Examkin

Soru

Zorluk: OrtaAccident, Error, and Injury Prevention

A practical nurse (PN) is caring for a client with mild dementia who is receiving continuous intravenous (IV) fluids and has a high risk for falls. Which interventions should the PN implement to maintain a safe environment and prevent injuries? Select all that apply.

  1. Maintain the bed in the lowest possible position with the wheels locked when the client is resting.Cevap
  2. Secure the IV tubing to the client's hospital gown using a clip while they are out of bed.Cevap
  3. Ensure the client's call light, eyeglasses, and frequently used items are placed within easy reach.Cevap
  4. D
    Raise all four side rails on the bed while the client is sleeping to prevent an accidental fall.
  5. E
    Complete the initial comprehensive fall risk assessment to establish the client's baseline safety needs.
  6. F
    Leave prescribed oral medications on the bedside table to avoid waking the sleeping client.

Cevap

The correct interventions are maintaining the bed in the lowest locked position, securing the IV tubing to the gown, and keeping essential items within easy reach.
Maintaining the bed in its lowest, locked position minimizes injury risk if a fall occurs and provides stability during transfers. Securing IV lines prevents accidental dislodgement and reduces tripping hazards when the client moves. Keeping essential items like the call light and eyeglasses within reach prevents the client from stretching or leaving the bed unassisted, directly mitigating fall triggers.

Adım Adım Çözüm

1
Identify the client's specific risk factors based on the clinical scenario.
The client has mild dementia, is receiving continuous IV fluids, and is at high risk for falls.
Understanding the client's vulnerabilities helps prioritize the most appropriate safety interventions.
2
Evaluate each potential intervention for safety, effectiveness, and adherence to the PN scope of practice.
Keeping the bed low, securing lines, and placing items within reach are safe, standard practices. Using four side rails is an inappropriate restraint. Leaving medications is unsafe. Initial assessments are out of the PN scope.
Interventions must directly mitigate fall risks without violating safety protocols, legal scopes of practice, or evidence-based guidelines.
3
Select the appropriate interventions that safely prevent accidents and injuries.
The correct actions are maintaining a low bed, securing the IV tubing, and keeping items within reach.
These actions address the environmental hazards directly related to the client's condition and medical equipment.

Anahtar Kavram

Accident and Injury Prevention in Fall-Risk Clients
Bu soruyu puanla

Konular

Accident, Error, and Injury Prevention

Bu konudan daha fazla soru