A nurse is preparing to administer IV fluids to a client.
The nurse notes sparks when plugging in the IV pump.
Which of the following actions should the nurse take first?
Notify the biomedical department to fix the pump.
Obtain a replacement pump.
Label the pump with a defective equipment sticker.
Unplug the pump.
The Correct Answer is D
The correct answer is d. Unplug the pump.
Rationale for Choice A:
- While notifying the biomedical department to fix the pump is important, it is not the immediate priority in this situation. The first step is to ensure patient and staff safety by removing the potential electrical hazard.
- Delaying the removal of the sparking pump could lead to electrical shock, fire, or other serious consequences.
- Biomedical staff can be notified after the immediate safety risk has been addressed.
Rationale for Choice B:
- Obtaining a replacement pump is necessary to continue the client's IV therapy, but it is not the first action the nurse should take.
- The priority is to eliminate the electrical hazard posed by the sparking pump.
- Once the faulty pump is unplugged and safety is ensured, the nurse can then proceed to obtain a replacement pump.
Rationale for Choice C:
- Labeling the pump with a defective equipment sticker is important to prevent others from using it, but it does not address the immediate safety risk.
- The priority is to disconnect the pump from the power source to eliminate the risk of electrical shock or fire.
- Labeling can be done after the pump has been unplugged and the situation has been assessed.
Rationale for Choice D:
- Unplugging the pump is the correct first action because it immediately removes the electrical hazard, preventing potential harm to the patient, staff, or equipment.
- This action prioritizes safety and mitigates the risk of electrical shock, burns, fire, or other serious consequences.
- It is essential to act quickly and decisively in such situations to ensure a safe environment for everyone involved.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
When receiving a new prescription over the telephone from a client’s provider, the nurse should first write down the complete prescription to ensure that all the details are accurately recorded.
Choice B is wrong because reading back the prescription to the provider should be done after writing down the complete prescription.
Choice C is wrong because documenting the prescription as a telephone prescription in the medical record should be done after writing down the complete prescription and reading it back to the provider.
Choice D is wrong because ensuring that the provider signs the prescription should be done after writing down the complete prescription, reading it back to the provider, and documenting it in the medical record.
Correct Answer is C
Explanation
The Braden scale measures six elements: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
“The higher the score, the higher the pressure injury risk”: This statement is incorrect.
The lower the score on the Braden scale, the higher the risk for pressure injury.
“Each element has a range from one to five points”: This statement is incorrect.
Each element has a range from one to four points, except for friction/shear which has a range from one to three points.
“The client’s age is part of the measurement”: This statement is incorrect. Age is not one of the elements measured by the Braden scale.
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