A fire is found in a client’s room during a routine medication pass. What is the nurse’s first action?

Activate the fire alarm

Contain the fire

Notify the supervisor

Remove the client from the room

Answer and Explanation

The Correct Answer is A

If a fire is found in a client's room during a routine medication pass, the nurse's first action should be to activate the fire alarm. Activating the fire alarm will alert other staff members and activate the fire suppression system, which can help to contain the fire and prevent it from spreading to other areas of the facility. This will also initiate the evacuation of other clients and staff members, as well as alert the fire department.

Once the fire alarm has been activated, the nurse should safely evacuate the client and themselves from the room, if possible, and then notify the supervisor and the fire department.

Containing the fire or attempting to put it out should only be done if it can be done safely and without putting oneself or others at risk.

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Correct Answer is D

Explanation

Encouraging ambulation would be inappropriate if the client has decreased mobility.

A. Document on the reddened area B. Ask the client how the area became reddened C. Assess the client’s diet D. Relieve pressure from the right heel

Correct Answer is D

Explanation

Relieving pressure from the heel is essential to prevent further damage to the skin and underlying tissues. This can be achieved by using specialized cushions, repositioning the client regularly, or elevating the foot to reduce pressure.

While documenting the reddened area is important to monitor the progression of the wound, asking the client how the area became reddened and assessing their diet may not be the most relevant interventions in this situation.

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A fire is found in a client’s room during a routine medication pass. What is the nurse’s first action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has decreased mobility. What nursing intervention would be inappropriate to promote mobility?

Correct Answer is D

Explanation

A client has a reddened area on his right heel. What is the best intervention by the nurse to prevent further skin and tissue breakdown?

Correct Answer is D

Explanation

What client should be seen by the nurse first?

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