A nurse accidentally sticks her hand with a syringe after administering an IM injection to a client. Which of the following actions should the nurse take first?

Wash the area of the puncture thoroughly with soap and water.

Notify the employee health services

Complete an incident report

Report the incident to the charge nurse

Answer and Explanation

The Correct Answer is A

A. Wash the area of the puncture thoroughly with soap and water: The first action the nurse should take after a needlestick injury is to immediately wash the area with soap and water. This is crucial for minimizing the risk of infection and exposure to potentially infectious materials. Prompt cleaning of the puncture site is essential in reducing the risk of transmission of bloodborne pathogens.

B. Notify employee health services: While notifying employee health services is important for follow-up care and evaluation, it should be done after the initial wound care has been performed. Immediate action should focus on cleaning the injury first.

C. Complete an incident report: Completing an incident report is a necessary step for documentation and accountability in the healthcare setting. However, it should be done after the immediate first aid for the needlestick injury has been addressed.

D. Report the incident to the charge nurse: Reporting the incident to the charge nurse is important for ensuring appropriate follow-up and support, but the priority should be to address the injury first. The nurse should take care of the puncture wound before notifying others about the incident.

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Correct Answer is A

Explanation

A. Turn and reposition the patient every 2 hours: This task can be delegated to nursing assistive personnel (NAP). NAPs are trained to assist with basic patient care tasks, including turning and repositioning patients to prevent pressure injuries and promote comfort.

B. Apply hydrocolloid dressing to the pressure injury: This task should not be delegated to NAPs, as applying dressings requires knowledge of wound care principles and techniques, which falls under the scope of nursing practice.

C. Change pressure injury dressings every shift: Changing dressings is a nursing responsibility that requires assessment and skill in managing wound care. This task should be performed by the nurse to ensure proper technique and evaluate the wound condition.

D. Assess the patient's skin condition: Skin assessment is a nursing responsibility that requires clinical judgment and expertise. The nurse must assess the skin to identify any changes or complications related to pressure injuries, which should not be delegated to NAPs.

A. Use the cane on the same side as the injured or weaker leg. B. Move the cane and the stronger leg forward together. C. Adjust the cane height so the handle is above the waist level. D. Hold the cane on the side opposite the injured or weaker leg.

Correct Answer is D

Explanation

A. Use the cane on the same side as the injured or weaker leg: This approach is incorrect. The cane should be used on the opposite side of the weaker leg to provide better support and balance during ambulation. Using the cane on the same side would not provide adequate stability and could increase the risk of falling.

B. Move the cane and the stronger leg forward together: This step is not recommended. The proper technique involves moving the cane first, followed by the weaker leg, and then bringing the stronger leg forward. This sequence helps maintain stability and balance while walking.

C. Adjust the cane height so the handle is above the waist level: The cane should be adjusted so that the handle is at the level of the wrist when the client is standing upright, which allows for proper elbow flexion while using the cane. If the handle is too high, it can lead to poor posture and increased strain.

D. Hold the cane on the side opposite the injured or weaker leg: This is the essential step for ensuring stability and safety when using a cane. By holding the cane on the opposite side, the client can use the cane for support while stepping forward with the weaker leg, enhancing balance and reducing the risk of falls. This technique allows for better weight distribution and improved mobility.

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A nurse accidentally sticks her hand with a syringe after administering an IM injection to a client. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is D

Explanation

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