positioning of the car seat is based on body weight and age. At 20 lbs (9 kg), the infant or child 12 months or oldermay be placed in a forward-facing child seat.

20.    Answer C. Accidents (particularly motor vehicle) are the leading cause of death for all age groups from toddlerhood to adulthood. Poisoning while significant for this age group, is not as prevalent. Deaths from congenital defects occur most often in the neonatal and infancy stages. Influenza deaths, while possible, are much more uncommon in children. In assessing a patient in a critical illness or injury situation, the nurse brings her knowledge of age-specific causes of death.

21.    Answer C. Accidents are the number one cause of death for ages 1-44 with motor vehicle accidents accounting for the majority, while congenital conditions and medical illnesses claim the youngest and the oldest.

22.    Answer D. Motor vehicle accidents are the leading cause of death for all races and both sexes in the 1-44 year old age group.

23.    Answer C. To prevent thermal burns and scalding, hot water thermostats should be set at 120 or less. Adult skin can tolerate temperatures somewhat higher (that is, 140 or less). The class here involved parents of children.

24.    Answer A. Falls in the elderly are the leading cause of accidental injury and are associated with a large number of nursing home and hospital admissions. The other choices are possible causes but are much less common in the age group.

25.    Answer C. The nurse’s first response is to assess that the person is actually choking and then rapidly proceed to intervene using the Heimlich. Back blows are not indicated in adults with obstructed airways and might actually create a complete obstruction by dislodging a foreign body that was only partially blocking the airway.

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