An elderly man fell during his hospitalization and has died from a head injury sustained in the fall.
What is the role of the risk manager in this situation?

To find the root cause so that the person who is responsible can be identified.

To protect the nursing staff from litigation.

To find the root cause so preventative measures can be put in place.

To determine why the nurses were never told that the patient was a high fall risk.

Answer and Explanation

The Correct Answer is C

The role of the risk manager is to identify and analyze the factors that contributed to the adverse event and to implement strategies to prevent or reduce the likelihood of recurrence. The risk manager is not concerned with assigning blame or protecting the staff from litigation, but rather with improving the quality and safety of care.

Choice A is wrong because it implies a punitive approach that does not address the underlying system issues.

Choice B is wrong because it suggests a defensive attitude that does not foster a culture of learning and improvement.

Choice D is wrong because it assumes that the nurses were not aware of the patient’s fall risk, which may not be the case.

The risk manager should investigate all aspects of the situation, including the communication and documentation of the patient’s fall risk assessment and interventions.

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Correct Answer is C

Explanation

his intervention can help prevent pressure ulcers by reducing the amount of pressure on bony prominences and promoting blood circulation to the skin.

Choice A is wrong because placing the patient in a side-lying position only can increase the risk of skin breakdown by limiting the patient’s mobility and exposing the same areas to pressure. The patient should be repositioned frequently and encouraged to change positions if able.

Choice B is wrong because massaging bony prominences can cause tissue damage and increase the risk of skin breakdown by impairing blood flow to the area. Massaging should be avoided over bony prominences and areas of redness.

Choice D is wrong because keeping the head of the bed elevated higher than 30 degrees can cause shearing forces on the skin, which can lead to skin breakdown. The head of the bed should be kept at the lowest degree of elevation possible.

Choice E is wrong because inspecting skin every shift is not enough for a patient at risk for impaired skin integrity. The skin should be inspected at least every 2 hours or more frequently depending on the patient’s condition. Early detection of skin changes can help prevent further damage and promote healing.

Normal ranges for skin integrity are:

• Skin color: consistent with ethnicity and genetic background, no pallor, cyanosis, or jaundice.

• Skin moisture: dry to touch, no excessive perspiration or dryness. • Skin texture: smooth, soft, intact, with even surface.

• Skin temperature: warm to touch, no hyperthermia or hypothermia. • Skin turgor: elastic, returns to original shape after being pinched. • Skin integrity: no lesions, wounds, abrasions, or ulcers.

A. Fluid volume excess. B. Risk for infection. C. Ineffective thermoregulation. D. Pain.

Correct Answer is A

Explanation

Fluid volume excess is wrong because appendicitis does not cause fluid retention or overload. It may cause fluid loss due to vomiting, fever, or rupture of the appendix. Therefore, a more appropriate nursing diagnosis would be the risk for deficient fluid volume.

Choice B. Risk for infection is correct because appendicitis is an inflammatory condition that can lead to bacterial infection, especially if the appendix ruptures and causes peritonitis or abscess formation.

Choice C. Ineffective thermoregulation is correct because appendicitis can cause fever due to inflammation and infection.

Choice D. Pain is correct because appendicitis causes acute abdominal pain that usually starts in the periumbilical area and then localizes to the right lower quadrant. The pain may be accompanied by nausea, vomiting, and rebound tenderness.

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An elderly man fell during his hospitalization and has died from a head injury sustained in the fall. What is the role of the risk manager in this situation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The RN identifies that a client is at risk for impaired skin integrity. Which interventions should the nurse add to this client’s plan of care?

Correct Answer is C

Explanation

Which of the following nursing diagnoses would the nurse be LEAST likely to choose for a patient with appendicitis?

Correct Answer is A

Explanation

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Which thermoregulatory condition is an elderly person most at risk for?

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An elderly man fell during his hospitalization and has died from a head injury sustained in the fall.
What is the role of the risk manager in this situation?