CHAPTER 20

Patient Environment and Safety

REVIEW QUESTIONS FOR THE NCLEX® EXAMINATION

Directions: Choose the best answer(s) for each of the following questions.

1. The main cause of noise in the hospital is (322)

1. people talking.

2. equipment and alarm sounds.

3. meal delivery carts.

4. footsteps of all the workers.

2. Interventions by the nurse that help prevent patient falls are to (Select all that apply.) (330, Box 20.3)

1. provide night lighting for trips to the bathroom.

2. allow the patient to walk only with assistance.

3. keep the pathway between the bed and bathroom clear.

4. allow minimal patient belongings in the room.

3. A new Joint Commission Patient Safety Goal concerns (330)

1. increasing the use of protective devices.

2. improving safety of medical alarms.

3. decreasing the use of nurse overtime.

4. transferring toxic materials into nontoxic containers.

4. Infection control guidelines for patient safety require that infectious waste such as soiled dressings be
treated as biohazards and be (322)

1. sterilized before disposal.

2. placed in closed plastic bags.

3. burned as soon as possible.

4. placed in the utility room trash.

5. To prevent falls by older patients, you should (Select all that apply.) (330, Box 20.3)

1. encourage the use of nonskid mats in tubs or showers.

2. insist on bright lighting at all times.

3 encourage use of firm, rubber-soled slippers.

4. keep side rails up when the patient is in bed.

5. remove extension cords.

6. The evidence demonstrates that using bed rails as a restraint can be (335)

1. harmful.

2. harmless.

3 effective.

4. useless.

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7. When securing a protective device, it is essential that (336)

1. a double knot be used.

2. only one finger can be inserted between the device and the patient.

3. an index and middle finger fits between the device and the patient.

4. it is tied securely to the side rails.

8. When utilizing a safety belt for a patient in a wheelchair, you must (335, 338-339, Skill 20.3)

1. explain to the family exactly why it is being used.

2. document the specific reason the belt is needed.

3. fasten it to the chair loosely.

4. obtain the patient’s permission for use.

9. When utilizing a limb immobilizer protective device, you must (338, Skill 20.3)

1. massage the area proximal to its attachment frequently.

2. flex the joint before applying the device.

3. check the circulation and sensation distal to the device frequently.

4. exercise all joints at least twice per shift.

10. Medications may have side effects that contribute to the risk of falls, especially for older adults.
When evaluating a patient’s drugs for side effects that may increase the risk of falling, look at those that
affect the ____________ system. (Fill in the blank.) (330, Box 20.3)

11. A measure to promote patient safety after finishing a nursing procedure is to (330, Box 20.3)

1. explain the reason for the procedure.

2. elevate the head of the bed to semi-Fowler position.

3. replace the bed in the lowest position.

4. tell the patient when you will return to the room.

12. Safety measures for the patient during ambulation include the use of (Select all that apply.) (330)

1. a gait belt any time the patient is unsteady.

2. two people at all times for ambulation.

3. a rolling IV pole for stability.

4. wearing of firm, nonskid footwear.

13. One measure to prevent nighttime wandering in older adults is (330)

1. administer sleeping medication at bedtime.

2. give a back rub and warm milk at bedtime.

3. place the patient in a room with another patient.

4. increase daytime stimulation to decrease napping.

14. The best choice for a protective device to assist a patient who cannot maintain an upright sitting
posture in a wheelchair would be (337)

1. a security vest.

2. a safety belt.

3. a protective jacket.

4. wrist-immobilizing devices.

15. An important nursing action for the patient using wrist and ankle immobilizers is to (336, Box 20.6,
338-339, Skill 20.3)

1. allow only 4 inches of movement of each extremity.

2. offer fluids at 4-hour intervals.

3. check on the patient every 2 hours while immobilized.

4. document their removal and exercises performed every 2 hours.

16. Which must be present on the nursing unit for each biohazard substance used or stored on the unit?
(333)

1. MDS

2. MSDS

3. DCP

4. DSS

17. The first action to be taken in the event of a fire is to (332)

1. activate the fire alarm.

2. rescue the patient.

3. contain the fire.

4. extinguish the flames.

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CRITICAL THINKING ACTIVITIES

1. Your patient is a 78-year-old male with pneumonia who is quite confused. He is prone to falls. He has
just been admitted and keeps trying to get out of bed. What measures should you use to keep him in
bed without using a protective device?

2. In reviewing Box 20.5, what would you need to do in your home to make it safer from fire?

3. Check your home for poison safety. What do you need to do to protect people in your home from
poisoning?

4. Your patient is a 65-year-old female who has a history of falls. To manage her hypertension, her
health care provider has started her on an ACE inhibitor. What patient education should you provide to
reduce her risk for falls?