A client smoking in his bathroom has dropped a cigarette butt into wastepaper basket, which begins to smolder. Which of the following actions is the nurse's priority?

Activate the fire alarm.

Move any clients in the immediate vicinity.

Close the fire doors on the unit.

Use a fire extinguisher to put out the fire.

Answer and Explanation

The Correct Answer is A

A) Activate the fire alarm: The nurse's priority in the event of a fire is to activate the fire alarm immediately. This alerts others in the building, including staff and emergency responders, to the potential danger. It initiates the necessary protocol to ensure the safety of all individuals in the area and enables timely evacuation if needed. Ensuring that others are aware of the fire risk is the first critical step in managing the situation effectively.

B) Move any clients in the immediate vicinity: While moving clients away from the immediate danger is important, it should come after the alarm has been activated. The fire alarm alerts everyone to evacuate or take necessary precautions, allowing the nurse and other staff to focus on evacuation or safety measures. The priority is to ensure that everyone is aware of the potential fire hazard and follows the evacuation procedures.

C) Close the fire doors on the unit: Closing fire doors is part of fire containment, but it should occur after the alarm has been activated and the fire response plan is in motion. Fire doors are designed to limit the spread of fire, but the initial priority is to alert others to the fire, activate the alarm, and ensure everyone is aware of the emergency situation.

D) Use a fire extinguisher to put out the fire: Using a fire extinguisher is appropriate if the fire is small and manageable, but activating the fire alarm is still the first priority. In cases of small fires, if safe to do so, the nurse can attempt to put it out. However, the primary focus should be on alerting everyone in the facility to the danger so that emergency protocols can be followed.

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Free Nursing Study Resources

Correct Answer is ["A","B","C","E"]

Explanation

A) Place the bedside table within the client's reach: This is an important safety measure to help prevent falls. By ensuring that the bedside table is within easy reach, the client will be less likely to try to reach for objects outside their immediate area, reducing the risk of falls from overextending or getting up unnecessarily.

B) Teach balance and strengthening exercises: Teaching balance and strengthening exercises is a key preventative measure for older adults at risk for falls. These exercises help improve muscle strength, coordination, and stability, which can significantly reduce the likelihood of falls.

C) Provide information about home safety checks: Providing information about home safety is essential to prevent falls in older adults. This includes advising the patient on eliminating hazards (like loose rugs, clutter, or inadequate lighting) and ensuring that the home environment is conducive to safety. A home safety check is part of creating a fall-prevention strategy.

D) Administer sedative at bedtime: Administering sedatives to older adults, especially those at risk for falls, can increase the likelihood of confusion, dizziness, or impaired coordination, which can lead to falls. This is not a recommended intervention. Non-pharmacologic methods for improving sleep hygiene should be prioritized over sedative medications when possible.

E) Lock beds and wheelchairs when not providing care: Locking beds and wheelchairs when not in use is a fundamental safety measure to prevent accidental movement of the bed or wheelchair. This action reduces the risk of the patient falling out of bed or from a wheelchair if they try to move or shift positions.

A. Provide support by holding the client’s arm. B. Assume narrow base of support. C. Lean the client toward the wall. D. Lower the lent to the floor.

Correct Answer is D

Explanation

A. Provide support by holding the client’s arm:
While holding the client's arm may seem like a way to prevent the fall, it can actually increase the risk of injury, as the nurse might not be able to support the client’s full weight and could cause additional strain or injury. In the event of a fall, it is safer to focus on guiding the client gently to the floor.

B. Assume a narrow base of support:
Assuming a narrow base of support could make the nurse more vulnerable to losing balance as well. A broader base of support, such as standing with feet shoulder-width apart, provides better stability, but this action does not directly address the client’s fall.

C. Lean the client toward the wall:
Leaning the client toward the wall may be helpful in some situations but does not directly prevent a fall. It may not be safe or feasible depending on the environment, and leaning the client toward a wall might cause further harm if not executed carefully.

D. Lower the client to the floor:
When a client begins to fall, the priority is to prevent injury. The nurse should gently lower the client to the floor while maintaining control, guiding the fall as much as possible to minimize injury. This approach ensures the client is not at risk of further harm and that the nurse can then assess the client for injuries.

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A client smoking in his bathroom has dropped a cigarette butt into wastepaper basket, which begins to smolder. Which of the following actions is the nurse's priority?

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Naxlex Comprehensive Predictor Exams

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