A nurse admitting and orienting an older adult to the hospital unit discusses fall prevention and demonstrates the use of the call bell to the patient. The patient's daughter asks: "Why don't you just put up all the side rails to prevent my mother from getting out of bed by herself and falling. That should work, right?" What is the nurse's best response?
"Side rails do not decrease falls, but they do decrease fall related injuries."
"There is no evidence that side rail use decreases falls, and in fact, there is a greater risk of injury."
"Side rails are only effective when used with patients who have dementia"
Side rails have only proven to be effective in decreasing falls in patients who have already fallen."
The Correct Answer is B
A. "Side rails do not decrease falls, but they do decrease fall-related injuries."
Explanation: While side rails may reduce the severity of injuries if a fall occurs, they are not proven to decrease the overall rate of falls. Additionally, side rails themselves can pose risks, including entrapment.
B. There is no evidence that side rail use decreases falls, and in fact, there is a greater risk of injury."
Explanation: The use of side rails as a fall prevention measure has been associated with risks and has not been shown to effectively decrease the overall rate of falls. There is evidence that side rails can contribute to injuries, including entrapment, when patients attempt to climb over or through them. The focus in fall prevention has shifted towards individualized assessments, environmental modifications, and other strategies that address the specific needs and risks of each patient.
C. "Side rails are only effective when used with patients who have dementia."
Explanation: The effectiveness of side rails is not limited to patients with dementia. However, the use of side rails as a general fall prevention strategy has been questioned, and their use should be carefully considered based on individual assessments and risks.
D. "Side rails have only proven to be effective in decreasing falls in patients who have already fallen."
Explanation: The use of side rails is not universally proven to be effective in decreasing falls, even in patients who have previously fallen. The decision to use side rails should be based on a thorough assessment of the individual's needs and risks, considering alternatives to promote safety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Constipation is a common side effect of opioid medications like morphine. It is a priority to address because constipation can lead to discomfort, increased pain, and other complications. Preventive measures such as increased fiber intake, adequate hydration, and bowel regimen may be necessary.
B. Poor solid food intake and C. poor liquid intake are concerns, but they are secondary to the immediate issue of constipation. Adequate nutrition and hydration are important for overall recovery, but constipation can have more immediate and uncomfortable consequences.
D. Diarrhea is not a common side effect of morphine. In fact, constipation is a more common gastrointestinal side effect. If the patient were to experience diarrhea, it could be indicative of another issue or complication that needs to be addressed, but it is not the primary preventive care concern associated with morphine use.
Correct Answer is C
Explanation
A. Driving in heavy traffic is fine as long as it is not raining.
Explanation: Driving in heavy traffic can pose challenges for individuals, especially those who may experience age-related changes in vision, reaction time, and cognitive function. The recommendation is to avoid heavy traffic, especially if it might increase stress and the likelihood of accidents.
B. If you have a passenger, you may drive at any time of the day.
Explanation: The presence of a passenger does not necessarily eliminate the potential challenges associated with age-related changes in driving abilities. It is important for older individuals to consider factors such as time of day, visibility, and overall driving conditions.
C. Limit driving to familiar places close to home.
Explanation: Limiting driving to familiar places close to home is a safer practice for older individuals who may face challenges with vision, reaction time, and other factors that can impact driving. Familiar routes are more likely to be navigated confidently, reducing the risk of getting lost or encountering unexpected challenges.
D. Playing music will help keep you alert.
Explanation: While playing music can be enjoyable, it may not be an effective strategy for maintaining alertness, especially during challenging driving conditions. The focus should be on adopting safe driving habits and minimizing distractions to ensure overall safety on the road.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.