Copyright © 2021, Elsevier Inc. All rights reserved. 1Chapter 01: Foundations of Safe Client Care
Hollen & Stein: Concept-Based Clinical Nursing Skills, 1st Edition
MULTIPLE CHOICE 1. What was the main finding of the Institute of Medicine’s 1999 report To Err is Human: Building a Better Healthcare System?
a.Nursing personnel need better training and education to prevent errors.
b.Registered nurses should take the lead in reducing healthcare-associated errors.
c.Faulty systems, processes, and conditions combined cause the majority of errors.
d.Over 198,000 patients die each year when they are patients in a hospital.
ANS: C
The report To Err is Human: Building a Better Healthcare System provided the shocking information that as many as 98,000 patients die in hospital due to preventable errors. Instead of most errors being the fault of one person, the report stated tha t faulty systems, processes, and conditions combined were to blame. Although nurses are in a prime position to recognize and problem-solve these implicated contributors, the report did not specify that nurses should take the lead in solving the problem .
DIF: Cognitive Level: Remembering TOP: Integrated Process: Teaching-Learning 2. A nurse meets the assigned clients at the start of a shift. After performing hand hygiene and introducing one’s self, what does the nurse do next?
a.Begin a head-to-toe assessment.
b.Identify the client using two identifiers.
c.Assess the client for pain.
d.Ensure the call light is within reach.
ANS: B
A critical task in healthcare for safety, client identification is paramount for preventing errors. After performing hand hygie ne and introducing him- or herself, the nurse identifies the client using two unique identifiers. The head-to-toe and pain assessments come shortly afterward. The nurse ensures the client can reach the call light prior to leaving the room.
DIF: Cognitive Level: Understanding TOP: Nursing Process: Assessment 3. A nurse has worked with the same client for 2 days. When entering the room to administer medications, the nurse performs hand hygiene. What action does the nurse take next?
a.Provide any needed teaching.
b.Ask if the client has any care requests.
c.Assess vital signs and pain.
d.Identify the client using two identifiers.
ANS: D
Every time the client is to receive medication, diagnostic studies, or any other healthcare intervention, the nurse must identi fy the client using two unique identifiers, even if the client is well known to the nurse. Assessments, teaching, and determining clie nt requests would come afterward.
DIF: Cognitive Level: Applying TOP: Nursing Process: Assessment 4. A nurse’s neighbor states “My father got a nosocomial infection after surgery!” What does the nurse understand happened to the client?
a.The client received contaminated blood products.
b.The client nearly died from a postoperative infection.
c.The client acquired an infection while in the hospital.
d.The client received poor preoperative skin preparation.
ANS: C
A nosocomial infection is one acquired in the hospital. It does not designate how the infection occurred, so the client might h ave become infected through contaminated blood products or from poor preoperative skin preparation. It does not mean the client had a life-threatening infection, only that is occurred in hospital.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Teaching-Learning 5. A nurse is making rounds on clients at risk for infection. Which client does the nurse see first?
a.A client with an intravenous (IV) line
b.A client who has a central line
c.A client with an indwelling bladder catheter
d.A client with an IV and bladder catheter
ANS: D
One of the biggest risk factors for hospital acquired infections (HAIs) is the presence of invasive lines. The more lines, the more risk. The client with both an IV and a catheter has the highest risk. The clients with an IV or a catheter have less risk. Nurs es have adopted protocols that have dramatically reduced central line infections.
DIF: Cognitive Level: Applying TOP: Nursing Process: Assessment Copyright © 2021, Elsevier Inc. All rights reserved. 2 6. A nursing manager concerned about the infection rate on the unit wants to implement measures to reduce the transmission of infectious organisms. What action by the manager is best?
a.Provide a stethoscope dedicated to each client.
b.Ensure gloves are well-stocked in each room.
c.Restrict all plants and fresh foods from rooms.
d.Screen all visitors for contagious illnesses.
ANS: A
In the chain of infection, one of the most important components is the mode of transmission. Stethoscopes can serve as a mode o f indirect contact transmission unless they are disinfected between clients. Providing each client with an individual stethoscope will reduce this risk. Gloves are important, but they can become contaminated too and serve as a mode of transmission. Plants and fr esh foods are an uncommon source of transmission unless the client is immunosuppressed. Screening visitors for contagious illness i s an unrealistic long-term action plan.
DIF: Cognitive Level: Applying TOP: Nursing Process: Implementation 7. A nurse is observing a student nurse. What action by the student demonstrates the need for more education on Standard Precautions?
a.The student performs hand hygiene before all client contacts.
b.The student conscientiously wears gloves when taking vital signs.
c.The student confirms that urine possibly contains infectious microbes.
d.The student wears a gown when cleaning liquid stool off the client.
ANS: B
Standard Precautions operates under the principle that all bodily fluids other than sweat could potentially contain infectious microbial agents that pose a risk to the healthcare worker. Contact with skin, if free of those fluids, does not require wearin g gloves, so the nurse would provide more education to the student. Hand hygiene is the first step of Standard Precautions. The student is being prudent by confirming a possible source of contamination. Nurses determine which infection prevention practice to use based upon the type of client–nurse interaction and the possibility of exposure to blood, other body fluids, or pathogens, so wearing a gown while cleaning liquid stool is appropriate.
DIF: Cognitive Level: Analyzing TOP: Nursing Process: Evaluation 8. A faculty member has taught the correct technique for taking gloves off (doffing). While observing students practice, which act ion by a student indicates the need to review the material?
a.Pulls glove off dominant hand first
b.Takes first glove off by grasping it on the outside
c.Takes second glove off by grasping it under the cuff
d.Turns the gloves inside out when second glove is removed
ANS: A
The correct way to remove gloves starts with doffing the glove on the nondominant hand first, without touching the bare skin. T his student would need further review of the skill. Removing the first glove by grasping it on the outside, grasping the second glo ve under the cuff, and turning the gloves inside out to prevent microbe spread are all correct actions. These students would not n eed remediation.
DIF: Cognitive Level: Analyzing TOP: Nursing Process: Evaluation 9. In order to move a client safely, which of the following actions does the nurse take first?
a.Gather enough help for the task.
b.Assess the client’s ability to bear weight.
c.Delegate using the lift chair.
d.Administer pain medication.
ANS: B
The first thing the nurse does when preparing to transfer a client is to assess the client’s ability to bear weight and follow instructions. The findings will determine how much assistance (if any) the client needs. If the client needs maximal assistance , then the nurse gathers enough help and any lifting devices needed and assigns roles to each team member. If the client has pain, the nurse would administer pain medication, but that is not related to safety.
DIF: Cognitive Level: Applying TOP: Nursing Process: Implementation 10. Hospital administration has rejected a request from nursing services for ceiling-mounted lifting/transferring devices pointing to the expense. What response by the Chief Nursing Officer would be best?
a.“We need the equipment to stay competitive in hiring nurses.”
b.“They are required by The Joint Commission so we have to get them.”
c.“The cost of employee injuries from lifting is more expensive.”
d.“We will save money with fewer client-injury lawsuits being filed.”
ANS: C
Data show that when hospitals implemented safe client handling equipment, hospitals achieved savings by reducing lost work days and reducing worker compensation costs that met or exceeded the cost of the equipment. This is not a main focus for nurse recruitment and the equipment is not mandated. Fewer client injuries leading to lawsuits is a probability, but the savings in reducing employee injury have been documented by the ANA.
DIF: Cognitive Level: Understanding TOP: Integrated Process: Communication and Documentation
