A nurse enters a client's room and sees a small fire in the client's bathroom.
Identify the sequence of steps the nurse should take.
(Move the steps, placing them in the order of performance. Use all the steps.)
Use the unit's fire extinguisher to attempt to put out the fire.
Close all nearby windows and doors.
Activate the facility's fire alarm system.
Transport the client to another area of the nursing unit.
The Correct Answer is D,C,B,A
In the event of a fire, the nurse should prioritize safety and follow the facility’s emergency protocols, which typically align with the “RACE” acronym: Rescue: d. Transport the client to another area of the nursing unit. Ensure the client is safe from immediate danger. Alarm: c. Activate the facility’s fire alarm system. Alert others in the facility by activating the fire alarm. Confine: b. Close all nearby windows and doors. Prevent the spread of fire by closing doors and windows. Extinguish: a. Use the unit’s fire extinguisher to attempt to put out the fire. If it’s safe to do so, attempt to extinguish the fire using a fire extinguisher. Remember, the safety of the client and the nurse is the top priority. If the fire is too large or the situation too dangerous, the nurse should evacuate and wait for the fire department to handle the situation. Always follow the specific procedures of your healthcare facility.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Correct Answer is B
Explanation
The correct answer is Choice b: New onset of hearing loss.
Gentamicin, a potent aminoglycoside antibiotic, is renowned for its propensity to cause ototoxicity, particularly manifesting as new-onset hearing loss. Ototoxicity refers to damage to the inner ear structures responsible for hearing and balance, primarily the cochlea and vestibular apparatus. The mechanism of gentamicin-induced ototoxicity involves its accumulation in the endolymphatic fluid of the inner ear, leading to direct toxicity to the sensory hair cells and subsequent hearing impairment.
Manifestations of gentamicin-induced ototoxicity can vary, ranging from subtle high-frequency hearing loss to profound sensorineural deafness. Patients may experience tinnitus (ringing in the ears), difficulty hearing in noisy environments, and imbalance or vertigo. Notably, gentamicin-induced hearing loss is often irreversible and may progress even after discontinuation of the medication.
Now, let's delve into the rationales for the other choices:
Choice a: Hypotension Gentamicin administration is not typically associated with hypotension. However, systemic side effects such as nephrotoxicity and neurotoxicity can occur, particularly with prolonged or high-dose therapy. Nephrotoxicity may manifest as acute kidney injury, characterized by a rise in serum creatinine and blood urea nitrogen levels, oliguria, and fluid-electrolyte imbalances. Neurotoxicity, on the other hand, can lead to symptoms like muscle weakness, paresthesia, and confusion. Monitoring of blood pressure is essential in patients receiving gentamicin, but hypotension is not a direct adverse effect of the medication.
Choice c: Hyperthermia Gentamicin therapy is aimed at treating bacterial infections, such as pyelonephritis, and does not typically induce hyperthermia. Pyelonephritis itself is associated with fever, chills, and flank pain due to the inflammatory response to the urinary tract infection. Administration of gentamicin aims to eradicate the causative bacteria and resolve the underlying infection, which should, in turn, alleviate fever. However, persistent or worsening fever despite antibiotic therapy may indicate treatment failure or the presence of complicating factors, warranting further evaluation and management.
Choice d: Slurred speech Slurred speech is not a recognized adverse effect of gentamicin. Instead, it may suggest central nervous system involvement, such as cerebrovascular accidents (strokes), intoxication, or neurological disorders affecting speech production. Gentamicin primarily exerts its toxic effects on the inner ear structures, leading to auditory dysfunction rather than impairments in speech articulation. Therefore, the presence of slurred speech would prompt an assessment for alternative etiologies unrelated to gentamicin therapy.
In conclusion, while gentamicin is an effective antibiotic for treating infections, it carries the risk of ototoxicity, particularly manifested as new-onset hearing loss. Careful monitoring for this adverse effect is crucial to promptly identify and manage potential complications.
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