28. 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 into the box on the right, placing them in the order of performance. Use all the steps) (ORDERED RESPONSE)
Transport the client to another area of the nursing unit.
Activate the facility’s fire alarm system.
Use the unit’s fire extinguisher to attempt to put out the fire.
Close all nearby windows and doors.
The Correct Answer is A,B,D,C
A. The first priority is to rescue any individuals in immediate danger. Moving the client ensures their safety before addressing the fire. Delaying this step could expose the client to smoke inhalation or burns.
B. Once the client is safe, the nurse must activate the fire alarm system. This alerts the rest of the facility and triggers the emergency response protocol. Early alarm activation helps prevent the fire from spreading further.
C. Attempting to extinguish the fire comes only after other safety measures. If the fire is small and controllable, using a fire extinguisher may prevent escalation. However, it must only be attempted when it is safe to do so.
D. Closing nearby windows and doors helps contain the fire to one area. This reduces oxygen flow and slows the spread of fire and smoke throughout the unit. Containment is a key step in minimizing damage and injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. NPH insulin: This is an intermediate-acting insulin with a delayed onset and is not appropriate for continuous infusion. It is not used in the acute management of diabetic ketoacidosis (DKA).
B. 0.45% saline: Hypotonic saline may be used later in DKA management, but initial fluid resuscitation requires isotonic fluids to restore intravascular volume and improve perfusion.
C. Glargine insulin: This is a long-acting insulin used for basal control and is not suitable for continuous infusion. It lacks the rapid onset and titratability needed in acute DKA treatment.
D. Normal saline: Isotonic 0.9% saline is the fluid of choice for initial resuscitation in DKA to treat dehydration, improve perfusion, and stabilize blood pressure before initiating insulin therapy.
Correct Answer is D
Explanation
A. Place the client in a side-lying position for the procedure: Paracentesis is typically performed with the client in an upright or high-Fowler’s position to allow fluid to pool in the lower abdomen for easier access and drainage.
B. Administer a low-volume hypertonic enema the night before the procedure: Enemas are not routinely indicated for paracentesis since the bowel does not obstruct access to ascitic fluid, making this an unnecessary step.
C. Ensure the client has a full bladder just prior to the procedure: A full bladder increases the risk of accidental puncture during needle insertion. The bladder should be emptied to reduce this risk.
D. Weigh the client before and after the procedure: Weighing the client allows the healthcare team to estimate the volume of ascitic fluid removed and assess fluid balance, making this a key nursing responsibility.
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