A nurse is preparing an in-service for an annual skills fair at a community medical facility about fire safety. Place the steps in the order in which they should be performed in the case of a fire emergency. (Move the steps into the box on the right, placing them in the selected order of performance. Use all the steps.)
Confine the fire
Rescue the clients
Pull the fire alarm
Extinguish the fire.
The Correct Answer is B, C, A, D
Answer: B, C, A, D Rationale: B (Rescue the clients): The immediate priority in any fire situation is to ensure the safety of individuals, which includes removing clients from danger. C (Pull the fire alarm): After clients are safe, the next step is to alert others of the fire and call for assistance. A (Confine the fire): Once the alarm is activated, the fire should be contained by closing doors or windows to prevent it from spreading. D (Extinguish the fire): If it is safe to do so, the fire should be extinguished using the appropriate equipment. If not, evacuation is the next step.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "The oral medication you will take after this IV will dissolve the clot": This statement is incorrect. While anticoagulants like warfarin or direct oral anticoagulants (DOACs) may be prescribed to prevent the formation of new clots or to treat existing clots, heparin, whether administered intravenously or subcutaneously, is not typically used to dissolve existing clots.
B. "A pharmacist is the person to answer that question": This response deflects the client's question and does not provide useful information. While pharmacists are knowledgeable about medications, nurses are responsible for educating clients about their treatments and should be able to provide accurate information regarding heparin therapy.
C. "Heparin does not dissolve clots. It stops new clots from forming": This is the correct response. Heparin is an anticoagulant medication that works by inhibiting the formation of new clots rather than dissolving existing ones. It does so by inhibiting the activity of clotting factors in the blood, thus preventing the clot from enlarging or new clots from forming.
D. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level": While this statement provides information about the time required for heparin to achieve a therapeutic effect, it does not address the client's specific question about clot dissolution. Heparin's anticoagulant effects occur rapidly, but its primary action is prevention rather than dissolution of existing clots.
Correct Answer is ["C","D","E"]
Explanation
A. Increase hematocrit: Fluid overload typically leads to hemodilution, resulting in a decrease in hematocrit rather than an increase. Therefore, an increase in hematocrit would not be expected in a client with fluid overload.
B. Increased temperature: Fluid overload is not typically associated with an increased body temperature. Instead, fever may indicate an infection or another underlying cause. Therefore, an increased temperature would not be a typical finding in a client with fluid overload.
C. Increased heart rate: Fluid overload can lead to an increased heart rate as the body attempts to maintain adequate cardiac output in the presence of excess fluid volume. An elevated heart rate is a compensatory mechanism to maintain tissue perfusion despite the increased workload on the heart.
D. Increased respiratory rate: Fluid overload can cause pulmonary congestion, leading to increased respiratory effort and a higher respiratory rate as the body attempts to compensate for decreased gas exchange efficiency. An increased respiratory rate helps to improve oxygenation and remove excess carbon dioxide from the body.
E. Increased blood pressure: Fluid overload often leads to increased blood pressure due to the increased volume of circulating blood, which can strain the cardiovascular system. Elevated blood pressure is a common manifestation of fluid overload and reflects the increased workload on the heart and blood vessels.
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