NURS_347_01_SP25_Exam 3
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A nurse is caring for a stable toddler diagnosed with accidental poisoning due to the ingestion of cleaning solution. What must be included in educating parents about how to protect a toddler from unintentional poisoning?
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Do not leave toddler alone
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Closely monitor the child's activity
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Keep poisonous products locked up
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Label poisonous products
Explanation
Correct Answer: (C) Keep poisonous products locked up
The most effective and direct intervention to prevent unintentional poisoning in toddlers is to keep all poisonous products, including cleaning solutions, medications, and chemicals, stored in locked cabinets that are completely inaccessible to children. Toddlers are naturally curious and explore their environment through touch and taste, making physical barriers the most reliable prevention strategy against accidental ingestion.
Why the other options are incorrect:
A. Not leaving a toddler alone is impractical as a sole safety strategy since constant supervision at all times is not always possible. Physical safeguards such as locked storage are more reliable and consistent preventive measures.
B. Closely monitoring the child's activity is important but insufficient on its own. A momentary lapse in supervision can result in accidental ingestion if products are within reach. Securing the products themselves is the priority.
D. Labeling poisonous products is useful for adults and older children who can read, but toddlers cannot read labels and will not be deterred by them. Labels alone provide no protection for this age group.
A nurse is preparing to file a safety event report after a client experienced a fall. Which statement is correct regarding the filing of a safety event report?
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The nurse should make a copy of the safety event report and place it in the client's medical record.
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The nurse should record the incident in the client's medical record and fill out a safety event report separately.
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The nurse should await results of the x-ray before filing the report.
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The nurse should include a note on the client's chart that mentions the report.
Explanation
When a patient experiences a fall or any safety incident, the nurse must document the event objectively in the client's medical record as part of the legal and clinical record of care. Additionally, a safety event report, also called an incident report, must be completed separately as an internal quality improvement tool. These are two distinct documents that serve different purposes. The medical record captures what happened clinically, while the safety event report is used by the facility to analyze, track, and prevent future incidents.
Why the other options are incorrect:
A. The safety event report should never be placed in or referenced in the client's medical record. It is a confidential internal facility document used for quality improvement and is legally protected from discovery in many jurisdictions. Placing it in the chart could compromise its protected status.
C. Waiting for x-ray results before filing the report is incorrect. The safety event report should be filed promptly after the incident occurs, regardless of diagnostic outcomes. Delay in reporting undermines the purpose of timely incident documentation.
D. Including a note on the client's chart that mentions the safety event report is incorrect practice. The existence of an incident report should not be referenced in the medical record, as this could compromise its confidential and legally protected nature.
A client with HIV has been admitted to a health care facility. Which nursing diagnosis should be the priority, keeping in mind the client's condition?
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Risk for Imbalanced Nutrition
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Risk for Activity Intolerance
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Risk for Infection
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Risk for Ineffective Coping
Explanation
Correct Answer: (C) Risk for Infection
HIV severely compromises the immune system by destroying CD4 T-cells, leaving the client highly susceptible to opportunistic infections. Using Maslow's hierarchy of needs and the ABCs of prioritization, physiological threats such as infection take priority over nutritional, activity, or psychosocial concerns. Preventing and managing infection is the most critical nursing priority for an HIV-positive client.
Why the other options are incorrect:
A. Risk for Imbalanced Nutrition is a valid concern in HIV clients due to poor appetite and malabsorption but is not the highest priority compared to the life-threatening risk of infection.
B. Risk for Activity Intolerance may occur as the disease progresses due to fatigue and weakness but is not the immediate priority upon admission.
D. Risk for Ineffective Coping is an important psychosocial diagnosis but falls lower in priority when physiological needs such as infection prevention are present.
A client is agitated, combative, and pulling at their intravenous line and urinary catheter. For patient safety, restraints are applied. Which statement made by the nurse is inaccurate?
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"An alternative to restraints is moving the patient to a visible room near the nurse's station."
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"Restraints should always be used as a last resort for safety of the patient and staff."
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"Restraints can initially be applied by a nurse and requires an order by the physician within 72 hours."
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"A chemical restraint constitutes the use of medications for patient safety."
Explanation
Correct Answer: (C) "Restraints can initially be applied by a nurse and requires an order by the physician within 72 hours."
This statement is inaccurate because while a nurse may apply restraints in an emergency situation to ensure immediate patient safety, a physician's order must be obtained within 1 hour, not 72 hours. The Joint Commission and facility policies mandate that a licensed provider evaluate the patient and provide a written order for restraints within a very short timeframe after emergency application. The 72-hour timeframe stated in option C is dangerously incorrect and represents a serious violation of restraint standards.
Why the other options are incorrect:
A. Moving an agitated patient to a visible room near the nurse's station is a recognized and appropriate least-restrictive alternative to restraints, allowing for closer monitoring without physical restriction.
B. Restraints being used as a last resort is a true and accurate statement. Restraints are only appropriate when all other less-restrictive interventions have been considered or attempted.
D. Chemical restraints referring to the use of medications to control behavior for patient safety is an accurate definition. Medications such as sedatives used to restrain a patient's movement or behavior are classified as chemical restraints.
A nurse is providing ongoing postoperative care to a client who has had knee surgery. The nurse assesses the dressing and finds it saturated and oozing with sanguinous drainage. The client is restless and has a rapid pulse. What should the nurse do first?
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Document the amount of blood lost and report it to the physician
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Document the findings and report to the physician immediately
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Assess the client every 15 minutes for 4 hours and monitor for further complications
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Apply a pressure dressing to attempt to control the bleeding
Explanation
The client is exhibiting signs of active hemorrhage including a saturated dressing with sanguinous drainage, restlessness, and a rapid pulse, all of which indicate possible hypovolemic shock developing. The immediate nursing priority is to apply a pressure dressing to control the bleeding and prevent further blood loss. This is a direct life-saving intervention that must be performed before documentation or notification, as stopping the source of blood loss takes precedence.
Why the other options are incorrect:
A. Documenting the amount of blood lost is important but is not the first action. Intervention must precede documentation in an emergency situation involving active bleeding.
B. Reporting to the physician is necessary but should occur after the nurse has taken immediate action to control the bleeding. Calling for help while applying pressure would be appropriate, but reporting alone is not the first priority.
C. Assessing every 15 minutes is a monitoring strategy for stable patients. This client is showing signs of active hemorrhage and deterioration, requiring immediate intervention rather than scheduled monitoring.
The image shows a leg with a visible raised, hardened, and inflamed area along the path of a vein, with surrounding skin discoloration and nodular appearance.
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Thrombophlebitis
Explanation
The image depicts thrombophlebitis, a condition characterized by inflammation of a vein accompanied by the formation of a blood clot. It commonly presents as a visibly red, warm, tender, and hardened cord-like area along the affected vein, often seen in the lower extremities as shown in the image. The surrounding skin discoloration and palpable nodular firmness along the vein are classic clinical features. Thrombophlebitis can occur superficially or in deeper veins and requires prompt assessment to rule out deep vein thrombosis, which carries a risk of pulmonary embolism.
A client informs the nurse about difficulty getting a restful sleep. What education can the nurse provide to encourage adequate sleep and rest? Select all that apply.
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Drink a glass of wine 1 hour prior to bed to assist with staying asleep.
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Eat chocolate before bed.
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Eat a small protein- and carbohydrate-containing snack about an hour before bedtime.
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Discontinue the use of tobacco or tobacco products.
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Perform moderate exercise.
Explanation
Eating a small protein and carbohydrate snack about an hour before bedtime can promote sleep by providing tryptophan, an amino acid that supports serotonin and melatonin production, which facilitate sleep onset. Discontinuing tobacco and tobacco products improves sleep quality because nicotine is a stimulant that disrupts sleep initiation and maintenance and reduces total sleep time. Performing moderate exercise during the day promotes deeper, more restorative sleep, though it should be avoided too close to bedtime to prevent stimulation.
Why the other options are incorrect:
A. Drinking alcohol before bed is not recommended for promoting restful sleep. While alcohol may initially induce drowsiness, it disrupts sleep architecture, reduces REM sleep, and causes fragmented and non-restorative sleep during the second half of the night.
B. Eating chocolate before bed is discouraged because chocolate contains caffeine and theobromine, both of which are stimulants that can interfere with sleep onset and reduce sleep quality.
A 77-year-old female with functional incontinence is admitted for surgical follow up. She should automatically be put on diapers.
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True
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False
Explanation
Automatically placing a patient with functional incontinence in diapers without individualized assessment and a care plan is not appropriate nursing practice. Functional incontinence results from physical or cognitive barriers that prevent a person from reaching the toilet in time, not from an inability of the bladder to function. The appropriate nursing approach includes scheduled toileting, ensuring the bathroom is accessible, addressing mobility limitations, and using the least restrictive and most dignity-preserving continence management strategies. Diapers may be used as part of a care plan but should never be the automatic default intervention without individualized assessment.
The nurse is providing education to a client regarding pain control after surgery. What time does the nurse inform the client is the best time to request pain medication?
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Only after all nonpharmacological pain relief techniques have been performed
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When the pain starts to reach an uncomfortable pain level above 7/10
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When there is no pain, but it is time for the PRN pain medication to be administered
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Before the pain at the surgical site becomes severe and uncontrolled
Explanation
The best time to request pain medication is before the pain escalates to a severe and uncontrollable level. Once pain becomes severe, it is significantly harder to manage and requires larger doses of medication to achieve relief. Proactive and preemptive pain management leads to better postoperative outcomes, improved patient comfort, earlier mobilization, and reduced risk of complications such as atelectasis and deep vein thrombosis that result from reluctance to move due to uncontrolled pain.
Why the other options are incorrect:
A. Waiting until all nonpharmacological techniques have been performed before requesting medication is not appropriate in the postoperative setting. Pharmacological and nonpharmacological approaches are often used together, and delaying medication until all other methods are exhausted can allow pain to become unmanageable.
B. Waiting until pain reaches above 7 out of 10 means the patient is already experiencing significant pain before seeking relief. At this level, pain is already difficult to control and negatively impacts recovery and comfort.
C. Requesting medication only when it is scheduled but pain is absent is unnecessary and does not reflect appropriate patient-centered pain management. PRN medications should be taken based on the presence and anticipation of pain, not on a rigid schedule when there is no discomfort.
The client states that their spouse reports that the client's snoring awakens the spouse at night. The spouse is present at the appointment. To obtain further data, what will the nurse ask the spouse?
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Is the snoring followed by silence and then a snort
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How loud is the snoring
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How long does the client snore at night
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How often is the spouse awakened due to the snoring
Explanation
Correct Answer: (A) Is the snoring followed by silence and then a snort
The pattern of snoring followed by a period of silence and then a sudden snort or gasping sound is the classic clinical presentation of obstructive sleep apnea. Asking the spouse about this specific pattern is the most diagnostically significant question because it helps the nurse identify whether the client is experiencing apneic episodes during sleep, where breathing temporarily stops and then resumes with a snort. This is critical information that distinguishes simple snoring from a potentially serious sleep disorder requiring further evaluation and treatment.
Why Other Options are Incorrect:
B. Asking how loud the snoring is provides subjective information about sound intensity but does not help identify whether a clinically significant breathing disorder such as sleep apnea is present.
C. Asking how long the client snores gives general information about sleep disruption but does not help differentiate between benign snoring and apneic episodes associated with sleep apnea.
D. Asking how often the spouse is awakened addresses the impact on the spouse's sleep rather than providing diagnostic data about the nature and clinical significance of the client's snoring pattern.
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