A nurse is caring for a group of clients.
For which of the following situations should the nurse complete an incident report? (Select all that apply.)
A client receives burns from a heating pad.
A client reports being dissatisfied with the temperature of the meals provided.
A client becomes disoriented and falls out of bed.
A client's visitor becomes dizzy and faints in the client's room.
A client is unable to afford the physical therapy that the provider recommends.
Correct Answer : A,C,D
Choice A rationale
A client who receives burns from a heating pad has experienced harm due to the healthcare setting or treatment. An incident report should be completed to document the injury and investigate the cause to prevent future occurrences.
Choice B rationale
A client's dissatisfaction with meal temperature does not typically require an incident report unless it leads to significant issues such as foodborne illness or other adverse effects. It is usually managed through the facility's complaint process.
Choice C rationale
If a client becomes disoriented and falls out of bed, it is crucial to complete an incident report to document the event, assess the cause, and implement measures to prevent similar incidents. This helps ensure client safety and continuous quality improvement.
Choice D rationale
When a client's visitor becomes dizzy and faints in the client's room, an incident report should be completed to document the occurrence and initiate an investigation into the cause. This helps in providing appropriate care and preventing future incidents.
Choice E rationale
A client's inability to afford recommended physical therapy is an important issue but does not typically require an incident report. This situation should be addressed through social services or financial counseling to find a solution.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Using disinfectant to clean the blood pressure cuff after use is an appropriate infection control measure. It reduces the risk of cross-contamination between clients by ensuring medical equipment is sanitized.
Choice B rationale
Double-bagging a client's linens each day is not necessary unless the linens are heavily soiled or contaminated with pathogens. Routine double-bagging is not an effective infection control practice and is resource-intensive.
Choice C rationale
Wearing sterile gloves when bathing a client who is incontinent is unnecessary. Non-sterile gloves are sufficient for this task, and sterile gloves should be reserved for surgical or invasive procedures to maintain sterility.
Choice D rationale
Rinsing contaminants from a bedpan with hot water can create aerosols that spread pathogens. Proper protocol involves cleaning and disinfecting the bedpan with appropriate solutions to ensure infection control. .
Correct Answer is C
Explanation
Choice A rationale
Injecting air into the ampule prior to drawing the medication into a syringe is incorrect because ampules are sealed glass containers, and injecting air could cause the liquid to spill out due to pressure changes.
Choice B rationale
Adding 0.5 mL of diluent to the medication is not appropriate for most medications in ampules unless specifically instructed by the medication guidelines. Ampules typically contain ready-to-use medication.
Choice C rationale
Using a filter needle to aspirate the medication is the correct action. A filter needle is used to prevent any glass particles from being drawn into the syringe, ensuring the medication is safe for administration.
Choice D rationale
Cleansing the tip of the ampule with an alcohol swab after opening is unnecessary because the ampule's contents are sterile and the risk of contamination is minimized if the ampule is handled correctly.
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