Chapter 04: Patient Safety and Quality Improvement

Question 1

The nurse is caring for an older patient who has a non–weight-bearing cast on the left lower
extremity. The patient ambulates without using a walker despite repeated instruction from the
nurse to call for assistance. Which response by the nurse is most likely to keep the patient
from falling?
a. Apply a vest restraint and offer frequent toileting.
b. Plan fall prevention with patient, family, and health care provider.
c. Inform family that the patient needs physical restraints.
d. Document that the patient has a high potential for falling.

Answer 1

b. Plan fall prevention with patient, family, and health care provider.

Question 2

The nurse plans a fall prevention program for a confused patient. Which task from the
program is suitable for the nurse to delegate to nursing assistive personnel (NAP)?
a. Evaluating patient understanding of fall prevention plan
b. Keeping the patient’s bed in the low position at all times
c. Assessing the patient’s circulatory and respiratory status
d. Instructing the patient’s family about alternatives to restraints

Answer 2

b. Keeping the patient’s bed in the low position at all times

Question 3

The nurse plans care for a patient who requires physical restraint. Which is a suitable goal for
this patient?
a. The patient remains free of any injury.
b. The nurse checks the restraint every hour.
c. The nurse uses the least restrictive restraint.
d. The patient allows the nurse to apply restraints.

Answer 3

a. The patient remains free of any injury.

Question 4

The nurse applies a physical restraint to the patient. Which entry should the nurse make after
applying the restraint?
a. Performed restraint application reluctantly
b. Applied bilateral soft lamb’s wool wrist restraints; skin pink, moist, and intact
c. Will perform a neurovascular assessment every 4 hours
d. Checked provider’s prescription for prn restraints

Answer 4

b. Applied bilateral soft lamb’s wool wrist restraints; skin pink, moist, and intact

Question 5

The patient sustains a minor leg abrasion and stops breathing for a few seconds during a
tonic-clonic seizure. Which is the best nursing documentation after the patient’s seizure?
a. Type of muscle contractions
b. Size and description of the abrasion
c. Length of the patient’s apneic episode
d. Description of the seizure in detail

Answer 5

d. Description of the seizure in detail

Question 6

A patient at risk for falling is being ambulated. Which action by the nurse is most important to
prevent the patient from falling?
a. Raising the bed to an appropriate working height
b. Placing nonskid shoes on the patient
c. Dangling the patient on the side of the bed for 10 minutes
d. Turning on the brightest lights in the room

Answer 6

b. Placing nonskid shoes on the patient

Question 7

The nurse is orienting a group of new nurses and explaining the concept of sentinel events and
their causes. What should the nurse explain as a common root cause of all sentinel event?
a. Medication errors
b. Falls
c. Communication failures
d. High patient-to-nurse ratios

Answer 7

c. Communication failures

Question 8

The nurse discovers smoke in the second-floor utility room. What intervention should he or
she implement first?
a. Find the fire extinguisher and try to extinguish the fire.
b. Evacuate the entire second floor to the first-floor lobby.
c. Rescue any patients, visitors, or staff in immediate danger.
d. Pull the nearest alarm box and call the telephone operator.

Answer 8

c. Rescue any patients, visitors, or staff in immediate danger.

Question 9

The daughter of a patient tells the nurse that using the bathroom is embarrassing for the
patient and she refuses to use a nurse call system when she needs to get up. Which is the best
response by the nurse?

a. Ask the patient why she does not use the nurse call system.
b. Instruct the daughter to remain at the patient’s side.
c. Tell the patient that getting up requires cooperation.
d. Discuss nurse call system alternatives with patient and daughter

Answer 9

d. Discuss nurse call system alternatives with patient and daughter

Question 10

Although the interdisciplinary team is responsible for the safety of the patient, who has the
ultimate responsibility for making the patient’s bedside area safe?
a. The nurse
b. Housekeeping
c. Nursing assistive personnel (NAP)
d. The maintenance department

Answer 10

a. The nurse

Question 11

The nurse listens to a family’s request to bring a few familiar items into the room of a patient
who is confused. What response by the nurse is best?
a. No, because personal items can increase patient agitation.
b. No, because personal items can create too much clutter.
c. Yes, personal items are likely to restore cognitive function.
d. Yes, personal items can comfort a confused person.

Answer 11

d. Yes, personal items can comfort a confused person.

Question 12

The nurse plans a restraint-free environment but cannot find activities to engage an agitated
middle-aged patient. Which should the nurse implement to maintain the patient’s safety?
a. Request help from interdisciplinary team members.
b. Transfer the patient to a private room to protect others.

c. Document that the patient is uncooperative and hostile.
d. Ask the health care provider for a sedation prescription.

Answer 12

a. Request help from interdisciplinary team members.

Question 13

A patient has been wandering and is at risk for falling. Which approach by the nurse regarding
the use of chemical and physical restraints in the long-term care setting should be considered
initially?
a. Use nonprescription restraints first.
b. Obtain with a telephone prescription.
c. Implement alternative measures first.
d. Notify patient’s family within 24 hours

Answer 13

c. Implement alternative measures first.

Question 14

The nurse plans a safety program for the patients on a medical-surgical unit. Which patient
has the greatest likelihood of falling?
a. A 79-year-old after a pacemaker battery replacement
b. A 68-year-old anemic patient who is dehydrated and has heart failure
c. A 21-year-old 2 hours postarthroscopy after a college football injury
d. A 33-year-old patient post–right salpingectomy for ectopic pregnancy

Answer 14

b. A 68-year-old anemic patient who is dehydrated and has heart failure

Question 15

The nurse finds the patient pulling on the nasogastric tube (NGT) and surgical drain and fears
that the patient will pull them out. Which nursing intervention should the nurse implement to
maintain the patient’s self-esteem and avoid applying restraints?
a. Cover or camouflage tubes and drains.
b. Provide constant activity for the patient.
c. Instruct family members to watch the patient.
d. Keep the patient close to the nurses’ station

Answer 15

a. Cover or camouflage tubes and drains.

Question 16

The patient wearing bilateral wrist restraints complains hand numbness, and the nurse assesses
pale, cool fingers. Which is the nurse’s priority intervention?
a. Notify the provider quickly.
b. Remove the wrist restraints.
c. Try another type of restraint.
d. Increase the restraint padding.

Answer 16

b. Remove the wrist restraints.

Question 17

The patient is having a generalized tonic-clonic seizure. To maintain the airway, which
intervention should the nurse implement after the patient’s motor activity ceases?
a. Apply chin-lift position.
b. Insert a curved oral airway.
c. Sit the patient in upright position.
d. Turn the patient to the side

Answer 17

d. Turn the patient to the side

Question 18

The nurse is instructing a patient who has a difficult-to-control seizure disorder on home care
issues. Which issue affecting safety is most important for the nurse to address with patient
teaching before discharge?
a. Avoiding substances containing alcohol
b. Maintaining a current list of medications
c. Keeping a supply of medications at work
d. Purchasing lawn equipment with a safety switch

Answer 18

d. Purchasing lawn equipment with a safety switch

Question 19

A child had surgery on the face and needs to keep the hands away from the surgical site.
Which restraint should the nurse use to accomplish this outcome?
a. A jacket restraint
b. Mitten restraints
c. A mummy restraint
d. Elbow restraints

Answer 19

d. Elbow restraints

Question 20

The nurse participates in the investigation of an incident in the agency. As a result of the root
cause analysis, what would the nurse expect as the ultimate outcome?

a. Identification of the person at fault
b. An appropriate consequence for the individual at fault
c. Reason the event occurred
d. A plan for the prevention of this event

Answer 20

d. A plan for the prevention of this event

Question 21

The nurse is giving report to the night 1900–0700 shift and describes a confused elderly
patient who wanders. What action by the oncoming nurse is most appropriate?
a. Ask the family about how patient communicates needs.
b. Assess the patient with the Mini-Mental State Exam in the morning.
c. Recommend the oncoming nurse request prn sedation medications.
d. Move the patient to a room near the nurses’ station.

Answer 21

a. Ask the family about how patient communicates needs.

Question 22

The nurse is caring for a patient who has brought in a personal CPAP device to use at night.
What does the nurse need to do in addition to contacting respiratory therapy?
a. Have the device inspected by the appropriate hospital department for safety.
b. Have the patient take it home and use one from the hospital supply.
c. Tell the patient that the personal machine cannot be used.
d. Notify the provider to get permission for the patient to use the machine.

Answer 22

a. Have the device inspected by the appropriate hospital department for safety.

Question 23

The nurse is caring for a patient and is exposed to a chemotherapy drug during IV
administration. Where can the nurse obtain information about the drug that is necessary for an
exposure-related incident?
a. The nurse’s supervisor
b. Poison control center

c. SDS sheets
d. Employee health service

Answer 23

c. SDS sheets

Question 24

A student is caring for a patient admitted with acute alcohol withdrawal. The patient is very
agitated and flailing about in the bed. What action by the student requires the registered nurse
to intervene?
a. Coordinates with the nursing staff so someone is always with the patient.
b. Restrains the patient so prevent falling out of bed and medical device removal.
c. Requests order to remove urinary catheter placed in the emergency department
d. Places the patient on safety precautions and communicates this action.

Answer 24

b. Restrains the patient so prevent falling out of bed and medical device removal.

Question 25

A patient is having a seizure and has fallen to the floor. After placing a pillow under the
patient’s head, what action does the nurse take next?
a. Call for help.
b. Suction the airway.
c. Position patient supine.
d. Hold arms securely

Answer 25

a. Call for help.

Question 26

A nurse is caring for a child who has frequent seizures. The family does not want the seizures
treated and appear to be in awe when they occur. What action by the nurse is best?
a. Inform social services about the noncompliant family.

b. Teach the family the profound consequences of untreated seizures.
c. Assess the family’s cultural values and norms related to seizures.
d. Ask the family to leave during a seizure and treat the child then.

Answer 26

c. Assess the family’s cultural values and norms related to seizures.

Question 27

After noticing a fire in a patient’s room, what action by the nurse takes priority?

a. Yelling for help
b. Removing the patient from the room
c. Pulling the fire alarm
d. Calling security

Answer 27

b. Removing the patient from the room

Question 28

At a safety workshop nurses are being taught to use the fire extinguishers on common fires.
What action by the nurse requires the teacher to review the material?
a. Grabbing an ABC-type fire extinguisher
b. Pulling the pin completely out of the extinguisher
c. Aiming at the highest point of the flames
d. Using the extinguisher in a sweeping motion

Answer 28

c. Aiming at the highest point of the flames

Question 29

The nurse is caring for a patient who just received a diagnosis of a seizure disorder. What
supplies should the nurse gather to have at the bedside? (Select all that apply.)
a. A suction device with catheters
b. Extra pillows to pad the bed
c. A padded tongue blade
d. Oxygen source and nasal cannula
e. Intubation equipment

Answer 29

a. A suction device with catheters

d. Oxygen source and nasal cannula

Question 30

A nurse notes smoke coming from a garbage can in an otherwise empty nursing station.
Which actions should the nurse take? (Select all that apply.)
a. Activate the fire alarm.
b. Use a type ABC fire extinguisher.
c. Rescue the patients from the unit.
d. Put wet towels along the base of the doors.
e. Use a type B fire extinguisher.
f. Aim the nozzle at the top of the fire.

Answer 30

a. Activate the fire alarm.

b. Use a type ABC fire extinguisher.

Question 31

Which of the following are examples of alternatives to restraint use in patient care? (Select all 
that apply.)
a. Frequent observation of patients
b. Involving patients and families
c. Frequent reorientation
d. Four side rails
e. Wraparound belt with quick release

Answer 31

a. Frequent observation of patients
b. Involving patients and families
c. Frequent reorientation

e. Wraparound belt with quick release

Question 32

The Joint Commission restricts the use of restraints to the least restrictive device necessary to
prevent disruption of needed care. The order for restraints must include which of the
following? (Select all that apply.)
a. Type

b. Duration
c. Purpose
d. Location
e. Size

Answer 32

a. Type

b. Duration
c. Purpose
d. Location

Question 33

A nurse is assessing a patient after a seizure. What precipitating factors does the nurse
consider as possibly causing the seizure? (Select all that apply.)
a. Hypoglycemia
b. Hypoxia
c. Alcohol abuse
d. Electrolyte imbalances
e. Emotional excitement

Answer 33

a. Hypoglycemia
b. Hypoxia
c. Alcohol abuse
d. Electrolyte imbalances

Question 34

The nurse is reminding the unlicensed assistive personnel about manifestations of a possible
impending seizure. What manifestations does the nurse include? (Select all that apply.)
a. Staring
b. Rapid eye blinking
c. Not responding
d. Sudden fever
e. Head nodding

Answer 34

a. Staring
b. Rapid eye blinking
c. Not responding

e. Head noddin