Chapter 25: Safety
Yoost & Crawford: Fundamentals of Nursing: Active Learning for Collaborative
Practice, 2nd Edition
MULTIPLE CHOICE
1. The nursing instructor asks the student nurse to identify what Robert Wood Johnson
Foundation funded project that focuses on nurses’ increased attention to patient safety?
OSHA (Occupational Safety and Health Agency)
MSDS (material safety data sheets)
QSEN (Quality and Safety Education for Nurses)
ADA (Americans with Disability Act)
a.
b.
c.
d.
ANS: C
QSEN, or the Quality and Safety Education for Nurses, was funded by the RWJ to focus on
preparing nurses of the future with the knowledge, skills, and attitudes to advance quality and
safety on the job. MSDS are material safety data sheets, OSHA is the Occupational Safety and
Health Agency, and ADA is the Americans with Disability Act.
DIF: Remembering
OBJ: 25.1
MSC: NCLEX Client Needs Category: Safe and Effective Care
TOP: Implementation
NOT: Concepts: Safety
2. The nurse knows changes in which body system affect overall mobility increasing the
propensity of falling?
a. Neurologic
b. Hepatic
c. Cardiopulmonary
d. Musculoskeletal
ANS: D
Impairments in the musculoskeletal system can impact mobility through restrictions of range
of motion and strength, increasing the chances of falling. Changes to the neurologic system
can impair cognitive functioning, changes to the hepatic system can affect mental status, and
changes to the cardiopulmonary system can affect activity tolerance.
DIF: Understanding
OBJ: 25.2
MSC: NCLEX Client Needs Category: Safe and Effective Care
TOP: Assessment
NOT: Concepts: Safety
3. The nurse is visiting a patient with cardiac disease who has been experiencing increased
episodes of shortness of breath when exercise is attempted. The nurse is concerned that the
patient’s decrease in activity may lead to which outcome?
a. Orthostatic hypotension
b. Increase risk of heart disease
c. Loss of short-term memory
d. Worsening shortness of breath
ANS: A
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Inactivity in patients with cardiopulmonary disease can lead to an unsafe drop in blood
pressure with position changes, or orthostatic hypotension. The patient already has heart
disease. Loss of short-term memory is not related to the shortness of breath. The lack of
activity is not likely to worsen the shortness of breath; improving activity level may help
things eventually.
DIF: Applying
OBJ: 25.2
TOP: Assessment
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Safety
4. The nurse recognizes conversations about safe sexual practices, including the consequences of
unprotected sex such as pregnancy and sexually transmitted infections, are important to begin
in what patient population?
a. Adults
b. School-aged children
c. Adolescents
d. Older adults
ANS: C
Sexual curiosity and experimentation occur in the adolescent patient population.
Conversations about safe sexual practices, including the consequences of unprotected sex,
such as pregnancy and sexually transmitted infections, are important. These conversations are
also important for adults and older adults but are handled differently in context with their agerelated needs. School-aged children may be too young depending on their age and their
environment. The nurse must use judgment on when to have the conversation.
DIF: Understanding
OBJ: 25.4
MSC: NCLEX Client Needs Category: Safe and Effective Care
TOP: Implementation
NOT: Concepts: Safety
5. The nurse manager is developing a training guide and identifies which organization that is the
best for resources to help develop guidelines to prevent exposure to hazardous situations and
decrease the risk of injury in the workplace?
a. OSHA (Occupational Safety and Health Administration)
b. CDC (Centers for Disease Control and Prevention)
c. QSEN (Quality and Safety Education for Nurses)
d. NIOSH (National Institute for Occupational Safety and Health)
ANS: A
Occupational Safety and Health Administration (OSHA) was established in 1970 to provide
employers with guidelines for preventing exposure to hazardous chemicals and hazardous
situations and reducing the risk of injury in the workplace. The CDC is the Centers for
Disease Control and Prevention and provides information to address exposure to infectious
diseases. QSEN, or the Quality and Safety Education for Nurses, was funded by the RWJ to
focus on preparing nurses of the future with the knowledge, skills, and attitudes to advance
quality and safety on the job. NIOSH, or the National Institute for Occupational Safety and
Health, is a federal agency within the CDC that was established to conduct research and
recommend interventions for the prevention of work-related injury and illness.
DIF: Understanding
OBJ: 25.7
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Health Care Organizations
TOP: Implementation
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6. The nurse is educating parents about firearm safety. Which parent statement indicates to the
nurse a need for further education?
“I should make sure I obtain the proper permits.”
“It is okay to store firearms with ammunition loaded.”
“I should store all firearms without ammunition.”
“I should make sure all firearms have trigger locks in place.”
a.
b.
c.
d.
ANS: B
Firearms should be stored in a secure location with trigger locks in place. Ammunition should
be stored in a separate location also locked. Proper permits should be obtained as appropriate.
Loaded firearms should never be stored where children can access them.
DIF: Applying
OBJ: 25.4
TOP: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety
7. The nurse recognizes that a patient is using a portable generator in the house as a power
source. What source of poisoning does the nurse appropriately identify?
Lead
Carbon monoxide
Antifreeze
Pesticide
a.
b.
c.
d.
ANS: B
Sources of carbon monoxide include automobiles, stoves, gas ranges, portable generators,
lanterns, the burning of charcoal and wood, and heating systems. Lead is found in lead-based
paints in toys, buildings, and ceramic dishes; sources of lead include water from lead pipes or
pipes soldered with lead, gasoline or soil contaminated by gasoline, and household dust that
may contain paint chips or soil. Antifreeze and pesticides are liquids.
DIF: Applying
OBJ: 25.4
TOP: Assessment
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Safety
8. The nurse is educating the patient about the proper disposal of medications in the home.
Which statement by the patient indicates a good understanding of the information?
a. “Remove the label from the bottle and throw in the trash.”
b. “Flush the medication down the disposal.”
c. “Mix the medications with kitty litter, place the mixture in a jar, and put the jar in
the trash.”
d. “Dissolve the medication in water and pour down the drain.”
ANS: C
Flushing or pouring the medication down the drain can contaminate the water system.
Throwing the medication in the trash poses potential for someone to remove the medication
and use it. This can be avoided by mixing it with an undesirable substance like kitty litter or
coffee grounds.
DIF: Applying
OBJ: 25.7
TOP: Intervention
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Safety
9. The nurse knows that which patient has a teaching need based on statements by the patient’s
parents?
a. “My 6-month-old daughter only sleeps with me when she’s ill.”
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b. “I do not put pillows in the bed with my 3-month-old son.”
c. “I do not feed popcorn to my 2-year-old.”
d. “I have discussed the risks of the ‘choking game’ with my 16-year-old.”
ANS: A
Small children should never sleep in the bed with others because of the risk of suffocation.
The rest of the statements are appropriate. Pillows do present a hazard to a 3-month-old, and
popcorn is a choking risk for a 2-year-old. The choking game is a risk to any adolescent.
DIF: Applying
OBJ: 25.4
TOP: Intervention
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Patient Education
10. The nurse is teaching a student nurse about restraint use in patients. Which statement by the
student nurse indicates a learning need regarding restraints?
a. “Having all four side rails up on the bed is considered a restraint.”
b. “The use of restraints has been shown to decrease fall-related injuries.”
c. “Death has been associated with the use of restraints.”
d. “Medications administered to control behavior are considered a chemical
restraint.”
ANS: B
Restraints may be physical or chemical. A physical restraint is a mechanical or physical
device, such as material or equipment attached or adjacent to the patient’s body, used to
restrict movement. Examples of physical restraints are wrist or ankle restraints, a jacket or
vest, and side rails. A medication that is administered to a patient to control behavior is a
chemical restraint. The use of restraints has been associated with patient injury including
death and does not prevent patient falls.
DIF: Applying
OBJ: 25.4
TOP: Intervention
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Safety
11. The nurse displays an understanding of high-risk populations for MRSA when identifying
which group as the lowest risk?
Prison inmates
College dorm residents
Team athletes
Food service workers
a.
b.
c.
d.
ANS: D
High-risk populations for MRSA include those living in close quarters or those who have
frequent skin-to-skin contact, including prison inmates, college dorm residents, and team
athletes. Food service workers work together but do not generally live in close quarters or
have skin-to-skin contact frequently.
DIF: Understanding
OBJ: 25.1
MSC: NCLEX Client Needs Category: Safe and Effective Care
TOP: Assessment
NOT: Concepts: Infection
12. The nurse knows that which assessment tool is not used to assess fall risk?
a. Glasgow Falls Scale
b. Johns Hopkins Hospital Fall Assessment Tool
c. Morse Fall Scale
d. Hendrich II Fall Risk Model
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ANS: A
The Glasgow is a coma scale used to measure level of consciousness, not falls. The rest are
scales used to assess the risk for falls in patients.
DIF: Remembering
OBJ: 25.4
MSC: NCLEX Client Needs Category: Safe and Effective Care
TOP: Assessment
NOT: Concepts: Safety
13. The patient has a nursing diagnosis of Risk for Falls. The nurse identifies which goal to be
most important?
Patient will ambulate twice a day.
Patient will have no symptoms of infection.
Patient will perform activities of daily living.
Patient will have no injuries during hospital stay.
a.
b.
c.
d.
ANS: D
All the goals except lack of infection are appropriate for a patient with a Risk for Falls
diagnosis; however, the most important goal is for the patient to have no injuries during the
hospitalization.
DIF: Applying
OBJ: 25.5
TOP: Planning
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Safety
14. Which collaborative team member would be most effective in assisting the nurse to identify
medication alternatives that are less likely to cause drowsiness and dizziness to reduce the risk
of falls in the elderly patient?
a. Nursing case manager
b. Charge nurse
c. Physical therapist
d. Pharmacist
ANS: D
The nurse collaborates with the pharmacist and health care provider to identify and implement
safe medication alternatives for older adults to minimize side effects such as drowsiness,
dizziness, and orthostatic hypotension, which can increase fall risk. Although case managers
and charge nurses might have some experience in this area, pharmacists are educated to focus
on medication. Physical therapists evaluate the patient’s ability to perform and maintain
balance during routine activities such as sitting, standing, and walking.
DIF: Applying
OBJ: 25.6
TOP: Planning
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Safety
15. The nurse is concerned about helping the patient find resources to obtain assistive equipment
to be used in the home. Which team member should the nurse contact first?
Occupational therapist
Physical therapist
Health care provider
Social worker
a.
b.
c.
d.
ANS: D
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The nurse should collaborate with the social worker to identify community resources for
obtaining assistive equipment. The social worker facilitates contact with insurance companies
or other agencies to assist with the financing of recommended therapeutic assistive and
specialty devices. Occupational therapists evaluate the patient for safe performance of
activities of daily living (ADLs) such as bathing, dressing, and grooming, and they make
recommendations to enhance safe performance of these activities, such as the use of specialty
equipment (e.g., grippers for pants, oversized shoehorns). Physical therapists evaluate the
patient’s ability to perform and maintain balance during routine activities such as sitting,
standing, and walking. They make recommendations for assistive devices such as canes and
walkers to promote safe performance of these activities. Health care providers order the
equipment.
DIF: Understanding
OBJ: 25.6
MSC: NCLEX Client Needs Category: Safe and Effective Care
TOP: Planning
NOT: Concepts: Collaboration
16. Which statement by the patient indicates to the nurse a teaching need regarding safety in the
home?
a. “I will put a night-light in every room.”
b. “I will not use an extension cord to plug in multiple items.”
c. “I will wash my throw rugs in the bathroom regularly.”
d. “I will keep all cleaning supplies out of reach of children.”
ANS: C
Throw rugs present a fall or tripping hazard. Night-lights help light halls to prevent falls,
extension cords can present a trip hazard, and cleaning supplies can contain poisonous
materials.
DIF: Applying
OBJ: 25.6
TOP: Planning
MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Safety
17. The ER nurse is triaging a patient with suspected poisoning. Who should the nurse anticipate
contacting first?
Family services
Radiology
Poison Control Center
Respiratory
a.
b.
c.
d.
ANS: C
If poisoning is suspected, the National Poison Control Center should be contacted
immediately. This information will be needed to determine treatment. Respiratory may be
needed, and radiology and family services may also be needed, but that will be determined
after the treatment plan is determined.
DIF: Applying
OBJ: 25.3
TOP: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Caring Behaviors
18. The staff nurse knows that many health care facilities use the fire emergency response defined
by which acronym?
a. RACE
b. PASS
c. PACE
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d. QSEN
ANS: A
RACE stands for rescue, alarm, contain, and extinguish. QSEN is the Quality and Safety
Education for Nurses. PASS is pull, aim, squeeze, and sweep for fire extinguishers. PACE is
not a health care acronym.
DIF: Understanding
OBJ: 25.4
MSC: NCLEX Client Needs Category: Safe and Effective Care
TOP: Implementation
NOT: Concepts: Safety
19. The nurse is ambulating a patient back from the bathroom when the patient begins to have a
seizure. Which action should the nurse do first?
a. Lower the patient to the floor if standing.
b. Move sharp or hard objects away from the patient.
c. Turn the patient’s head to the side to prevent aspiration.
d. Attempt to place a tongue blade to prevent choking.
ANS: A
During a seizure, a patient should be protected from injury by first lowering the patient to the
ground if standing. The nurse should then place the head on a soft surface and turn it to the
side to prevent aspiration and move sharp or hard objects out of the way. The nurse should
never attempt to force any object into a seizing patient’s mouth.
DIF: Applying
OBJ: 25.7
TOP: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety
20. The nurse is caring for a confused, combative patient. Which action would be considered last
by the nurse to control behavior of the client?
Orient the patient frequently.
Apply restraints.
Move the patient to a room close to the nurse’s station.
Encourage the family to spend time with the patient.
a.
b.
c.
d.
ANS: B
All alternatives to physical restraints should be considered prior to their use.
DIF: Applying
OBJ: 25.7
TOP: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety
21. The nurse knows which method to be an appropriate way to tie restraints?
a. Knot tied to the bed frame
b. Quick-release knot tied to the side rail
c. Bow tied to the bed rail
d. Quick-release ties attached to the bed frame
ANS: D
Restraints should never be tied in a knot because the knot may prohibit a quick exit in the
event of an emergency requiring evacuation. Instead, use quick-release ties or mechanisms
such as buckles. Restraints are never be tied to side rails because injuries may result when
they are raised or lowered. They should be tied to a stable part of the bed such as the frame.
DIF: Understanding
OBJ: 25.7
TOP: Implementation
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MSC: NCLEX Client Needs Category: Safe and Effective Care
NOT: Concepts: Safety
22. Which statement by the nurse correctly identifies the UAP role in patient restraint use?
a. “The UAP can perform initial assessment.”
b. “The UAP can apply a restraint.”
c. “The UAP can assist with applying and monitoring of a physical restraint.”
d. “The UAP can contact the health care provider and request an order for restraints.”
ANS: C
The UAP cannot perform the initial assessment, and most facilities require that a registered
nurse or licensed practical nurse. Applying a restraint. The health care provider should be
contacted by the nurse, not the UAP. The UAP can assist with applying the restraint and can
perform monitoring checks under the direction of a Registered Nursing.
DIF: Applying
OBJ: 25.7
TOP: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety
MULTIPLE RESPONSE
1. The nurse is explaining the National Patient Safety Goals (NPSG) to the student nurse. Which
answers indicate that the student has a good understanding of these goals? (Select all that
apply.)
a. The NPSG’s focus on treating chronic infections quickly
b. The NPGS’s focus on improving staff communication
c. The NPGS’s focus on using medications safely
d. The NPGS’s focus on identifying patients correctly
ANS: B, C, D
The NPSG focus on specific goals each year. The goals for 2018 included: identify patients
correctly, improve staff communication, improve the safety of using medications, reduce harm
associated with clinical alarm systems, reduce risk of health care–associated infections and the
hospital identifies safety risks inherent in its patient population. Although treating chronic
infections quickly is important, it is not an NPSG.
DIF: Applying
OBJ: 25.1
TOP: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Safety
2. The nurse is providing education to a cardiac patient who has multiple life stressors that are
impacting the patient’s health. Which statements by the patient indicate a good understanding
of actions that can be taken to reduce stressors? (Select all that apply.)
a. “I should change my job.”
b. “I should plan some downtime.”
c. “I should meet with a financial counselor.”
d. “I should talk with my family about my situation.”
e. “I should make my family go to counseling with me.”
ANS: B, C, D
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In adulthood, life stressors such as financial concerns, work-related demands, and efforts to
balance work with family life are common challenges that can take a physical toll on the body.
Individuals should plan relaxation periods or vacations. Meeting with financial counselors and
talking with family can help to achieve that balance. Changing jobs may be beneficial but
could also create more stress and forcing family to go to counseling may also not be a wise
choice.
DIF: Applying
OBJ: 25.7
TOP: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Patient Education
3. The nurse is providing education to a community group on environmental safety. Which
safety measures are effective in improving their environmental safety? (Select all that apply.)
Use of night-lights throughout the home
Illumination of stairwells and pathways
Installation of motion-activated lighting on the exterior of the home
Application of wax to all floors to increase shine
Staying indoors when air pollution is high
a.
b.
c.
d.
e.
ANS: A, B, C, E
Inadequate lighting presents safety concerns in home, work, community, and health care
environments. For an individual to safely and successfully navigate pathways and perform
various activities while avoiding potential obstacles and hazards, the environment must be
well illuminated. Well-lit, glare-free halls, stairways, rooms, and work spaces help to reduce
the risk of tripping, slipping, and falling. Night-lights reduce the risk of injuries to children,
guests, and older adults. Lighting the exterior of the house will also reduce the risk of falling.
Staying indoors during episodes when air pollution is high can help prevent chronic lung
disease. Waxed floors are slippery.
DIF: Applying
OBJ: 25.7
TOP: Implementation
MSC: NCLEX Client Needs Category: Safe and Effective Care NOT: Concepts: Patient Safety
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