A nurse is reinforcing information with a nursing colleague about sentinel events. Which of the following statements by the nursing colleague indicates an understanding?
"An example of a sentinel event is administering incompatible blood products to a client."
"An example of a sentinel event is administering client medications 30 minutes late."
"An example of a sentinel event is documenting vital signs at the wrong time in the client’s electronic health record."
"An example of a sentinel event is administering a prescribed sedative to a client for insomnia."
The Correct Answer is A
Choice A reason: A sentinel event is a serious adverse event that results in death, permanent harm, or severe temporary harm to a patient. Administering incompatible blood products to a client is a sentinel event because it can cause fatal hemolytic reactions.
Choice B reason: Administering client medications 30 minutes late is not a sentinel event, unless it leads to a serious adverse outcome for the patient. Medication errors are common and preventable, and they should be reported and analyzed to improve patient safety.
Choice C reason: Documenting vital signs at the wrong time in the client’s electronic health record is not a sentinel event, unless it leads to a serious adverse outcome for the patient. Documentation errors are also common and preventable, and they should be corrected and avoided to ensure accurate and timely information.
Choice D reason: Administering a prescribed sedative to a client for insomnia is not a sentinel event, unless it leads to a serious adverse outcome for the patient. Sedatives are commonly used to treat insomnia, and they should be prescribed and administered with caution and monitoring⁵.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: This statement is false and should not be included in the teaching. Increase in saliva production does not increase the risk for dehydration, but rather helps to moisten the mouth and facilitate swallowing and digestion. Saliva production may decrease with aging due to factors such as medication side effects, dry mouth, or reduced fluid intake.
Choice B reason: This statement is false and should not be included in the teaching. Decrease in systolic blood pressure does not increase the risk for dehydration, but rather indicates a lower force of blood against the artery walls. Systolic blood pressure may decrease with aging due to factors such as reduced cardiac output, decreased vascular resistance, or orthostatic hypotension.
Choice C reason: This statement is true and should be included in the teaching. Decrease in kidney function increases the risk for dehydration, as it reduces the ability of the kidneys to concentrate urine and conserve water. Kidney function may decrease with aging due to factors such as reduced blood flow, decreased glomerular filtration rate, or loss of nephrons.
Choice D reason: This statement is false and should not be included in the teaching. Increase in percentage of body water does not increase the risk for dehydration, but rather indicates a higher proportion of water in relation to body weight. Percentage of body water may decrease with aging due to factors such as loss of muscle mass, increased fat tissue, or hormonal changes.
Correct Answer is A
Explanation
Choice A reason: This action is correct because airway protection is the first priority for a client who is unconscious and has trauma to multiple systems. The nurse should assess the client's airway patency, breathing, and oxygenation, and intervene as needed to secure and maintain the airway. The nurse should also monitor the client for signs of aspiration, bleeding, or obstruction, and suction the airway as needed.
Choice B reason: This action is incorrect because stabilizing cardiac arrhythmias is not the first priority for a client who is unconscious and has trauma to multiple systems. The nurse should assess the client's circulation, blood pressure, and pulse, and intervene as needed to treat any arrhythmias, shock, or hemorrhage. However, this is not a priority over the client's airway, which is essential for survival.
Choice C reason: This action is incorrect because preventing musculoskeletal disability is not the first priority for a client who is unconscious and has trauma to multiple systems. The nurse should assess the client's mobility, sensation, and alignment, and intervene as needed to prevent or treat any fractures, dislocations, or nerve injuries. However, this is not a priority over the client's airway, which is essential for survival.
Choice D reason: This action is incorrect because decreasing intracranial pressure is not the first priority for a client who is unconscious and has trauma to multiple systems. The nurse should assess the client's level of consciousness, pupillary response, and neurological status, and intervene as needed to prevent or treat any increased intracranial pressure, cerebral edema, or brain injury. However, this is not a priority over the client's airway, which is essential for survival.
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