A charge nurse in a long-term care facility notices the smell of alcohol on a nurse's breath.
Which of the following actions should the nurse take first?
Call the supervisor to ask for another nurse.
Document objective findings about the situation.
Remove the nurse from the client care area.
Assign clients to the remaining staff.
The Correct Answer is C
Choice A rationale:
Calling the supervisor to ask for another nurse is not the first action the charge nurse should take when noticing the smell of alcohol on a nurse's breath. While it's important to involve the supervisor, immediate action to ensure patient safety is required.
Choice B rationale:
Documenting objective findings about the situation is a valid step in the process, but it should not be the first action. The charge nurse's primary responsibility is to address the immediate safety concerns.
Choice C rationale:
Removing the nurse from the client care area is the first action the charge nurse should take when smelling alcohol on a nurse's breath. This action ensures patient safety and prevents potential harm caused by impaired nursing care.
Choice D rationale:
Assigning clients to the remaining staff is not the first action to take when there is suspicion of alcohol impairment in a nurse. Patient safety and addressing the situation involving the impaired nurse take precedence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Evaluating the client for signs of infection is an important nursing action in post-procedure care, but it is not the priority immediately following an amniotomy. The primary concern after an amniotomy is fetal well-being, so monitoring the fetal heart rate is the priority.
Choice B rationale:
Checking the fetal heart rate pattern is the priority nursing action following an amniotomy. Amniotomy involves breaking the amniotic sac, which can potentially lead to changes in the fetal heart rate. Monitoring the fetal heart rate helps assess the baby's well-being and detects any signs of fetal distress.
Choice C rationale:
Observing the color and consistency of amniotic fluid is important for assessing the fluid for signs of meconium staining or infection, but it is not the immediate priority after an amniotomy. Checking the fetal heart rate takes precedence.
Choice D rationale:
Taking the client's temperature is an important part of assessing for infection or fever, but it is not the immediate priority following an amniotomy. Fetal well-being and monitoring are the primary concerns in the immediate post-amniotomy period.
Correct Answer is D
Explanation
The correct answer is d. Wipe any excess medication from the inner canthus outward.
Choice A reason: Gently massaging the eyelid is not recommended because it does not facilitate the absorption of ophthalmic ointment and may cause additional irritation or spread the infection.
Choice B reason: The instruction is incorrect because the child has been prescribed bacitracin, not erythromycin. It’s important to follow the prescribed medication and dosage instructions.
Choice C reason: Placing an occlusive dressing over the eye is not advised for bacterial conjunctivitis as it can create a moist environment that may promote bacterial growth.
Choice D reason: This is the correct action. After applying the ointment, wiping away excess from the inner canthus outward prevents the spread of infection and keeps the area clean. This method prevents potential irritation and ensures that the medication does not obstruct vision.
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