Question 1

A fire has started in a work area on the unit. Which of the following is the response which demonstrates correctly using a fire extinguisher?

Accepted Answer

A)  Aim the stream to the top of the flames. 
B)  Squeeze the pin to activate the extinguisher. 
C)  Move the extinguisher in a sweeping, side to side motion. 
D)  Call 911. 
A)  Aim the stream to the top of the flames. 
B)  Squeeze the pin to activate the extinguisher. 
C)  Move the extinguisher in a sweeping, side to side motion. 
D)  Call 911.

Question 2

An older adult patient who is unable to get out of bed complains that the room is too cold because of the air-conditioning and asks the nurse to open the window. The nurse's best reply is:

Accepted Answer

A)  "Certainly, that will let in warm air from outside and should make you warmer." 
B)  "The air conditioner is set to keep the most comfortable temperature in the room." 
C)  "I'll adjust the thermostat in your room and get a blanket for you." 
D)  "Agency policy prevents me from opening the window." 
A)  "Certainly, that will let in warm air from outside and should make you warmer." 
B)  "The air conditioner is set to keep the most comfortable temperature in the room." 
C)  "I'll adjust the thermostat in your room and get a blanket for you." 
D)  "Agency policy prevents me from opening the window."

Question 3

An older adult patient is discharged home after hip surgery. The statement that indicates a family member understands discharge safety instructions given by the nurse is:

Accepted Answer

A)  "I will install grab bars in the bathroom for both the toilet and bathtub." 
B)  "I will put all personal items away to prevent my mother from dropping things." 
C)  "I will dim the lights at night to prevent wakefulness." 
D)  "I will ensure that my mother takes naps during the day to prevent tiredness." 
A)  "I will install grab bars in the bathroom for both the toilet and bathtub." 
B)  "I will put all personal items away to prevent my mother from dropping things." 
C)  "I will dim the lights at night to prevent wakefulness." 
D)  "I will ensure that my mother takes naps during the day to prevent tiredness."

Question 4

There is evidence that a resident in a home care environment might have accidentally ingested gasoline left by the gardeners. The nurse should first:

Accepted Answer

A)  call the family members to notify them of the incident. 
B)  call the poison control center and describe the situation. 
C)  induce the patient to vomit. 
D)  place the gasoline can in a safe place. 
A)  call the family members to notify them of the incident. 
B)  call the poison control center and describe the situation. 
C)  induce the patient to vomit. 
D)  place the gasoline can in a safe place.

Question 5

A patient is agitated and confused and keeps getting out of bed and needs to be observed constantly. The best initial nursing intervention is to:

Accepted Answer

A)  have a family member or friend sit with the patient. 
B)  obtain an order for a sedative from the health care provider. 
C)  instruct the nurse's aide to apply a vest protective device. 
D)  make sure the side rails are up and close the door. 
A)  have a family member or friend sit with the patient. 
B)  obtain an order for a sedative from the health care provider. 
C)  instruct the nurse's aide to apply a vest protective device. 
D)  make sure the side rails are up and close the door.

Question 6

The certified nursing assistant (CNA) places a confused, weak patient in a wheelchair and applies a vest protective device. The nurse should instruct the CNA to: (Select all that apply.)

Accepted Answer

A)  secure the ties in the front to prevent the patient from falling. 
B)  secure the ties in the back to prevent the patient from falling. 
C)  use a double knot to prevent the patient from undoing the tie. 
D)  use a half bow knot to secure the device to a chair. 
E)  provide passive range of motion to the upper extremities as needed. 
A)  secure the ties in the front to prevent the patient from falling. 
B)  secure the ties in the back to prevent the patient from falling. 
C)  use a double knot to prevent the patient from undoing the tie. 
D)  use a half bow knot to secure the device to a chair. 
E)  provide passive range of motion to the upper extremities as needed.

Question 7

A patient who has right-sided weakness following a stroke is admitted to a long-term care facility and exhibits increasing wandering and inability for self-care. To protect the patient from the most frequent cause of injury among the older adult, the nurse's most efficient intervention would be:

Accepted Answer

A)  provide a night light in the bathroom. 
B)  keep pathways clear of paper, shoes, and equipment. 
C)  apply a personal alarm. 
D)  provide hip protectors. 
A)  provide a night light in the bathroom. 
B)  keep pathways clear of paper, shoes, and equipment. 
C)  apply a personal alarm. 
D)  provide hip protectors.

Question 8

The doctor has written an order to place a resident in the nursing home in a vest protective device. It is the nurse's responsibility to:

Accepted Answer

A)  check with the nursing supervisor about the legality of the order. 
B)  remove the device every 2 hours and change the patient's position. 
C)  remove the device every 4 hours to toilet the patient. 
D)  apply the device loosely to prevent circulation impairment. 
A)  check with the nursing supervisor about the legality of the order. 
B)  remove the device every 2 hours and change the patient's position. 
C)  remove the device every 4 hours to toilet the patient. 
D)  apply the device loosely to prevent circulation impairment.

Exam 20: Patient Environment and Safety

A fire has started in a work area on the unit. Which of the following is the response which demonstrates correctly using a fire extinguisher?

An older adult patient who is unable to get out of bed complains that the room is too cold because of the air-conditioning and asks the nurse to open the window. The nurse's best reply is:

An older adult patient is discharged home after hip surgery. The statement that indicates a family member understands discharge safety instructions given by the nurse is:

There is evidence that a resident in a home care environment might have accidentally ingested gasoline left by the gardeners. The nurse should first:

A patient is agitated and confused and keeps getting out of bed and needs to be observed constantly. The best initial nursing intervention is to:

The certified nursing assistant (CNA) places a confused, weak patient in a wheelchair and applies a vest protective device. The nurse should instruct the CNA to: (Select all that apply.)

A patient who has right-sided weakness following a stroke is admitted to a long-term care facility and exhibits increasing wandering and inability for self-care. To protect the patient from the most frequent cause of injury among the older adult, the nurse's most efficient intervention would be:

The doctor has written an order to place a resident in the nursing home in a vest protective device. It is the nurse's responsibility to:

Nursing and the Health Care System

Concepts of Health, Illness, Stress, and Health Promotion

Legal and Ethical Aspects of Nursing

The Nursing Process and Critical Thinking

Assessment, Nursing Diagnosis, and Planning

Implementation and Evaluation

Documentation of Nursing Care

Communication and the Nurse Patient Relationship

Patient Education and Health Promotion

Delegation, Leadership, and Management

Growth and Development: Infancy Through Adolescence

Adulthood and the Family

Promoting Healthy Adaptation to Aging

Cultural and Spiritual Aspects of Patient Care

Loss, Grief, and End-of-Life Care

Infection Prevention and Control: Protective Mechanisms and Asepsis

Infection Prevention and Control in the Hospital and Home

Safe Lifting, Moving, and Positioning of Patients

Assisting with Hygiene Personal Care Skin Care and the Prevention of Pressure Ulcers

Measuring Vital Signs

Assessing Health Status

Admitting Transferring and Discharging Patients

Diagnostic Tests and Specimen Collection

Fluid, Electrolyte, and Acid-Base Balance

Concepts of Basic Nutrition and Cultural Considerations

Nutritional Therapy and Assisted Feeding

Assisting with Respiration and Oxygen Delivery

Promoting Urinary Elimination

Promoting Bowel Elimination

Pain Comfort and Sleep

Complementary and Alternative Therapies

Pharmacology and Preparation for Drug Administration

Administering Oral, Topical, and Inhalant Medications

Administering Intradermal, Subcutaneous, and Intramuscular Injections

Administering Intravenous Solutions and Medications

Care of the Surgical Patient

Providing Wound Care and Treating Pressure Ulcers

Promoting Musculoskeletal Function

Common Physical Care Problems of the Older Adult

Common Psychosocial Care Problems of Older Adults

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